Evidence-Based Practice in the Face of Complexity and Comorbidity: A Case Study of an Adolescent With Asperger's Syndrome, Anxiety, Depression, and Chronic Pain.

PROBLEM Working with clients who present with multiple conditions and comorbidities, including mental health difficulties, neurodevelopmental disorders, and physical health conditions, requires the therapist to go beyond the existing evidence base to make decisions about which specific cognitive behavior therapy (CBT) models and resultant treatment approaches to draw on in therapy. Routine outcome monitoring across a number of parameters, including goal progress, symptom improvement, and changes in functioning, are core to maintaining accountability through monitoring the ongoing impact of idiosyncratic interventions. METHOD The case of a young person (age 17 years) who presented with mixed anxiety and depression in the context of autism spectrum disorder (ASD) and chronic pain are presented. In addition to evidence-based adaptations to CBT for clients with ASDs, the therapist selected a cognitive model of low self-esteem as a means of collaboratively conceptualizing the client's difficulties. FINDINGS AND CONCLUSION Routine outcome measurement demonstrated the effectiveness of the intervention.