Internet Delivered CBT for OCD in Adolescents With ASD - A Clinical Case Series

Study Overview
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Brief Summary
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The aim of this study is to test the feasibility and acceptability of an internet-delivered cognitive behavior therapy (ICBT) intervention originally developed for neurotypical adolescents with obsessive compulsive disorder (OCD) in adolescents with OCD and autism spectrum disorder (ASD). This feasibility study will inform us how to adapt the original intervention to the specific needs of patients with ASD.

Detailed Description
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To evaluate the effectiveness of ICBT for OCD in adolescents with ASD, this study will use a single case experimental design with weekly measures during two phases: A-B. The A-phase will consist of baseline measures at least three weeks prior to treatment. The B-phase will consist of the 12 weeks ICBT-program as well as one measure post-treatment. Single case descriptions of each participant will be presented. Weekly measures on the Obsessional Compulsive Inventory - Child version (OCI-CV) will be analyzed through visual inspection of each participants graph and through computation of Percentage of Non-overlapping Data (PND). PND is a frequently used effect measure in SCED and reflects how large percentage of the measurements during the treatment-phase that do not overlap with any of the measurements during the base-line phase. To assess the feasibility and comprehension of the ICBT treatment semi-structured interviews (face-to-face or telephone) will be conducted with participants and parents weekly during the four first weeks of ICBT and semi-weekly during the rest of the treatment. Detailed notes will be taken during each interview and will serve as content material for a thematic analysis trying to determine possible accommodations to the ICBT protocol to better suit patients with ASD.

Official Title
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Internet Delivered Cognitive Behavior Therapy for Obsessive-compulsive Disorder in Adolescents With Autism Spectrum Disorder - A Clinical Case Series

Conditions
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Obsessive Compulsive Disorder, Autism Spectrum Disorder

Intervention / Treatment
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* Behavioral: Internet-delivered Cognitive Behavior Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: a diagnosis of OCD as defined by DSM-5 [40] a diagnosis of autism defined by DSM-5 a total score of ≥ 16 on the Children's Yale-Brown Obsessive-Compulsive Scale, CY-BOCS [14] age between 12 and 17 years ability to read and write Swedish access to the internet a parent that is able to co-participate in the treatment Participants on psychotropic medication must have been on a stable dose for the last 6 weeks prior to baseline assessment Exclusion Criteria: psychosis or bipolar disorder, severe eating disorder suicidal ideation subject not able to read or understand the basics of the ICBT material completed CBT for OCD within last 12 months (defined as at least 5 sessions of CBT including exposure and response prevention) ongoing psychological treatment for OCD or another anxiety disorder

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Internet-delivered CBT<br>12 weeks of internet-delivered cognitive behavior therapy provided through a secure internet platform and online clinician contact | Behavioral: Internet-delivered Cognitive Behavior Therapy<br>* The treatment consists of standard cognitive behavior therapy for obsessive-compulsive disorder and is delivered via an internet platform and regular therapist contact several times per week via email and telephone. The treatment is 12 weeks. Both parents and adolescents are involved in treatment. Parents will also receive three lectures on 1, Autism spectrum disorder, 2, CBT and functional analysis and 3, Parental strategies<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Obsessional Compulsive Inventory - Child version, OCI-CV | Self-rated OCD symptom levels | Change from baseline to 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Children's Yale Brown Obsessive Compulsive Scale | Clinician-rated OCD symptom levels | Change from baseline to 12 weeks | 
| Mini International Neuropsychiatric Interview for Children and Adolescents, MINI-KID | psychiatric screening of comorbidity | Baseline | 
| Clinical Global Impression - Severity, CGI-S | Global symptom levels | Change from baseline to 12 weeks | 
| Clinical Global Impression - Improvement, CGI-I | Global symptom improvement | Post treatment(12 weeks) | 
| Children's Global Assessment Scale, CGAS | Global level of functioning | Change from baseline to 12 weeks | 
| Children´s Depression Inventory - Short version | Symptom level of depressive mood | Change from baseline to 12 weeks | 
| Strength and difficulties, SDQ | General psychopathology | Change from baseline to 12 weeks | 
| Family Accommodation Scale, Parent-Report, FAS-PR | Parental accommodation to OCD symptoms | Change from baseline to 12 weeks | 
| Patient ICBT Adherence Rating, PIAR | Patient Adherence to internet delivered CBT | after 6 weeks and at post treatment(12 weeks) | 
| Education, Work and Social Adjustment Scale - child and parent version, EWSAS | Global functioning | Change from baseline to 12 weeks |