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An Initial Case Series of Intensive Cognitive–Behavioral Therapy for Obsessive–Compulsive Disorder in Adolescents with Autism Spectrum Disorder

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Abstract

Obsessive–compulsive disorder (OCD) is prevalent among youth with autism spectrum disorder (ASD). Cognitive–behavioral therapy (CBT) with ASD-specific modifications has support for treating OCD in this population; however, use of intensive CBT in youth with ASD and severe OCD has not been tested. The current study examined the preliminary effectiveness of an individualized intensive CBT protocol for OCD in adolescents with ASD. Nine adolescents (aged 11–17 years) completed a regimen of intensive CBT (range 24–80 daily sessions) incorporating exposure with response prevention (ERP). Treatment materials, language and techniques were modified in accordance with evidence-based findings for this population. Seven of nine participants (78%) were treatment responders, and large treatment effects (d = 1.35–2.58) were obtained on primary outcomes (e.g., obsessive–compulsive symptom severity). Preliminary findings suggest that an intensive CBT approach for OCD is effective among adolescents with ASD.

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References

  1. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Washington DC

    Book  Google Scholar 

  2. Centers for Disease Control and Prevention. (2014) Prevalence of autism spectrum disorder among children aged 8 years: autism and developmental disabilities monitoring network. MMWR Surveill Summ 63:1–21

    Google Scholar 

  3. Dean M, Kasari C, Shih W, Frankel F, Whitney R, Landa R et al (2014) The peer relationships of girls with ASD at school: comparison to boys and girls with and without ASD. J Child Psychol Psychiatry 55:1218–1225

    Article  PubMed  Google Scholar 

  4. Smith LE, Greenberg JS, Mailick MR (2014) The family context of autism spectrum disorders: influence on the behavioral phenotype and quality of life. Child Adolesc Psychiatr Clin N Am 23:143–155

    Article  PubMed  Google Scholar 

  5. Joshi G, Petty C, Wozniak J, Henin A, Fried R, Galdo M et al (2010) The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: a large comparative study of a psychiatrically referred population. J Autism Dev Disord 40:1361–1370

    Article  PubMed  Google Scholar 

  6. Posserud M, Hysing M, Helland W, Gillberg C, Lundervold AJ (2016) Autism traits: the importance of “co-morbid” problems for impairment and contact with services. Data from the Bergen Child Study. Res Dev Disabil. doi:10.1016/j.ridd.2016.01.002

    PubMed  Google Scholar 

  7. Leyfer OT, Folstein SE, Bacalman S, Davis NO, Dinh E, Morgan J et al (2006) Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. J Autism Dev Disord 36:849–861

    Article  PubMed  Google Scholar 

  8. Bellini S (2004) Social skill deficits and anxiety in high-functioning adolescents with autism spectrum disorders. Focus Autism Other Dev Disabl 19:78–86

    Article  Google Scholar 

  9. Lewin AB, Wood JJ, Gunderson S, Murphy TK, Storch EA (2011) Phenomenology of comorbid autism spectrum and obsessive–compulsive disorders among children. J Dev Phys Disabil 23:543–553

    Article  Google Scholar 

  10. McGuire JF, Piacentini J, Lewin AB, Brennan EA, Murphy TK, Storch EA (2015) A meta-analysis of cognitive behavior therapy and medication for child obsessive–compulsive disorder: moderators of treatment effectiveness, response, and remission. Depress Anxiety 32:580–593

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sánchez-Meca J, Rosa-Alcázar AI, Iniesta-Sepúlveda M, Rosa-Alcázar Á (2014) Differential efficacy of cognitive–behavioral therapy and pharmacological treatments for pediatric obsessive–compulsive disorder: a meta-analysis. J Anxiety Disord 28:31–44

    Article  PubMed  Google Scholar 

  12. Geller DA, Biederman J, Stewart SE, Mullin B, Farrell C, Wagner KD (2003) Impact of comorbidity on treatment response to paroxetine in pediatric obsessive–compulsive disorder: is the use of exclusion criteria empirically supported in randomized clinical trials? J Child Adolesc Psychopharmacol 13:19–29

    Article  Google Scholar 

  13. Storch EA, Merlo LJ, Larson MJ, Geffken GR, Lehmkuhl HD, Jacob ML (2008) Impact of comorbidity on cognitive–behavioral therapy response in pediatric obsessive–compulsive disorder. J Am Acad Child Adolesc Psychiatry 47:583–592

    Article  PubMed  Google Scholar 

  14. Storch EA, Björgvinsson T, Riemann B, Lewin AB, Morales MJ, Murphy TK (2010) Factors associated with poor response in cognitive–behavioral therapy for pediatric obsessive–compulsive disorder. Bull Menninger Clin 74:167

