Cognitive-behavioral therapy for anxiety in youth with an autism spectrum disorder appears efficacious; however, maintenance of treatment gains has not yet been studied. Using a sample of 32 youth who had benefited at least minimally from a past trial of cognitive-behavioral therapy for anxiety in autism spectrum disorder, this study assessed anxiety symptoms in youth 10–26 months following treatment completion. Compared to baseline, follow-up scores were associated with large effects for treatment. Relative to post-treatment, a small effect for return in symptoms was present and significantly fewer individuals were rated as responders at follow-up. Future studies should investigate factors associated with poor treatment maintenance and modifications or additions to treatment that may help maintain treatment gains.
APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Text revision. Washington, DC: APA.
2.
BarrettPFarrellLDaddsM. (2005) Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: long-term follow-up and predictors of outcome. Journal of the American Academy of Child and Adolescent Psychiatry44: 1005–1014.
3.
Cartwright-HattonSRobertsCChitsabesanP. (2004) Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders. British Journal of Clinical Psychology43: 421–436.
4.
ChalfantAMRapeeRCarrollL (2007) Treating anxiety disorders in children with high functioning autism spectrum disorders: a controlled trial. Journal of Autism and Developmental Disorders37: 1842–1857.
5.
De BruinEIFerdinandRFMeesterS. (2007) High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders37: 877–886.
6.
DurhamRCChambersJAMacDonaldRR. (2003) Does cognitive-behavioural therapy influence the long-term outcome of generalized anxiety disorder? An 8–14 year follow-up of two clinical trials. Psychological Medicine33: 499–509.
7.
EhrenreichJTSimpsonGWoodJJ (2009) Anxiety-Focused Intervention for Youth with Autism: Manual for Adolescents Transitioning to Adulthood (Unpublished treatment manual). Coral Gables, FL: University of Miami.
8.
EybergSMEdwardsDBoggsSR. (1998) Maintaining the treatment effects of parent training: the role of booster sessions and other maintenance strategies. Clinical Psychology: Science and Practice5: 544–554.
9.
GadowKDDevincentCSchneiderJ (2008) Predictors of psychiatric symptoms in children with an autism spectrum disorder. Journal of Autism and Developmental Disorders38: 1710–1720.
10.
Garcia-LopezLJOlivaresJBeidelD. (2006) Efficacy of three treatment protocols for adolescents with social anxiety disorder: a 5-year follow-up assessment. Journal of Anxiety Disorders20: 175–191.
11.
GillottAFurnissFWalterA (2001) Anxiety in high-functioning children with autism. Autism5: 277–286.
12.
GlennDGolinelliDRoseRD. (2013) Who gets the most out of cognitive behavioral therapy for anxiety disorders? The role of treatment dose and patient engagement. Journal of Consulting and Clinical Psychology84(4): 639–349.
13.
GreenSABen-SassonASotoTW. (2011) Anxiety and sensory over-responsivity in toddlers with autism spectrum disorders: bidirectional effects across time. Journal of Autism and Developmental Disorders42(6): 1112–1119.
14.
GuyW (1976) The Clinical Global Impressions Scale. In: GuyW (ed.) ECDEU Assessment Manual for Psychopharmacology, Revised. Rockville, MD: National Institute of Mental Health, pp. 218–222.
15.
HimleJAVan EttenMLJaneckAS. (2006) Insight as a predictor of treatment outcome in behavioral group treatment for obsessive-compulsive disorder. Cognitive Therapy and Research30: 661–666.
16.
HorwitzSMHoagwoodKStiffmanAR. (2001) Reliability of the services assessment for children and adolescents. Psychiatric Services52: 1088–1094.
17.
HwangBHughesC (2000) The effects of social interactive training on early social communicative skills of children with autism. Journal of Autism and Developmental Disorders30: 331–343.
18.
In-AlbonTSchneiderS (2007) Psychotherapy of childhood anxiety disorders: a meta-analysis. Psychotherapy and Psychosomatics76: 15–24.
19.
KendallPC (1994) Treating anxiety disorders in children: results of a randomized clinical trial. Journal of Consulting and Clinical Psychology62: 100–110.
20.
KimJASzatmariPBrysonSE. (2000) The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism4: 117–132.
21.
Le CouteurAHadenGHammalD. (2008) Diagnosing autism spectrum disorders in pre-school children using two standardised assessment instruments: the ADI-R and the ADOS. Journal of Autism and Developmental Disorders38: 362–372.
22.
Le CouteurALordCRutterM (2003) The Autism Diagnostic Interview: Revised (ADI-R). Los Angeles, CA: Western Psychological Services.
23.
LewinABPerisTSDe NadaiAS. (2012) Agreement between therapists, parents, patients, and independent evaluators on clinical improvement in pediatric obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology80: 1103–1107.
24.
LewinsohnPMClarkeGNSeeleyJR. (1994) Major depression in community adolescents: age at onset, episode duration, and time to recurrence. Journal of the American Academy of Child and Adolescent Psychiatry33: 809–818.
25.
LeyferOTFolsteinSEBacalmanS. (2006) Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. Journal of Autism and Developmental Disorders36: 849–861.
26.
LordCRisiSLambrechtL. (2000) The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders30: 205–223.
27.
LordCRutterMLe CouteurA (1994) Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders24: 659–685.
28.
LordCRutterMDiLavorePC. (2001) Autism Diagnostic Observation Schedule. Los Angeles, CA: Western Psychological Services.
29.
LynehamHJRapeeRM (2005) Agreement between telephone and in-person delivery of a structured interview for anxiety disorders in children. Journal of the American Academy of Child and Adolescent Psychiatry44: 274–282.
30.
