Skip to main content
SpringerLink
Log in

Development of a Cognitive-Behavioral Intervention Program to Treat Anxiety and Social Deficits in Teens with High-Functioning Autism

  • Published:
Clinical Child and Family Psychology Review Aims and scope Submit manuscript

Abstract

Anxiety is a common co-occurring problem among young people with autism spectrum disorders (ASD). Characterized by deficits in social interaction, communication problems, and stereotyped behavior and restricted interests, this group of disorders is more prevalent than previously realized. When present, anxiety may compound the social deficits of young people with ASD. Given the additional disability and common co-occurrence of anxiety in ASD, we developed a manual-based cognitive-behavioral treatment program to target anxiety symptoms as well as social skill deficits in adolescents with ASD [Multimodal Anxiety and Social Skills Intervention: MASSI]. In this paper, we describe the foundation, content, and development of MASSI. We also summarize data on treatment feasibility based on a pilot study that implemented the intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  • Attwood, T. (2004). Cognitive behaviour therapy for children and adults with Asperger’s syndrome. Behaviour Change, 21, 147–161.

    Article  Google Scholar 

  • Baron-Cohen, S. (1995). Mindblindness: An essay on autism and theory. Cambridge, MA: MIT Press.

    Google Scholar 

  • Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in high-functioning children with autism. Child Development, 71, 447–456.

    Article  PubMed  Google Scholar 

  • Beaumont, R., & Sofrononoff, K. (2008). A multi-component social skills intervention for children with Asperger syndrome: The junior detective training program. The Journal of Child Psychology and Psychiatry, 49(7), 743–753.

    Article  Google Scholar 

  • Bellini, S. (2004). Social skill deficits and anxiety in high-functioning adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 19, 78–86.

    Article  Google Scholar 

  • Bellini, S. (2006a). The development of social anxiety in adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 21, 138–145.

    Article  Google Scholar 

  • Bellini, S. (2006b). Building social relationships: A systematic approach to teaching social interaction skills to children and adolescents with autism spectrum disorders and other social difficulties. Shawnee Mission, KS: Autism Asperger Publishing Co.

    Google Scholar 

  • Bellini, S., & Akullian, J. (2007). A meta-analysis of video modeling and video self-modeling interventions for children and adolescents with autism spectrum disorders. Exceptional Children, 73(3), 264–287.

    Google Scholar 

  • Bellini, S., Peters, J. K., Benner, L., & Hopf, A. (2007). A meta-analysis of school-based social skills interventions for children with autism spectrum disorders. Remedial and Special Education, 28(3), 153–162.

    Article  Google Scholar 

  • Bradley, E. A., Summers, J. A., Wood, H. L., & Bryson, S. E. (2004). Comparing rates of psychiatric and behavior disorders in adolescents and young adults with severe intellectual disability with and without autism. Journal of Autism and Developmental Disorders, 34, 151–161.

    Article  PubMed  Google Scholar 

  • Carroll, K. M., & Nuro, K. F. (2002). One size cannot fit all: A stage model for psychotherapy manual development. Clinical Psychology Science and Practice, 9, 396–406.

    Article  Google Scholar 

  • Carter, A., Davis, N., Klin, A., & Volkmar, F. (2005). Social development in autism. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (3.th ed., pp. 312–334). Hoboken, NJ: Wiley.

    Google Scholar 

  • Chalfant, A., Rapee, R., & Carroll, L. (2007). Treating anxiety disorders in children with high functioning autism spectrum disorders: A controlled trial. Journal of Autism and Developmental Disorders, 37, 1842–1857.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F. (2007). Modular cognitive-behavioral therapy for childhood anxiety disorders. In J. B. Persons (Ed.), Guides to individualized evidence-based treatment. New York: Guilford.

    Google Scholar 

  • Chu, B. C., Choudhury, M. S., Shortt, A. L., Pincus, D. B., Creed, T. A., & Kendall, P. C. (2004). Alliance, technology, and outcome in the treatment of anxious youth. Cognitive and Behavioral Practice, 11, 44–55.

    Article  Google Scholar 

  • Colle, L., Baron-Cohen, S., & Hill, J. (2007). Do children with autism have a theory of mind? A non-verbal test of autism vs. specific language impairment. Journal of Autism and Developmental Disorders, 37(4), 716–723.

    Article  PubMed  Google Scholar 

  • DeWit, D. J., Ogborne, A., Offord, D. R., & MacDonald, K. (1999). Antecedents of the risk of recovery from DSM-III-R social phobia. Psychological Medicine, 29, 569–582. doi:10.1017/s0033291799008399.

