Parent-led, stepped-care cognitive-behavioral therapy for youth with autism and co-occurring anxiety: Study rationale and method

Abstract

Anxiety disorders affect up to 50% of individuals with autism spectrum disorder (ASD) and are significantly impairing to the person affected, as well as to their loved ones. Cognitive-behavioral therapy (CBT) has been established as the gold-standard treatment for anxiety disorders among typically developing youth and adults, and demonstrates similar efficacy among youth with highfunctioning autism (HFA). Many CBT interventions utilize a ‘‘full-package’’ treatment approach to treat co-occurring anxiety in youth with ASD. However, these service delivery systems are often therapistintensive, costly, and impractical, thereby compromising full engagement and treatment adherence. This paper describes the design, rationale, and methodology of a study examining stepped-care CBT for youth with HFA and co-occurring anxiety – a clinical trial examining the efficacy of low-intensity, parent-led CBT as the first line of treatment and utilizing a more intensive, therapist-led intervention for nonresponders. The study will evaluate the potential benefits of stepped-care and parent-led therapistassisted interventions, predictors of treatment response, and the economic value of using a steppedcare model. Implications for practice will be discussed.