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COGNITIVE BEHAVIOR THERAPY FOR COMORBID OBSESSIVE-COMPULSIVE DISORDER IN HIGH-FUNCTIONING AUTISM SPECTRUM DISORDERS: A RANDOMIZED CONTROLLED TRIAL

Authors

  • Ailsa J. Russell Ph.D.,

    Corresponding author
    1. University of Bath, Bath, United Kingdom
    • Department of Psychology, Institute of Psychiatry, Kings College London, London, United Kingdom
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  • Amita Jassi D.Clin.Psy.,

    1. South London and Maudsley NHS Trust, London, United Kingdom
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  • Miguel A. Fullana Ph.D.,

    1. Department of Psychosis Studies, Institute of Psychiatry, Kings College London, London, United Kingdom
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  • Hilary Mack D.Clin.Psy.,

    1. South London and Maudsley NHS Trust, London, United Kingdom
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  • Kate Johnston D.Clin.Psy.,

    1. Department of Psychology, Institute of Psychiatry, Kings College London, London, United Kingdom
    2. South London and Maudsley NHS Trust, London, United Kingdom
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  • Isobel Heyman M.B.B.S., Ph.D., F.R.C.Psych.,

    1. Child and Adolescent Psychiatry, Institute of Psychiatry, Kings College London, London, United Kingdom
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  • Declan G. Murphy M.B.B.S., F.R.C.Psych., M.D. (USA),

    1. Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Kings College London, London, United Kingdom
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  • David Mataix-Cols Ph.D.

    1. Department of Psychology, Institute of Psychiatry, Kings College London, London, United Kingdom
    2. Department of Psychosis Studies, Institute of Psychiatry, Kings College London, London, United Kingdom
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  • The study was registered as a controlled trial (ISRCTN87114880).

Correspondence to: A. J. Russell, W6 University of Bath, Claverton Down, Bath BA2 7AY. E-mail: a.j.russell@bath.ac.uk

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.

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