(see Poster Gallery) Cognitive-Behavioral Therapy for Youth with Intellectual and/or Developmental Disabilities: A Systematic Review

Background/Purpose: Youth with intellectual and/or developmental disabilities (I/DD) often struggle with depression and anxiety disorders which adversely impact their health across the life course. Despite disproportionate risk for mental health symptoms and its adverse sequelae, youth with I/DD are less likely to receive appropriate, evidence-based mental health treatment in comparison to typically developing youth. Interventions, such as cognitive behavioral therapy (CBT), can be effective when adapted to meet the needs of youth with I/DD. However, there is little understanding of the types of adaptations employed in CBT, nor guidance on implementation strategies for this population. The objectives of this systematic review are to describe: 1) types of CBT interventions tested for youth with I/DD (11-25 years) with co-morbid depressive or anxiety symptomatology; 2) adaptations to CBT interventions; 3) implementation strategies and/or outcomes; 4) efficacy of CBT on depression and anxiety outcomes.

Methods: A literature search of EMBASE, PubMed, PsycINFO and CINAHL databases was conducted by five reviewers using relevant terms. After citation tracking, 3070 were identified and of these, 18 met the inclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the process and reporting of this systematic review. Data were extracted from the articles and coded by independent reviewers.The reviewers and supervisors met regularly to review coding decisions and resolve inconsistencies.

Results: This systematic review identified 18 empirical studies that evaluated the efficacy of CBT interventions for youth with I/DD and co-morbid anxiety and/or depressive symptoms. Of the studies, 16 focused on youth with autism spectrum disorder (ASD), and two targeted youth with attention deficit hyperactivity disorder (ADHD). Study sample size ranged from 7-159 youth with a pooled sample size of N=594. The mean age of participants was 14.7 years and the majority identified as male (75%). The most commonly tested CBT interventions were Facing your Fears (n=3), Behavioral Interventions for Anxiety in Children with Autism (BIACA; n=4) and Multimodal Anxiety and Social Skill Intervention (MASSI; n=3). The remaining eight studies employed diverse CBT interventions. Commonly reported adaptations included modularized intervention delivery, visual supports, language adaptation, specific skills training, parent involvement and incorporation of youth interests. Implementation outcomes were inconsistently reported across studies and few focused on barriers or facilitators to implementation. Overall, CBT had positive impacts on youth mental health with only four studies reporting null findings.

Conclusion: Cognitive behavioral therapy is a promising therapeutic approach for youth with I/DD and co-morbid anxiety and/or depression. However, these findings largely pertain to youth with ASD, and may not generalize to youth with other types of I/DD. Additional studies on adaptations for youth with diverse types of I/DD are needed to extend access to CBT to a broader population of youth with disabilities. Finally, research on implementation outcomes among youth with I/DD is needed to enable replication of CBT interventions in community contexts.