Treating Anxiety and Depression in Patients with Autism Spectrum Disorder

Saturday, April 7: 1:30 PM  - 3:00 PM 
159C 
Symposium 
Mezzanine Level 
Room: Harding 
Credits: 1.5 
Children with Autism Spectrum Disorder display higher rates of anxiety and depression compared to community samples. However, making an accurate diagnosis is often challenging as there is considerable overlap between the symptoms of ASD and anxiety and depression disorders. It is therefore, imperative for clinicians to be aware of the behavior manifestations of anxiety and depression when working with children and adolescents with ASD. It also useful for clinicians to be informed of the standardized assessments that are used to make an accurate ASD diagnosis, such as the ADOS-2. By learning how to make an accurate diagnosis in this population, audience members will be able to make a more effective treatment plan. When working with individuals with ASD and comorbid anxiety and depression it is imperative to not only treat the anxiety and depressive symptoms, but also treat the social skills deficits. Speakers will present on data from social skills curriculum created at the Seaver Autism Center (Seaver NETT and J.O.B.S.S) which included emotion regulation lessons in addition to social skills lessons, such as nonverbal communication and theory of mind. Presenters will also discuss current research on evidence based behavioral treatments for children and adolescents with ASD and comorobid anxiety and depression. This symposium will highlight the modifications that clinicians will need to make to their existing treatment protocols when working with individuals with comorobid ASD. These modifications include using restricted interests to increase motivation, utilizing more visual supports, and making abstract concepts more concrete. Psychotropic medications play a critical role when treating anxiety and depression in children and adolescents with ASD. This symposium will include current evidence based medication treatments for children with ASD. Speakers will also include clinical case vignettes to highlight some of the pitfalls when working with this population as well as some of the strategies that can be implemented to overcome treatment barriers. A clinical researcher will be the discussant and together with the clinicians will discuss novel interventions and how they can inform clinical practice.

Learning Objectives

1. To become familiar with evidenced-based pharmacological treatments in the management of autism spectrum disorder and anxiety and depression.
2. At the end of this session participants will be able to modify already existing CBT treatments for anxiety and depression when working with patients with comorobid ASD.
3. Participants will be better able to make a differential diagnosis of anxiety and depression when working with patients with ASD 

Chair

Michelle Gorenstein-Holtzman, PsyD, Seaver Autism Center

Discussant

Lance Clawson, PhD, Georgetown University

Audience Level

Introductory

Demographic

Children & Adolescents

Diversity/Content

Diversity - No

Duration

90 minutes

Disorder

Autism Spectrum Disorders

Treatment Approach

CBT

Presentations

Evidenced-Based Pharmacological Treatments

Objective The goal of this presentation is to provide the audience with a broad overview of current trends in the pharmacological management of autism spectrum disorder (ASD) with a particular focus on anxiety and depression. Emphasis will be placed on using the existing evidence-base and employing a targeted symptom domain approach. Background ASD is a clinically heterogeneous neurodevelopmental disorder. Treatment response to pharmacological interventions often varies from patient to patient. Furthermore, each dimension may also have distinct neurobiological/genetic mechanism. Importantly, specific dimensions may be reliably identified and responsive to treatment. Anxiety and depression symptoms often present in the context of ASD. The challenge lies in identifying specific features that may be within the dimension of anxiety and/or a mood disorder. Methods Extensive review of the literature was performed to define core and associated symptoms that have been targeted as outcomes in clinical trials with medications. Results We will review in detail medications that have been used in individuals with autism to target core symptoms of social communication and repetitive behaviors, behavioral control and treatment of concurrent psychiatric disorders. The presentation will focus on providing information on the following families of medication: neuroleptics, mood stabilizers, serotonergic medications, stimulants, alpha agonists, norepinephrine reuptake inhibitors, and other pharmacological approaches including naltrexone, oxytocin, beta-blockers and nutritional supplements. Finally we will review the emerging role of pharmacogenetics when choosing a medication in the treatment of patients with ASD. Conclusion Psychopharmacological management of ASD has benefited from an increase in clinical research over the past decade. Targeting symptom domains is most likely to produce optimal outcomes, but the psychiatrist should carefully weigh the evidence-base and complexity of the clinical presentation against side effect profile when deciding on pharmacological treatments.  