McNally KeehnRHLincolnAJBrownMZ. (2013) The Coping Cat program for children with anxiety and autism spectrum disorder: a pilot randomized controlled trial. Journal of Autism and Developmental Disorders43: 57–67.
31.
McNemarQ (1947) Note on the sampling error of the difference between correlated proportions or percentages. Psychometrika12: 153–157.
32.
MerloLJLehmkuhlHDGeffkenGR. (2009) Decreased family accommodation associated with improved therapy outcome in pediatric obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology77: 355–360.
33.
MillsRWingL (2005) Researching Interventions in ASD and Priorities for Research: Surveying the Membership of the NAS. London: National Autistic Society.
34.
O’LearyEMBarrettPFjermestadKW (2009) Cognitive-behavioral family treatment for childhood obsessive-compulsive disorder: a 7-year follow-up study. Journal of Anxiety Disorders23: 973–978.
35.
PatelSRSimpsonHB (2010) Patient preferences for OCD treatment. Journal of Clinical Psychiatry71: 1434–1439.
36.
RaoPABeidelBCMurrayMJ (2008) Social skills interventions for children with Aspergers syndrome or high-functioning autism: a review and recommendations. Journal of Autism and Developmental Disorders38(2): 353–361.
37.
ReavenJBlakeley-SmithACulhane-ShelburneK. (2012) Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial. Journal of Child Psychology and Psychiatry and Allied Disciplines53: 410–419.
38.
RuferMHandIAlslebenH. (2005) Long-term course and outcome of obsessive-compulsive patients after cognitive-behavioral therapy in combination with either fluvoxamine or placebo: a 7-year follow-up of a randomized double-blind trial. European Archives of Psychiatry and Clinical Neuroscience255: 121–128.
39.
RUPP (2002) The Pediatric Anxiety Rating Scale (PARS): development and psychometric properties. Journal of the American Academy of Child and Adolescent Psychiatry41: 1061–1069.
40.
RussellAJJassiAFullanaMA. (2013) Cognitive behavior therapy for comorbid obsessive-compulsive disorder in high-functioning autism spectrum disorders: a randomized controlled trial. Depression and Anxiety30(8): 697–708.
41.
RussellAJMataix-ColsDAnsonM. (2005) Obsessions and compulsions in Asperger syndrome and high-functioning autism. British Journal of Psychiatry186: 525–528.
42.
RussellESofronoffK (2005) Anxiety and social worries in children with Asperger syndrome. Australian and New Zealand Journal of Psychiatry39: 633–638.
43.
SilvermanWKAlbanoAM (1996) The Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions. San Antonio, TX: Psychological Corporation.
44.
SimonoffEPicklesACharmanT. (2008) Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry47: 921–929.
45.
SofronoffKAttwoodTHintonS (2005) A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry and Allied Disciplines46: 1152–1160.
46.
SpenceSHDonovanCLMarchS. (2011) A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety. Journal of Consulting and Clinical Psychology79: 629–642.
47.
SpenceSHHolmesJMMarchS. (2006) The feasibility and outcome of clinic plus internet delivery of cognitive-behavior therapy for childhood anxiety. Journal of Consulting and Clinical Psychology74: 614–621.
48.
SpikerMALinCEVan DykeM. (2011) Restricted interests and anxiety in children with autism. Autism16(3): 306–320.
49.
SportelBEde HulluEde JongPJ. (2013) Cognitive bias modification versus CBT in reducing adolescent social anxiety: a randomized controlled trial. PLoS One8: e64355.
50.
StevensJWangWFanL. (2009) Parental attitudes toward children’s use of antidepressants and psychotherapy. Journal of Child and Adolescent Psychopharmacology19: 289–296.
51.
StorchEAArnoldEBLewinAB. (2013) The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry52: 132–142.
52.
StorchEAWoodJJEhrenreich-MayJ. (2012) Convergent and discriminant validity and reliability of the Pediatric Anxiety Rating Scale in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders42(11): 2374–2382.
53.
SungMOoiYPGohTJ. (2011) Effects of cognitive-behavioral therapy on anxiety in children with autism spectrum disorders: a randomized controlled trial. Child Psychiatry & Human Development42: 634–649.
54.
VahabzadehABuxtonDMcDougleC. (2013) Current state and future prospects of pharmacological interventions for autism. Neuropsychiatry3: 245–259.
55.
WarrenZVeenstra-VanderWeeleJStoneW. (2011) Therapies for children with autism spectrum disorders. Comparative effectiveness review, Agency for Healthcare Research and Quality, Rockville, MD, 12August.
56.
WhiteKSPayneLAGormanJM. (2013a) Does maintenance CBT contribute to long-term treatment response of panic disorder with or without agoraphobia? A randomized controlled clinical trial. Journal of Consulting and Clinical Psychology81: 47–57.
57.
WhiteSWOllendickTAlbanoAM. (2013b) Randomized controlled trial: multimodal anxiety and social skill intervention for adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders43: 382–394.
58.
WoodJJDrahotaA (2005) Behavioral Interventions for Anxiety in Children with Autism (BIACA) (Unpublished intervention manual). Los Angeles, CA: UCLA.
59.
WoodJJGadowKD (2010) Exploring the nature and function of anxiety in youth with autism spectrum disorders. Clinical Psychology: Science and Practice17: 281–292.
60.
WoodJJDrahotaASzeK. (2009) Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Journal of Child Psychology and Psychiatry and Allied Disciplines50: 224–234.
61.
ZandtFPriorMKyriosM (2007) Repetitive behaviour in children with high functioning autism and obsessive compulsive disorder. Journal of Autism and Developmental Disorders37: 251–259.
