The Impact of Comorbidity on Cognitive-Behavioral Therapy Response in Youth with Anxiety and Autism Spectrum Disorder

Nicole M. McBride, Saira A. Weinzimmer, Valérie La Buissonnière-Ariza, Sophie C. Schneider, Jill Ehrenreich May, Adam B. Lewin, Joseph F. McGuire, Wayne K. Goodman, Jeffrey J. Wood, Eric A. Storch

Research output: Contribution to journalArticlepeer-review


The impact of externalizing comorbidity on treatment outcome was examined in 104 youth ages 7–16 (M = 11.09 years) with autism spectrum disorder and primary anxiety/obsessive compulsive disorder who completed modular cognitive behavioral therapy (CBT) for anxiety/OCD. Three comorbidity profiles were utilized for group comparisons: participants with oppositional defiant or conduct disorder with attention-deficit hyperactivity disorder (ODD; CD; ADHD; group EXT, n = 25); those without ODD/CD and only ADHD (group ADHD, n = 46); and those without externalizing comorbidity (NO-EXT, n = 33). Post-treatment outcomes were measured continuously (Pediatric Anxiety Rating Scale, Clinical Global Impression-Severity) and categorically (treatment response, remission). The ADHD group was four times more likely of being a treatment responder compared to NO-EXT (OR 4.05). Comorbidity group did not impact remission. After controlling for pre-treatment scores, there was a significantly greater reduction of the CGI-S for ADHD versus NO-EXT and EXT versus NO-EXT, but results did not significantly differ for the PARS. Results suggest that a modular CBT approach yields positive impact for treatment outcomes in youth with comorbid externalizing problems, particularly among those with comorbid ADHD.

Original languageEnglish (US)
Pages (from-to)625-635
Number of pages11
JournalChild Psychiatry and Human Development
Issue number4
StatePublished - Aug 1 2020


  • Anxiety disorders
  • Autism spectrum disorder
  • Cognitive-behavioral therapy
  • Externalizing disorders
  • Obsessive–compulsive disorder

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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