Presenter

Pilar Trelles, M.D., Seaver Autism Center

Treating Anxiety and Depression in Patients with Autism Spectrum Disorder

Treating Anxiety and Depression in Individuals with Autism Spectrum Disorder- Diagnosis Diagnosing autism spectrum disorder (ASD) can be extremely difficult as currently, there are no medical tests to diagnose this disorder. Clinicians determine a diagnosis of ASD based on observation of a child's behavior and thorough assessment of developmental history. Evaluations are performed to elucidate the core and associated features and diagnostic comorbidity in ASD. Because ASD is a complex and heterogeneous disorder, the results of these evaluations are crucial to optimizing treatment outcomes. Clinicians with specialized training in ASD utilize an array of standardized assessments to clarify diagnosis, evaluate associated symptoms, and identify strengths and weaknesses in order to inform diagnoses and make appropriate treatment recommendations. Dr. Halpern will review gold-standard autism diagnostic assessments, including the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and the Autism Diagnostic Interview, Revised (ADI-R). Thus, ASD is a behavioral diagnosis and the foundation for its understanding and treatment lies in sound assessment and diagnosis. However, medical and psychiatric comorbidity often complicate the clinical picture. According to current research, nearly three-quarters of children with autism spectrum disorder (ASD) also have another medical or psychiatric condition. These include anxiety and depression. The majority of individuals with ASD present with symptoms of anxiety and many, especially those who are higher functioning and aware of their deficits, may present with symptoms of depression. Thus, this talk will also focus on understanding and clarifying autism diagnosis as well as comorbid symptoms and diagnoses.  

Presenter

Danielle Halpern, Psy.D., Seaver Autism Center

Treating Anxiety in Patients with Autism Spectrum Disorder

This presentation will focus on evidence-based treatments designed to address anxiety in children with autism spectrum disorder (ASD) in order to provide participants with sufficient knowledge to navigate options in approaching patient care. This talk will review current best practices in the treatment of ASD and anxiety and will give examples of how to utilize potential treatments through case vignettes. Principles of behavioral and cognitive-behavioral treatment, recent findings from relevant studies, and recommendations for integration into the educational plans of patients will be discussed as part of this presentation. We will discuss treatment protocols such as Facing Your Fears (Reaven, Blakeley-Smith, Nichols, & Hepburn, 2011), Multimodal Anxiety and Social Skills Intervention (White et al., 2013), and Coping Cat (Kendall & Hedtke, 2006), as well as simple modifications clinicians can make to already existing treatment approaches. Audience members will gain an understanding of the potential barriers to treatment and how to address these challenges within this population. This presentation will address current trends in the treatment of ASD and anxiety and best practices across the lifespan to address the diverse needs of affected individuals.  

Presenter

Lauren Donnelly, Ph.D., NYU Child Study Center

Treating Depression in Individuals with ASD: From Research to Clinical Practice ,  Handout (2) ,  Handout (3) ,  Handout (4)

Identifying depressive disorder in children and adolescents with ASD is challenging due to communication deficits as well as difficulty with expressing emotions. During the talk, audience members will learn how to identify depression in this population. It is imperative to make an accurate diagnosis, as untreated depression can lead to a worsening of ASD symptoms. This symposium will include data from two social skills curricula created at the Seaver Autism Center (Seaver N.E.T.T. and J.O.B.S.S) that focused on emotion regulation as well as other social skills. This talk will emphasize the importance of enhancing social skills while simultaneously targeting depression in this population using case vignettes. In addition, there will be a focus on current evidence based treatment protocols and strategies that a clinician can use when working with this population. 

Presenter

Michelle Gorenstein-Holtzman, PsyD, Seaver Autism Center