LAY ABSTRACT: Cognitive behavioral therapy is a common treatment for emotional problems in people with autism. Most studies of cognitive behavioral therapy and autism have focused on efficacy, meaning whether a treatment produces results under "ideal" conditions, like a lab or research setting. Effectiveness trials, by contrast, investigate whether a treatment produces results under "real-world" conditions, like a community setting (e.g. hospital, community mental health center, school). There can be challenges in bringing a cognitive behavioral therapy treatment out of a lab or research setting into the community, and the field of implementation science uses frameworks to help guide researchers in this process. In this study, we reviewed efficacy and effectiveness studies of cognitive behavioral therapy treatments for emotional problems (e.g. anxiety, depression) in children and youth with autism. Our search found 2959 articles, with 33 studies meeting our criteria. In total, 13 studies were labelled as effectiveness and 20 as efficacy. We discuss how the effectiveness studies used characteristics of an implementation science framework, such as studying how individuals learn about the treatment, accept or reject it, how it is used in the community over time, and any changes that happened to the individual or the organization (e.g. hospital, school, community mental health center) because of it. Results help us better understand the use of cognitive behavioral therapy in the community, including how a framework can be used to improve effectiveness studies.
There is a growing number of young people, diagnosed with an autism-spectrum disorder (ASD), transitioning to adulthood. Among this number, individuals without an intellectual disability have significant adaptive deficits and need individualized care and support services to better target vocational, social, and educational prospects and outcomes. Group-based interventions, including patient education, social-skills training, and cognitive-behavioral therapy, are widely used in clinical settings to improve the daily life and prospects of ASD individuals facing the challenge of transitioning to adulthood. We performed a systematic review of studies concerning the efficiency of group-based educational interventions with a focus on the transition to adulthood for young, ASD individuals without intellectual disability (ID). As a result of this systematic search, 21 studies out of 163 were found to be eligible for inclusion. We observed considerable heterogeneity across the studies, in terms of effect sizes and intervention design, delivery, and the comparison of controls. Strong evidence was found in favor of social-skills training and cognitive-behavioral therapy interventions. Professionals should consider group-based psychoeducational intervention to be an appropriate and relevant service for young subjects with ASD without ID transitioning to adulthood. Further research is needed on larger samples using multicentric designs to validate efficacy before generalization.
Background: Given the prevalence of depression in persons with autism spectrum disorder (ASD), effective treatment is crucial; however, a systemic review on the topic has not been published in over a decade. This study aimed to systematically examine the efficacy of psychosocial and pharmacological treatments for depression in youth and adults with ASD to inform clinical practice. Method: PsycINFO, PubMed, and CINAHL online databases were searched for peer-reviewed journal articles containing any combination of the following terms in the abstract: (1) autism, autistic, Asperger, or “pervasive developmental disorder,” (2) depression or depressive and (3) treatment, intervention, trial, therapy, medication, drug, or antidepressant. Evidence from studies meeting the predetermined criteria of inclusion was assessed for its strength to inform clinical decision-making. Results: Twenty psychosocial treatment studies and five pharmacological treatment studies met the criteria of inclusion. Psychosocial interventions studied the effectiveness of cognitive remediation therapy, behavioral therapy, cognitive-behavioral therapy (CBT), combined psychosocial intervention, mindfulness-based therapy (MBT), and social, academic, and/or vocational skills training. Pharmacological interventions studied the effectiveness of anti-epileptic drug, norepinephrine reuptake inhibitor, stimulant, atypical antipsychotic, and NMDA receptor antagonist treatment. Conclusions: Although much recent research has investigated potentially effective treatments for depression in individuals with ASD, the strength of the evidence remains generally poor. However, studies indicate preliminary efficacy for MBT. A number of investigations have examined the effect of CBT on depression in persons with ASD; however, the results are inconsistent. Further research is needed to advance clinical practice for individuals with ASD and comorbid depression.