    Article  PubMed  Google Scholar 

  15. Ung D, Selles R, Small BJ, Storch EA (2015) A systematic review and meta-analysis of cognitive–behavioral therapy for anxiety in youth with high-functioning autism spectrum disorders. Child Psychiatry Hum Dev 46:533–547

    Article  PubMed  Google Scholar 

  16. Sofronoff K, Attwood T, Hinton S (2005) A randomized controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. J Child Psychol Psychiatry 46:1152–1160

    Article  PubMed  Google Scholar 

  17. Reaven JA, Blakeley-Smith A, Nichols S, Dasari M, Flanigan E, Hepburn S (2009) Cognitive–behavioral group treatment for anxiety symptoms in children with high-functioning autism spectrum disorders a pilot study. Focus Autism Other Dev Disabl 24:27–37

    Article  Google Scholar 

  18. White SW, Albano AM, Johnson CR, Kasari C, Ollendick T, Klin A (2010) Development of a cognitive–behavioral intervention program to treat anxiety and social deficits in teens with high-functioning autism. Clin Child Fam Psychol Rev 13:77–90

    Article  PubMed  PubMed Central  Google Scholar 

  19. Storch EA, Lewin AB, Collier AB, Arnold E, De Nadai AS, Dane BF (2014) A randomized controlled trial of cognitive–behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety. ‎Depress Anxiety 32:174–181

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sze KM, Wood JJ (2007) Cognitive behavioral treatment of comorbid anxiety disorders and social difficulties in children with high-functioning autism: a case report. J Contemp Psychother 37:133–143

    Article  Google Scholar 

  21. Wood JJ, Drahota A, Sze K, Har K, Chiu A, Langer DA (2009) Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. J Child Psychol Psychiatry 50:224–234

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wood JJ, Ehrenreich-May J, Alessandri M, Fujii C, Renno P, Laugeson E (2015) Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: a randomized, controlled trial. Behav Ther 46:7–19

    Article  PubMed  Google Scholar 

  23. White SW, Ollendick T, Albano AM, Oswald D, Johnson C, Southam-Gerow MA (2013) Randomized controlled trial: multimodal anxiety and social skill intervention for adolescents with autism spectrum disorder. ‎J Autism Dev Disord 43:382–394

    Article  PubMed  PubMed Central  Google Scholar 

  24. El-Ghoroury NH, Krackow E (2011) A developmental–behavioral approach to outpatient psychotherapy with children with autism spectrum disorders. J Contemp Psychother 41:11–17

    Article  Google Scholar 

  25. Elliott SJ, Fitzsimons L (2014) Modified CBT for treatment of OCD in a 7-year-old boy with ASD—a case report. J Child Adolesc Psychiatr Nurs 27:156–159

    Article  PubMed  Google Scholar 

  26. Lehmkuhl HD, Storch EA, Bodfish JW, Geffken GR (2008) Brief report: exposure and response prevention for obsessive compulsive disorder in a 12-year-old with autism. J Autism Dev Disord 38:977–981

    Article  PubMed  PubMed Central  Google Scholar 

  27. Nadeau JM, Arnold EB, Storch EA, Lewin AB (2014) Family cognitive–behavioral treatment for a child with autism and comorbid obsessive compulsive disorder. ‎Clin Case Stud 13:22–36

    Article  Google Scholar 

  28. Reaven J, Hepburn S (2003) Cognitive–behavioral treatment of obsessive–compulsive disorder in a child with asperger syndrome:a case report. Autism 7:145–164

    Article  PubMed  Google Scholar 

  29. Rooney M, Alfano CA, Walsh KS, Parr AF (2011) Differential diagnosis and treatment of obsessive–compulsive, inattentive, and sleep symptoms in a 7-year-old with PDD-NOS. Clin Case Stud 10:133–146

    Article  Google Scholar 

  30. Murray K, Jassi A, Mataix-Cols D, Barrow F, Krebs G (2015) Outcomes of cognitive behaviour therapy for obsessive–compulsive disorder in young people with and without autism spectrum disorders: a case controlled study. Psychiatry Res 228:8–13

    Article  PubMed  Google Scholar 

  31. Russell AJ, Mataix-Cols D, Anson MAW, Murphy DGM (2009) Psychological treatment for obsessive–compulsive disorder in people with autism spectrum disorders–a pilot study. Psychother Psychosom 78:59–61

    Article  PubMed  Google Scholar 

  32. Russell AJ, Jassi A, Fullana MA, Mack H, Johnston K, Heyman I, Mataix-Cols D (2013) Cognitive behavior therapy for comorbid obsessive–compulsive disorder in high-functioning autism spectrum disorders: a randomized controlled trial. Depress Anxiety 30:697–708

