Behavior Therapy for Irritability and Aggression in Adolescents with Autism
Abstract
Approximately half of children and adolescents on the autism spectrum experience challenging behaviors such as irritability and aggression that interfere with the child’s life and functioning. Aggressive behavior is of particular concern because it poses a risk of injury, and it is also a leading cause of exclusion from educational services, referral for mental health services, and even psychiatric hospitalization. Currently available treatments for aggressive behavior in individuals on the autism spectrum include psychiatric medications that can have significant side effects and parent training that is based on applied behavioral analyses and has been studied only in young children. Strikingly, no behavioral or psychological interventions are available for adolescents on the autism spectrum who continue to experience clinically significant levels of irritability and disruptive behavior. To address this gap in available treatments, we developed a novel intervention that we call Behavioral Therapy for Irritability and Aggression (BTIA) for adolescents on the autism spectrum. The main goals of BTIA are to help adolescents develop emotion regulation skills to handle frustration and to strengthen skills for navigating the challenging and diverse experiences associated with the transition to adulthood. The proposed study will test whether BTIA can be helpful to adolescents on the autism spectrum and to their families. This application addresses key Areas of Interest in the Fiscal Year 2019 Autism Research Program Clinical Trials Award, including (1) testing a novel behavioral intervention, (2) alleviating irritability and aggression co-occurring with autism spectrum disorder (ASD), and (3) improving adaptive behavior required for a successful transition from adolescence to adulthood. Specifically, we will conduct a randomized controlled study of BTIA versus a supportive therapy control condition in 126 adolescents (aged 12 to 18 years) with a diagnosis of autism and significant levels of disruptive behaviors such as aggression, anger outbursts, and oppositional behavior. BTIA consists of 15 90-minute weekly sessions that will be conducted with the teens and their parents by experienced therapists using a structured, detailed manual. During treatment, adolescents will learn emotion regulation and problem-solving strategies for managing frustration, and parents will learn practical skills for coaching their children to acquire emotional resilience in potentially frustrating situations. BTIA also includes a module for prevention of behavioral difficulties in school in order to optimize the opportunities for increasing a child’s engagement with social and academic goals. The effects of BTIA on the reduction of behavioral problems will be rated by an experienced clinician who does not know which treatment each participant is receiving (a “blinded” evaluator). Study participants will receive a thorough diagnostic assessment of autism spectrum disorder and other forms of psychopathology that may co-occur with ASD. We will also conduct a detailed evaluation of language and cognitive abilities to make sure that BTIA can be useful to adolescents with a wide range of abilities. In addition to testing the effects of BTIA on disruptive behavior, we will examine the changes in adaptive functioning, or children’s ability to function competently in their everyday environment, before and after treatment. Studies show that aggression contributes to the tendency for children on the autism spectrum to demonstrate everyday skills below where would be expected based on their cognitive ability and that aggressive behavior can interfere with multiple aspects of a child’s life. For example, aggressive behavior can result in peer rejection and exclusion from socialization opportunities and contribute to continuing social challenges. Difficulty getting along with others, maintaining friendships, and managing diverse interperson
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010718
Entities
People
- Denis G. Sukhodolsky
Organizations
- United States Army
- Yale University