Background: Many children with autism spectrum disorders (ASD) experience mental health problems (Simonoff et al., 2008), of which anxiety is common (MacNeil, Lopes, & Minnes, 2009; White, Oswald, Ollendick, & Scahill, 2009). A recent meta-analysis of 31 studies reported that around 40% of children with ASD meet criteria for an anxiety disorder (van Steensel, Bogels, & Perrin, 2011). The reasons may include their experiences (e.g. being bullied) as well as ASD characteristics (e.g. language difficulties, resistance to change, poor social skills, concrete interpretations).
Objectives: Recent studies suggest that cognitive behaviour therapy (CBT) adapted to the thinking style and needs of children with ASD can have a positive effect in reducing anxiety. The ‘Exploring Feelings’ program (Attwood 2004) originally developed in Australia, was modified for clinical use in the UK for young people with ASD and a co-morbid anxiety disorder. The program runs as 7 weekly sessions for 2 hours, where children and parents learn the same techniques in two separate groups. A randomised pilot study was undertaken to investigate the acceptability and feasibility parameters for use in a UK community context.
Methods: Thirty-two children, aged 9 to 13 years, were randomised to immediate or delayed therapy. Child and parent sessions were run in parallel, under the supervision of experienced clinical psychologists. The primary blinded outcome measures addressed change in overall functioning after 3 months (Clinical Global Impressions-Improvement), and in the primary anxiety diagnosis (Anxiety Disorders Interview Schedule).
Results: Children met diagnostic criteria for between 1 and 6 anxiety disorders (median 3). At follow-up both parents and children in the immediate therapy group were more likely to report a reduction in anxiety symptoms, and severity of primary diagnosis reduced more, than in the delayed group.. Although all children still met criteria for an anxiety disorder, only 3 out of 17 children were referred on for further individual therapy. Fidelity of delivery of the group therapy was high, and attendance was 91%.
Conclusions: The evidence suggests adapted group-based CBT for children with ASD and high anxiety in middle childhood has the potential to be beneficial. This pilot trial has established that children and families were willing to be recruited and randomised, the format and content of the groups were feasible within UK child and adolescent mental health services, the outcome measures were appropriate for use in a future fully powered trial, the intervention was appreciated by families, and attrition was very small.
This abstract describes independent research commissioned by the National Institute for Health Research (NIHR) under the Research for Patient Benefit programme (PB-PG-0408-16069). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.