The therapeutic alliance in cognitive-behavioral therapy for school-aged children with autism and clinical anxiety

Abstract

Little is known about the alliance between therapists and children with autism spectrum disorder who are receiving psychological therapies in outpatient treatment settings. This study examined the therapeutic alliance in children with autism spectrum disorder and clinical anxiety, who were receiving cognitive behavioral therapy in a randomized, controlled trial. The Therapeutic Alliance Scale for Children was administered to a sample of children and youth with autism spectrum disorder and anxiety ( N = 64; aged 7–14) as well as to their parents and therapists. A comparison sample of typically developing youth with clinical anxiety ( N = 36; aged 5–12) was included. The child-therapist alliance was more positive among typically developing children than among children with autism spectrum disorder; correspondingly, the parent-therapist alliance was also more positive among parents of typically developing children. Therapist reports of positive child-therapist alliance predicted post-treatment reductions in anxiety among children with autism spectrum disorder, although child reports of this alliance did not. Parent reports of positive parent-therapist alliance also predicted post-treatment reductions in the child’s anxiety in the group with autism spectrum disorder. A strong therapeutic alliance appears to be associated with better treatment outcomes in children with autism spectrum disorder receiving cognitive behavioral therapy, although a thoughtful and diagnostically sensitive approach is advisable to promote a positive alliance with children with autism spectrum disorder.

Measuring therapeutic alliance in children with autism during cognitive behavior therapy

“…Children with autism may have challenges with perspective taking and following social norms and cues (Davidson et al, ), which may impact the therapeutic relationship. While ample research suggests that these deficits in social skills affect the ability to develop and maintain relationships (Laugeson, Gantman, Kapp, Orenski, & Ellingsen, ; Stichter et al, ), our findings align with those of recent studies and show that working relationships with child clients with autism and their family members may be reliably measured (Klebanoff et al, ).…”

“…Recently, researchers have begun to examine TA in cognitive–behavioural interventions for children with autism (Brown et al, ; Klebanoff, Rosenau, & Wood, ). Cognitive behaviour therapy (CBT) is considered a “promising” evidence‐based intervention for children with autism to address associated emotional problems (Wong et al, ).…”

“…Appropriately measuring and understanding the underlying processes (e.g., alliance) that facilitate optimal treatment effects is critical to understand why some children with autism improve while others do not, especially because of their high risk for psychopathology. Recently, Klebanoff et al () evaluated the role of TA for children with autism and clinical anxiety who were undergoing CBT in a randomized controlled trial. Though their findings demonstrated that child ratings of alliance were significantly related to therapists' ratings, only therapist‐reported alliance predicted reductions in anxiety.…”

Therapeutic alliance in youth with autism spectrum disorder receiving cognitive-behavioral treatment for anxiety

“…In a small qualitative study, Houlding (2014) found that mothers of children with ASD ( N = 3) perceived strong therapeutic alliance as essential to their and their child’s participation in CBT for obsessive compulsive disorder (OCD). Furthermore, among children who participated in modular CBT for anxiety, Klebanoff (2015) found that therapist alliance ratings were weaker for youth with versus without ASD, but still positively associated with anxiety improvement in the ASD group. These studies suggest connections between alliance and CBT response in children with ASD that warrant further investigation.…”

Estilo Personal Del Terapeuta De Psicólogos Que Trabajan En Autismo

“…En estudios previos, si bien la función Instruccional ha sido señalada como quizás la más importante del EPT por sus vínculos con la alianza terapéutica (Corbella et al, 2007), ha sido también cuestionada por su escaso apoyo en los estudios psicométricos (Silva y Guedes, 2016). Por tal motivo debería continuar estudiándose, especialmente en el tratamiento de pacientes con TEA, porque la alianza terapéutica también desempeña un papel central (Brown et al, 2015;Goodman, Chung, Fischel yAthey-Lloyd, 2017;Klebanoff, 2015).…”