Running Head: INTEGRATIVE LITERATURE REVIEW !

Integrative Literature Review

Abigail Hennigan

Bon Secours Memorial College of Nursing

NUR 4122: Nursing Research

Christine Turner, PhD

April 8, 2018

I pledge.
INTEGRATIVE LITERATURE REVIEW !2

Abstract

Purpose: The purpose of this integrative review is to determine the efficacy of cognitive

behavioral therapy (CBT) in reducing symptoms of co-occurring disorders in children diagnosed

with autism spectrum disorders.

Background: Children diagnosed with autism spectrum disorders are at high risk of developing

co-occurring psychiatric disorders. There is a limited evidence supporting appropriate treatment

modalities for reducing the symptoms of these co-occurring disorders.

Method: There is an integrative review in which research was collected from online nursing

databases. The five quantitative articles were chosen based on specific criteria. The articles used

were determined based on their relations the authors PICOT question.

Limitations: Limitations of the review include the author’s lack of experience in conducting an

integrative review, lack of research articles available, and the short time span allowed to conduct

the review.

Results and Findings: The evidence complied for this integrative review supports the

conclusion that CBT is an appropriate treatment modality for reducing symptoms of co-occurring

psychiatric disorder in children diagnosed with autism spectrum disorder.

Implications and Recommendations: The implications of suing CBT to reduce symptoms of

co-occurring psychiatric disorders included increasing positive patient outcome sin home,

school, and community environments. Recommendations for further research should include a

broader sample size and the use of objective data collection sources.
INTEGRATIVE LITERATURE REVIEW !3

Integrative Literature Review

The purpose of this integrated review is to determine if cognitive behavioral therapy can

be used to decrease the symptoms of co-occurring disorders in children diagnosed with autism

spectrum disorder. Co-occurring disorders in children diagnosed with autism spectrum disorder

include, but are not limited to, obsessive compulsive disorder, anxiety, and depression. The need

for this research is supported by the Journal on Developmental Disabilities' recognition that

there are few studies evaluating interventions for these specific conditions (Vause, Hoekstra, &

Feldman, 2014).

For children diagnosed with autism spectrum disorder, co-occurring disorders can

interfere with their functionality in school, home, and community environments (Reaven,

Blakeley-Smith, Culhane-Shelburne, Hepburn, 2012). It is important to modify treatment options

for these children in order to increase positive patient outcomes. Indications for this review

includes the fact that, according to the CDC, autism spectrum disorder crosses racial, ethnic, and

socioeconomic boarders (2016). The aim of this literature review is to examine the “literature”

related to the author’s PICOT question: Does cognitive behavioral therapy decrease the

symptoms of co-occurring disorders in children diagnosed with autism spectrum disorder?

Design and Methods

This integrative review of the literature concentrated on five research articles. The articles

utilized pertain to the author’s PICOT question, “Does cognitive behavioral therapy decrease the

symptoms of co-occurring disorders in children diagnosed with autism spectrum disorder?” The

author’s initial search method used PubMed and EBSCO Discovery Service. The search words
INTEGRATIVE LITERATURE REVIEW !4

were autism spectrum disorder and cognitive behavioral therapy. The results yielded 987

articles. The articles were then filtered by year, language, status of publication, peer review

status, and relevance to the PICOT question. The articles were limited to publication dates

between 2013 and 2018. Only peer review, English language articles were selected for review.

Full-text availability was the last filter applied. Many articles were disqualified due to these

filters.

The remaining articles were chosen based on relevance to the author’s PICOT question.

An evaluation of the effectiveness of cognitive behavioral therapy was a requirement for each

research article. The article’s research subjects had to focus on the pediatric population

diagnosed with autism spectrum disorder. Based on these requirements, five articles were

selected for the following integrative literature review. All five articles are quantitative studies

(Reaven et al., 2012; Russell et al., 2013, Storch et al., 2013; Storch et al., 2015, Vause et al.,

2014).

Findings

The results of the articles clearly identify a decrease in symptoms severity when children

diagnosed with autism spectrum disorder are treated with cognitive behavioral therapy (Reaven

et al., 2012; Russell et al., 2013, Storch et al., 2013; Storch et al., 2015, Vause et al., 2014). A

summary of the five research articles is located in Table 1- Article Evaluation. The following is a

brief overview of each article’s findings.

