1/3 Treatment of Anxiety in Autism Spectrum Disorder

描述（由申请人提供）：自闭症谱系障碍（ASD）是影响1%美国儿童的常见神经发育综合征。40%到50%的ASD儿童患有共病焦虑症，造成的痛苦和损害远远超过ASD本身造成的痛苦和损害。在受影响的青少年中，高度焦虑与ASD症状的严重程度增加和社会适应不良有关。此外，自闭症儿童的父母认为，与焦虑相关的问题是他们的孩子面临的两大挑战之一。虽然标准的认知行为疗法（CBT）已经被确立为一种有效和安全的治疗典型发展中的青少年焦虑症的方法，但它在ASD合并症中的应用仍然未知。到目前为止，还没有实验研究将标准的认知行为干预与针对患有焦虑和ASD的儿童的个性化认知行为干预进行比较。文献中的这一空白尤其值得关注，因为对于患有ASD和共病焦虑的青少年，没有经验支持的治疗选择，而且现有的药物干预可能存在一些缺点（例如，对这一人群的疗效有限、副作用和药物潜力）

DESCRIPTION (provided by applicant): 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.