Interventions for adults with autism spectrum disorders who experience
anxiety
A snapshot of research for adults and health professionals
This guide was written in December 2014 by Ms Cindy Nicollet1, Dr Kate van Dooren2 and Professor Nick Lennox3.
1
Ms Nicollet is a psychologist undertaking her PhD through The Cooperative Research Centre for Living with
Autism Spectrum Disorders (Autism CRC) and QCIDD
2
Dr van Dooren holds a PhD in Public Health and is undertaking her postdoctoral fellowship through the Autism
CRC and QCIDD
3
Dr Lennox is the Director of the Queensland Centre of Intellectual and Developmental Disability (QCIDD) and
Autism CRC project leader of 3.015: Health and wellbeing for adults
The purpose of this resource is to provide a brief overview of interventions that aim to help adults with ASD to
address anxiety. We aim to equip adults with ASD and the health professionals who support them with
information that helps them to better understand the literature related to anxiety and adults with ASD.
This resource was developed through Ms Nicollet’s PhD research, which is part of the Cooperative Research
Centre for Living with Autism Spectrum Disorders (Autism CRC) project called Tools, strategies and techniques
developed to improve the health and wellbeing for adults with ASD. This project aims to enhance health and
wellbeing in adults with ASD and their families.
Anxiety & adults with ASD
Anxiety can affect any person, including a person with ASD. Experiencing anxiety can be challenging, because it
can make employment, education and socialising difficult. For a person with ASD, anxiety can impact social
relationships and increase repetitive, idiosyncratic behaviours and routines. It is important to find appropriate
interventions to assist individuals with ASD and anxiety, particularly for adults who want to work, study or be
social. But, we know very little about ‘what works’ to help adults with ASD with their anxiety.
What we did
We searched online databases using specific keywords to find studies that examined the effectiveness of
interventions to reduce anxiety among adults with ASD. Since there is very little work that focusses on adults,
we also looked for interventions for adolescents aged 13 years or older. We read all the relevant papers and
assessed the quality of the studies they presented.
What we found
We found 13 papers that described interventions aiming to reduce anxiety among adolescents and adults with
ASD. The table below describes each of the 13 papers. We ranked the papers using Downs and Black Checklist
for Quality Assessment of non-RCTs, with a higher score (out of 28) suggesting the paper met more of the items
on the checklist. A higher score doesn’t necessarily equate to a ‘better’ paper; instead it means that the study
described was conducted in a way that meets scientific criteria for validity: it’s one way to assess whether the
study findings can be applied to other groups and contexts.
Next steps
As part of her PhD, Ms Nicollet will use the literature presented here, as well as discussions with adults with ASD
and mental health professionals, to develop an online anxiety intervention for adults with ASD. For more
information about this project, please contact Ms Nicollet at c.nicollet@uq.edu.au.
References
You can find these papers online. Those marked with a * are available for free to download by clicking on the
title and following the URL.
Cardaciotto, L., & Herbert, J. D. (2004). Cognitive Behavior Therapy for Social Anxiety Disorder in the Context of
Asperger's Syndrome: A Single-Subject Report. Cognitive and Behavioral Practice, 11, 75-81.
*Freitag, C. M., Cholemkery, H., Elsuni, L., Kroeger, A. K., Bender, S., Kunz, C. U., & Kieser, M. (2013). The
group-based social skills training SOSTA-FRA in children and adolescents with high functioning autism
spectrum disorder--study protocol of the randomised, multi-centre controlled SOSTA--net trial. Trials,
14(6), 12. doi: 10.1186/1745-6215-14-6
*Kiep, M., Spek, A. A., & Hoeben, L. (2014). Mindfulness-based therapy in adults with an autism spectrum
disorder: Do treatment effects last? Mindfulness, 8. doi: 10.1007/s12671-014-0299-x
*Langdon, P. E., Murphy, G. H., Wilson, E., Shepstone, L., Fowler, D., Heavens, D., . . . Russell, A. (2013).
Asperger syndrome and anxiety disorders (PAsSA) treatment trial: A study protocol of a pilot,
multicentre, single-blind, randomised crossover trial of group cognitive behavioural therapy. British
Medical Journal Open, 3(7), 6. doi: 10.1136/bmjopen-2013-003449
*McGillivray, J. A., & Evert, H. T. (2014). Group Cognitive Behavioural Therapy Program Shows Potential in
Reducing Symptoms of Depression and Stress Among Young People with ASD. Journal of Autism &
Developmental Disorders, 11. doi: 10.1007/s10803-014-2087-9
*Ozsivadjian, A., & Knott, F. (2011). Anxiety problems in young people with autism spectrum disorder: a case
series. Clin Child Psychol Psychiatry, 16(2), 203-214. doi: 10.1177/1359104511404749
*Reaven, J., Blakeley-Smith, A., Leuthe, E., Moody, E., & Hepburn, S. (2012). Facing your fears in adolescence:
cognitive-behavioral therapy for high-functioning autism spectrum disorders and anxiety. Autism Res
Treat, 2012, 13. doi: 10.1155/2012/423905
Russell, A. J., Jassi, A., Fullana, M. A., Mack, H., Johnston, K., Heyman, I., Mataix‐Cols, D. (2013). Cognitive
behavior therapy for comorbid obsessive-compulsive disorder in high-functioning autism spectrum
disorders: A randomized controlled trial. Depress Anxiety, 30(8), 697-708.