    Article  PubMed  Google Scholar 

  • Engstrom, I., Ekstrom, L., & Emilsson, B. (2003). Psychosocial functioning in a group of Swedish adults with Asperger syndrome of high-functioning autism. Autism, 7, 99–110.

    PubMed  Google Scholar 

  • Foxx, R. M. (2008). Applied behavior analysis treatment of autism: The state of the art. Child and Adolescent Psychiatric Clinics of North America, 17, 821–834.

    Article  PubMed  Google Scholar 

  • Ghaziuddin, M. (2002). Asperger syndrome: Associated psychiatric and medical conditions. Focus on Autism and Other Developmental Disabilities, 17, 138–144.

    Article  Google Scholar 

  • Grant, B. F., Hasin, D. S., Blanco, C., Stinson, F. S., Chous, S. P., Goldstein, R. B., et al. (2005). The epidemiology of social anxiety disorder in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 66, 1351–1361.

    Article  PubMed  Google Scholar 

  • Green, G. (1996). Early behavioral intervention for autism: What does research tell us? In C. Maurice, G. Green, & S. C. Luce (Eds.), Behavioral intervention for young children with autism: a manual for parents and professionals. Austin, TX: Pro-Ed.

    Google Scholar 

  • Howlin, P., Goode, J., Hutton, J., & Rutter, M. (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry, 45, 212–229.

    Article  PubMed  Google Scholar 

  • Johnson, C. R., Handen, B. J., Butter, E., Wagner, A., Mulick, J., Sukhodolsky, D. G., et al. (2007). Development of a parent training program for children with pervasive developmental disorders. Behavioral Interventions, 22, 201–221.

    Article  Google Scholar 

  • Karver, M. S., Handelsman, J., Fields, S., & Bickman, L. (2006). Meta-analysis of therapeutic relationship variables in youth and family therapy: The evidence for different relationship variables in the child and adolescent treatment outcome literature. Clinical Psychology Review, 26(1), 50–65.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., Aschenbrand, S. G., & Hudson, J. L. (2003). Child-focused treatment of anxiety. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents. New York: Guilford Press.

    Google Scholar 

  • Klin, A., Jones, W., Schultz, R., & Volkmar, F. (2003). The enactive mind—from actions to cognition: Lessons from autism. In D. J. Cohen & F. R. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (2nd ed., pp. 682–704). New York: Wiley.

    Google Scholar 

  • Klin, A., & Volkmar, F. R. (2000). Treatment and intervention guidelines for individuals with Asperger syndrome. In A. Klin, F. R. Volkmar, & S. S. Sparrow (Eds.), Asperger syndrome (pp. 340–366). New York: Guilford Press.

    Google Scholar 

  • Kuusikko, S., Pollock-Wurman, R., Jussila, K., Carter, A. S., Mattila, M., Ebieling, H., et al. (2008). Social anxiety in high-functioning children and adolescents with autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 38, 1697–1709.

    Article  PubMed  Google Scholar 

  • Lehmkuhl, H. D., Storch, E. A., Bodfish, J. W., & Geffken, G. R. (2008). Brief report: Exposure and response prevention for obsessive compulsive disorder in a 12-year-old with autism. Journal of Autism and Developmental Disorders, 38, 977–981.

    Article  PubMed  Google Scholar 

  • Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Jr., Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., & LeCouteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.

    Article  PubMed  Google Scholar 

  • Losh, M., Adolphs, R., Poe, M. D., Couture, S., Penn, D., Baranek, G. T., et al. (2009). Neuropsychological profile of autism and broad autism phenotype. Archives of General Psychiatry, 66(5), 518–526.

    Article  PubMed  Google Scholar 

  • Loveland, K. A., & Tunali-Kotoski, B. (2005). The school-age child with an autistic spectrum disorder. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (3rd ed., pp. 247–287). New York: Wiley.

    Google Scholar 

  • Lyneham, H. J., Abbott, M. J., Wignall, A., & Rapee, R. M. (2003). The cool kids family program—therapist manual. Sydney, Australia: Macquarie University.

    Google Scholar 

  • McAfee, J. (2001). Navigating the social world: A curriculum for individuals with Asperger’s syndrome, high functioning autism and related disorders. Arlington, TX: Future Horizons.

