ABSTRACT
BACKGROUND: High rates of anxiety disorders, particularly obsessive compulsive disorder (OCD) are reported in people with Autism spectrum disorders (ASD). Group cognitive behavioral treatment (CBT) has been found effective for anxiety in young people with ASD but not been OCD specific. One uncontrolled pilot study of individual CBT for OCD for adults with ASD showed good treatment efficacy. METHODS: Forty-six adolescents and adults (mean age 26.9 years, 35 Males) with ASD and comorbid OCD were randomized to CBT for OCD or anxiety management (AM), a plausible control treatment. Treatments were matched in duration (mean of 17.4 sessions CBT; 14.4 sessions AM), the Yale-Brown Obsessive Compulsive Severity Scale (YBOCS) as primary outcome measure and evaluations blind to treatment group. Treatment response was defined as > 25% reduction in YBOCS total severity scores. RESULTS: Both treatments produced a significant reduction in OCD symptoms, within-group effect sizes of 1.01 CBT group and 0.6 for the AM group. There were no statistically significant differences between the two groups at end of treatment, although more responders in the CBT group (45 versus 20%). Effect sizes for self-rated improvement were small (0.33 CBT group; -0.05 AM group). Mild symptom severity was associated with improvement in the AM but not the CBT group. Family/carer factors were important for both groups, in that increased family accommodation was associated with poorer outcome. CONCLUSIONS: Evidence-based psychological interventions, both AM and CBT, were effective in treating comorbid OCD in young people and adults with ASD.
Subject(s)
Child Development Disorders, Pervasive/psychology , Cognitive Behavioral Therapy/methods , Obsessive-Compulsive Disorder/therapy , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Obsessive-Compulsive Disorder/psychology , Severity of Illness Index , Treatment Outcome , Young AdultABSTRACT
La presencia de síntomas obsesivo-compulsivos en los niños con trastornos del espectro autista parece elevada. Dado que estos pacientes podrían beneficiarse con el tratamiento convencional del trastorno obsesivo-compulsivo, se requiere un importante índice de presunción para la detección de esta comorbilidad.
Subject(s)
Humans , Male , Female , Child , Child Psychiatry/instrumentation , Child Psychiatry/methods , Autistic Disorder/diagnosis , Autistic Disorder/rehabilitation , Autistic Disorder/therapy , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/therapyABSTRACT
OBJECTIVE: To compare the clinical characteristics and symptom severity of children with obsessive disorder (OCD) plus autism spectrum disorders (ASD) with those of children with OCD plus Tourette's syndrome (TS) or OCD alone. METHOD: Children with OCD and ASD (OCD/ASD) (n = 12, mean age = 14.33, range: 12-18) were compared to children with OCD and TS (OCD/TS) (n = 12, mean age = 13.92, range: 9-17) and children with OCD-alone (OCD) (n = 12, mean age = 12.92, range: 9-17) on measures of obsessive-compulsive (OC) symptom frequency, severity, interference and other clinical variables. RESULTS: Patients from the OCD/ASD group rated their OC symptoms as equally distressing, time consuming and contributing to a similar level of interference in functioning as patients in the OCD/TS and OCD groups. The types of symptoms were similar across groups but patients with OCD/TS reported greater frequency of ordering and arranging compulsions, and a trend towards more sexual obsessions. Patients with OCD/ASD reported more peer relationship problems compared with the other two groups. CONCLUSIONS: Children with ASD may experience a similar level of impairment from OC symptoms as children with TS plus OCD and children with OCD only. It is suggested that it is useful to establish both diagnoses given that obsessions and compulsions may respond to treatment, and their alleviation may improve functioning in children on the autism spectrum.
