Reaven et al., 2009

Study DescriptionInterventionInclusion/Exclusion
Criteria/Population
Baseline MeasuresOutcomes
Author:
Reaven et al., 2009
Country:
US
Practice setting:
Academic
Intervention setting:
Clinic
Enrollment period:
NR
Funding:
Organization for Autism Research; Doug Flutie Foundation; US DHHS
Administration on Developmental Disabilities
Author industry relationship disclosures:
NR
Design:
Non-randomized controlled trial
Intervention:
12 weekly 1.5 hour CBT sessions targeting anxiety reduction, including large group time, separate parent and child group meetings, and parent- child dyads
Assessment:
Two to three 2 hour assessment sessions; diagnostic and developmental batteries (ADOS, SCQ, WASI, K-SADS-PL, SCARED) administered by research team (clinical psychologist with extensive experience in autism, graduate student, postdoctoral fellow)
Groups:
G1: active treatment
G2: waitlist control
Provider:
Clinicians, parents
Measure of treatment fidelity reported:
Yes
Co-interventions held stable during treatment:
No*
Concomitant therapies, n (%):
Anti-anxiety or antidepressant medications:
G1: 5 (50)
G2: 9 (39.1)
Other psychotropic medications:
G1: 4 (40)
G2: 13 (56.5)
Vitamins and supplements:
G1: 6 (60)
G2: 20 (87)
Restricted diet:
G1: 2 (20)
G2: 8 (34)
Inclusion criteria:
  • Aged 7–14 years
  • Diagnosis on the autism spectrum as verified by exceeding the criteria on module III of the ADOS, exceeding the cutoff on the Social Communication Questionnaire, and receiving a current clinical diagnosis of ASD by a licensed clinical psychologist with extensive experience with children with autism
  • Overall IQ ≥ 70
  • Verbally fluent as evidenced by participation in Module III of the ADOS
  • Significant anxiety symptoms (parent report of clinically significant symptoms of a social phobia, separation anxiety, or generalized anxiety on the Kiddie- Schedule for Affective Disorders and Schizophrenia; or exceeding the subscale cutoffs on the SCARED)
Exclusion criteria:
  • Children with primary symptoms of obsessive-compulsive disorder
  • Receiving group or individual therapy focused on anxiety reduction
Age, months ± SD (range):
132.20 ± 22.80 (97–177)
Mental age:
FSIQ, months ± SD (range):
102.46 ± 16.22 (65–141)
Verbal IQ, months ± SD (range):
101.76 ± 19.51 (65–141)
Nonverbal IQ, months ± SD (range):
101.76 ± 15.07 (75–144)
Commonly occurring comorbidities:
SCARED score, parent report, mean ± SD (range):
Total:
G1: 32.70 ± 12.21 (20–54)
G2: 29.35 ± 10.69 (7–51)
Panic symptoms:
G1: 4.40 ± 4.2 (0–15)
G2: 4.91 ± 4.55 (1–18)
Generalized anxiety:
G1: 9.94 ± 2.61 (5–13)
G2: 9.84 ± 3.82 (3–16)
Separation anxiety:
G1: 4.92 ± 3.87 (1–13)
G2: 5.13 ± 4.39 (0–16)
Social anxiety:
G1: 9.40 ± 3.12 (5–14)
G2: 6.82 ± 5.32 (0–14)
School anxiety:
G1: 1.80 ± 2.09 (0–7)
G2: 2.43 ± 1.94 (0–7)
SCARED, child report, mean ± SD (range):
Total:
G1: 25.67 ± 9.84 (4–34)
G2: 26.09 ± 11.99 (3–48)
Panic symptoms:
G1: 4.67 ± 4.72 (1–15)
G2: 6.04 ± 3.67 (0–15)
Commonly occurring co- morbidities:
SCARED, parent report, mean ± SD (range)
Total:
G1: 19.53 ± 8.82 (9–38)
G2: 27.33 ± 8.85 (9–52)
ANOVA: time (P = 0.01), treatment × time interaction (P = 0.01)
Panic symptoms:
G1: 2.34 ± 2.54 (0–7)
G2: 5.76 ± 4.44 (1–19)
Generalized anxiety
G1: 6.20 ± 2.86 (2–12)
G2: 9.14 ± 3.16 (2–17)
Separation anxiety:
G1: 2.60 ± 2.63 (0–8)
G2: 4.60 ± 2.81 (0–11)
Social anxiety:
G1: 6.80 ± 2.25 (4–12)
G2: 6.57 ± 3.47 (0–14)
School anxiety:
G1: 1.5 ± 1.95 (0–3)
G2: 1.27 ± 1.16 (0–3)
Number of prescribed medications, n (%):
None: 11 (33.3)
One: 9 (27.3)
Two: 6 (18.2)
Three: 2 (6.1)
Four: 0
Five: 5 (15.2)
Medications, n (detail):
Anti-anxiety medication PRN: 2 (1 clonipin; 1 busparone)
SSRI: 14 (3 fluvoxamine; 3 fluoxetine; 4 sertraline; 2 paroxetine; 2 citalopram)
Trazedone: 3
Mood stability: 4 (1 lithium; 2 depakote; 1 trileptal)
