Adapted cognitive behavior therapy for obsessive–compulsive disorder with co-occurring autism spectrum disorder: a clinical effectiveness study
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Abstract
Obsessive-compulsive disorder and autism spectrum disorder commonly co-occur. Adapted cognitive behavior therapy for obsessive-compulsive disorder in adults with autism spectrum disorder has not previously been evaluated outside the United Kingdom. In this study, 19 adults with obsessive-compulsive disorder and autism spectrum disorder were treated using an adapted cognitive behavior therapy protocol that consisted of 20 sessions focused on exposure with response prevention. The primary outcome was the clinician-rated Yale-Brown Obsessive-Compulsive Scale. Participants were assessed up to 3 months after treatment. There were significant reductions on the Yale-Brown Obsessive-Compulsive Scale at post-treatment (d = 1.5), and improvements were sustained at follow-up (d = 1.2). Self-rated obsessive-compulsive disorder and depressive symptoms showed statistically significant reductions. Improvements in general functioning and quality of life were statistically non-significant. Three participants (16%) were responders at post-treatment and four (21%) were in remission from obsessive-compulsive disorder. At follow-up, three participants (16%) were responders and one (5%) was in full remission. Adapted cognitive behavior therapy for obsessive-compulsive disorder in adults with co-occurring autism spectrum disorder is associated with reductions in obsessive-compulsive symptoms and depressive symptoms. However, outcomes are modest; few patients were completely symptom free, and treatment engagement was low with few completed exposures and low adherence to homework assignments. We identify and discuss the need for further treatment refinement for this vulnerable group.
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Many of the identified adaptations have been prioritised by autistic adults, including improving communication, providing environmental adjustments and developing clinicians' knowledge of autism.
“Many of these adaptations have been prioritised by autistic adults,60 including improving communication, providing environmental adjustments and developing clinicians’ knowledge of autism.”
From Approaches to improving mental healthcare for autistic people: Systematic review (2024) · cites this paper as [60]
The Treatment section describes communication-focused adaptations, but does not say autistic adults prioritised them or identify environmental adjustments and clinician knowledge as their priorities. The Discussion says the study was conducted with minimal input from affected individuals and recommends consulting them in future treatment development. No page numbers are available in our copy. (LLM, conf=0.78)
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- Authors
- Flygare, O., Andersson, E., Ringberg, H., Hellstadius, A.-C., Edbacken, J., Enander, J., Dahl, M., Aspvall, K., Windh, I., Russell, A., Mataix-Cols, D., & Rück, C.
- Affiliations
- Karolinska University Hospital (SE)
- Karolinska Institutet (SE)
- Region Stockholm (SE)
- Stockholm University (SE)
- Psykologpartners W&W AB, Stockholm, Sweden
- University of Bath (GB)
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Corresponding author
- Flygare, Oskar
- Venue
- Autism
- Publisher
- SAGE Publications
- Published
- 2019-06-12
- Volume
- 24
- Issue
- 1
- Pages
- 190-199
- ISSN
- 1362-3613 (ISSN-L)
- 1461-7005
- OpenAlex
- W2946919268
- Cited by
- 25
- References
- 58
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 4 · 2023: 1 · 2022: 3 · 2021: 8 · 2020: 3 · 2019: 1
- FWCI
- 4.35
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Autism (publishedVersion)
- PubMed (publishedVersion)
- Pure (University of Bath) (submittedVersion, other-oa)
- PsyArXiv (OSF Preprints) (submittedVersion, cc-by)
- PsyArXiv (OSF Preprints) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- obsessive-compulsive disorder, autism spectrum disorder, comorbidities, exposure and response prevention, Yale-Brown Obsessive Compulsive Scale, depressive symptoms, treatment engagement, homework adherence
- MeSH terms
- Autism Spectrum Disorder, Adult, Female, Humans, Male, Obsessive-Compulsive Disorder, Sweden, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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