How Effective is Modified CBT for Adolescents with OCD and Autism?

What you need to know

• A modified CBT program for adolescents with both OCD and autism showed significant reductions in OCD symptoms
• About half of participants were treatment responders, with improvements maintained at 3-month follow-up
• The extended 20-session format provided additional benefit compared to standard 14-session CBT
• Participants and families reported high satisfaction with the autism-specific adaptations to the treatment

Background on OCD and Autism

Obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) often occur together in young people. OCD involves intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels driven to perform. ASD is characterized by difficulties with social communication and interaction, as well as restricted and repetitive patterns of behavior or interests.

When a person has both OCD and ASD, it can make treatment more challenging. Standard cognitive-behavioral therapy (CBT) for OCD is typically less effective for those who also have autism. This study evaluated a new CBT program specifically adapted for adolescents with both OCD and autism to see if it could lead to better outcomes.

About the Modified CBT Program

The treatment program evaluated in this study was based on standard CBT for OCD but included several modifications to make it more suitable for young people with autism:

• Extended from 14 to 20 weekly sessions
• Longer psychoeducation phase (up to 6 sessions instead of 2)
• Highly structured session content with visual aids and schedules
• Incorporation of special interests where possible
• More parental involvement
• Sessions to understand differences between OCD and autism-related behaviors
• Simplified language and concepts
• Practice generalizing skills learned in therapy to real-life situations

The goal was to provide the core components of CBT for OCD while adapting the delivery to match the cognitive and developmental needs of autistic adolescents.

Study Design and Participants

The study included 34 adolescents (average age 15) who had both OCD and autism. Most were boys (68%) and had moderate to severe OCD symptoms at the start. On average, their OCD had started around age 11.

Importantly, 91% were already on medication for OCD, and 74% had previously tried some form of CBT - so this was a group that had not fully responded to standard treatments. The study took place at a specialized OCD clinic in London.

Participants received the 20-session modified CBT program. They were assessed for OCD symptoms and other outcomes at the start of treatment, midway through (sessions 7 and 14), at the end of treatment, and at a 3-month follow-up appointment.

Key Findings

OCD Symptom Improvement

The study found significant reductions in OCD symptoms over the course of treatment:

• By the end of treatment, OCD severity scores decreased by an average of 11 points on a standard rating scale (the Children’s Yale-Brown Obsessive Compulsive Scale or CY-BOCS).
• 51.5% of participants were classified as treatment responders, meaning they had at least a 35% reduction in OCD symptoms.
• 21.2% reached remission, defined as having minimal OCD symptoms.
• Improvements were maintained at the 3-month follow-up, with 52.9% responders and 35.3% in remission.

Benefits of Extended Treatment

An important finding was that OCD symptoms continued to improve in the latter half of treatment:

• There was a significant 5-point reduction in OCD scores between session 14 and the end of treatment at session 20.
• This suggests the extended 20-session format provided additional benefit beyond a standard 14-session CBT program.

Other Areas of Improvement

In addition to OCD symptoms, the study found improvements in:

• Family accommodation (how much families change routines or participate in OCD rituals)
• Overall functioning and quality of life
• Some autism-related repetitive behaviors, though this was not a primary target of treatment

Participant Satisfaction

Adolescents and parents reported high satisfaction with the treatment:

• Over 80% were happy or very happy with the program overall
• Most found the autism-specific adaptations helpful, including visual aids, sessions on distinguishing OCD from autism, and increased parent involvement

Conclusions

• The adapted CBT program shows promise for improving OCD symptoms in autistic adolescents who have not fully responded to standard treatments
• Extending treatment to 20 sessions appears to provide additional benefit beyond typical 14-session CBT
• Autism-specific modifications were well-received by participants and may contribute to better engagement and outcomes
• More research is needed to directly compare this approach to standard CBT and test it in different clinical settings

While this study had some limitations, including a small sample size and lack of control group, it provides encouraging evidence for an adapted CBT approach for this population. The findings suggest that tailoring OCD treatment to the needs of autistic adolescents may lead to better outcomes. Future studies can build on this work to further refine and evaluate autism-adapted CBT programs for OCD.