    Google Scholar 

  • Minshew, N. J., Goldstein, G., & Siegel, D. J. (1997). Neuropsychologic functioning in autism: Profile of a complex information processing disorder. Journal of the International Neuropsychological Society, 3, 303–316.

    PubMed  Google Scholar 

  • Myles, B. (2003). Behavioral forms of stress management for individuals with Asperger syndrome. Child and Adolescent Psychiatric Clinics of North America, 12, 123–141.

    Article  PubMed  Google Scholar 

  • Myles, B., Barnhill, G., Hagiwara, T., Griswold, D., & Simpson, R. (2001). A synthesis of studies on the intellectual, academic, social/emotional and sensory characteristics of children with Asperger syndrome. Education and Training in Mental Retardation and Developmental Disabilities, 36, 304–311.

    Google Scholar 

  • Ollendick, T. H., & King, N. J. (1998). Empirically supported treatments for children with phobic and anxiety disorders: Current status. Journal of Clinical Child Psychology, 27, 156–167.

    Article  PubMed  Google Scholar 

  • Ollendick, T. H., King, N. J., & Chorpita, B. F. (2006). Empirically supported treatments for children and adolescents. In P. C. Kendall (Ed.), Child and adolescents therapy: Cognitive-behavioral procedures (3rd ed., pp. 492–520). New York, NY: Guilford Press.

    Google Scholar 

  • Ozonoff, S. (1997). Causal mechanisms of autism: Unifying perspectives from an information-processing framework. In D. J. Cohen & F. R. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (2nd ed., pp. 868–879). New York: Wiley.

    Google Scholar 

  • Ozonoff, S., & Jensen, J. (1999). Brief report: Specific executive function profiles in three neurodevelopmental disorders. Journal of Autism and Developmental Disorders, 29, 171–177.

    Article  PubMed  Google Scholar 

  • Pavuluri, M. N., Graczyk, P. A., Henry, D. B., Carbray, J. A., Heidenreich, J., & Miklowitz, D. J. (2004). Child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: Development and preliminary results. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 528–537.

    Article  PubMed  Google Scholar 

  • Rao, P. A., Beidel, D. C., & Murray, M. J. (2008). Social skills interventions for children with Asperger’s syndrome or high-functioning autism: A review and recommendations. Journal of Autism and Developmental Disorders, 38, 353–361.

    Article  PubMed  Google Scholar 

  • Reaven, J., Blakeley-Smith, A., Nichols, S., Dasari, M., Flanigan, E., & Hepburn, S. (2009). Cognitive-behavioral group treatment for anxiety symptoms in children with high-functioning autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 24(1), 27–37.

    Article  Google Scholar 

  • Reaven, J., & Hepburn, S. (2003). Cognitive-behavioral treatment of obsessive-compulsive disorder in a child with Asperger syndrome: A case report. Autism, 7, 145–164.

    Article  PubMed  Google Scholar 

  • Research Units on Pediatric Psychopharmacology [RUPP] Autism Network. (2007). Parent training for children with pervasive developmental disorders: A multi-site feasibility trial. Behavioral Interventions, 22, 179–199.

    Article  Google Scholar 

  • Schreibman, L. (2000). Intensive behavioral/psychoeducational treatments for autism: Research needs and future directions. Journal of Autism and Developmental Disorders, 30, 373–378.

    Article  PubMed  Google Scholar 

  • Shirk, S. R., Gudmundsen, G., Kaplinski, H. C., & McMakin, D. L. (2008). Alliance and outcome in cognitive-behavioral therapy for adolescent depression. Journal of Clinical Child & Adolescent Psychology, 37(3), 631–639.

    Article  Google Scholar 

  • Shirk, S. R., & Karver, M. (2003). Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review. Journal of Consulting and Clinical Psychology, 71, 452–464.

    Article  PubMed  Google Scholar 

  • Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for DSM- IV–Child and parent versions. San Antonio, TX: Graywind.

    Google Scholar 

  • Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 921–929.

    Article  PubMed  Google Scholar 

  • Smith, T., Scahill, L., Dawson, G., Guthrie, D., Lord, C., & Odom, S., et al. (2007). Designing research studies on psychosocial interventions in autism. Journal of Autism and Developmental Disorders, doi: 10.1007/s10803-006-0173-3 .

  • Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomized controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46, 1152–1160.

    Article  PubMed  Google Scholar 

  • Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., et al. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36, 117–128.

    Article  PubMed  Google Scholar 

  • Sze, K. M., & Wood, J. J. (2007). Cognitive behavioral treatment of comorbid anxiety disorders and social difficulties in children with high-functioning autism: A case report. Journal of Contemporary Psychotherapy, 37, 133–143.

