Improving access to evidence-based treatment for obsessive-compulsive disorder in youth with autism: Randomised controlled trial and subsequent clinical implementation

Research problem / specific questions Autism Spectrum Disorders (ASD) are neurodevelopmental disorders associated with life-long struggles and high societal costs affecting about 2% of all children and adults.

A large majority of young people with autism have comorbid mental disorders, such as obsessive-compulsive disorder (OCD), which are potentially treatable. However, these treatments are rarely available because they require access to highly specialised clinics. The families of children with ASD demand more access to treatment for these comorbidities.

Access to specialist treatment could be improved dramatically if routine aspects of treatment could be digitalised.

The overarching purpose of this project is to co-develop and evaluate the efficacy and cost-effectiveness of a novel digital intervention for OCD in young people with autism, and to follow through with a nationwide implementation of the intervention.

Data and method We propose to partner with patients, families, and clinicians to develop a novel digital intervention and evaluate its efficacy and cost-effectiveness in a fully powered multicentric (Stockholm, Lund, Gothenburg) randomised controlled trial (N=220), comparing our novel digital intervention with an active comparator.

Next, we will implement the intervention in the national Stöd och Behandling digital platform and will conduct a real-world evaluation of the intervention in the same three clinics.

Plan for project realisation The project brings together a multidisciplinary team of researchers with a track record in child and adolescent psychiatry, clinical trials, digital interventions, biostatistics, health economics, and implementation science.

The team also includes service users and patient organisations that will contribute with their lived experience, as well as health professionals. RelevanceThis project originated as a direct response to a demand from families who have children with ASD.

This will be the first properly powered trial of a digital intervention for a comorbid psychiatric disorder in autistic children anywhere, and the first to conduct a health economic evaluation.

This will also be a rare example of national implementation of a digital intervention for youth with mental health problems and of a formal evaluation of the implementation.

If successful, this project could represent a new model for the development and implementation of digital interventions for a broader range of comorbidities in youth with ASD.