In a study conducted by Reaven (2012), the authors sought to determine if cognitive

behavioral therapy could decrease the symptoms of anxiety in children diagnosed with autism
INTEGRATIVE LITERATURE REVIEW !5

spectrum disorder. The authors of the study analyzed the severity of anxiety in patients who

spent 16 weeks in cognitive behavioral therapy compared with adolescents who spent 16 weeks

in their normal treatment modalities. The authors conducted a experimental design with a

randomized control trial. The sample consisted of 50 youth ages seven to fourteen from

Colorado. Quantitative data was collected using the Clinical Global Impression Scale and the

SCARED, Screen for Child Anxiety and Related Emotional Disorders, tool. Independent clinical

evaluators were blind to the participant’s treatment group and analyzed anxiety symptoms before

treatment, after treatment, and at a 3 month follow-up appointment. Findings were in favor of

cognitive behavioral therapy. There was a significant reduction in the number of anxiety

disorders for children who were randomly assigned to the cognitive behavioral group.

In a study conducted by Russell (2013), a randomized trial was conducted to analyze the

effectiveness of cognitive behavioral therapy (CBT) in reducing symptoms of obsessive

compulsive disorder in adolescents diagnosed with autism spectrum disorder. The authors

randomly assigned participants into a cognitive behavioral therapy group and an anxiety

management (AM) control group. The sample consisted of 46 participants from London, United

Kingdom. Qualitative data was collected using the Yale-Brown Obsessive Compulsive Severity

Scale (YBOCS), CGI scale, and the use of self reporting. The clinical evaluators who analyzed

the participants were blind to the participant’s treatment group. The participants were evaluated

before treatment and after the treatment and then at a 3, 6, and twelve month follow-up

appointment. For the participants randomly assigned to the CBT group, their YBOCS scores

steady declined from 25 to 15. Finds favored both AM and CBT. For the participants randomly

assigned to the AM group, there was still a steady decline, but only from 25to 20. While the
INTEGRATIVE LITERATURE REVIEW !6

decline in YBOCS scores for the CBT group was more significant, the authors of the study found

that both the AM group and the CBT group responded positively to the therapy.

This integrative review analyzed two studies conducted by Storch (2013, 2015). The first,

a study conducted by Storch and Arnold (2013) sought to determine if children diagnosed with

autism spectrum disorder with co-occurring anxiety disorders could benefit from cognitive

behavioral therapy. The destined used randomized control trials and participants were randomly

assigned to either the CBT group or the treatment-as-usual group. The treatment-as-usual

participants were instructed to continue their current interventions; these interventions included

psychotherapy and psychotherapy. The same size consisted of 45 children ages 7 to 11 from St.

Petersburg, Florida. The authors of the study used Program and Activity Reporting System

(PARS), Anxiety Disorder Interview Schedule (ADIS), and Cognitive Impression-Severity (CGI)

tools to collect data. The quantitative data was analyzed by trained evaluators who were blind to

the participant’s intervention condition. Findings from the PARS, ADIS, and CGI were in favor

of CBT. The PARS calculated a 29% reduction in post treatment surveys when compared with

post treatment surveys. Adolescents who received CBT showed substantial improvements in

anxiety symptom management when compared with the TAU group.

The second study conducted by Storch and Lewin (2015), evaluated the effectiveness of

cognitive behavioral therapy for children diagnosed with autism spectrum disorder and co-

occurring anxiety disorders. The designed of the study used randomized controlled trials to

compare children diagnosed with autism spectrum disorder participating in cognitive behavioral

therapy and treatment-as-usual interventions. Participants of the TAU group were instructed to
INTEGRATIVE LITERATURE REVIEW !7

continue their current interventions; these interventions included psychotherapy, school

counseling, social skills training, and pharmacological management. The sample consisted of 31

children ages 11 to 16 from Florida. Storch and Lewin used PARS, ADIS, and CGI tools to

collect data. Data was analyzed by trained graduate-lvil independent evaluators who were blind

to the participants treatment condition. Finds were in favor of the CBT group. There was a steady

decline from baseline in the PARS, ADIS, and CGI scores. Participants who were randomly

assigned to the CBT group demonstrated superior improvements when compared with

participants randomly assigned to the TAU group.

