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Evaluation ViewAttendees 2

Spotlight Research Presentations

Autism Spectrum and Developmental Disorders

Controlled Comparison of CBT, Sertraline, and Pill Placebo for Autistic Children and Youth with Impairing Anxiety: Primary and Secondary Outcomes from a Double-Blind Trial

Spotlight Research 7 - Controlled Comparison of CBT, Sertraline, and Pill Placebo for Autistic Children and Youth with Impairing Anxiety: Primary and Secondary Outcomes from a Double-blind Trial

Saturday, November 16, 2024
10:30 AM – 11:30 AM EST
Location: Grand Ballroom I/J, Level 5, Downtown Marriott
Earn 1 Credit
Keywords: Clinical Trial, CBT, Medication
Recommended Readings: Wood, J. J., Kendall, P. C., Wood, K. S., Kerns, C., Seltzer, M., Small, B. J., Lewin, A. B., & Storch, E. A. (2020). Cognitive Behavioral Treatments for Anxiety in Youth with Autism Spectrum Disorder: A Randomized Clinical Trial. Journal of the American Medical Association (JAMA): Psychiatry, 77, 474-483. doi:10.1001/jamapsychiatry.2019.4160,  
Linden, A., Best, L., Elise, F., Roberts, D., Branagan, A., Tay, Y. B. E., ... & Gurusamy, K. (2023). Benefits and harms of interventions to improve anxiety, depression, and other mental health outcomes for autistic people: A systematic review and network meta-analysis of randomised controlled trials. Autism, 27(1), 7-30.
,   Deb, S., Roy, M., Lee, R., Majid, M., Limbu, B., Santambrogio, J., ... & Bertelli, M. O. (2021). Randomised controlled trials of antidepressant and anti-anxiety medications for people with autism spectrum disorder: systematic review and meta-analysis. BJPsych Open, 7(6), e179.,   ,  

    Chair(s)

  • JW

    Jeffrey J. Wood, Ph.D.

    Professor
    UCLA
    Los Angeles, California, United States

    • Panelist(s)

  • SB

    Surina Bothra, B.A.

    Assistant Clinical Research Coordinator
    UC Davis MIND Institute
    Sacramento, California, United States

  • KW

    Karen S. Wood, Ph.D.

    Staff Research Associate
    University of California, Los Angeles
    Los Angeles, California, United States

  • MS

    Marjorie Solomon, Ph.D.

    Interim Director MIND Institute, Professor of Psychiatry
    UC Davis, Psychiatry Department, MIND Institute
    Sacramento, California, United States

Background: Cognitive behavioral therapy (CBT) is a promising intervention modality for autistic youth (Linden et al., 2023). However, few studies have examined CBT in relation to credible, active comparators; hence, the evidence base of CBT for autistic youth is considered weak (Lyra et al., 2017). Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to autistic youth seeking treatment in community settings (Feroe et al., 2021). However, SSRIs, while efficacious for youth in the general population, have been rarely studied, and with inconclusive results, among autistic youth.

Method: The present study attempted to significantly advance the evidence base for practice guidelines for autistic youth by (1) testing the efficacy of CBT for impairing anxiety using stringent comparators (double-blind administration of an SSRI or pill placebo) while (2) simultaneously testing the efficacy of an SSRI (sertraline) in relation to pill placebo. Autistic youth (N=61) aged 8-14 years old with IQ >50 were randomized to either personalized CBT (Behavioral Interventions for Anxiety in Children on the Autism Spectrum; BIACA) or double-blinded sertraline or pill placebo in a 1:1:1 ratio. All conditions entailed 16 sessions. The primary outcome measure was independent evaluator (IE) ratings on the Pediatric Anxiety Rating Scale (PARS). Secondary outcome measures included a personalized measure of youth mental health needs (the Youth Top Problems [YTP] scale; Weisz et al., 2012) as well as adverse events.

Results: In mixed linear models, youth who received CBT or sertraline exhibited greater improvement on the PARS than did youth who received pill placebo (ps < .05). The caregivers of youth who received CBT reported greater progress on personalized youth outcomes than did the caregivers of youth in the sertraline or pill placebo conditions (p < .01). There was a lower frequency of adverse events in the CBT arm than in the other conditions.

Conclusion: This is the first study to show that CBT and sertraline outperform pill placebo for an IE-rated measure of anxiety in a double-blind trial. A brief CBT treatment addressing stakeholder goals while limiting adverse events could be a desirable option for families of autistic youth with impairing anxiety.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. State three ways to adapt CBT for autistic youth.
  2. Identify four CBT practices that are useful in personalizing intervention for autistic youth.
  3. Describe two useful assessment approaches for autistic youth with impairing anxiety.
  4. Articulate pros and cons of CBT and SSRI medication treatment for autistic youth with anxiety.
  5. Share common adverse events associated with SSRI medication when prescribed to autistic youth.
  6. This presentation intends to support professional growth and sophistication pertaining to the evidence based treatment of autism and anxiety.
  7. This presentation intends to promote greater clinical skills for practitioners working with individuals on the autism spectrum.