Cognitive-behavioral therapy (CBT) with exposure/response prevention is effective among youth with autism spectrum disorders (ASDs) and comorbid anxiety symptoms. This case illustrates the application of a modularized family-based CBT approach with a school-aged boy with autistic disorder and comorbid obsessive-compulsive disorder (OCD). Following 16 family sessions over 21 weeks, “Jerry,” a 9-year-old Caucasian male, showed significant reduction in obsessive-compulsive symptoms. Jerry’s parents also reported improvements in emotional regulation, participation in school activities, and in his parent–child relationships. This case study illustrates the use of family-based CBT, which has been modified to account for social and behavioral deficits endemic to ASDs, for school-aged youth with autism and comorbid OCD.
AbramowitzJ. S.WhitesideS. P.DeaconB. J. (2005). The effectiveness of treatment for pediatric obsessive-compulsive disorder: A meta-analysis. Behavior Therapy, 36, 55-63.
2.
AchenbachT. M. (2001). Manual for ASEBA school-age forms and profiles. Burlington: University of Vermont.
3.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorder (DSM-IV-TR). Washington, DC: Author.
4.
BelliniS. (2004). Social skill deficits and anxiety in high-functioning adolescents with autism. Focus on Autism and Other Developmental Disabilities, 19, 78-86.
5.
Centers for Disease Control and Prevention. (2012). Prevalence of autism spectrum disorders: Autism and development disabilities monitoring network, 14 sites, United States, 2008. Surveillance Summaries, 61 (3), 1-19.
6.
ChalfantA. M.RapeeR.CarollL. (2007). Treating anxiety disorders in children with high-functioning autism spectrum disorders: A controlled trial. Journal of Autism and Developmental Disorders, 37, 1842-1857.
7.
ChamberlainB.KasariC.Rotheram-FullerE. (2007). Involvement or isolation? The social networks of children with autism in regular classrooms. Journal of Autism and Developmental Disorders, 37, 230-242.
8.
ConstantinoJ. N. (2002). The social responsiveness scale. Los Angeles, CA: Western Psychological Services.
9.
DrahotaA.WoodJ. J.SzeK. M.Van DykeM. (2010). Effects of cognitive behavioral therapy on daily-living skills in children with high-functioning autism and concurrent anxiety disorders. Journal of Autism and Developmental Disorders, 41, 257-265.
10.
EvansD. W.CanaveraK. K.MaccubbinE.TagaK. (2005). The fears, phobias and anxieties of children with autism spectrum disorders and down syndrome: Comparisons with developmentally and chronologically age-matched children. Child Psychiatry and Human Development, 36, 3-26.
11.
FarrugiaS.HudsonJ. (2006). Anxiety in adolescents with Asperger syndrome: Negative thoughts, behavioral problems, and life interference. Focus on Autism and Other Development, 21, 25-35.
12.
GellerD. A.MarchJ. (2012). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51, 98-113.
13.
GuyW. (1976). Clinical global impressions. In GuyW. (Ed.), ECDEU assessment manual for psychopharmacology, revised (pp. 218-222). Rockville, MD: National Institute of Mental Health.
14.
JoshiG.PettyC.WozniakJ.HeninA.FriedR.GaldoM.. . . BiedermanJ. (2010). The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: A large comparative study of a psychiatrically referred population. Journal of Autism and Developmental Disorders, 40, 1361-1370.
15.
LewinA. B.PerisT. S.De NadaiA. S.McCrackenJ. T.PiacentiniJ. (2012). Agreement between therapists, parents, patients, and independent evaluators on clinical improvement in pediatric obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 80, 1103-1107.
16.
LewinA. B.PiacentiniJ. (2010). Evidence-based assessment of child obsessive compulsive disorder: Recommendations for clinical practice and treatment research. Child & Youth Care Forum, 39, 73-89.
17.
LewinA. B.StorchE. A.GeffkenG. R.GoodmanW. K.MurphyT. K. (2006). A neuropsychiatric review of pediatric obsessive-compulsive disorder: Etiology and efficacious treatments. Neuropsychiatric Disease and Treatment, 2, 21-31.
18.
LewinA. B.WoodJ. J.GundersonS.MurphyT. K.StorchE. A. (2011). Phenomenology of comorbid autism spectrum and obsessive-compulsive disorders among children. Journal of Developmental and Physical Disabilities, 23, 543-553.
19.
LordC.RutterM.Le 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 Disorders, 24, 659-685.
20.
MarchJ. (1998). Manual for the multidimensional anxiety scale for children. Toronto, Ontario, Canada: Multi-health Systems.
21.