In a study conducted by Vause (2014), the author sought to determine the efficacy of

function-based cognitive behavioral therapy when aimed at reducing symptoms of obsessive

compulsive disorder in children diagnosed with autism spectrum disorder. The authors of the

study used a single-case experimental design. The sample consisted of two children ages ten and

eight from Ontario, Canada. Each child participated in the March and Mulle Treatment Protocol,

a from of function-based cognitive behavioral therapy. The March and Mulle Protocol included

psychoeducation/mapping, cognitive training, exposure and response prevention, and relapse

prevention. Data was collected using the Autism Diagnostic Interview scale (ADIS), Quality of

Life Impact Questionnaire, and the Children’s Yale-Brown Obsessive Compulsive Scale. Each

child was evaluated for target behaviors before the interventions. Examples of target behaviors

include, but were not limited to, excessively digging fingernails into bars of soap and brining

garbage home from school. For both participants, the target behaviors were steady reduced

throughs treatment and painted at the 3 and 4 month follow-up. Using function-based cognitive
INTEGRATIVE LITERATURE REVIEW !8

behavioral therapy in a single-case experimental design can reduce the symptoms of obsessive

compulsive disorder in children diagnosed with autism spectrum disorder.

Discussion/Implications

The articles selected for review indicate a positive correlation between the use of

cognitive behavioral therapy and the reduction of anxiety disorder and obsessive compulsive

disorder symptoms. The researcher framed the review according to the following themes: anxiety

disorders and obsessive compulsive disorders. The following is a discussion on the implications

of the paper organized by the common themes in relation the researcher’s PICOT question.

Cognitive Behavioral Therapy

The aim of this literature review is to examine the studies related to the author’s PICOT

question: Does cognitive behavioral therapy decrease the symptoms of co-occurring disorders in

children diagnosed with autism spectrum disorder? Cognitive Behavioral Therapy was utilized in

all five studies (Reaven et al., 2012; Russell et al., 2013, Storch et al., 2013; Storch et al., 2015,

Vause et al., 2014). Three of the studies were aimed at reducing symptoms of co-occurring

anxiety disorders (Reaven et al., 2012, Storch et al., 2013, Storch et al., 2015), while the other

two articles were aimed at reducing symptoms of obsessive compulsive disorders (Russell et al.,

2013, Vause et al., 2013). The following discussion addresses the themes of anxiety disorder and

obsessive compulsive disorder.

INTEGRATIVE LITERATURE REVIEW !9

Anxiety Disorder.

Three of the articles examined the use of cognitive behavioral therapy when aimed at

reducing symptoms of co-occurring anxiety disorders (Reaven et al., 2012, Storch et al., 2013,

Storch et al., 2015). In each of these articles, the authors of the study concluded that the

reduction of symptoms severity from baseline to follow up was more significant in the cognitive

behavioral therapy group than compared with the treatment-as-usual treatment group (Reaven et

al., 2012, Storch et al., 2013, Storch et al., 2015).Parents reported a decrease in disorder

interference for home, school, and community settings (Reaven et al., 2012, Storch et al., 2013,

Storch et al., 2015). Limitations of these studies included modest sample sizes and no follow-up

appointments after 6 months (Reaven et al., 2012, Storch et al., 2013, Storch et al., 2015). The

authors of the studies identified that, before implementation into practice, future research should

include a broader sample size along while implementing long term follow-up appointments

(Reaven et al., 2012, Storch et al., 2013, Storch et al., 2015).

Obsessive Compulsive Disorder.

Two of the articles exampled the use of cognitive behavioral therapy when aimed at

reducing symptoms of co-occurring obsessive compulsive disorders (Russell et al., 2013, Vause

et al., 2013). In each of these articles, the authors of the study concluded that cognitive

behavioral therapy was an appropriate treatment modality for reducing the symptoms of

obsessive compulsive disorder (Russell et al., 2013, Vause et al., 2013). A study by Russell

(2013) found that anxiety management was also a treatment modality appropriate for reducing

symptoms of obsessive compulsive disorder. Each study identified a variety of obsessive

INTEGRATIVE LITERATURE REVIEW !10

compulsive disorders (Russell et al., 2013, Vause et al., 2013). Examples of these symptoms

include the following: excessively digging fingernails into a bar of soap, repetitive questioning,

the vocal ritual of listing people, places, and things, and bringing home garbage from school

(Vause et al, 2013). The authors identified that limitations of the studies included a limited

sample size and the fact that parent reporting is not subjective, and thus limit the reliability of

study results (Russell et al., 2013, Vause et al., 2013). Before implementing into practice, the

authors of the studies suggested that further research should include a broader sample size and

incorporate objective data sources along with parent reports (Russell et al., 2013, Vause et al.,

2013).

