Wood Jeffrey J, Rosenau Kashia A, Muscatello Virginia, Cooper Kate, Wood Karen S, Kendall Philip C, Storch Eric A
Department of Education, University of California, Los Angeles, USA.
David Geffen School of Medicine, University of California, Los Angeles, USA.
J Autism Dev Disord. 2025 May 8. doi: 10.1007/s10803-025-06852-6.
Autistic children and youth can experience both mental health and adaptive skill needs, making the assessment of high priority goals from the caregiver's standpoint an important objective in psychological treatment planning. Modular cognitive behavioral therapy (CBT) tailored to each family's goals may be optimally suited to addressing different treatment priorities in autistic youth with interfering anxiety. The present study investigated the effects of adapted, modular CBT as compared to standard-of-practice CBT and treatment-as-usual (TAU) on caregiver-defined treatment goals.
A multisite randomized, controlled trial compared an adapted, modular CBT program with standard-of-practice CBT and TAU for autistic youth with interfering anxiety (N = 167; aged 7-13 years). At baseline, caregivers described their child's three highest priority clinical needs in their own words and rated the severity of these problems on a Likert-type scale, using the Youth Top Problems (YTP) scale. A broad range of clinical needs (e.g., internalizing, externalizing, and autism-related needs) were described by caregivers on this measure. At each treatment session, these problems were rated by caregivers. Youth coping was rated by caregivers each month.
Youth randomized to adapted CBT exhibited more rapid reductions in total YTP ratings in comparison with the TAU and standard-of-practice CBT conditions over the course of 16 weeks. Increased youth coping partly mediated this effect.
In adapted/modular CBT, the treatment emphasis can be readily adjusted to address caregiver-defined goals and this feature may contribute to its advantage in reducing scores on a personalized measure of treatment goals.
TRIAL REGISTRATION NUMBER(S): ClinicalTrials.gov NCT02028247.
自闭症儿童和青少年可能同时存在心理健康和适应技能方面的需求，因此从照顾者的角度评估高度优先的目标是心理治疗规划中的一个重要目标。针对每个家庭目标量身定制的模块化认知行为疗法（CBT）可能最适合解决患有干扰性焦虑的自闭症青少年的不同治疗重点。本研究调查了与常规治疗标准CBT和常规治疗（TAU）相比，适应性模块化CBT对照顾者定义的治疗目标的影响。
一项多中心随机对照试验，将一种适应性模块化CBT方案与常规治疗标准CBT和TAU进行比较，用于患有干扰性焦虑的自闭症青少年（N = 167；年龄7 - 13岁）。在基线时，照顾者用自己的语言描述孩子三个最优先的临床需求，并使用青少年首要问题（YTP）量表在李克特式量表上对这些问题的严重程度进行评分。照顾者在该量表上描述了广泛的临床需求（如内化、外化和与自闭症相关的需求）。在每次治疗 session，照顾者对这些问题进行评分。照顾者每月对青少年的应对情况进行评分。
在16周的过程中，随机分配到适应性CBT组的青少年与TAU组和常规治疗标准CBT组相比，YTP总评分下降得更快。青少年应对能力的提高部分介导了这一效果。
在适应性/模块化CBT中，治疗重点可以很容易地调整以解决照顾者定义的目标，这一特点可能有助于其在降低个性化治疗目标测量分数方面的优势。
ClinicalTrials.gov NCT02028247 。
