2/3 CBT for Anxiety Disorders in Autism: Adapting Treatment for Adolescents

2/3 CBT 治疗自闭症焦虑症：调整青少年治疗

• 批准号: 7938085
• 负责人: ERIC A. STORCH
• 金额: $ 23.66万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-21 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7938085
• 关键词: 9 year old; Address; Adherence; Adolescence; Adolescent; Adverse effects; Adverse event; Affect; Age; American; Anhedonia; Anxiety; Anxiety Disorders; Applications Grants; Attention; Authorship; Autistic Disorder; Behavioral; Biostatistics Core; Budgets; California; Case Series; Centers for Disease Control and Prevention (U.S.); Characteristics; Child; Childhood; Cities; Clinic; Clinical; Clinical Services; Clinical Trials; Cognitive Therapy; Collaborations; Community Outreach; Competence; Conduct Clinical Trials; Consensus; Consultations; Contracts; Data; Data Analyses; Data Collection; Data Set; Decision Making; Depressed mood; Development; Diagnosis; Disadvantaged; Disease; Distress; Doctor of Medicine; Doctor of Philosophy; Drug Interactions; Educational process of instructing; Elements; Enrollment; Ensure; Evidence based intervention; Faculty; Family; Feedback; Florida; Foundations; Frequencies; Funding; Future; Goals; Gold; Grant; Head; Health Services Research; Heterogeneity; Impairment; Individual; Information Systems; Institutes; Institution; Intervention; Lead; Link; Los Angeles; Manuals; Manuscripts; Measurement; Measures; Mediation; Mental Health; Mental disorders; Minority Groups; Modification; Monitor; Mood Disorders; Morbidity - disease rate; Motivation; National Institute of Mental Health; Nature; Neurobiology; Outcome; Paper; Parents; Participant; Patients; Peer Group; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Positioning Attribute; Preparation; Procedures; Process; Protocols documentation; Psychiatry; Psychopathology; Psychopharmacology; Public Domains; Public Health; Publications; Quality Control; Randomized; Randomized Controlled Trials; Recording of previous events; Recovery; Recruitment Activity; Relative (related person); Relaxation Therapy; Research; Research Design; Research Infrastructure; Research Personnel; Resources; Risk; Role; Sample Size; Sampling; School-Age Population; Schools; Services; Site; Social Adjustment; Structure; Supervision; Symptoms; Techniques; Testing; Tic disorder; Time; Training; Treatment Efficacy; Treatment Protocols; United States; United States National Institutes of Health; Universities; Validity and Reliability; Videoconferences; Videoconferencing; Voting; Wood material; Work; Writing; Youth; age group; arm; autism spectrum disorder; base; comparative trial; cost; data integrity; data management; design; disability; early adolescence; early childhood; efficacy testing; efficacy trial; electronic data; expectation; experience; flexibility; human subject; improved; innovation; meetings; multidisciplinary; neuropsychiatry; novel; pilot trial; preference; programs; protocol development; psychosocial; public health relevance; quality assurance; research facility; response; skills; social; social skills; standard care; sugar; symposium; therapy development; treatment effect; trial comparing