Second generation antipsychotics: 6 (3 risperidone; 2 seroquel; 1 abilify)
Attention deficit medication: 15 (9 Concerta; 5 Adderall; 1 Tenex)
Multivitamins and general nutritional supplements: 21
Omega-3 supplements: 8
N at enrollment:
G1: 10
G2: 23
N at follow-up:
G1: 10
G2: 21
Gender, n (%):
Male:
G1: 7 (70)
G2: 19 (82.6)
Female:
G1: 3 (30)
G2: 4 (17.4)
Race/ethnicity, n (%):
White:
G1: 8 (80)
G2: 19 (82.6)
African American:
G1: 1 (10)
G2: 1 (4.3)
Hispanic:
G1: 1 (10)
G2: 1 (4.3)
Other:
G1: 0
G2: 2 (8.6)
SES:
Maternal education, n (%):
High school:
G1: 0
G2: 2 (8.7)
Some college:
G1: 3 (30)
G2: 6 (26.1)
College graduate:
G1: 4 (40)
G2: 8 (34.8)
Postcollege:
G1: 3 (30)
G2: 6 (26.1)
Missing:
G1: 0
G2: 1 (4.3)
Household income: NR
Diagnostic approach:
In Study
Diagnostic tool/method:
See inclusion criteria
Diagnostic category, n (%):
Autism:
G1: 3 (30)
G2: 12 (52.2)
PDD-NOS:
G1: 2 (20)
G2: 2 (8.7)
Aspergers:
G1: 5 (50)
G2: 9 (39.1)
Generalized anxiety:
G1: 5.33 ± 4.15 (0–14)
G2: 6.23 ± 3.89 (0–14)
Separation anxiety:
G1: 4 ± 3.87 (0–11)
G2: 6.09 ± 3.09 (0–13)
Social anxiety:
G1: 6.89 ± 3.44 (2–13)
G2: 7.23 ± 4.25 (1–14)
School anxiety:
G1: 2.44 ± 1.87 (0–5)
G2: 2.05 ± 1.60 (0–6)
Percentage of children in both groups obtaining SCARED scores within the clinically significant range:**
Panic:
Parent report: 27.3
Child report: 38.7
Generalized:
Parent report: 69.7
Child report: 19.4
Separation:
Parent report: 54.5
Child report: 51.6
Social:
Parent report: 51.5
Child report: 45.2
School:
Parent report: 33.3
Child report: 41.9
Total anxiety symptoms:
Parent report: 66.7
Child report: 51.6
SCARED, child report, mean ± SD (range):
Total:
G1: 20.50 ± 12.69 (1–31)
G2: 24.85 ± 16.34 (4–64)
ANOVA: time (P = 0.67), treatment × time interaction (P = 0.99)
Panic symptoms:
G1: 3.33 ± 3.07 (0–8)
G2: 5.60 ± 5.94 (0–21)
Generalized anxiety:
G1: 4.33 ± 2.50 (0–7)
G2: 6.45 ± 6.14 (0–16)
Separation anxiety:
G1: 2.83 ± 2.40 (0–6)
G2: 5.90 ± 5.14 (0–21)
Social anxiety:
G1: 6.33 ± 3.72 (0–10)
G2: 6.50 ± 4.53 (0–14)
School anxiety:
G1: 2.83 ± 2.10 (1–6)
G2: 0.91 ± 0.03 (0–2)
Percentage of children in both groups obtaining SCARED scores within the clinically significant range:**
Panic:
Parent report: 16
Child report: 17.6
Generalized:
Parent report: 8
Child report: 17.6
Other characteristics, n (%):
Primary anxiety diagnosis:
Generalized anxiety:
G1: 7 (70)
G2: 15 (65.2)
Separation anxiety:
G1: 2 (20)
G2: 4 (17.3)
Social anxiety:
G1: 1 (10)
G2: 4 (17.4)
Food allergies and restricted diet: 10 (31.2)
Separation:
Parent report: 24
Child report: 29.4
Social:
Parent report: 32
Child report: 47.1
School:
Parent report: 16
Child report: 17.6
Total anxiety symptoms:
Parent report: 28
Child report: 41.2
Harms:
NR
Modifiers:
NR

Comments:

*

1 child in G1 was placed on a different mood stabilizer and 2 children in G2 received higher doses of medicine for attentional difficulties; data on changes in therapy not available for 13 participants.

**

Chi-square analyses for the entire sample on pretreatment and post-treatment assessments indicated significant differences in clinical classification for parent report (P = 0.03), but not for child report (P = 0.48).

1 child in G1 was placed on a different mood stabilizer and 2 children in G2 received higher doses of medicine for attentional difficulties; data on changes in therapy not available for 13 participants.

Chi-square analyses for the entire sample on pretreatment and post-treatment assessments indicated significant differences in clinical classification for parent report (P = 0.03), but not for child report (P = 0.48).

From: Appendix C, Evidence Tables

Cover of Therapies for Children With Autism Spectrum Disorders
Therapies for Children With Autism Spectrum Disorders.
Comparative Effectiveness Reviews, No. 26.
Warren Z, Veenstra-VanderWeele J, Stone W, et al.

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