Development and Pilot Testing of Transdiagnostic Exposure Therapy/Behavioral Activation for Autistic Adolescents With...

Internalizing disorders disproportionately affect autistic adolescents, though limited research has focused on tailoring therapy for this population. The purposes of this paper were (1) to describe the development of a transdiagnostic exposure therapy/behavioral activation intervention for autistic adolescents with internalizing disorders, and (2) to present a pilot test of feasibility, acceptability, and efficacy of the intervention. The development of this therapy is described in detail, which prioritized the following domains: (1) building on the existing evidence base of exposure-based cognitive behavioral therapy for autistic youth with anxiety disorders, (2) involving caregivers considerably, (3) incorporating autism-specific considerations into case conceptualization and treatment planning, (4) using a neurodiversity-affirming lens, (5) considering changes in therapy delivery for autistic adolescents, and (6) providing a conceptualization-driven, flexible, transdiagnostic framework to therapy. This adapted, exposure-therapy/behavioral activation approach was pilot tested with 14 adolescent-caregiver dyads, and showed strong acceptability and feasibility based on qualitative and quantitative data. The treatment response rate was 78% (11/14; based on the Clinical Global Impression-Improvement scale), and the primary diagnosis remission rate was 57% at the posttreatment assessment (8/14; based on the absence of the primary diagnosis assessed at baseline with a structured diagnostic interview), which benchmarks well on similar treatments that have been published in this literature among nonautistic youth. These pilot data provide a strong justification for a follow-up randomized trial testing efficacy and mechanisms.