CBT for anxiety in kids with autism meta-analysed

A short post today to bring the findings reported by Celal Perihan and colleagues [1] to your attention with regards to the use of cognitive behavioural therapy (CBT) for anxiety in the context of paediatric autism.

It was yet another case of authors meta-analysing (boiling down) the data from the existing research literature and coming to a conclusion. Twenty-odd studies reported on the use of CBT - talking therapy - for an important quality-of-life draining issue for many diagnosed on the autism spectrum: anxiety (see here and see here). Researchers concluded that CBT did seem to be associated with a reduction in some anxiety-linked symptoms/behaviours but things weren't altogether cut-and-dried on the usefulness of CBT in this context.

I wasn't surprised by these results. I've blogged before about how CBT for anxiety in the context of autism might be a useful option for some (see here). That being said, I'm not 100% in favour of CBT being used in this context. I say that because, as things stand, we don't know enough about why anxiety seems to be over-represented in relation to autism (see here). I've opined on various occasions that anxiety is probably a lot more than 'just a comorbidity' when it comes to some autism (see here). In that context, the use of CBT 'for anxiety' is a little bit like saying that CBT is being used 'for autism'. And the evidence for that is pretty unconvincing (see here).

If you really want to convince me that CBT is good for anxiety in the context of autism, try pitting CBT against some of the other non-psychology interventions that have been talked about for anxiety in relation to autism (see here). See what comes out on top rather than just looking at CBT vs. treatment-as-usual (whatever that means). Oh, and bear in mind that we still don't know enough about the presentation of anxiety in those on the autism spectrum who are perhaps not able to participate in CBT (see here)...

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[1] Perihan C. et al. Effects of Cognitive Behavioral Therapy for Reducing Anxiety in Children with High Functioning ASD: A Systematic Review and Meta-Analysis. J Autism Dev Disord. 2019. Feb 27.

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Buspirone for anxiety accompanying autism?

OK, before heading into the findings reported by Tolga Atilla Ceranoglu and colleagues [1] talking about the *potential* usefulness of the anxiolytic medicine called buspirone in the context of autism, I feel I should reiterate my oft-cited blogging caveat that no medical or clinical advice is given or intended. It's particularly important in this case because (a) anxiety accompanying autism is a really, really important issue (see here), and (b) I don't want anyone to assume that I'm giving any 'quick fix advice' on this topic. I'm not.

The Ceranoglu paper represents a "retrospective chart review" where the files of some 31 youth diagnosed with an autism spectrum disorder (ASD) who were treated with buspirone were analysed. We are told that: "Effectiveness was assessed through the Clinical Global Impressions Scale (CGI) severity (CGI-S) and improvement (CGI-I) scores noted by the treating clinician." The words 'high-functioning' are also used in the Ceranoglu paper; I assume to denote a cohort of young people who were verbal and had a good level of 'adaptive behaviour skills'. As I've said before, I'm not totally sold on the idea of 'high' and 'low' functioning in the context of autism but readily recognise that there are few alternative descriptions at present. The reliance on such a 'high-functioning' cohort probably also ties into other work with anxiety and autism in mind (see here).

Researchers report that use of buspirone "for an average duration of 272 ± 125 days" coincided with some important scores using the CGI. So: "Significant improvement in anxiety symptoms... was observed in 58% and mild improvement... in 29% of the HF-ASD patients who received buspirone treatment." The important issue of adverse side-effects is also covered in the Ceranoglu paper as we are told that: "Buspirone was well tolerated with no adverse events reported by the majority of participants, with the exception of two subjects who developed treatment emergent adverse events (activation and mood lability)."

A quick trawl of the available peer-reviewed literature on the topic of buspirone and autism reveals that there's quite a bit of history (see here). Anxiety is already part-and-parcel of that research history, in line with the clinical indication for buspirone, but I also note other studies [2] talking about its possible usefulness in the context of other, more traditionally core autistic behaviours too.

Insofar as the question of 'where next?' for buspirone and anxiety and autism, well, Ceranoglu et al also provide an answer: "Further research with prospective and randomized-controlled trials is necessary." I agree with this on the basis that, whilst we know that anxiety is very much over-represented when it comes to autism, conversations need to turn to what can be done about such a quality-of-life-draining issue, on the basis that clinically indicated 'talk therapy' may not be right for everyone (see here)...

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[1] Ceranoglu TA. et al. A Retrospective Chart Review of Buspirone for the Treatment of Anxiety in Psychiatrically Referred Youth with High-Functioning Autism Spectrum Disorder. J Child Adolesc Psychopharmacol. 2018 Nov 16.

[2] Chugani DC. et al. Efficacy of Low-Dose Buspirone for Restricted and Repetitive Behavior in Young Children with Autism Spectrum Disorder: A Randomized Trial. J Pediatr. 2016 Mar;170:45-53.e1-4.

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