DESCRIPTION (provided by applicant): Autism spectrum disorders (ASD) affect approximately 1 out of 150 children and adolescents in the United States, making them one of the most common neurobiological conditions. Comorbid anxiety disorders affect as many as 80% of youth with ASD, causing substantial distress and impairment over and above that caused by an ASD diagnosis alone. While cognitive-behavioral therapy (CBT) has been established as the gold standard treatment for anxiety disorders among typically developing youth, and innovative work by the investigative team supports its utility in children with ASD and comorbid anxiety, a protocol does not exist for early adolescents with ASD and comorbid anxiety disorders. In fact, there are no empirically supported treatment options for early adolescents with ASD and comorbid anxiety disorders; and existing pharmacological interventions may have some disadvantages (e.g., limited efficacy in this population, side effects, and potential drug x drug interactions). Accordingly, we are proposing to develop a CBT protocol for anxiety and comorbid ASD in early adolescence, as well as a credible comparison protocol (Relaxation Training; RT) for use in a future multisite clinical trial to test the efficacy of CBT in this population. In response to the Recovery Act Limited Competition, each site will hire and train at least three new study staff to conduct this study. Initial protocol development efforts will focus on adapting relevant treatment elements from an efficacious CBT program for younger children with ASD and comorbid anxiety to the characteristics and clinical needs of early adolescents. Developmentally appropriate, novel treatment components will then be added. An extant RT treatment protocol will also be modified for use with early adolescents with ASD. In response to the NIH Roadmap Initiative, attention will be paid to protocol adaptability with varying presentations. Measures of treatment integrity and competence will be developed along with the protocols. Thereafter, protocol and measure development will be refined through our experiences treating 18 young adolescents (ages 11-14 years) with ASD and comorbid anxiety disorder(s) as well as through clinician, patient, and expert feedback. The feasibility of implementation of both protocols will then be examined in the context of a pilot study incorporating all the features of the planned future efficacy trial comparing CBT and RT, but with a limited sample size (N = 48). At the end of the project, refined treatment manuals will be completed, integrity and competence measures will be finalized and tested for reliability and validity, and the three recruitment sites will have developed protocols promoting and assessing the consistency of treatment delivery and assessment procedures across sites, and a linked R01 grant to test the efficacy of CBT will be written. The three recruitment sites for this study are the University of California, Los Angeles (UCLA); the University of South Florida; and the University of Miami. The UCLA Neuropsychiatric (Semel) Institute's Biostatistics Core will provide data management services. Considering the rising number of youth diagnosed with ASD, and the lack of empirically supported treatment options for those young adolescents with comorbid anxiety, our proposed work toward an efficacious CBT protocol will provide a timely contribution to public health efforts. PUBLIC HEALTH RELEVANCE: Comorbid anxiety disorders affect as many as 80% of youth with autism spectrum disorders, causing substantial distress and impairment over and above the autism spectrum diagnosis alone. Cognitive behavioral therapy (CBT) is the gold standard treatment among typically developing youth with an anxiety disorder but has yet to be adapted to meet the unique needs of adolescents with ASD and comorbid anxiety. With more youth being diagnosed with ASD after the early childhood period, a treatment protocol such as that proposed could contribute to public health efforts to address the mental health needs of early adolescents with ASD.

描述（由申请人提供）：自闭症谱系障碍 (ASD) 影响美国 150 名儿童和青少年中大约 1 名，使其成为最常见的神经生物学疾病之一。共病焦虑症影响多达 80% 的 ASD 青少年，其造成的痛苦和损害远远超过仅 ASD 诊断所造成的痛苦和损害。虽然认知行为疗法 (CBT) 已被确立为典型青少年焦虑症治疗的黄金标准，并且研究团队的创新工作支持其在患有自闭症谱系障碍 (ASD) 和共病焦虑症儿童中的实用性，但尚不存在针对青少年早期的治疗方案患有 ASD 和共病焦虑症。事实上，对于患有自闭症谱系障碍和共病焦虑症的早期青少年，没有经验支持的治疗方案。现有的药物干预措施可能存在一些缺点（例如，对该人群的疗效有限、副作用以及潜在的药物间相互作用）。因此，我们建议针对青春期早期的焦虑和共病 ASD 制定 CBT 方案，以及可靠的比较方案（放松训练；RT），用于未来的多中心临床试验，以测试 CBT 在该人群中的功效。为了响应《恢复法限制竞争》，每个中心将雇用和培训至少三名新研究人员来进行这项研究。最初的方案制定工作将侧重于调整针对患有 ASD 和共病焦虑的幼儿的有效 CBT 计划中的相关治疗要素，以适应早期青少年的特征和临床需求。然后将添加适合发育的新型治疗成分。现有的 RT 治疗方案也将进行修改，以用于患有自闭症谱系障碍 (ASD) 的早期青少年。为了响应 NIH 路线图倡议，将关注不同演示文稿的协议适应性。治疗完整性和能力的衡量标准将与方案一起制定。此后，我们将通过治疗 18 名患有 ASD 和共病焦虑症的青少年（11-14 岁）的经验以及临床医生、患者和专家的反馈来完善方案和措施的制定。然后，将在一项试点研究的背景下审查实施这两种方案的可行性，该研究纳入了计划的未来疗效试验的所有特征，比较 CBT 和 RT，但样本量有限 (N = 48)。项目结束时，将完成完善的治疗手册，最终确定诚信和能力衡量标准并测试其可靠性和有效性，三个招募地点将制定协议，促进和评估治疗提供的一致性以及跨地点的评估程序，并将编写链接的 R01 拨款来测试 CBT 的功效。本研究的三个招聘地点是加州大学洛杉矶分校 (UCLA)；南佛罗里达大学；和迈阿密大学。加州大学洛杉矶分校神经精神病学（塞梅尔）研究所的生物统计学核心将提供数据管理服务。考虑到诊断患有自闭症谱系障碍的青少年人数不断增加，以及患有共病焦虑的青少年缺乏经验支持的治疗方案，我们提出的有效 CBT 方案的工作将为公共卫生工作做出及时的贡献。 公共卫生相关性：共病焦虑症影响多达 80% 的自闭症谱系障碍青少年，除了自闭症谱系诊断之外，还会造成严重的痛苦和损害。认知行为疗法 (CBT) 是患有焦虑症的典型发育青少年的黄金标准治疗方法，但尚未适应患有 ASD 和共病焦虑症青少年的独特需求。随着越来越多的青少年在幼儿期后被诊断出患有自闭症谱系障碍，所提出的治疗方案可能有助于公共卫生工作，以满足患有自闭症谱系障碍的青少年的心理健康需求。

