Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
Autism Center, Texas Children's Hospital, Houston, TX, USA.
Braz J Psychiatry. 2020 Nov-Dec;42(6):638-645. doi: 10.1590/1516-4446-2020-0897.
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.
焦虑障碍影响高达 50%的自闭症谱系障碍（ASD）个体，对受影响者及其亲人都有显著的影响。认知行为疗法（CBT）已被确立为典型发展的青少年和成年人焦虑障碍的金标准治疗方法，并且在高功能自闭症（HFA）的青少年中也显示出类似的疗效。许多 CBT 干预措施采用“全套餐”治疗方法来治疗 ASD 青少年共病的焦虑。然而，这些服务提供系统通常需要大量治疗师，成本高昂且不切实际，从而影响了全面参与和治疗依从性。本文描述了一项研究的设计、原理和方法，该研究检查了针对 HFA 青少年和共病焦虑的阶梯式 CBT——这是一项临床试验，旨在检查低强度、家长主导的 CBT 作为一线治疗的疗效，并为无反应者利用更密集的、治疗师主导的干预措施。该研究将评估阶梯式护理和家长主导的治疗师辅助干预的潜在益处、治疗反应的预测因素以及使用阶梯式护理模式的经济价值。将讨论对实践的影响。
