Randomized Controlled Trial: Multimodal Anxiety and Social Skill Intervention for Adolescents with Autism Spectrum Disorder

Abstract

Anxiety is common among adolescents with autism spectrum disorders (ASD) and may amplify the core social disability, thus necessitating combined treatment approaches. This pilot, randomized controlled trial (RCT) evaluated the feasibility and preliminary outcomes of the Multimodal Anxiety and Social Skills Intervention (MASSI) program in a sample of 30 adolescents with ASD and anxiety symptoms of moderate or greater severity. The treatment was acceptable to families, subject adherence was high, and therapist fidelity was high. A 16% improvement in ASD social impairment (within-group effect size = 1.18) was observed on a parent-reported scale. Although anxiety symptoms declined by 26%, the change was not statistically significant. These findings suggest MASSI is a feasible treatment program and further evaluation is warranted.

Cognitive-Behavioral Therapy for Anxiety in Children With High-Functioning Autism: A Meta-analysis

“…Three studies also included large social skills components as part of treatment. 34,40,43 Given the core impairment in social functioning and a possibility that anxiety and social deficits in ASD may be interrelated, combining CBT with social skills seems clinically relevant, and these studies support the feasibility of combined treatments. However, randomized studies with larger samples are needed to evaluate the relative contributions of these interventions.…”

“…34,35,39,40,42,43 As shown in Fig 2, CBT was superior to control conditions for anxiety symptoms in children with ASD as reported by the parents (random effects model ES = 1.19; 95% CI, 0.23 to 2.14; z = 2.44, P = .02; fixed effect model ES = 0.78). However, one study 35 had an ES estimate (d = 4.34) that was much larger than that of the other studies (range, d = 0.10-1.23).…”

“…34,35,[39][40][41][42][43][44] Overall ESs on clinician-and parent-rated outcome measures of anxiety were d = 1.19 and d = 1.21, respectively, and in the large range. When the outlying studies were removed, the magnitude to these effects decreased to d = 0.57 for the parent ratings and d = 0.89 for the clinician ratings, but they remained statistically significant (ie, CBT was superior to control conditions).…”

“…Eight studies 34,35,[39][40][41][42][43][44] involving 469 participants (252 treatment, 217 comparison) met our inclusion criteria and were included in the analyses. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses 45 flow diagram of study selection is shown in Fig 1. The characteristics of the 8 included studies are shown in Table 1.…”

“…Thus, we combined waitlist-controlled studies with studies that used TAU-controlled conditions because these 2 types of control conditions in studies of children with autism appear to be essentially the same. We note that there was considerable heterogeneity among the studies in describing concomitant treatments including providing no information, 35,39 reporting a number of REVIEW ARTICLE PEDIATRICS Volume 132, Number 5, November 2013 e1347 subjects receiving concomitant medication, 41,43,44 and reporting medication, psychological, and school-based services. 34,42 Careful characterization of concomitant treatments including medication and psychoeducational and behavioral interventions in future randomized controlled studies will enable estimating the effects of these concomitant treatments on the magnitude of response to CBT for anxiety.…”