项目成果

Frequency and Clinical Correlates of Sleep-Related Problems Among Anxious Youth with Autism Spectrum Disorders.

患有自闭症谱系障碍的焦虑青少年中睡眠相关问题的频率和临床相关性。

• DOI: 10.1007/s10578-014-0496-9
• 发表时间: 2015
• 期刊: Child psychiatry and human development
• 影响因子: 2.9
• 作者: Nadeau,JoshuaM;Arnold,ElysseB;Keene,AmandaC;Collier,AmandaB;Lewin,AdamB;Murphy,TanyaK;Storch,EricA
• 通讯作者: Storch,EricA

Defining treatment response and symptom remission for anxiety disorders in pediatric autism spectrum disorders using the Pediatric Anxiety Rating Scale.

• DOI: 10.1007/s10803-015-2483-9
• 发表时间: 2015-10
• 期刊: Journal of autism and developmental disorders
• 影响因子: 3.9
• 作者: Johnco CJ;De Nadai AS;Lewin AB;Ehrenreich-May J;Wood JJ;Storch EA
• 通讯作者: Storch EA

Clinical characteristics of high-functioning youth with autism spectrum disorder and anxiety.

患有自闭症谱系障碍和焦虑的高功能青少年的临床特征。

• DOI: 10.2217/npy.13.9
• 发表时间: 2013
• 期刊: Neuropsychiatry
• 作者: Ung,Danielle;Wood,JeffreyJ;Ehrenreich-May,Jill;Arnold,ElysseB;Fuji,Cori;Renno,Patricia;Murphy,TanyaK;Lewin,AdamB;Mutch,PJane;Storch,EricA
• 通讯作者: Storch,EricA

Inter-rater Reliability of the Anxiety Disorders Interview Schedule for DSM-IV in High-Functioning Youth with Autism Spectrum Disorder.

患有自闭症谱系障碍的高功能青少年的 DSM-IV 焦虑症访谈时间表的评估者间可靠性。

• DOI: 10.1007/s10882-013-9343-3
• 发表时间: 2014
• 期刊: Journal of developmental and physical disabilities
• 影响因子: 1.8
• 作者: Ung,Danielle;Arnold,ElysseB;DeNadai,AlessandroS;Lewin,AdamB;Phares,Vicky;Murphy,TanyaK;Storch,EricA
• 通讯作者: Storch,EricA

The role of co-occurring disruptive behavior in the clinical presentation of children and adolescents with anxiety in the context of autism spectrum disorders.

共发生的破坏性行为在自闭症谱系障碍背景下焦虑的儿童和青少年的临床表现中的作用。

• DOI: 10.1007/s10578-012-0294-1
• 发表时间: 2012
• 期刊: Child psychiatry and human development
• 影响因子: 2.9
• 作者: Storch,EricA;Arnold,ElysseB;Jones,AnnaM;Ale,ChelseaM;Wood,JeffreyJ;Ehrenreich-May,Jill;Lewin,AdamB;Mutch,PJane;Murphy,TanyaK
• 通讯作者: Murphy,TanyaK