Limitations

In conducting this review of the literature, the author encountered many limitations. A

large inflating factor is the author’s inexperience and lack of known about the process of

conducting an integrative review. The author has few qualifications for providing a reliable, in

depth discussion. The author has no first hand insight into the subject matter at hand. The

researcher was only able to provide limited insight into the discussed PICOT question.

Furthermore, choosing the articles for review created a limitation. The author had

difficulty finding research articles pertaining to her initial research interests. This inhibited the

collection process, but was out of the author’s control. The author had to broaden her research

topic in order to have enough research articles to present in the review. All the while, only

choosing five research articles published since 2013 delimited the literature review. This is not a
INTEGRATIVE LITERATURE REVIEW 1! 1

comprehensive review of the literature as evidence by the review’s delimitations and the author’s

short writing time frame. These factors should be taken in consideration for further research.

Conclusions

The evidence compiled for this integrated review of the literature support the conclusion

that cognitive behavior therapy is an appropriate treatment modality in reducing symptoms of co-

occurring psychiatric disorders in children diagnosed with autism spectrum disorder (Reaven et

al., Russell et al., 2013, Storch et al., 2015, Vause et al., 2014). This answers the authors PICTO

question: Does cognitive behavioral therapy decrease the symptoms of co-occurring disorders in

children diagnosed with autism spectrum disorder? Positive treatment outcomes were seen in

children who participated in connive behavioral therapy. Future research should include a

broader sample size, objective data collection tools, and long term follow-up appointments. In

relation to the PICOT question, the literature reflects a positive response to cognitive behavioral

therapy in reducing the severity of anxiety and OCD symptoms for children diagnosed with

autism's spectrum disorder. 


INTEGRATIVE LITERATURE REVIEW !12

References

Centers for Disease Control and Prevention. (2016). Autism Spectrum Disorder (ASD).

Retrieved April 03, 2018, from https://www.cdc.gov/ncbddd/autism/data.html

Reaven, J., Blakeley-Smith, A., Culhane-Shelburne, K., & Hepburn, S. (2012). Group cognitive

behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a

randomized trial. Journal Of Child Psychology & Psychiatry, 53(4), 410-419.

Russell, A. J., Jassi, A., Fullana, M. A., Mack, H., Johnston, K., Heyman, I., & ... Mataix-Cols,

D. (2013). Cognitive behavior therapy for comorbid obsessive-compulsive disorder in high-

functioning autism spectrum disorders: a randomized controlled trial. Depression & Anxiety

(1091-4269), 30(8), 697-708.

Storch, E. A., Arnold, E., De Nadai, Lewin, A. B., Nadeau, J. M., Jones, A. M., De Nadai, A. S,

Mutch, P. J., Selles, R. R., Ung, D., Murphy, T. K. (2013). The effect of cognitive behavioral

therapy versus treatment as usual for anxiety in children with autism spectrum disorders: a

randomized controlled trial. Journal of the American Academy of Child and Adolescent

Psychaitry, 52(2), 132-142.

Storch, E. A., Lewin, A. B., Collier, A. B., Arnold, E., De Nadai, A. S., Dane, B. F., & ... Murphy,

T. K. (2015). A randomized controlled trial of cognitive-behavioral therapy versus treatment

as usual for adolescents with autism spectrum disorders and comorbid anxiety. Depression

And Anxiety, 32(3), 174-181. doi:10.1002/da.22332

INTEGRATIVE LITERATURE REVIEW !13

Vause, T., Hoekstra, S., & Feldman, M. (2014). Evaluation of Individual Function-Based

Cognitive-Behavioural Therapy for Obsessive Compulsive Behaviour in Children with

Autism Spectrum Disorder. Journal On Developmental Disabilities, 20(3), 30-41.

