Abstract Co-morbid emotional disturbances are not uncommon in individuals with Asperger syndrome (AS) especially during the tumultuous period of adolescence. The few empirical studies that exist have only examined treatment outcomes for anxiety and anger in individuals with AS during childhood but there are no available treatment studies for adolescents or adults. Therefore, this research project aimed to examine the efficacy of a modified cognitive-behaviour therapy (CBT) program for emotional disturbance in young people with a diagnosis of AS. Firstly, it was important to establish the need for treatment by examining the prevalence and presentation of emotional disturbance in this population. Secondly, an investigation of the role of pessimistic attributional style, negative problem orientation and social competence as risk factors for emotional disturbance helped to determine the suitability of CBT. It was also essential that an existing CBT program was modified to suit the cognitive profile of young people with AS. Finally, the efficacy of a modified CBT program was evaluated in a pilot study and randomised controlled trial. In the first study, 68 young people with existing diagnosis of AS between the ages of 11 and 23 years completed a battery of measures that assessed for AS characteristics, emotional disturbances, risk factors, and cognitive ability. The results of this study indicated that approximately 21%, 20% and 40% of young people reported elevated levels of depression, anxiety, and anger symptoms respectively. Furthermore, approximately 60% of young people reported elevated levels on at least one of the emotional disturbance measures (i.e., depression, anxiety or anger symptoms), while 40% of adolescents reported elevated levels on at least two. Therefore, the study suggests that there is a need to develop evidence-based treatment for young people with AS. In addition, significant associations were found between pessimistic attributional style, negative problem orientation and social competence, and emotional disturbance. Multiple regressions suggested that these risk factors account for approximately 54%, 39% and 25% of variance in depression, anxiety and anger respectively. These results are consistent with the literature for typically developing young people, and thus, cognitive-behaviour therapy typically used to treat mood and anxiety disorders in the general population should be efficacious for the AS population. Furthermore, CBT has been shown to be efficacious in treating anxiety and anger problems in children with AS. Although there are no existing CBT programs targeting depression in young people with AS, there are numerous CBT programs for typically developing young people. One example is the Aussie Optimism Program (AOP), an Australian adaptation of the Penn Prevention program which has a strong evidence-base for treating depression. Based on the AS literature, the program was modified to suit the cognitive profile of young people with AS. These modifications include providing affective education, using visual materials, small groups with high therapist to adolescent ratio, and other modifications to assist learning. Study Two piloted the modified program with three young people with AS. The pilot study provided some evidence that the modified Aussie Optimism reduced symptoms of emotional disturbance, but the sample size was too small to obtain clear results. In addition, observations from the pilot study were used to further modify the CBT program, which enhanced the structure and delivery of the program. The final modified CBT program consisted of six 2-hour sessions teaching young people to identify emotions and discriminate between different levels of emotional intensity; to cope with emotions; to identify and challenge negative thoughts; and to solve problems. Finally, a randomised controlled trial was used in Study Three to examine the efficacy of the modified CBT in treating depression in young people with AS. Given the high co-morbidity of emotional disturbance, the study also tested the efficacy of CBT program in reducing symptoms of anxiety and anger. Forty-four young people with AS were randomly allocated to the intervention (n = 21) or the waitlist control (n = 23). The results of Study Three demonstrated that young people with high levels of depression and anger symptoms initially showed a significant reduction after the intervention, compared with the waitlist control group. Although anxiety levels reduced from time 1 to time 2 for the intervention group, the pattern of results was not statistically significant. Reliable change index (RCI) indicated that young people with high levels of symptoms at Time 1 showed meaningful clinical changes across measures of depression, anxiety and anger (parent and adolescent report) only in the intervention group (42-83%), but not in the waitlist control group (8-12%). Results in Study Three suggest that CBT modified to suit the cognitive profile of AS is efficacious in reducing depression and anger symptoms. Some of the methodological limitations of this study include a small sample size, attrition, participant variability, and a lack of longer-term follow-up. Despite these methodological limitations, these three studies provided strong evidence for the efficacy of CBT in treating emotional disturbance in young people with AS by establishing the need for an intervention, identifying the importance of the risk factors targeted by CBT, and demonstrating the efficacy of a modified CBT in reducing symptoms of emotional disturbance, specifically depression and anger, using a randomised controlled trial.
| Identifer | oai:union.ndltd.org:ADTP/254252 |
| Creators | Lake-hui Quek |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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