The Role of Pragmatic Speech in the Effectiveness of an Anxiety-Focused Cognitive Behavior Therapy for Adolescents with Autism Spectrum Disorders

Background:

Many children and adolescents with autism spectrum disorder (ASD) face communication challenges in everyday social interactions. While language and communication impairments have been assessed through semantic, syntax, and morphology domains in children with ASD, few studies have looked into pragmatic aspects of speech and how the challenges in pragmatic speech may affect treatment progress. Pragmatic domain of language focuses on the social aspects of language and communication which is often impaired in individuals with ASD. Therefore, it is important to consider the role of pragmatic speech when evaluating the effectiveness of many cognitive behavioral treatments that aim to address the social difficulties of individuals with ASD and anxiety.

Objectives:

The goal of the current project is to investigate whether assessed pragmatic speech ability is associated with treatment response following brief cognitive behavioral therapy targeting anxiety and social competence. 

Methods:

Pragmatic speech was evaluated in adolescents with ASD and at least one anxiety disorder using the Children’s Communication Checklist-2 (CCC-2; Bishop, 2003), a parent questionnaire used to assess pragmatic communication. Participants were randomly assigned to two conditions: 15 of the individuals received a 14-week cognitive-behavioral treatment program for anxiety and social skills (Multimodal Anxiety and Social Skills Intervention for Adolescents: MASSI) and 15 of the individuals were assigned to a waitlist condition. CCC-2 and the Multidimensional Anxiety Scale for Children (MASC; March, 1997), a measure of anxiety symptoms, were collected at baseline and at the end of the 14-week trial.

Results:

Results from the participants with complete data (n = 15 for treatment; n = 12 for waitlist condition) show that while General Communication Composite (GCC) score was not related to amount of anxiety reported at baseline by the adolescents on the MASC (r = .122, p = .544), communication skills were found to be correlated with a reduction of anxiety symptoms between baseline and endpoint of the study for the treatment group only (r = .539, p = .038). Specifically, greater deficits in communication skills at baseline predicted a reduction of anxiety symptoms from pre-treatment to post-treatment. This effect was found only for self-report, not the parent report, of change in anxiety symptoms.

Conclusions:

Overall, this study suggests that pragmatic speech predicts self-reported anxiety reduction in adolescents with ASD who receive cognitive-behavioral treatment for anxiety and social skills. This finding provides support for a relationship between ASD severity and anxiety, in that severity of ASD as assessed by deficits in social communication, is predictive of improvement with treatment. In addition, since communication skills predicted self-reported change in anxiety, but not parent-reported change in anxiety, this study highlights an important distinction between self-report and parent-report of anxiety in adolescents with ASD. Lastly, these findings highlight the importance of exploring facets of social communication, in addition to semantic, syntax, and morphology aspects, that are a factor in response to cognitive-behavioral treatment for ASD and anxiety.