Thérapie cognitivo-comportementale de groupe pour la dépression chez les jeunes autistes, guidée par la communauté et adaptée à l'autisme (CBT-DAY) : faisabilité, acceptabilité et efficacité préliminaires

Titre original en anglais : Community-guided, autism-adapted group cognitive behavioral therapy for depression in autistic youth (CBT-DAY): Preliminary feasibility, acceptability, and efficacy

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Schwartzman, J. M., Roth, M. C., Paterson, A. V., Jacobs, A. X., & Williams, Z. J. (2023). Community-guided, autism-adapted group cognitive behavioral therapy for depression in autistic youth (CBT-DAY): Preliminary feasibility, acceptability, and efficacy. Autism, 28(8), 1902-1918. https://doi.org/10.1177/13623613231213543

Date de publication: 27/11/2023 Ajout dans AutiHub: 07/07/2026 Type: Article Langue de l’article: Anglais
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Auteurs

Auteur·ices des publications
5
Auteur·ices de la publication identifié·es comme autistes
1 / 5 (20,0 %)
  1. Jessica M. Schwartzman
  2. Marissa C. Roth
  3. Ann V. Paterson
  4. Alexandra X Jacobs
  5. Zachary J. Williams *

Résumé

Cette étude a examiné la faisabilité, l'acceptabilité et l'efficacité préliminaires d'une thérapie cognitivo-comportementale adaptée à l'autisme pour la dépression chez les jeunes autistes, CBT-DAY. Vingt-quatre jeunes autistes (âgés de 11 à 17 ans) ont participé à l'essai pilote non randomisé, dont 5 filles cisgenres, 14 garçons cisgenres et 5 jeunes non binaires. Les jeunes ont participé à 12 semaines de CBT-DAY, et leurs symptômes dépressifs (c'est-à-dire le principal critère clinique) ainsi que leur réactivité émotionnelle et leur estime de soi (c'est-à-dire les mécanismes de l'intervention) ont été évalués par auto-évaluation et par évaluation des personnes qui s'en occupent à quatre moments : au départ (semaine 0), à mi-parcours (semaine 6), après le traitement (semaine 12) et au suivi (semaine 24). Les résultats suggèrent que CBT-DAY pourrait être faisable (16,67 % d'attrition) dans un contexte ambulatoire et acceptable pour les adolescents et les personnes qui s'en occupent. Les modèles bayésiens linéaires à effets mixtes ont montré que CBT-DAY pourrait être efficace pour cibler la réactivité émotionnelle [β T1-T3 = −2.53, CrI 95% (−4.62, −0.58), P d = 0.995, d = −0.35] et l'estime de soi [β T1-T3 = −3.57, CrI 95% (−5.17, −2.00), P d > 0.999, d = −0.47], ainsi que la sévérité des symptômes dépressifs chez les jeunes [β = −2.72, CrI 95% (−3.85, −1.63), P d > 0.999]. Les bénéfices du traitement ont été maintenus au suivi. Une thérapie cognitivo-comportementale de groupe conçue pour et avec des personnes autistes est prometteuse pour cibler la réactivité émotionnelle et l'estime de soi afin d'améliorer la sévérité des symptômes dépressifs chez les jeunes. Les résultats peuvent être utilisés pour mettre en œuvre des essais plus vastes et mieux contrôlés de CBT-DAY. L'essai a été enregistré sur Clinicaltrials.gov (identifiant : NCT05430022 ; https://beta.clinicaltrials.gov/study/NCT05430022 ). Résumé grand public La dépression chez les jeunes constitue un problème important de santé publique dans le monde entier, en particulier chez les jeunes autistes, qui sont plus de deux fois plus susceptibles de souffrir de dépression que leurs pairs non autistes. Bien que les voies menant à la dépression soient complexes, la réactivité émotionnelle et une estime de soi négative sont deux facteurs de risque de dépression chez les jeunes autistes et non autistes. Bien que les jeunes autistes soient plus susceptibles de souffrir de dépression que leurs pairs non autistes, les options de psychothérapie pour les jeunes autistes sont très limitées ; l'orientation de la communauté dans l'élaboration et l'évaluation de programmes de psychothérapie est une approche prometteuse dans l'autisme. Par conséquent, dans cette étude, nous avons conçu une CBT-DAY adaptée à l'autisme, en collaboration avec des membres de la communauté autiste. Plus précisément, CBT-DAY a combiné des approches affirmant la neurodiversité et cognitivo-comportementales afin de cibler la réactivité émotionnelle et l'estime de soi chez les jeunes pour améliorer la sévérité des symptômes dépressifs dans un contexte de groupe sur 12 semaines. Nous avons examiné la faisabilité, l'acceptabilité et l'efficacité préliminaires de CBT-DAY dans un essai pilote non randomisé. En outre, nous avons mis en œuvre un protocole rigoureux pour évaluer, surveiller et traiter les préjudices potentiels liés à cette intervention. Les résultats obtenus auprès de 24 jeunes autistes (âgés de 11 à 17 ans) suggèrent que CBT-DAY pourrait être faisable à utiliser dans un contexte clinique ambulatoire et généralement acceptable pour les jeunes et les personnes qui s'en occupent. La participation à CBT-DAY pourrait être associée à des améliorations significatives de la réactivité émotionnelle et de l'estime de soi des jeunes, ainsi que de la sévérité des symptômes dépressifs selon l'auto-évaluation uniquement. Des analyses exploratoires ont montré que la participation à CBT-DAY pourrait également être associée à des améliorations significatives des symptômes internalisés. Les résultats démontrent le potentiel prometteur des approches affirmant la neurodiversité et cognitivo-comportementales pour traiter les symptômes dépressifs chez certains jeunes autistes.

