Treating Anxiety Disorders in Children with High Functioning Autism Spectrum Disorders: A Controlled Trial

Abstract

A family-based, cognitive behavioural treatment for anxiety in 47 children with comorbid anxiety disorders and High Functioning Autism Spectrum Disorder (HFA) was evaluated. Treatment involved 12 weekly group sessions and was compared with a waiting list condition. Changes between pre- and post-treatment were examined using clinical interviews as well as child-, parent- and teacher-report measures. Following treatment, 71.4% of the treated participants no longer fulfilled diagnostic criteria for an anxiety disorder. Comparisons between the two conditions indicated significant reductions in anxiety symptoms as measured by self-report, parent report and teacher report. Discussion focuses on the implications for the use of cognitive behaviour therapy with HFA children, for theory of mind research and for further research on the treatment components.

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

“…CBT for anxiety was not significantly different from control conditions as reported by the children (random effects model ES = 0.68 (95% CI, 20.17 to 1.54; z = 1.56, P = .12; fixed effect model ES = 0.48). Furthermore, this effect appears to be largely driven by 1 study, 35 with an ES of 2.69 (ESs in other studies ranges from 0.03 to 0.49). We performed a sensitivity analysis by removing the Chalfant et al study and found that the estimated weighted mean ES decreased from 0.68. to 0.17 (95% CI, 20.13 to 0.47; z = 1.09, P = .27).…”

“…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). We explored this effect by conducting a sensitivity analysis by removing the outlier, and we found that the estimated weighted mean ES would decrease from 1.19 to 0.57 (95% CI, 0.16 to 0.97; z = 2.73, P = .006) with the Chalfant et al study removed.…”

“…We included the PARS from the Storch et al 34 study because this scale has been designed to measure severity of anxiety in clinical trials and it has been used as a primary outcome in the Child/Adolescent Anxiety Multimodal Study. 9 We decided to include the SCAS from the Chalfant et al 35 study because this measure has been a most commonly used self-report in studies of CBT for anxiety in ASD (see Table 1). …”

“…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.…”