National Adult ADHD and Autism Service, South London and Maudsley NHS Foundation Trust, London, UK.
Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK.
Clin Psychol Psychother. 2017 Nov;24(6):O1474-O1484. doi: 10.1002/cpp.2108. Epub 2017 Jul 26.
To investigate the effectiveness of psychological therapy in reducing psychological distress for adults with autism spectrum conditions (ASC) and co-morbid mental health conditions in routine clinical practice. To explore the effect of individual characteristics and service factors on change in general distress.
In a specialist psychological therapies service for adults with ASC, the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) self-report questionnaire of psychological distress is completed by clients at start and end of therapy. Change over time and reliable and clinical change was assessed for 81 of a total of 122 clients (66.4%). Factors which may influence change over time were explored using available clinical information.
Overall, there was a significant reduction in CORE-OM score during therapy with a small effect size. Most clients showed an improvement in psychological distress over therapy (75.4% improved, with 36.9% of these showing reliable changes). Significant and comparable reductions from pre-therapy to post-therapy were seen across the sample, showing that individual differences did not mediate therapy effectiveness. CORE-OM scores mediate the association between age of ASD diagnosis and hours of therapeutic input required, with greater age at diagnosis and higher distress associated with longer therapy duration.
Our preliminary findings suggest that psychological therapy may be effective in reducing general distress for clients with ASC and co-morbid mental health conditions and should be routinely offered. Individuals who are diagnosed with ASD in adulthood are likely to require a longer course of therapy when their general distress scores are high.
在常规临床实践中,调查心理疗法对减少伴有共病精神健康状况的成年自闭症谱系障碍(ASC)患者的心理困扰的有效性。探索个体特征和服务因素对一般困扰变化的影响。
在针对 ASC 成人的专业心理治疗服务中,客户在治疗开始和结束时使用临床结局在常规评估-结局测量(CORE-OM)自我报告问卷完成心理困扰的评估。对总共 122 名客户中的 81 名(66.4%)进行了随时间变化的评估和可靠的临床变化。使用现有的临床信息探讨了可能影响随时间变化的因素。
总体而言,在治疗过程中 CORE-OM 评分显著降低,效应量较小。大多数客户在治疗过程中心理困扰得到改善(75.4%有所改善,其中 36.9%显示可靠变化)。整个样本中都出现了治疗前和治疗后显著且可比的降低,表明个体差异并没有调节治疗效果。CORE-OM 分数在 ASD 诊断年龄和所需治疗投入时间之间的关系中起中介作用,诊断年龄越大,困扰程度越高,所需的治疗时间越长。
我们的初步发现表明,心理疗法可能对减少伴有共病精神健康状况的 ASC 患者的一般困扰有效,应常规提供。当一般困扰评分较高时,成年后被诊断为 ASD 的个体可能需要更长的治疗疗程。