Brazilian Journal of Psychiatry ()

Parent-led, stepped-care cognitive-behavioral therapy for youth with autism and co-occurring anxiety: study rationale and method

  • Ana C. Ramirez,
  • Stacey C. Grebe,
  • Morgan M. McNeel,
  • Danica L. Limon,
  • Sophie C. Schneider,
  • Leandra N. Berry,
  • Robin P. Goin-Kochel,
  • Sandra L. Cepeda,
  • Robert G. Voigt,
  • Alison Salloum,
  • Eric A. Storch

DOI
https://doi.org/10.1590/1516-4446-2020-0897

Abstract

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Anxiety disorders affect up to 50% of individuals with autism spectrum disorder (ASD) and are significantly impairing to the person affected, as well as to their loved ones. Cognitive-behavioral therapy (CBT) has been established as the gold-standard treatment for anxiety disorders among typically developing youth and adults, and demonstrates similar efficacy among youth with high-functioning autism (HFA). Many CBT interventions utilize a “full-package” treatment approach to treat co-occurring anxiety in youth with ASD. However, these service delivery systems are often therapist-intensive, costly, and impractical, thereby compromising full engagement and treatment adherence. This paper describes the design, rationale, and methodology of a study examining stepped-care CBT for youth with HFA and co-occurring anxiety – a clinical trial examining the efficacy of low-intensity, parent-led CBT as the first line of treatment and utilizing a more intensive, therapist-led intervention for nonresponders. The study will evaluate the potential benefits of stepped-care and parent-led therapist-assisted interventions, predictors of treatment response, and the economic value of using a stepped-care model. Implications for practice will be discussed.

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