Running Head: INTEGRATIVE LITERATURE REVIEW !14

Table 1 - Article Evaluation

First Author Reaven, J., Blakeley-Smith, A., Culhane-Shelburne, K., &

(Year)/ Hepburn, S. (2012). Group cognitive behavior therapy for
Qualifications children with high-functioning autism spectrum disorders and
anxiety: a randomized trial. Journal Of Child Psychology &
Psychiatry, 53(4), 410-419.

Qualifications: All authors of the study are professors at the

University of Colorado with a doctor of philosophy (PhD).
Heaven specializes her practice in clinical psychology and
developmental disabilities.
Background/ Children diagnosed with autism spectrum disorder often have
Problem co-occuring anxiety disorders. Anxiety can adversely effect
Statement these individuals ability to cooperate in the home and school
environment.

Conceptual/ - Facing Your Fears protocol was used as framework

theoretical
Framework

Design/ • Randomized trial, experimental design

Method/ • Children (and their families) were randomly assigned to
Philosophical participated in either a treatment-as-usual study or a group
Underpinnings cognitive behavioral therapy study. After a 16 week period
the participates were evaluated for the presence of anxiety
disorders.
Sample/ Setting/ - ITT sample included 50 youth (ages 7 to 14) in Colorado
Ethical - IRB approved
Considerations - Colorado Multiple Institutional Review board compliance
- The paper did not tell the reader if the participants gave
consent or assent. It was clarified that the participants of the
study reached out to the researchers with interest in the
study.
Major Variables - TAU study - participants continued with their treatment
Studied (and their methods as usual. These treatments included
definition), if pharmacological treatment, social skills interventions,
appropriate psychosocial interventions targeting coping skills, and
family-focused interventions targeting behavioral issues.
- CBT study - participants were a part of a multi-family group
sessions specifically designed for children diagnosed with
autism spectrum disorder.
INTEGRATIVE LITERATURE REVIEW !15

Measurement - Clinical Global Impression Scale ratings were compiled by

Tool/Data ICEs
Collection - Screen for Child Anxiety and Related Emotional Disorders
Method (SCARED) utilizing parent and child report of total anxiety
symptoms (pre-treatment, post-treatment, 3 months follow
up, and 6 month follow up)
Data Analysis - For the CBT group, Clinical Global Impression Scale scores
of 1 or 2 reflected ‘a clinically meaningful improvement.’
50% of the CBT group obtained a CGIS-I score reflecting a
positive treatment response.
- For the CBT group, SCARED results showed a steady
decrease in symptom severity from pre-treatment to post
treatment
Findings/ - For the CBT group, there was a significant reduction in the
Discussion number of anxiety disorder diagnosis. For the TAU group,
there was not a significant reduction in the number of
diagnostic anxiety.

Appraisal/Worth For children diagnosed with autism spectrum who have co-
to practice occurring anxiety disorders, cognitive behavioral therapy can
be used to reduce the symptoms of anxiety.

First Author Russell, A. J., Jassi, A., Fullana, M. A., Mack, H.,
(Year)/ Johnston, K., Heyman, I., & ... Mataix-Cols, D. (2013).
Qualifications Cognitive behavior therapy for comorbid obsessive-
compulsive disorder in high-functioning autism spectrum
disorders: a randomized controlled trial. Depression &
Anxiety (1091-4269), 30(8), 697-708.

Qualifications: Russell has a PhD, working in the

Department of Psychology, Institute of Psychiatry, Kings
College London, London, United Kingdom

Background/ - Adolescents diagnosed with autism spectrum disorder often

Problem suffer from oc-occurring obsessive compulsive disorder.
Statement While there is research to suggest that cognitive behavioral
therapy is an appropriate treatment for anxiety disorders, but
there is no evidence that is is an appropriate treatment for
obsessive compulsive disorders.
INTEGRATIVE LITERATURE REVIEW !16

Conceptual/
theoretical
Framework

Design/ - Randomized control trial

Method/ - Participants were randomly assigned to CBT study or an
Philosophical anxiety management study
Underpinnings

