Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial

Abstract

Background Children with autism spectrum disorders often present with comorbid anxiety disorders that cause significant functional impairment. This study tested a modular cognitive behavioral therapy (CBT) program for children with this profile. A standard CBT program was augmented with multiple treatment components designed to accommodate or remediate the social and adaptive skill deficits of children with ASD that could pose barriers to anxiety reduction. Method Forty children (7–11 years old) were randomly assigned to 16 sessions of CBT or a 3-month waitlist (36 completed treatment or waitlist). Therapists worked with individual families. The CBT model emphasized behavioral experimentation, parent-training, and school consultation. Independent evaluators blind to treatment condition conducted structured diagnostic interviews and parents and children completed anxiety symptom checklists at baseline and posttreatment/postwaitlist. Results In intent-to-treat analyses, 78.5% of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment, as compared to only 8.7% of the waitlist group. CBT also out-performed the waitlist on diagnostic outcomes and parent reports of child anxiety, but not children's self-reports. Treatment gains were maintained at 3-month follow-up. Conclusions The CBT manual employed in this study is one of the first adaptations of an evidence-based treatment for children with autism spectrum disorders. Remission of anxiety disorders appears to be an achievable goal among high-functioning children with autism.

Psychological therapies for people with intellectual disabilities: A systematic review and meta-analysis

“…It is also worth noting that the methodological quality of psychological therapy research for children and adolescents with IDs is much lower than that involving adults, as no independent groups designs or RCTs were identified, bearing in mind that there are some RCTs involving children with autistic spectrum disorders (Sofronoff, Attwood, & Hinton, 2005;Wood et al, 2009). Ethical concerns in the recruitment of young people with IDs for intervention studies may partially explain the current lack of research, but should not be seen as justification for the lack of controlled outcome studies.…”

Cognitive-Behavioral Therapy for Anxiety in Children With High-Functioning Autism: A Meta-analysis

“…34,35,[39][40][41][42][43][44] Overall ESs on clinician-and parent-rated outcome measures of anxiety were d = 1.19 and d = 1.21, respectively, and in the large range. When the outlying studies were removed, the magnitude to these effects decreased to d = 0.57 for the parent ratings and d = 0.89 for the clinician ratings, but they remained statistically significant (ie, CBT was superior to control conditions).…”

“…34,35,39,40,42,43 As shown in Fig 2, CBT was superior to control conditions for anxiety symptoms in children with ASD as reported by the parents (random effects model ES = 1.19; 95% CI, 0.23 to 2.14; z = 2.44, P = .02; fixed effect model ES = 0.78). However, one study 35 had an ES estimate (d = 4.34) that was much larger than that of the other studies (range, d = 0.10-1.23).…”

“…Eight studies 34,35,[39][40][41][42][43][44] involving 469 participants (252 treatment, 217 comparison) met our inclusion criteria and were included in the analyses. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses 45 flow diagram of study selection is shown in Fig 1. The characteristics of the 8 included studies are shown in Table 1.…”

“…34,35,40,42,44 One study 34 did not report the total score for the childreported outcome (RCMAS), so we averaged all reported RCMAS subscales to calculate the ES estimate that was included in the meta-analysis. Figure 4 depicts a forest plot of the effect of CBT on child-reported anxiety.…”