Abstract
Background:Comorbid anxiety disorders are prevalent in children with autism spectrum disorders (ASD), but only a minority receives adequate treatment for anxiety. Cognitive behavioral therapy (CBT) has been shown to be effective in treating anxiety disorders. The objectives of the present pilot study were to test the feasibility of the CBT program “Less stress” for comorbid anxiety disorders in children with ASD and explore whether an improvement in diagnostic outcomes for anxiety disorders and symptoms of anxiety was found after treatment.Methods:Participants were ten children diagnosed with ASD and anxiety disorders (eight boys, mean age = 9.5 years, range 8 - 12 years). The “Less Stress” program includes three months of weekly treatment sessions followed by three monthly booster sessions. Five therapists participated. A standardized semi-structured diagnostic interview with the mothers was used to assess comorbid disorders. Child anxiety symptoms were measured with the Revised Child Anxiety and Depression Scale (RCADS).Results:The therapists found the manual easy to use but adaptations were necessary, particularly shorter sessions due to frequent (n = 7) comorbid Attention-Deficit/Hyperactivity Disorder. The participants found the program useful and the parents noted that they had learned methods they could continue using after the end of the program.Eight of ten children completed the treatment. Seven of the eight completers benefited from the program. Five of those seven children were free from all anxiety disorders, while two had fewer anxiety disorders. On a group level, a significant mean reduction of anxiety symptoms (RCADS) was found after treatment.Conclusion:The therapists found the “Less stress” program to be a feasible intervention in a sample of children with ASD and comorbid anxiety. The significant reduction of anxiety after treatment is promising, but a replication in a larger and more rigorous study is needed to investigate the effectiveness of the intervention.
Highlights
Autism spectrum disorders (ASD) are characterized by early-onset core difficulties in social- and communication skills and unusually restricted, repetitive behavior and interests with an estimated worldwide population prevalence of about 1%, affecting more males than females [1]
Two children were treated at home, not at the clinic, due to previous problems related to clinic visits
Contrary to a study, reporting that a notable portion of youth with externalizing disorders, such as attention-deficit/hyperactivity disorder (ADHD) comorbid to autism spectrum disorders (ASD) and anxiety, did not meet criteria for these externalizing disorders after treatment for anxiety [65], we found no change in the presence of ADHD after “Less stress”
Summary
Autism spectrum disorders (ASD) are characterized by early-onset core difficulties in social- and communication skills and unusually restricted, repetitive behavior and interests with an estimated worldwide population prevalence of about 1%, affecting more males than females [1]. An early study found that children with ASD seem to respond less well to standard CBT for ”Less stress”: treatment of anxiety in ASD anxiety [14]. Exposure is one of the main components of general anxiety treatment [18], and exposure-based programs in English have been found to be effective in treating anxiety disorders in children with ASD [19,20,21]. Comorbid anxiety disorders are prevalent in children with autism spectrum disorders (ASD), but only a minority receives adequate treatment for anxiety. The objectives of the present pilot study were to test the feasibility of the CBT program “Less stress” for comorbid anxiety disorders in children with ASD and explore whether an improvement in diagnostic outcomes for anxiety disorders and symptoms of anxiety was found after treatment. The participants found the program useful and the parents noted that they had learned methods they could continue using after the end of the program
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