Sample/ Setting/ - 46 participants

Ethical - The study was registered as a controlled trial and was
Considerations approved by the local ethics committee
- Consent and Assent received
Major Variables - Cognitive behavioral therapy (CBT)
Studied (and their - Anxiety management (AM) a plausible control treatment
definition), if
appropriate

Measurement - Yale-Brown Obsessive Compulsive Severity Scale and

Tool/Data evaluations blind to treatment group
Collection - Clinical Global Impression and CGI Improvement Rating
Method Scales
- Self report of “minimally improved, unchanged or worst” or
“much or very much improved”
Data Analysis - CBT: There was a steady decline on the YBOCS scale (25
—> 15)
- AM: There was a steady decline on the YBOCS scale (25
—> 20)

Findings/ - Both the AM group and the CBT group had positive results.
Discussion Obsessive compulsive disorder symptom severity was
decreased.

Appraisal/Worth This study showed a positive correlation between both CBT

to practice and AM in decreasing symptom severity for patients
diagnosed with autism spectrum disorder.
INTEGRATIVE LITERATURE REVIEW !17

First Author Storch, E. A., Lewin, A. B., Collier, A. B., Arnold, E., De
(Year)/ Nadai, A. S., Dane, B. F., & ... Murphy, T. K. (2015). A
Qualifications randomized controlled trial of cognitive-behavioral therapy
versus treatment as usual for adolescents with autism
spectrum disorders and comorbid anxiety. Depression
And Anxiety, 32(3), 174-181. doi:10.1002/da.22332

Qualifications: Ph.D at Department of Pediatrics,

University of South Florida, St. Petersburg, Florida
Background/ Among adolescents diagnosed with autism spectrum
Problem disorder, there is a high risk of co-occurring anxiety disorders.
Statement The authors of the study researched the efficacy of cognitive
behavioral therapy in reducing symptoms of anxiety in
adolescents diagnosed with autism spectrum disorder.
Conceptual/ - No framework was identified.
theoretical
Framework

Design/ - Participants were randomly assigned to a CBT group or a

Method/ TAU group. Participants were then assessed by blinded raters
Philosophical at screening, posttreatment, and 1-month follow ups.
Underpinnings

Sample/ Setting/ - 31 children ages 11-16 with autism spectrum disorder

Ethical (ASD) and clinically significant anxiety
Considerations - Apart of a university-based, multidisciplinary behavior
health clinic specializing in the treatment of pediatric anxiety
in youth with and without autism spectrum disorder (ASD)
- Approved by the local institutional review board
- Assent? Consent?
Major Variables - Cognitive behavioral therapy (CBT)
Studied (and their - Treatment-as-usual (TAU)
definition), if
appropriate

Measurement - Anxiety Disorder Interview Schedule (ADIS-IV)

Tool/Data - Program and Activity Reporting System (PARS)
Collection - Clinical Global Impression- Severity and Improvement
Method
INTEGRATIVE LITERATURE REVIEW !18

Data Analysis There was a steady decline in the PARS, ADIS, and CGI-
Severity scores. From baseline to follow up there was a
steady decline.
Findings/ Subjects who participated in the CBT group demonstrated
Discussion superior improvements compared with the subjects who were
randomized into the TAU group.

Appraisal/Worth For patients diagnosed with autism spectrum disorder,

to practice cognitive behavioral therapy is an effective treatment modality
in reducing the symptoms of anxiety.

First Author Storch, E. A., Arnold, E., De Nadai, Lewin, A. B., Nadeau,
(Year)/ J. M., Jones, A. M., De Nadai, A. S, Mutch, P. J., Selles,
Qualifications R. R., Ung, D., Murphy, T. K. (2013). The effect of
cognitive behavioral therapy versus treatment as usual for
anxiety in children with autism spectrum disorders: a
randomized controlled trial. Journal of the American
Academy of Child and Adolescent Psychaitry, 52(2),
132-142.