    Article  PubMed  Google Scholar 

  33. Vause T, Neil N, Jaksic H, Jackiewicz G, Feldman M (2015) Preliminary randomized trial of function-based cognitive–behavioral therapy to treat obsessive compulsive behavior in children with autism spectrum disorder. Focus Autism Other Dev Disabl. doi:10.1177/1088357615588517

    Google Scholar 

  34. Scahill L, Riddle MA, McSwiggin-Hardin M, Ort SI, King RA, Goodman WK (1997) Children’s Yale-Brown obsessive compulsive scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 36:844–852

    Article  PubMed  Google Scholar 

  35. AACAP (2012) Practice parameter for the assessment and treatment of children and adolescents with obsessive–compulsive disorder. J Am Acad Child Adolesc Psychiatry 51:98–113

    Article  Google Scholar 

  36. Storch EA, Bagner DM, Geffken GR, Adkins JW, Murphy TK, Goodman WK (2007) Sequential cognitive–behavioral therapy for children with obsessive–compulsive disorder with an inadequate medication response: a case series of five patients. Depress Anxiety 24:375–381

    Article  PubMed  Google Scholar 

  37. Goodwin R, Koenen KC, Hellman F, Guardino M, Struening E (2002) Helpseeking and access to mental health treatment for obsessive–compulsive disorder. Acta Psychiatr Scand 106:143–149

    Article  PubMed  Google Scholar 

  38. Kessler RC, Avenevoli S, Costello EJ, Georgiades K, Green JG, Gruber MJ et al (2012) Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry 69:372–380

    Article  PubMed  Google Scholar 

  39. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593–602

    Article  PubMed  Google Scholar 

  40. Oswald TM, Winter-Messiers MA, Gibson B, Schmidt AM, Herr CM, Solomon M (2016) Sex differences in internalizing problems during adolescence in autism spectrum disorder. J Autism Dev Disord 46:624–636

    Article  PubMed  Google Scholar 

  41. Rosa-Alcázar AI, Sánchez-Meca J, Rosa-Alcázar Á, Iniesta-Sepúlveda M, Olivares-Rodríguez J, Parada-Navas JL (2015) Psychological treatment of obsessive–compulsive disorder in children and adolescents: a meta-analysis. Span J Psychol 18:e20

    Article  PubMed  Google Scholar 

  42. Leckman JF, Sholomskas D, Thompson D, Belanger A, Weissman MM (1982) Best estimate of lifetime psychiatric diagnosis: a methodological study. Arch Gen Psychiatry 39:879

    Article  PubMed  Google Scholar 

  43. Iniesta-Sepúlveda M, Rosa-Alcázar AI, Rosa-Alcázar Á, Storch EA (2014) Evidence-based assessment in children and adolescents with obsessive–compulsive disorder. J Child Fam Stud 23:1455–1470

    Article  Google Scholar 

  44. Storch EA, Murphy TK, Geffken GR, Soto O, Sajid M, Allen P et al (2004) Psychometric evaluation of the Children’s Yale–Brown obsessive–Compulsive Scale. Psychiatry Res 129:91–98

    Article  PubMed  Google Scholar 

  45. Wu MS, McGuire J, Arnold E, Lewin A, Murphy T, Storch EA (2014) Psychometric properties of the Children’s Yale-Brown Obsessive Compulsive Scale in Youth with Autism Spectrum Disorders and obsessive–Compulsive Symptoms. Child Psychiatry Hum Dev 45:201–211

    Article  PubMed  Google Scholar 

  46. Bird HR, Andrews H, Schwab-Stone M, Goodman S, Dulcan M, Richters J et al (1996) Global measures of impairment for epidemiologic and clinical use with children and adolescents. Int J Methods Psychiatr Res 6:295–307

    Article  Google Scholar 

  47. Endicott J, Nee J, Yang R, Wohlberg C (2006) Pediatric quality of life enjoyment and satisfaction questionnaire (PQ-LES-Q): reliability and validity. J Am Acad Child Adolesc Psychiatry 45:401–407

    Article  PubMed  Google Scholar 

  48. Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, Neer SM (1997) The screen for child anxiety related emotional disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 36:545–553

    Article  PubMed  Google Scholar 

  49. Stern JA, Gadgil MS, Blakeley-Smith A, Reaven JA, Hepburn SL (2014) Psychometric properties of the SCARED in youth with autism spectrum disorder. Res Autism Spectr Disord 8:1225–1234

    Article  PubMed  PubMed Central  Google Scholar 

  50. Irwin DE, Stucky B, Langer MM, Thissen D, DeWitt EM, Lai JS et al (2010) An item response analysis of the pediatric PROMIS anxiety and depressive symptoms scales. Qual Life Res 19:595–607

