Facing Your Fears in autistic youth with co-occurring psychiatric conditions: Reductions in symptoms of anxiety and depression

Autistic youth often experience psychiatric complexity, with up to 70 % of youth experiencing at least one mental health issue, and as many as 41 % experiencing two or more issues simultaneously, or complex psychiatric comorbidity. Adapted cognitive behaviour therapy (CBT) for anxiety is effective in reducing anxiety symptoms in autistic youth who have multiple anxiety conditions, as well as other psychiatric conditions (e.g., attention deficit hyperactivity disorder; ADHD). However, few studies have examined the secondary impact of CBT for anxiety on depressive symptoms, despite the high prevalence of depression in autistic youth. Additionally, it is unknown how psychiatric complexity may impact, or moderate, autistic youth’s response to treatment. Fifty-one autistic youth (8–13 years old) participated in an adapted CBT intervention for anxiety (Facing Your Fears). Participants were categorized into one of three groups of increasing psychiatric complexity (Anxiety only; Anxiety + ADHD; and Anxiety + other mental health conditions). Paired sample t-tests and linear mixed models highlighted that autistic youth generally benefitted from CBT for anxiety, as seen in reductions of anxiety and depressive symptoms. Caregivers of youth in all diagnostic groups reported a significant reduction in anxiety symptoms and depression at post-treatment; however, only youth in the Anxiety only group, or those with less psychiatric complexity, reported a reduction in anxiety. Autistic youth did not report any changes in depressive symptoms, regardless of psychiatric complexity. Further study is needed to determine if symptom reductions continue overtime, and whether participating in adapted CBT for anxiety is associated with reductions in other mental health symptoms. • Adapted cognitive-behavioural interventions, such as Facing Your Fears (FYF), are effective in reducing anxiety in autistic youth; however, it is unknown if these interventions impact depressive symptoms. • Here, we 1) investigated how participating in FYF impacts anxiety and depressive symptoms and 2) examined how the degree of psychiatric complexity may moderate this association in autistic youth (8-13 years of age; n=51). • According to caregivers, autistic youth generally benefited from participating in FYF, as seen by a reduction of anxiety and depressive symptoms, regardless of psychiatric complexity. • Only autistic youth with less psychiatric complexity (i.e., anxiety only) reported a reduction in anxiety from pre- to post-treatment, and autistic youth did not report any changes in depression, regardless of psychiatric complexity. • These findings highlight that transdiagnostic approaches may be especially beneficial in supporting the mental health needs of autistic youth.