Qualifications: Ph.D at Department of Pediatrics,

University of South Florida, St. Petersburg, Florida
Background/ - Children diagnosed with ASD are at a higher risk to be
Problem diagnosed with co-occurring anxiety disorders. There is a lack
Statement of research available to support an appropriate treatment
modality for this patient population.
Conceptual/ - No framework was identified.
theoretical
Framework

Design/ - Randomized control trial

Method/ - Participants were randomly assigned to either the CBT
Philosophical study or the TAU study
Underpinnings - They are assessed at baseline, post-treatment, and with a
3-month follow up.
INTEGRATIVE LITERATURE REVIEW !19

Sample/ Setting/ - 45 children (7-11 years of age) with high-cuntioning ASD an

Ethical clinically significant anxiety
Considerations - Written informed consent and assent was obtained from
parents and children.
- This study received approval from the local institutional
review board.
Major Variables - Cognitive behavioral therapy
Studied (and their - Treatment-as-usual
definition), if
appropriate

Measurement - The participants were measured by trained evaluators who

Tool/Data were blind to the participants’ intervention condition and not
Collection involved in treatment.
Method - Program and Activity Reporting System (PARS)
- Anxiety Disorder Interview Schedule (ADIS)
- Cognitive Impression-Severity (CGI)
Data Analysis - The PARS calculated a 29% reduction in post treatment
surveys in relations to pre treatment surveys.
- Large group difference in favor of the CBT were observed
for the PARS, ADIS, and CGI-Severity. At the 3-month
follow up, no signifiant changes from post treatment were
observed.
Findings/ - Youth receiving CBT showed substantial improvement
Discussion relative to TAU on primary anxiety outcomes. These
improvements were maintained at the 3 month follow up.
When CBT is adapted for anxious youth with high-
functioning ASD it has been successful in reducing anxiety
symptoms.

Appraisal/Worth Cognitive behavioral therapy is an appropriate treatment

to practice modality for adolescents diagnosed with autism spectrum
suffering from co-occurring anxiety.
INTEGRATIVE LITERATURE REVIEW !20

First Author Vause, T., Hoekstra, S., & Feldman, M. (2014). Evaluation
(Year)/ of Individual Function-Based Cognitive-Behavioural
Qualifications Therapy for Obsessive Compulsive Behaviour in Children
with Autism Spectrum Disorder. Journal On
Developmental Disabilities, 20(3), 30-41.

Qualifications: Department of Child and Youth studies,

Brock University, St. Catharines, ON and Centre for
Applied Disabilities Studies, Brock University, St.
Catharines, ON
Background/ - Children and youth diagnosed with autism spectrum
Problem disorder are at increased risk for being diagnosed with
Statement obsessive compulsive disorder. However, there is a lack of
evidence supporting an appropriate treatment modality for
this population.
Conceptual/ - March and Mulle (1998) CBT Manual
theoretical - Modified in accordance with participant’s cognitive-
Framework developmental levels and individual learning styles.

Design/ - Single-case experimental design to test the efficacy of

Method/ adapted CBT combined with function-based behavioral
Philosophical strategies to treat OCD symptoms
Underpinnings - The authors of the study used a variety of treatment
modalities.
- March and Mulle Treatment Protocol
Sample/ Setting/ - 2 children
Ethical - The study was approved by the University Research Ethics
Considerations board.
- Consent was obtained by both the parent and child.
Major Variables - General Psychoeducation/Mapping
Studied (and their - Protracted CT and ERP Tailored to Target Behaviors
definition), if - Family-focused Training
appropriate - Function-based assessment and intervention

Measurement - ADIS parent-report, CY=BOCS

Tool/Data - Quality of Life Impact Questionnaire
Collection - Parent reporting
Method
INTEGRATIVE LITERATURE REVIEW !21

Data Analysis - The ADIS-parent report indicated parent interference scores

and clinical severity ratings of 2 and 1 which is subclinical.
This suggests…
- Pre to post QLIQ showed a decrease in ratings of the
negative effects of OCD symptoms on family and individual
quality of life, from 31.5 to 16 and 28 to 9.
- Parents reported high satisfaction with the treatment with an
overall rating of 26 and 28.
- MAX SCORE: 28
Findings/ - Adapting function-based CBT treatment for OCD symptoms
Discussion in children with ASD had a positive influence on the
participants obsessive-compulsive behaviors and symptom
severity.
Appraisal/Worth - This study has limited generalizability as it’s participants are
to practice confined to 2 children.
- Parent reporting as a data collection source can be
unreliable.
- Going forward, it would be beneficial to have objective data
collected along side the parent reporting.