Judy Reaven

Autism Spectrum Disorder and Co-occurring Developmental, Psychiatric, and Medical Conditions Among Children in Multiple Populations of the United States

Background: Autism spectrum disorders (ASDs) often co-occur with other developmental, psychiatric, neurologic, or medical diagnoses. Objective: This study examined co-occurring non-ASD diagnoses and symptoms in a population-based cohort of 8 year olds identified with ASD. Method: Data on 2,568 children meeting surveillance case definition for ASD were collected by a multi-site surveillance program. Information was systematically abstracted and reviewed from existing health and education source records and systematically entered into a summary record in a secure database. Results: Eighty-one percent of study children were male; 63% white, 23% black, 14% Hispanic, Asian, or not stated. When age of ASD classification was available, 20% were classified before age 3 years, 36% between ages 3 and 5 years, and 44% after age 5 years. The co-occurrence of ≥1 non-ASD developmental diagnoses was 83%, ≥1 psychiatric diagnoses was 10%, ≥1 neurologic diagnoses was 16%, and at least one possibly causative genetic or neurologic diagnosis was 4%. Children with a previous ASD classification and co-occurring psychiatric or neurologic conditions were more likely to be diagnosed or classified at a later age. Each category of co-occurring non-ASD diagnosis was significantly increased in children whose records did not include an ASD diagnosis or educational classification but who met surveillance criteria for ASD. Conclusions: These data highlight the need for clinicians to keep in mind the high prevalence of associated diagnoses with an ASD diagnosis, and the possibility that in younger children other symptoms or disorders may be masking or obscuring core symptoms of ASD, which would lead to a diagnosis.

Cognitive-Behavioral Treatment of Obsessive- Compulsive Disorder in a Child with Asperger Syndrome A Case Report

This case report outlines the cognitive-behavioral treatment of obsessive-compulsive disorder in a 7-year-old female with Asperger syndrome. Interventions were based upon the work of March and Mulle and were adapted in light of the patient’s cognitive, social, and linguistic characteristics. Obsessive-compulsive symptoms improved markedly after approximately 6 months of treatment. Issues regarding symptom presentation, assessment, and treatment of a dually diagnosed patient are discussed.

The treatment of anxiety symptoms in youth with high-functioning autism spectrum disorders: developmental considerations for parents.

Anxiety symptoms are one of the most common mental health conditions in childhood. Children and adolescents with Autism Spectrum Disorders (ASD) are at risk for developing mental health symptoms and anxiety in particular, especially when compared with their peers - both in the general population as well as when compared to youth with other developmental disabilities. Cognitive behavior therapy (CBT) has been identified as the treatment of choice in addressing anxiety symptoms in the general population, and an emerging body of literature indicates that modified CBT for youth with ASD can be effective in reducing anxiety symptoms. In a review of these modified treatment protocols, parent involvement is emphasized as an important component of interventions for youth with ASD and anxiety. However, the majority of these studies only briefly describe the parents role, and little mention is made with regard to how the parents role evolves over time as children age into adolescence. In this paper, the parents role in the treatment of anxiety symptoms in children and adolescents with high-functioning ASD will be discussed with a particular emphasis on considerations for parents of teenagers. Specific recommendations for parent involvement will be provided.

Facing Your Fears in Adolescence: Cognitive-Behavioral Therapy for High-Functioning Autism Spectrum Disorders and Anxiety

Adolescents with high-functioning autism spectrum disorders (ASDs) are at high risk for developing psychiatric symptoms, with anxiety disorders among the most commonly cooccurring. Cognitive behavior therapies (CBTs) are considered the best practice for treating anxiety in the general population. Modified CBT approaches for youth with high-functioning ASD and anxiety have resulted in significant reductions in anxiety following intervention. The purpose of the present study was to develop an intervention for treating anxiety in adolescents with ASD based on a CBT program designed for school-aged children. The Facing Your Fears-Adolescent Version (FYF-A) program was developed; feasibility and acceptability data were obtained, along with initial efficacy of the intervention. Twenty-four adolescents, aged 13–18, completed the FYF-A intervention. Results indicated significant reductions in anxiety severity and interference posttreatment, with low rates of anxiety maintained at 3-month follow-up. In addition, nearly 46% of teen participants met criteria for a positive treatment response on primary diagnosis following the intervention. Initial findings from the current study are encouraging and suggest that modified group CBT for adolescents with high-functioning ASD may be effective in reducing anxiety symptoms. Limitations include small sample size and lack of control group. Future directions are discussed.

Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study

Youth with autism spectrum disorders frequently experience significant symptoms of anxiety. Empirically supported psychosocial interventions exist, yet access is limited, especially for families in rural areas. Telehealth (i.e. videoconferencing) has potential to reduce barriers to access to care; however, little is known about the feasibility or efficacy of directly intervening with youth with autism spectrum disorders through this modality. This study details the pilot testing of a telehealth version of an empirically supported intervention targeting anxiety in youth with autism spectrum disorders. The primary focus of this study is on feasibility, with evaluation of outcomes as a starting point for future randomized trials. In all, 33 families of youth with autism spectrum disorders and significant anxiety symptoms participated in this study (Telehealth Facing Your Fears (FYF) Intervention: n = 17; Wait-list control: n = 16). Youth of all functioning levels were included. Acceptability was strong; however, the usability of the technology was problematic for some families and impeded some sessions significantly. Fidelity of the telehealth version to the critical elements of the original, in vivo version was excellent. More work is needed to improve delivery of exposure practices and parent coaching. Preliminary efficacy analyses are promising, with improvements observed in youth anxiety over time (relative to a comparison group waiting for live intervention) and parent sense of competence (within group). Clearly, stronger designs are necessary to evaluate efficacy sufficiently; however, this study does provide support for further investigation of clinic-to-home videoconferencing as a direct intervention tool for youth with autism spectrum disorders and their parents.

Improving transportability of a cognitive-behavioral treatment intervention for anxiety in youth with autism spectrum disorders: Results from a US–Canada collaboration:

Anxiety disorders frequently co-occur in youth with autism spectrum disorders. In addition to developing efficacious treatments for anxiety in children with autism spectrum disorders, it is important to examine the transportability of these treatments to real-world settings. Study aims were to (a) train clinicians to deliver Facing Your Fears: Group Therapy for Managing Anxiety in Children with High-Functioning Autism Spectrum Disorders to fidelity and (b) examine feasibility of the program for novel settings. A secondary aim was to examine preliminary youth treatment outcome. Results indicated that clinicians obtained excellent fidelity following a workshop and ongoing consultation. Acceptability ratings indicated that Facing Your Fears Therapy was viewed favorably, and critiques were incorporated into program revisions. Meaningful reductions in anxiety were reported posttreatment for 53% of children. Results support the initial effectiveness and transportability of Facing Your Fears Therapy in new clinical settings.

Priorities for Advancing Research on Youth with Autism Spectrum Disorder and Co-occurring Anxiety

Research on anxiety disorders in youth with autism spectrum disorder (ASD) has burgeoned in the past two decades. Yet, critical gaps exist with respect to measuring and treating anxiety in this population. This study used the nominal group technique to identify the most important research priorities on co-occurring anxiety in ASD. An international group of researchers and clinicians with experience in ASD and anxiety participated in the process. Topics ranked as most important focused on understanding how ASD symptoms affect treatment response, implementing treatments in real world settings, developing methods to disentangle overlapping symptoms between anxiety and ASD, and developing objective measures to assess anxiety. Collectively, these priorities can lead to collaborative studies to accelerate research in the field.

Feasibility, Acceptability and Preliminary Treatment Outcomes in a School-Based CBT Intervention Program for Adolescents with ASD and Anxiety in Singapore.

