Intensive Cognitive Behavioral Therapy for Anxiety Disorders in School-aged Children with Autism: A Preliminary Comparison with Treatment-as-Usual
Intensive Cognitive Behavioral Therapy for Anxiety Disorders in School-aged Children with Autism: A Preliminary Comparison with Treatment-as-Usual
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DOI：
10.1007/s12310-012-9090-0
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发表时间：
2013-03-01
影响因子：
2.6
通讯作者：
Wood, Jeffrey J.
中科院分区：
文献类型：
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作者：
Fujii, Cori;Renno, Patricia;Wood, Jeffrey J.
患有自闭症谱系障碍 (ASD) 的儿童经常患有共病焦虑症，可能导致严重的功能障碍，尤其是在学校。实施强化模块化认知行为治疗 (CBT) 计划，以解决学校和社区的焦虑、自我调节和社会参与问题。特别强调通过让学校人员参与治疗过程来提高应对技能和积极社会行为的普遍性。儿童（7-11 岁）被随机分配至立即治疗组 (IT)，其中包括 32 次 CBT (n = 7) 疗程或 16 周照常治疗 (TAU) 组 (n = 5)。 CBT 课程强调行为实验和情绪调节训练，以及增加积极的同伴互动的社会辅导。学校观察和咨询被纳入治疗模式。对治疗条件不知情的独立评估者在基线和 IT/TAU 后进行了结构化诊断访谈。治疗后分析显示，IT 组中有 71.4% 的原发性焦虑症诊断得到缓解，而 TAU 组则没有。此外，以基线焦虑评分作为协变量进行的 ANCOVA 分析显示，治疗组在治疗后的焦虑严重程度方面存在统计学显着差异，有利于 IT 组。为期 32 次的 CBT 计划是针对患有自闭症谱系障碍 (ASD) 和中度至重度焦虑症的儿童的强化方法，似乎对焦虑症状产生了临床上显着的影响。通过纳入以学校为基础的治疗成分，可以增强应对技能的普遍性，因为这可以在儿童的日常环境中提供一致的支持。
Children with autism spectrum disorders (ASDs) frequently present with a comorbid anxiety disorder that can cause significant functional impairment, particularly at school. An intensive modular cognitive behavioral treatment (CBT) program was delivered to address anxiety, self-regulation, and social engagement in school and in the community. A particular emphasis was placed on increasing generalizability of coping skills and positive social behavior by involving school personnel in the treatment process. Children (7-11 years old) were randomly assigned to an immediate treatment condition (IT) that included 32 sessions of CBT (n = 7) or a 16-week treatment-as-usual (TAU) condition (n = 5). The CBT sessions emphasized behavioral experimentation and emotion regulation training as well as social coaching on increasing positive peer interactions. School observations and consultations were included in the treatment model. Independent evaluators blind to treatment condition conducted structured diagnostic interviews at baseline and post-IT/post-TAU. Post-treatment analyses showed that 71.4 % of the IT group had remitted from their primary anxiety disorder diagnosis as compared with none of the TAU group. In addition, an ANCOVA analysis conducted with baseline anxiety scores included as a covariate revealed a statistically significant difference by treatment group in anxiety severity favoring the IT group at post-treatment. The 32-session CBT program is an intensive approach for children with ASD and moderate-to-severe anxiety disorders that appears to yield a clinically significant impact on anxiety symptoms. The generalizability of coping skills may be enhanced by the inclusion of school-based treatment components due to the consistency of supports this permits across the child's daily settings.