    Article  PubMed  PubMed Central  Google Scholar 

  51. NIMH (1985) Rating scales and assessment instruments for use in pediatric psychopharmacology research. Psychopharmacol Bull 21:839–843

    Google Scholar 

  52. Lewin AB, Piacentini J (2010) Evidence-based assessment of child obsessive compulsive disorder: recommendations for clinical practice and treatment research. Child Youth Care Forum 39:73–89

    Article  PubMed  PubMed Central  Google Scholar 

  53. Pituch KA, Green VA, Didden R, Lang R, O’Reilly MF, Lancioni GE, Sigafoos J (2011). Parent reported treatment priorities for children with autism spectrum disorders. Res Autism Spectr Disord 5:135–143

    Article  Google Scholar 

  54. Storch EA, Lewin AB, De Nadai AS, Murphy TK (2010) Defining treatment response and remission in obsessive–compulsive disorder: a signal detection analysis of the Children’s Yale-Brown Obsessive Compulsive Scale. J Am Acad Child Adolesc Psychiatry 49:708–717

    PubMed  Google Scholar 

  55. Storch EA, Arnold EB, Lewin AB, Nadeau JM, Jones AM, De Nadai AS et al (2013) The effect of cognitive–behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 52:132–142

    Article  PubMed  Google Scholar 

  56. Conelea CA, Freeman JB (2015) What do therapists and clients do during exposures for OCD? Introduction to the special issue on theory-based exposure process. J Obsessive Compuls Relat Disord 6:144–146

    Article  Google Scholar 

  57. Taboas WR, McKay D, Whiteside SP, Storch EA (2015) Parental involvement in youth anxiety treatment: conceptual bases, controversies, and recommendations for intervention. J Anxiety Disord 30:16–18

    Article  PubMed  Google Scholar 

  58. Whiteside SP, McKay D, De Nadai AS, Tiede MS, Ale CM, Storch EA (2014) A baseline controlled examination of a 5-day intensive treatment for pediatric obsessive–compulsive disorder. Psychiatry Res 220:441–446

    Article  PubMed  Google Scholar 

  59. Storch EA, Lehmkuhl HD, Ricketts E, Geffken GR, Marien W, Murphy TK (2010) An open trial of intensive family based cognitive–behavioral therapy in youth with obsessive–compulsive disorder who are medication partial responders or nonresponders. J Clin Child Adolesc Psychol 39:260–268

    Article  PubMed  Google Scholar 

  60. Kerns CM, Kendall PC, Berry L, Souders MC, Franklin ME, Schultz RT et al (2014) Traditional and atypical presentations of anxiety in youth with autism spectrum disorder. J Autism Dev Disord 44:2851–2861

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The Funding for preparation this manuscript was provided to the first author by Ministry of Education, Culture and Sports of Spanish Government in the “José Castillejo” Program, Grant CAS15/00381. Ministry of Education, Culture and Sports had no role in the study, or the decision to submit the paper for publication.

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Authors and Affiliations

  1. Department of Psychology, Catholic University of Murcia, Murcia, Spain

    Marina Iniesta-Sepúlveda

  2. Department of Education, Catholic University of Murcia, 35 Campus de los Jerónimos, 30107, Guadalupe, Spain

    Marina Iniesta-Sepúlveda

  3. Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA

    Joshua M. Nadeau & Eric A. Storch

  4. Rogers Memorial Hospital, Oconomowoc, WI, USA

    Joshua M. Nadeau, Amaya Ramos, Brian Kay, Bradley C. Riemann & Eric A. Storch

  5. Department of Health Policy and Management, University of South Florida, Tampa, FL, USA

    Eric A. Storch

  6. Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA

    Eric A. Storch

  7. Department of Psychology, University of South Florida, St. Petersburg, FL, USA

    Eric A. Storch

  8. All Children’s Hospital – Johns Hopkins Medicine, St. Petersburg, FL, USA

    Eric A. Storch

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  1. Marina Iniesta-Sepúlveda
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  2. Joshua M. Nadeau
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  3. Amaya Ramos
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  4. Brian Kay
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  5. Bradley C. Riemann
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  6. Eric A. Storch
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Correspondence to Marina Iniesta-Sepúlveda.

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Iniesta-Sepúlveda, M., Nadeau, J.M., Ramos, A. et al. An Initial Case Series of Intensive Cognitive–Behavioral Therapy for Obsessive–Compulsive Disorder in Adolescents with Autism Spectrum Disorder. Child Psychiatry Hum Dev 49, 9–19 (2018). https://doi.org/10.1007/s10578-017-0724-1

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