Adolescents with autism spectrum disorder (ASD) are at high risk for anxiety difficulties and disorders. Clinic-based cognitive behavioral therapy (CBT) is effective; however, few published school-based CBT programs for youth with ASD exist. In this study, the Facing Your Fears CBT protocol was adapted for delivery and piloted within a school setting by non-clinicians, with culturally appropriate adaptations. 44 13–15 aged youth with ASD from 22 mainstream schools in Singapore participated. Feasibility, acceptability and preliminary treatment outcomes were examined. Decreases in youth and parent reported anxiety symptoms were reported. Staff and parents found the program useful. Stakeholder support was important for implementation. Initial findings reflect the importance of carefully bridging research-to-practice for youth with ASD and anxiety.

Bridging the Research to Practice Gap in Autism Research: Implementing Group CBT Interventions for Youth with ASD and Anxiety in Clinical Practice

Children with high-functioning autism spectrum disorders (ASD) are at high risk for developing psychiatric symptoms, particularly anxiety symptoms. Cognitive behavioral treatments (CBTs) are frequently used in the general pediatric population with good success to reduce anxiety symptoms. Recently published studies, including eight randomized clinical trials, have demonstrated significant reductions in anxiety symptoms for youth with ASD following the delivery of modified CBT interventions. Because these treatment studies have occurred exclusively in tightly controlled university settings, generalizability to other clinical settings may be limited. To enhance the portability and generalizability of novel interventions, it may be important to introduce new interventions into real-world clinical settings to inform protocol development, increase adoptability of the intervention, and subsequently maximize success for clinical practice, thus narrowing the research to practice gap. This chapter reviews barriers to the dissemination of evidence-based treatments and suggests approaches for fostering the dissemination and eventual adoption of empirically supported programs for the youth with ASD in real-world settings. Best practice guidelines for conducting clinical trainings also are discussed. Given the limited research conducted to date on dissemination and implementation of autism treatment research, particularly for focused interventions targeting comorbid psychiatric symptoms, examples of the successful dissemination of mental health interventions are presented to inform practice for autism research. Preliminary efforts in the dissemination of a group CBT program for managing anxiety in youth with ASD in clinic and school settings, as well as via telehealth delivery, also are examined.

Training clinicians to deliver group CBT to manage anxiety in youth with ASD: Results of a multisite trial.

Objective: Few guidelines are available regarding optimal training models for practitioners delivering cognitive–behavioral therapy (CBT) for anxiety in youth with autism spectrum disorder (ASD). The present study systematically compared 3 instructional conditions for delivering the Facing Your Fears program (FYF) to children with ASD and anxiety. Method: Thirty-four clinicians (Mage = 34 years; 94% women, 88% Caucasian) and an intent-to-treat sample of 91 children with ASD and anxiety (Mage = 11; 84% male 53% Caucasian) met eligibility criteria across 4 sites. A 3-group parallel design via a Latin square procedure was used to randomize 9 teams of clinicians to 1 of 3 training conditions: Manual, Workshop, Workshop-Plus. The effectiveness of instructional condition was assessed via implementation (CBT knowledge, treatment fidelity) and treatment outcomes (reductions in anxiety as measured by the Anxiety Disorders Interview Schedule-Parent (ADIS-P). Results: Clinicians in both Workshop conditions significantly increased CBT knowledge postworkshop, F(1, 18) = 19.8, p < .001. Excellent treatment fidelity was obtained across conditions (above 89%), although clinicians in the Workshop conditions obtained significantly higher fidelity ratings and delivered FYF with greater quality than the Manual condition. Children with ASD demonstrated significant reductions in anxiety symptoms for three of the four anxiety diagnoses, with no differences noted across instructional condition. Rates of improvement were lower than those obtained in a previous controlled trial. Conclusions: Results suggest that although there may be some advantage to participating in a Workshop, clinicians in all conditions could deliver FYF with excellent fidelity and yield positive treatment outcomes. Lack of a no-treatment comparison group limits interpretation of findings.