1/3 Treatment of Anxiety in Autism Spectrum Disorder

项目总结/摘要 自闭症谱系障碍（ASD）是一种常见的神经发育综合征，影响1%的美国儿童。 共病焦虑障碍影响40%至50%的ASD儿童，造成严重的痛苦和损害 远远超过孤独症所引起的。高度焦虑与ASD严重程度增加相关 症状和社会适应不良。此外，自闭症儿童的父母认为焦虑- 相关问题是他们的孩子面临的两大挑战之一。[标准做法] 认知行为疗法（CBT）已被确立为一种有效和安全的治疗焦虑症的方法 尽管它在典型发育中的青少年中存在疾病，但它在ASD共病病例中的作用仍然未知。到目前为止， 没有研究在实验上将标准实践CBT与认知行为干预进行比较， 对于患有焦虑和ASD共病的儿童进行个性化治疗。文献中的这一空白是 特别令人担忧的是，对于患有ASD的青少年没有药物支持的治疗选择， 共病焦虑和现有的药物干预可能具有一些缺点（例如，有限 在该人群中的疗效、副作用和药物X药物相互作用的可能性）。[因此，我们 建议在三个治疗地点进行随机对照试验，以评估 自闭症儿童焦虑行为干预（Behavioral Intervention for Anxiety in Children with Autism：BIACA） 相对于焦虑的标准实践CBT（应对猫计划）。在过去的五年里， BIACA干预措施已根据高功能儿童的特点和需求进行了调整和调整 ASD;应对猫计划反映了社区标准，该标准在以下方面得到了经验支持： 多项NIH资助的试验。为了响应NIH路线图倡议，BIACA采用了模块化治疗 这是一种个性化的方法，可以根据每个年轻人的独特需求进行个性化干预。[Thus，建议 研究将：（1）检查BIACA相对于应对猫的疗效，这代表了标准实践 治疗，（2）评估治疗收益的维持，（3）检查个性化的影响 对社会反应、孤独感和友谊质量等功能结果的干预，（4）测试 自闭症严重程度作为治疗结果的调节剂，以及（5）探索其他调节剂和介质， 治疗结果]。共180名患有ASD和并发焦虑症的青少年（年龄8 - 13岁）将被随机分组。 分配到两个治疗条件之一。这项研究的三个招募地点是加州大学洛杉矶分校， 南佛罗里达大学（USF）和坦普尔大学。USF将提供数据管理服务。 考虑到越来越多的儿童被诊断患有ASD， 共病焦虑，拟议的工作是量身定制的独特需求的青年与ASD，并将提供及时的 为公共卫生工作做出贡献。

Project Summary/Abstract Autism spectrum disorders (ASD) are common neurodevelopmental syndromes affecting 1% of U.S. children. Comorbid anxiety disorders affect 40 to 50% of children with ASD, causing substantial distress and impairment over and above that caused by ASD alone. High anxiety is associated with increased severity of ASD symptoms and social maladjustment in affected youth. Further, parents of children with ASD consider anxiety- related problems to be among the top two challenges facing their children. [Although standard practice cognitive-behavioral therapy (CBT) has been established as an efficacious and safe treatment for anxiety disorders among typically developing youth, its utility in comorbid cases with ASD remains unknown. To date, no studies have experimentally compared standard practice CBT to a cognitive-behavioral intervention that has been personalized for children with a comorbid presentation of anxiety and ASD.] This gap in the literature is of particular concern because there are no empirically-supported treatment options for youth with ASD and comorbid anxiety, and existing pharmacological interventions may have some disadvantages (e.g., limited efficacy in this population, side effects, and potential for drug x drug interactions). [Accordingly, we are proposing a randomized controlled trial to be conducted at three treatment sites to evaluate the efficacy of personalized CBT for anxiety in ASD (Behavioral Intervention for Anxiety in Children with Autism: BIACA) relative to standard practice CBT for anxiety (Coping Cat program). Over the last five years, the proposed BIACA intervention has been adapted and tailored to the characteristics and needs of high-functioning children with ASD; the Coping Cat program reflects the community standard that has been empirically supported in multiple NIH-funded trials.] In response to the NIH Roadmap Initiative, BIACA employs a modular treatment approach, allowing the intervention to be personalized to each youngster's unique needs. [Thus, the proposed research will: (1) examine the efficacy of BIACA relative to Coping Cat, which represents standard practice treatment, (2) evaluate the maintenance of treatment gains, (3) examine the impact of personalized intervention on functional outcomes such as social responsiveness, loneliness, and friendship quality, (4) test autism severity as a moderator of treatment outcome, and (5) explore other moderators and mediators of treatment outcome.] A total of 180 youth (ages 8-13 years) with ASD and co-occurring anxiety will be randomly assigned to one of the two treatment conditions. The three recruitment sites for this study are UCLA, the University of South Florida (USF), and Temple University. USF will provide data management services. Considering the rising number of children diagnosed with ASD together with the frequency and severity of comorbid anxiety, the proposed work is tailored to the unique needs of youth with ASD and will provide a timely contribution to public health efforts.