Emotion awareness and cognitive behavioural therapy in young people with autism spectrum disorder.
Cara Roberts-Collins, Gerwyn Mahoney-Davies, Ailsa Russell and 2 others
PMID 28750544WHAT IT FOUND
Young people with autism scored lower than matched controls on telling, describing, and analysing emotions.
In the autism groups, overall scores did not differ between CBT and no CBT, but the CBT group scored lower on telling emotions apart and higher on attending to others.
Key findings
01Participants with ASD scored lower overall on the emotion awareness questionnaire than matched typically developing participants.
02The ASD group scored lower on differentiating emotions, verbal sharing of emotions, attending to others' emotions, and analyses of own emotions, with no difference on not hiding emotions or bodily awareness.
03Within ASD, overall emotion awareness did not differ between those who had attended CBT and those who had not, but the CBT group scored lower on differentiating emotions and higher on attending to others' emotions, with no difference on the other subscales.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The young people had attended many different services, and CBT was not part of a systematic protocol or manualised intervention, so the study cannot attribute differences to a defined therapy. Before and after treatment symptom changes were not possible because services used different routine outcome measures, and emotion awareness was measured after treatment rather than before and after. Thirteen young people with ASD who disclosed prior CBT were included in the CBT group after recruitment and had incomplete self and clinician outcome data. Only 20 of 35 young people attending CBT at CAMHS consented, and clinicians may have selected those who responded well or were doing proper CBT. Participants had to contact the researcher, so they may have been more motivated and possibly more engaged in CBT. The study did not measure or control for cognitive ability, symptom severity, medication, number of CBT sessions, therapeutic alliance, or therapist factors. ASD diagnoses were made by local teams and verified by school or parent, not by standardised diagnostic assessment. The Emotion Awareness Questionnaire-30 was developed for ages 9 to 16 years but was used with participants up to age 20 years, so interpretation needs care. The study did not directly measure anxiety or depression, so emotional disorder status was inferred from referral for CBT. The comparison within ASD was small, with 33 in the CBT group and 23 without CBT, and the overall difference was not significant.
Declared interests
The paper reports that Dr Loades was funded by the National Institute for Health Research under Doctoral Research Fellowship DRF-2016-09-021. It does not report other conflicts of interest.
The easy way to misread this
Do not read the lower emotion awareness scores in the CBT group as evidence that CBT worsened emotion awareness. The study did not measure emotion awareness before and after CBT, the CBT was not standardised, and the overall emotion awareness scores did not differ between the CBT and no CBT groups.