    Article  Google Scholar 

  • Tantam, D. (2003). The challenge of adolescents and adults with Asperger syndrome. Child and Adolescent Psychiatric Clinics of North America, 12, 143–163.

    Article  PubMed  Google Scholar 

  • Tsatsanis, K. D. (2004). Heterogeneity in learning style in Asperger syndrome and high- functioning autism. Topics in Language Disorders, 24(4), 260–270.

    Article  Google Scholar 

  • Tse, J., Strulovich, J., Tagalakis, V., Meng, L., & Fombonne, E. (2007). Social skills training for adolescents with Asperger syndrome and high-functioning autism. Journal of Autism and Developmental Disorders, 37, 1960–1968.

    Article  PubMed  Google Scholar 

  • United States Centers for Disease Control and Prevention. (2007). Prevalence of autism spectrum disorders-Autism and developmental disabilities monitoring network, 14 sites, United States, 2002. Surveillance Summaries, MMWR 2007; 56(No. SS-1).

  • Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. The New England Journal of Medicine, 359(26), 2753–2766.

    Article  PubMed  Google Scholar 

  • Weisbrot, D. M., Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2005). The presentation of anxiety in children with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 15, 477–496.

    Article  PubMed  Google Scholar 

  • White, S. W., Koenig, K., & Scahill, L. (2007). Social skills development in children with autism spectrum disorders: A review of the intervention research. Journal of Autism and Developmental Disorders, 37, 1858–1868.

    Article  Google Scholar 

  • White, S. W., Ollendick, T., Scahill, L., Oswald, D., & Albano, A. (2009). Preliminary efficacy of a cognitive-behavioral treatment program for anxious youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, (in press).

  • White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009b). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229.

    Article  PubMed  Google Scholar 

  • Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224–234. doi:10.1111/j.1469-7610.2008.01948.x.

    Google Scholar 

  • Wood, J. J., & McLeod, B. M. (2008). Child anxiety disorders: A treatment manual for practitioners. New York: Norton.

    Google Scholar 

Download references

Acknowledgments

This project was supported by a grant from the National Institute of Mental Health [1K01MH079945-01; PI: S. W. White]. The authors acknowledge consultation from the grant’s full advisory panel, which includes: Matthew Fritz, PhD, Angela Scarpa, PhD, and Michael Southam-Gerow, PhD in addition to the authors of this paper. We also thank the participants in this study and their parents.

Author information

Authors and Affiliations

  1. Department of Psychology, Virginia Polytechnic Institute and State University, 109 Williams Hall (0436), Blacksburg, VA, 24061, USA

    Susan W. White & Thomas Ollendick

  2. Department of Psychiatry, Columbia University Medical Center, Room 2413 Unit/Box:741051 Riverside Drive, New York, NY, 10032, USA

    Anne Marie Albano

  3. University of Pittsburgh School of Medicine, Departments of Pediatrics and Psychiatry, Children’s Hospital of Pittsburgh, Autism Center 3420 Fifth Ave., Pittsburgh, PA, 15213, USA

    Cynthia R. Johnson

  4. Psychological Studies in Education UCLA, 68-268 Semel Institute and Center for Autism Research and Treatment UCLA, Los Angeles, CA, 90024, USA

    Connie Kasari

  5. Yale School of Medicine, Yale Child Study Center, 230 South Frontage Road, New Haven, CT, 06520, USA

    Ami Klin

  6. Department of Psychiatry, Virginia Commonwealth University, PO Box 980489, Richmond, VA, 23298-0489, USA

    Donald Oswald

  7. Yale School of Nursing and Child Study Center, Yale Child Study Center, 230 South Frontage Road, New Haven, CT, 06520, USA

    Lawrence Scahill

Authors
  1. Susan W. White
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anne Marie Albano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cynthia R. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Connie Kasari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Ollendick
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ami Klin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Donald Oswald
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lawrence Scahill
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susan W. White.

Rights and permissions

Reprints and permissions

About this article

Cite this article

White, S.W., Albano, A.M., Johnson, C.R. et al. Development of a Cognitive-Behavioral Intervention Program to Treat Anxiety and Social Deficits in Teens with High-Functioning Autism. Clin Child Fam Psychol Rev 13, 77–90 (2010). https://doi.org/10.1007/s10567-009-0062-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10567-009-0062-3

Keywords

Search

Navigation