This study examined the preliminary feasibility, acceptability, and efficacy of an autism-adapted cognitive behavioral therapy for depression in autistic youth, CBT-DAY. Twenty-four autistic youth (11–17 years old) participated in the pilot non-randomized trial including 5 cisgender females, 14 cisgender males, and 5 non-binary youth. Youth participated in 12 weeks of, CBT-DAY and youth depressive symptoms (i.e., primary clinical outcome) and emotional reactivity and self-esteem (i.e., intervention mechanisms) were assessed through self-report and caregiver report at four timepoints: baseline (week 0), midpoint (week 6), post-treatment (week 12), and follow-up (week 24). Results suggested that CBT-DAY may be feasible (16.67% attrition) in an outpatient setting and acceptable to adolescents and their caregivers. Bayesian linear mixed-effects models showed that CBT-DAY may be efficacious in targeting emotional reactivity [β T1-T3 = −2.53, CrI 95% (−4.62, −0.58), P d = 0.995, d = −0.35] and self-esteem [β T1-T3 = −3.57, CrI 95% (−5.17, −2.00), P d > 0.999, d = −0.47], as well as youth depressive symptom severity [β = −2.72, CrI 95% (−3.85, −1.63), P d > 0.999]. Treatment gains were maintained at follow-up. A cognitive behavioral group therapy designed for and with autistic people demonstrates promise in targeting emotional reactivity and self-esteem to improve depressive symptom severity in youth. Findings can be leveraged to implement larger, more controlled trials of CBT-DAY. The trial was registered at Clinicaltrials.gov (Identifier: NCT05430022; https://beta.clinicaltrials.gov/study/NCT05430022 ). Lay Abstract Depression in youth is a significant public health problem worldwide, particularly for autistic youth who are over twice as likely to experience depression than their non-autistic peers. Although pathways to depression are complex, emotional reactivity and negative self-esteem are two risk factors for depression in autistic and non-autistic youth. Although autistic youth are more likely to experience depression than their non-autistic peers, psychotherapy options for autistic youth are very limited; community guidance in the development and testing of psychotherapy programs is a promising approach in autism. Therefore, in this study, we designed an autism-adapted CBT-DAY, in collaboration with autistic community members. Specifically, CBT-DAY combined neurodiversity-affirming and cognitive behavioral approaches to target emotional reactivity and self-esteem in youth to improve depressive symptom severity in a group setting across 12 weeks. We examined the preliminary feasibility, acceptability, and efficacy of CBT-DAY in a pilot non-randomized trial. In addition, we implemented a rigorous protocol for assessing, monitoring, and addressing potential harms in this intervention. Results from 24 autistic youth (11–17 years old) suggest that CBT-DAY may be feasible to use in an outpatient clinical setting and generally acceptable to youth and their caregivers. Participation in CBT-DAY may be associated with significant improvements in youth emotional reactivity and self-esteem, as well as depressive symptom severity per self-report only. Exploratory analyses showed that participation in CBT-DAY may also be associated with significant improvements in internalizing symptoms. Findings demonstrate the potential promise of neurodiversity-affirming and cognitive behavioral approaches to treating depressive symptoms in some autistic youth.

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Références citées
71
Nombre total de références citées intégrées pour cette publication.
Références citées avec un·e auteur·ice identifié·e comme autiste
5 / 71 (7,0 %)
Occurrences d’auteur·ices cité·es identifié·es comme autistes
7 / 274 (2,6 %)
Parmi les occurrences rattachées à des auteurices intégré·es à la base de données AutiHub : 7 / 71 (9,9 %). Auteurices cité·es distinct·es identifié·es comme autistes : 6 / 253 (2,4 %).
Occurrences citées rattachées à la base AutiHub
71 / 274 (25,9 %)
Auteurices cité·es distinct·es rattaché·es : 55 / 253 (21,7 %)
Occurrences rattachées, non identifiées comme autistes
64 / 71 (90,1 %)
Parmi les seules occurrences rattachées. Sur l’ensemble des occurrences d’auteurices cité·es : 64 / 274 (23,4 %). Auteurices cité·es distinct·es rattaché·es, non identifié·es comme autistes : 49 / 55 (89,1 %).
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