*Spek, A. A., Ham, N. C., & Nyklícek, I. (2013). Mindfulness-based therapy in adults with an autism spectrum
disorder: a randomized controlled trial. Res Dev Disabil, 34(1), 246-253. doi:
10.1016/j.ridd.2012.08.009
Weiss, J. A., & Lunsky, Y. (2010). Group cognitive behaviour therapy for adults with Asperger syndrome and
anxiety or mood disorder: a case series. Clinical Psychology and Psychotherapy, 17(5), 438-446. doi:
10.1002/cpp.694
*White, S., Ollendick, T., Albano, A., Oswald, D., Johnson, C., Southam-Gerow, M., Scahill, L. (2013).
Randomized Controlled Trial: Multimodal Anxiety and Social Skill Intervention for Adolescents with
Autism Spectrum Disorder. Journal of Autism & Developmental Disorders, 43(2), 382-394. doi:
10.1007/s10803-012-1577-x
*White, S. W., Ollendick, T., Scahill, L., Oswald, D., & Albano, A. M. (2009). Preliminary efficacy of a cognitivebehavioral treatment program for anxious youth with autism spectrum disorders. J Autism Dev
Disord, 39(12), 1652-1662. doi: 10.1007/s10803-009-0801-9
Wright, K. P. (2013). Cognitive behavioural therapy for anxiety in a man with autism spectrum disorder,
intellectual disability, and social phobia. Advances in Mental Health and Intellectual Disabilities, 7(5),
284-292. doi: 10.1108/AMHID-06-2013-0040
Interventions aiming to reduce anxiety among adolescents and adults with ASD (presented in alphabetical order)
Author, Year
Country
Methods
N
Age
Outcome reported
Quality
Assessment Score
Out of 28
Cardaciatto & Herbert
2004
USA
14 weeks of individual Cognitive Behavioural Therapy (CBT)
N = 1 (male)
23 years
Consistently reported decreases in social anxiety and
depression throughout course of treatment
Freitag et al.
2013
Germany
Randomised controlled trial
N = 220
--
Study protocol only
Kiep et al.
2014
The
Netherlands
Pre-post intervention – Mindfulness-based therapy
N = 50 (16
female)
Males
(mean =
42.1
years);
Females
(mean =
37.9
years)
Significant positive effects of intervention following
completion of treatment, and carried through over 9
weeks after completing treatment
Langdon et al.
2013
UK
Study protocol - randomised, single-blind cross over trial. 24
weekly, 1 hour sessions
N = 36
16–65
years
Study protocol only
N = 32 (9
female)
15–25
years
Participants who were initially symptomatic reported
significantly lower depression and stress scores on
the DASS in comparison to waitlist. There was no
significant change in anxiety-related symptoms. The
benefits were maintained at 3 and 9 month followup.
18
N = 2, male
(Alfie 14 years;
Alfie – no change in parental or self-report measures
in terms of stress and anxiety. Still met criteria for
Generalised Anxiety Disorder (GAD)
11
12-highly structured, manualised, weekly group-based social skills
training
5 training groups, 9 weekly sessions of 2½ hours duration
8
Study protocol
only
19
Study protocol
only
Initially 3 one-to-one sessions followed by 21 group CBT sessions
McGillivray & Evert
2014
Australia
Quasi-experimental design - according to alternate order of
enrolment, the participants were allocated either to treatment
group or waitlist control
Think well, feel well, be well program, over 9 weeks, 2 hour
duration
Ozsivadjian & Knott
2011
UK
Case series
Standard CBT treatment, adapted to take into account of the
neuropsychological features of ASD
Reaven et al.
2012
USA
Quasi-experimental design
Russell et al.
2013
UK
Spek et al.
2013
The
Netherlands
Randomised controlled trial
Weiss & Lunsky
2010
Canada
Case series
White et al.
2009
USA
David –
15 years)
David – OCD behaviour reduced and returned upon
mutual termination of therapy
N = 24
13–18
years
Significant reductions in anxiety severity and
interference post-treatment, with low rates of
anxiety maintained at 3-month follow-up
18
N = 46
14–65
years
Both treatments produced a significant reduction in
OCD symptoms
22
N = 42
18–65
years
Significant reduction in depression, anxiety, and
rumination in the intervention group
23
N = 3 (1 female)
18–60
years
The 12 week group demonstrated promise in
addressing symptoms of anxiety
15
N = 2 (1 female)
(Todd -14
years;
Jodi – 14
years)
Todd – no longer met diagnostic criteria for Social
Phobia. At 6-month follow-up Social Phobia
remained non-clinical
16
N = 30
12–17
years
Decline in anxiety symptoms, but was not
statistically significant
21
N = 1 (male)
19 years
Step-wise reduction in anxiety for participant
16
Facing Your Fears - Adolescent Version: 14, 90 minute sessions,
conducted with parents in large and small group formats
Randomised controlled trial
CBT for OCD or anxiety management (control group)
Modified Mindfulness-based Therapy) protocol: 9 weekly sessions
of 2½ hours duration. Participants were instructed to practice 4060 minutes of meditation daily, six days a week
12 weekly, 1 hour sessions based on the structure and information
provided in the Mind over Mood workbook
Case series
Multi-component Integrated Treatment - manual-based
intervention targeting anxiety and social competence
White et al.
2013
USA
Wright
2013
UK
Randomised controlled trial
14-week intervention – individual therapy (up to 13 sessions),
group therapy (skills practice, 7 sessions), and parent education
and coaching (after each individual session)
A-B single case design – baseline assessment (A), and intervention
phase (B)
Jodi – Based on father’s report at 6-month follow-up,
continued to demonstrate significantly less
impairment due to anxiety