MarchJ. S.FranklinM.NelsonA.FoaE. (2001). Cognitive-behavioral psychotherapy for pediatric obsessive-compulsive disorder. Journal of Clinical Child Psychology, 30, 8-18.
22.
NadeauJ.SulkowskiM. L.UngD.WoodJ. J.LewinA. B.MurphyT. K.. . . StorchE. A. (2011). Treatment of comorbid anxiety and autism spectrum disorders. Neuropsychiatry, 1, 561-578.
23.
National Institute of Mental Health. (1985). Special feature: Rating scales and assessment instruments for use in pediatric psychopharmacology research. Pharmacology Bulletin, 21, 839-843.
24.
PerisT. S.YadegarM.AsarnowJ. R.PiacentiniJ. (2012). Pediatric obsessive compulsive disorder: Family climate as a predictor of treatment outcome. Journal of Obsessive-Compulsive and Related Disorders, 1, 267-273.
25.
PiacentiniJ.LangleyA. K. (2004). Cognitive-behavioral therapy for children who have obsessive-compulsive disorder. Journal of Clinical Psychology, 60, 1181-1194.
26.
The Psychological Corporation. (1999). Wechsler Abbreviated Scale of Intelligence. San Antonio, TX: Author.
27.
ReavenJ.Blakeley-SmithA.Culhane-ShelburneK.HepburnS. (2012). Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: A randomized control trial. Journal of Child Psychology and Psychiatry, 53, 410-419.
28.
RUPP (Research Units of Pediatric Psychopharmacology) Group. (2002). The pediatric anxiety rating scale (PARS): Development and psychometric properties. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 1061-1069.
29.
ScahillL.RiddleM. A.McSwiggin-HardinM.OrtS. I.KingR. A.GoodmanW. K.. . . & LeckmanJ. F. (1997). Children’s Yale-Brown obsessive compulsive scale: reliability and validity. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 844-852.
30.
SellesR. R.StorchE. A. (2013). Translation of anxiety treatment to youth with Autism Spectrum Disorders. Journal of Child and Family Studies, 22, 405-413.
31.
SellesR. R.UngD.NadeauJ. M.StorchE. A. (in press). Cognitive-behavioral therapy. In LuiselliJ. K. (Ed.), Children and youth with autism spectrum disorder (ASD): Recent advances and innovations in assessment, education, and intervention. Oxford, UK: Oxford University Press.
32.
SilvermanW. K.AlbanoA. M. (1996). The Anxiety Disorders Interview Schedule for DSM-IV–Child and parent versions. San Antonio, TX: Graywind.
33.
SimonoffE.PicklesA.CharmanT.LoucasT.BairdG. (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 & Adolescent Psychiatry, 47, 927-929.
34.
SofronoffK.AttwoodT.HintonS. (2005). A randomized controlled trial of CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46, 1152-1160.
35.
StorchE. A.ArnoldE. B.LewinA. B.NadeauJ.JonesA. M.De NadaiA. S.. . . MurphyT. K. (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 & Adolescent Psychiatry, 52, 132-142.
36.
StorchE. A.GeffkenG. R.MerloL. J.MannG.DukeD.MunsonM.. . . GoodmanW. K. (2007). Family-based cognitive behavioral therapy for pediatric obsessive-compulsive disorder: Comparison of intensive and weekly approaches. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 469-478.
37.
SukhodolskyD. G.ScahillL.GadowK. D.ArnoldL. E.AmanM. G.McDougleC. J.. . . VitielloB. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36, 117-128.
38.
van SteenselF. J.BögelsS. M.PerrinS. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14, 302-317.
39.
WeisbrotD. M.GadowK. D.DeVincentC. J.PomeroyJ. (2005). The presentation of anxiety in children with pervasive developmental disorders. Journal of Child Adolescent Psychopharmacology, 15, 477-496.
40.
WeiszJ. R. (2004). Psychotherapy for children and adolescents: Evidence-based treatments and case examples. New York, NY: Cambridge University Press.
41.
WhiteS. W. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29, 216-229.
42.
WoodJ. J.DrahotaA.SzeK. M.HarK.ChiuA.LangerD. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50, 224-234.
43.
WoodJ. J.DrahotaA.SzeK. M.Van DykeM.DeckerK.FujiiC.. . . SpikerM. (2009). Brief report: Effects of cognitive behavioral therapy on parent-reported autism symptoms in school-age children with high-functioning autism. Journal of Autism and Developmental Disorders, 39, 1608-1612.
44.
WoodJ. J.PiacentiniJ. C.Southam-GerowM.ChuB.SigmanM. (2006). Family cognitive behavioral therapy for child anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 45, 314-324.
