Family-Centered Cognitive Behavioral Therapy for Anxiety in Very Young Children with Autism Spectrum Disorder
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ORIGINAL PAPER
Family‑Centered Cognitive Behavioral Therapy for Anxiety in Very Young Children with Autism Spectrum Disorder Katherine Driscoll1 · Michael Schonberg2 · Melanie Farkas Stark2,4 · Alice S. Carter3 · Dina Hirshfeld‑Becker2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract To address the paucity of cognitive-behavioral therapy (CBT) protocols available to treat anxiety in preschoolers with ASD, we piloted a family-centered CBT protocol in a series of 16 children aged 3–7 years with ASD and anxiety disorders and explored its feasibility and efficacy. Children were assessed at baseline, post-treatment (PT), and 4-month follow-up (FU) using diagnostic interviews and parent questionnaires. Fourteen children completed at least 10 sessions (mean 14). At PT, 81% were rated “very much-” or “much-improved” on the CGI-Anxiety. Children displayed significant decreases on clinician- and parent-rated anxiety, and improved family function and coping. Gains were maintained at FU. Parent–child CBT is feasible for young children with ASD plus anxiety that shows potential for similar efficacy as with neurotypical children. Keywords Cognitive-behavioral-therapy · Anxiety disorders · Autism spectrum disorder · Preschoolers
Introduction Anxiety disorders and symptoms are among the most common coexisting conditions in children with ASD (Simonoff et al. 2008). Approximately 40% of children with ASD develop anxiety disorders, and a greater number exhibit subclinical anxiety symptoms (Strang et al. 2012; van Steensel et al. 2011; Vasa et al. 2013). The most prevalent disorders include generalized anxiety disorder, separation anxiety disorder, social phobia, and specific phobia (de Bruin et al. 2007). A survey by the National Autistic Society found that anxiety was the second most frequently cited problem reported by parents (Mills and Wing 2005). A study of the most important research priorities on co-occurring anxiety * Katherine Driscoll [email protected] 1
Developmental Medicine Center, Boston Children’s Hospital, and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
2
Child Cognitive‑Behavioral Therapy Program, Massachusetts General Hospital, and Harvard Medical School, 151 Merrimac Street, 3rd Floor, Boston, MA 02114, USA
3
Department of Psychology, University of Massachusetts, Boston, 100 William T. Morrissey Boulevard, Boston, MA 02125, USA
4
Present Address: Rhode Island Hospital, Providence, USA
in ASD identified implementing treatments in real world settings as one of four top priorities (Vasa et al. 2018). Anxiety in children with ASD can exacerbate social impairment, negatively affect daily living skills and adversely influence relationships with peers, teachers, and family (Drahota et al. 2011; Kim et al. 2000). In addition, anxiety in youth with ASD is associated with increased repetitive behaviors, decreased social reciprocity (Sukhodolsky et al. 2008), and poorer social adjustment (Bellini 2004). Children with ASD are
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