Psychotherapy for co-occurring symptoms of depression, anxiety and obsessive-compulsive disorder in children and adults with autism spectrum disorder: a systematic review and meta-analysis

Abstract

Individuals with autism spectrum disorder (ASD) struggle accessing psychotherapy services for comorbidities, including anxiety-, depressive- and obsessive-compulsive disorders (OCD). Apart from cognitive behavioural therapy (CBT) for anxiety in children with ASD, it is unclear whether psychotherapy is effective for these comorbid disorders. We therefore systematically reviewed any form of psychotherapy for co-occurring symptoms of anxiety, depression and OCD in individuals with ASD. Database searches were conducted until February 2022 using EMBASE, PsycINFO and PubMed. Randomised controlled trials (RCT) were included investigating any form of psychotherapy for symptoms of anxiety, depression and OCD in individuals with ASD. Summary data were extracted, and random-effects meta-analyses were conducted. For CBT 26 RCTs (n = 1251), and for social skills training (SST) 11 RCTs (n = 475) met criteria for inclusion. Pooled effect sizes indicated a moderate reduction of anxiety in children (g = −0.70) and a small reduction of depressive symptoms in adults (g = −0.39). For SST overall effect sizes were small for reduction of anxiety in children (g = −0.35) and adults (g = −0.34) and moderate for reduction of depressive symptoms in children (g = −0.50). Risk of bias was high in 18, moderate in 16 and low in 3 RCTs. Our results provide new and age-specific evidence that: (1) CBT is effective for reducing anxiety in children and to a lesser extent for depressive symptoms in adults with ASD; and (2) social skills interventions are effective for reducing anxiety in children and adults and for depressive symptoms in children with ASD.

Approaches to improve mental health care for autistic children and young people: a systematic review and meta-analysis

“…Inconsistencies in effect sizes with previous meta-analyses may be attributed to methodological differences such as inclusion criteria (e.g., some included non-adapted generic CBT (Sharma et al, 2021) and non-randomised controlled trials (Perihan et al, 2020; Ung, Selles, Small, & Storch, 2015)) or favouring different measures (Kreslins, Robertson, & Melville, 2015; Sharma et al, 2021; Sukhodolsky et al, 2013) and chosing pooled over separate meta-analyses (Perihan et al, 2020; Ung et al, 2015; Wichers, Van Der Wouw, Brouwer, Lok, & Bockting, 2023). Variation of effect sizes across different raters has been reported elsewhere (Kreslins et al, 2015; Sharma et al, 2021; Sukhodolsky et al, 2013).…”

Symptoms of Depression, Anxiety and Their Co-Occurrence among Orphaned Children in Sekhukhune District, Limpopo Province

“…The co-occurrence of depression and anxiety is common among both adults and children [ 31 ]. In children, the co-occurrence has been associated with a range of health and social problems, which include increased risk of co-occurring conditions, poor use of health care, school problems and high parenting aggravation [ 32 ], which may have long-term impacts. The current study found that the prevalence of co-occurring anxiety and depression was 32.14%, with those with severe symptoms being more than those with mild symptoms.…”

Autism Spectrum Disorder: Brain Areas Involved, Neurobiological Mechanisms, Diagnoses and Therapies

“…At present, the ongoing ASD therapy is limited to well-known brain drugs prescribed to both children and adult patients for many ASD co-symptoms: anxiety, depression, hyperactivity, and sleep problems [86,87]. Among these drugs, those effective against attention-deficit/hyperactivity disorders are employed as psychotropic and psychostimulants [1,[86][87][88].…”

“…At present, the ongoing ASD therapy is limited to well-known brain drugs prescribed to both children and adult patients for many ASD co-symptoms: anxiety, depression, hyperactivity, and sleep problems [86,87]. Among these drugs, those effective against attention-deficit/hyperactivity disorders are employed as psychotropic and psychostimulants [1,[86][87][88]. Ongoing research, now intensely investigated, supports an association between ASD and immune/inflammatory mechanisms and proposes the development and future employment for specific inhibitory drugs [89].…”