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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

Published online by Cambridge University Press:  21 November 2022

Robert H. Wichers Open the ORCID record for Robert H. Wichers [Opens in a new window] ,
Lisa C. van der Wouw ,
Marlies E. Brouwer ,
Anja Lok  and
Claudi L. H. Bockting
Robert H. Wichers*
Affiliation:
Amsterdam UMC - Locatie AMC: Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
Lisa C. van der Wouw
Affiliation:
Amsterdam UMC - Locatie AMC: Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
Marlies E. Brouwer
Affiliation:
Amsterdam UMC - Locatie AMC: Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
Anja Lok
Affiliation:
Amsterdam UMC - Locatie AMC: Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
Claudi L. H. Bockting
Affiliation:
Amsterdam UMC - Locatie AMC: Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
*
Author for correspondence: Robert H. Wichers, E-mail: r.wichers@amsterdamumc.nl
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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.

Keywords

Autism spectrum disordercomorbidityanxietydepressionpsychotherapycognitive behavioural therapysocial skills trainingsystematic reviewmeta-analysis
Type
Review Article
Information
Psychological Medicine , Volume 53 , Issue 1 , January 2023 , pp. 17 - 33
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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