Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: a randomized, controlled trial.
Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: a randomized, controlled trial.
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DOI：
10.1016/j.beth.2014.01.002
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发表时间：
2015-01
期刊：
影响因子：
3.7
通讯作者：
Storch EA
中科院分区：
文献类型：
--
作者：
Wood JJ;Ehrenreich-May J;Alessandri M;Fujii C;Renno P;Laugeson E;Piacentini JC;De Nadai AS;Arnold E;Lewin AB;Murphy TK;Storch EA
临床上升高的焦虑是自闭症谱系障碍（ASD）的常见损害特征。一个模块化的CBT程序设计为青少年与ASD，自闭症儿童焦虑的行为干预（BIACA），增强和修改，以解决早期青少年与ASD和临床焦虑的发展需求。33名青少年（11-15岁）被随机分配到16次CBT或同等的等待期。CBT模型强调暴露，挑战非理性信念，由照顾者提供的行为支持，以及许多ASD特定的治疗元素。独立评估者、父母和青少年在基线和治疗后/等待名单后评定症状严重程度。在意向治疗分析中，CBT组在独立评估者对儿科焦虑评定量表（PARS）的焦虑严重程度评分方面优于等待名单组，79%的CBT组在治疗后符合临床总体印象改善量表标准，而等待名单组只有28.6%。在诊断缓解或焦虑问卷测量方面没有发现组间差异。然而，家长报告数据表明，CBT对自闭症症状严重程度有积极的治疗效果。正在调查的CBT手册，增强了早期青少年ASD，产生了有意义的治疗效果的主要结局指标（PARS），虽然额外的发展修改手册可能是必要的。需要进一步研究检查该方案相对于活性对照的情况。
Clinically elevated anxiety is a common, impairing feature of autism spectrum disorders (ASD). A modular CBT program designed for preteens with ASD, Behavioral Interventions for Anxiety in Children with Autism (BIACA), was enhanced and modified to address the developmental needs of early adolescents with ASD and clinical anxiety. Thirty-three adolescents (11–15 years old) were randomly assigned to 16 sessions of CBT or an equivalent waitlist period. The CBT model emphasized exposure, challenging irrational beliefs, and behavioral supports provided by caregivers, as well as numerous ASD-specific treatment elements. Independent evaluators, parents, and adolescents rated symptom severity at baseline and post-treatment/post-waitlist. In intent-to-treat analyses, the CBT group outperformed the waitlist group on independent evaluators’ ratings of anxiety severity on the Pediatric Anxiety Rating Scale (PARS) and 79% of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment, as compared to only 28.6% of the waitlist group. Group differences were not found for diagnostic remission or questionnaire measures of anxiety. However, parent-report data indicated that there was a positive treatment effect of CBT on autism symptom severity. The CBT manual under investigation, enhanced for early adolescents with ASD, yielded meaningful treatment effects on the primary outcome measure (PARS), although additional developmental modifications to the manual are likely warranted. Future studies examining this protocol relative to an active control are needed.
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