Autism Clinic for Translational Research, Brain and Mind Centre, Child Neurodevelopment and Mental Health Team, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 100 Mallet Street, Camperdown, NSW, 2050, Australia.
School of Psychology, University of Sydney, Sydney, 2050, Australia.
Mol Autism. 2021 Feb 8;12(1):11. doi: 10.1186/s13229-021-00418-w.
There is a strong research imperative to investigate effective treatment options for adolescents and adults with autism spectrum disorder (ASD). Elevated social anxiety, difficulties with social functioning and poor mental health have all been identified as core treatment targets for this group. While theoretical models posit a strong bidirectionality between social anxiety and ASD social functioning deficits, few interventions have targeted both domains concurrently. Of the two group interventions previously conducted with adolescents and adults with ASD, significant results have only been observed in either social anxiety or social functioning, and have not generalised to changes in overall mood. The aim of this study was to evaluate the potential benefit, tolerability and acceptability of a group cognitive-behaviour therapy (CBT) intervention in young adults with ASD. Primary treatment outcomes were social anxiety symptoms and social functioning difficulties; secondary outcomes were self-reported mood and overall distress.
Ten groups of participants completed an eight-week, modified group CBT intervention targeting both social anxiety and social functioning, that included social skills training, exposure tasks and behavioural experiment components. Seventy-eight adolescents and young adults with ASD, without intellectual impairment, aged between 16 and 38 (M = 22.77; SD = 5.31), were recruited from the community, Headspace centres and the Autism Clinic for Translational Research at the Brain and Mind Centre, University of Sydney. Outcomes (social anxiety, social functioning and mood) were measured pre- and post-intervention via self-report questionnaires (administered either online or through the return of hard-copy booklets), and participants were invited to provide anonymous feedback on the intervention (at the mid-point and end of the intervention).
Participants demonstrated statistically significant improvements on all outcome measures in response to the intervention. Specifically, social anxiety symptoms decreased (p < .001), and specific subdomains of social functioning improved post-intervention, particularly in social motivation (p = .032) and restricted interests and repetitive behaviours (p = .025). Self-reported symptom improvements also generalised to mood (depression, anxiety and stress; p < .05). All improvements demonstrated small effect sizes. Participant feedback was positive and indicated strong satisfaction with the program.
The absence of a control group and follow-up measures, reliance on self-report instruments as outcome measures and the exclusion of those with intellectual disability represent significant limitations to this study.
These findings indicate that a group CBT intervention appears to be a beneficial intervention for self-reported social anxiety, social functioning and overall mental health in adolescents and young adults with ASD. The stand-alone nature of the intervention combined with positive participant feedback indicates it was well tolerated, has potential clinical utility and warrants further study in a randomised-controlled, follow-up design.
对于患有自闭症谱系障碍（ASD）的青少年和成年人，有强烈的研究需要探索有效的治疗选择。已确定升高的社交焦虑，社交功能障碍和心理健康不良均为该人群的核心治疗目标。尽管理论模型假定社交焦虑与 ASD 社交功能障碍之间存在很强的双向关系，但很少有干预措施同时针对这两个领域。以前针对 ASD 青少年和成年人进行的两项小组干预中，仅在社交焦虑或社交功能方面观察到了显著的结果，而在整体情绪变化方面没有普遍性。这项研究的目的是评估针对 ASD 年轻人的小组认知行为疗法（CBT）干预的潜在益处，耐受性和可接受性。主要治疗结果是社交焦虑症状和社交功能障碍；次要结果是自我报告的情绪和总体困扰。
十组参与者完成了为期八周的修改后的小组 CBT 干预，该干预针对社交焦虑和社交功能，包括社交技能培训，暴露任务和行为实验组成部分。从社区，Headspace 中心和悉尼大学大脑与思维中心的自闭症转化研究诊所招募了 78 名没有智力障碍的 ASD 青少年和年轻人，年龄在 16 至 38 岁之间（M=22.77；SD=5.31）。通过自我报告问卷（在线或通过返回硬拷贝手册）在干预前后测量结果（社交焦虑，社交功能和情绪），并邀请参与者对干预措施提供匿名反馈（在干预的中点和结束时）。
参与者针对干预措施表现出所有结果均有统计学意义上的改善。具体来说，社交焦虑症状减轻（p<0.001），社交功能的特定子领域在干预后得到改善，尤其是社交动机（p=0.032）和受限兴趣和重复行为（p=0.025）。自我报告的症状改善也扩展到了情绪（抑郁，焦虑和压力；p<0.05）。所有改善均表现出较小的效应大小。参与者的反馈是积极的，并表明对该计划非常满意。
缺乏对照组和随访措施，依赖自我报告工具作为结果测量以及排除智力残疾者，这些都是该研究的重大局限性。
这些发现表明，小组 CBT 干预似乎对 ASD 青少年和年轻人的自我报告社交焦虑，社交功能和整体心理健康有益。干预措施的独立性以及参与者的积极反馈表明，它具有良好的耐受性，具有潜在的临床应用价值，值得在随机对照，随访设计中进一步研究。
