Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: a systematic review and meta-analysis

Abstract

Background Anxiety is common in youth on the autism spectrum and cognitive behavioural therapy (CBT) has been adapted to address associated symptoms. The aim of the current systematic review and meta-analysis was to examine the efficacy of CBT for reducing anxiety in autistic youth. Method Searches of PubMed and Scopus databases were undertaken from January 1990 until December 2020. Studies were included if they consisted of randomised controlled trials (RCTs) using CBT to reduce anxiety in autistic youth. Separate random effects meta-analyses assessed anxiety ratings according to informant (clinician; parent; child), both at end-of-trial and at follow-up. Results A total of 19 RCTs met our inclusion criteria (833 participants: CBT N = 487; controls N = 346). Random effects meta-analyses revealed a large effect size for clinician rated symptoms (g = 0.88, 95% CI 0.55, 1.12, k = 11), while those for both parent (g = 0.40, 95% CI 0.24, 0.56; k = 18) and child-reported anxiety (g = 0.25, 95% CI 0.06, 0.43; k = 13) were smaller, but significant. These benefits were not however maintained at follow-up. Moderator analyses showed that CBT was more efficacious for younger children (for clinician and parent ratings) and when delivered as individual therapy (for clinician ratings). Using the Cochrane Risk of Bias 2 tool, we found concerns about reporting bias across most trials. Conclusions The efficacy of CBT for anxiety in autistic youth was supported in the immediate intervention period. However, substantial inconsistency emerged in the magnitude of benefit depending upon who was rating symptoms (clinician, parent or child). Follow-up analyses failed to reveal sustained benefits, though few studies have included this data. It will be important for future trials to address robustness of treatment gains overtime and to further explore inconsistency in efficacy by informant. We also recommend pre-registration of methods by trialists to address concerns with reporting bias.

Psychotherapy for co-occurring symptoms of depression, anxiety and obsessive-compulsive disorder in children and adults with autism spectrum disorder: a systematic review and meta-analysis

“…The latest 3 meta-analyses (Perihan et al, 2020;Sharma et al, 2021;Ung et al, 2015) investigating the effect of CBT on anxiety symptoms in children with ASD include studies up to 2020 and similar to our meta-analysis, investigated the impact of informant, CBT design (individual or group) or family involvement.…”

“…The most recent meta-analysis (Sharma et al, 2021) included 833 children in 19 RCTs and reported a large effect size for clinician rated symptoms ( g = 0.88), and small effect sizes for both parent ( g = −0.40) and child-reported anxiety ( g = −0.25), which is similar to our subgroup analysis on outcome assessor revealing that assessment of symptoms by clinician was significantly larger ( g = −0.98), in comparison to assessment by self/parents combined ( g = −0.24). Furthermore, their effect size for individual CBT ( g = −1.16) exceeded group design ( g = −0.53), similar to our results (individual: g = −1.33 v. group: g = −0.60).…”

“…The effectiveness of this and other modified CBTs as treatment for anxiety in children with ASD has been researched in a few meta-analyses over the past decade (Perihan et al, 2020; Reynolds, Wilson, Austin, & Hooper, 2012; Ung, Selles, Small, & Storch, 2015), with the most recent meta-analysis (Sharma, Hucker, Matthews, Grohmann, & Laws, 2021) showing a large significant effect for the reduction of clinician rated anxiety symptoms. However, lacking in these previous meta-analyses were data on the effects of CBT on symptoms of depression or OCD, and whether CBT is effective for adults with ASD.…”

Ansiedad y trastornos del espectro del autismo: notas para la intervención psicoeducativa

“…Los resultados de recientes revisiones y metaanálisis (Perihan et al, 2019;Sharma et al, 2021) sugieren que los TCC tienen el potencial de ser un componente eficaz para abordar los síntomas relacionados con la ansiedad en niños y niñas autistas. No obstante, está menos documentado su uso en adultos (Binnie y Blainey, 2013; Sánchez-Cueva et al, 2021;White et al, 2018).…”

Effects of Integrative Autism Therapy on Multiple Physical, Sensory, Cognitive, and Social Integration Domains in Children and Adolescents with Autism Spectrum Disorder: A 4-Week Follow-Up Study

“…Autism spectrum disorder (ASD) presents with multiple domains of functional and structural impairments, physical activity limitations, and associated social participation and integration restrictions, affecting 1 in 44 children in the United States [ 1 ]. Four major affected domains have been identified: (1) physical (mobility, strength, and balance) [ 2 , 3 ]; (2) sensory (tactile, visual, and auditory sensitivity) [ 4 , 5 ]; (3) cognitive (self-care, locomotion, communication, and social cognition) [ 6 ]; and (4) social integration (performance, satisfaction, fear of falling, and quality of life) [ 7 , 8 ]. Unfortunately, such dysfunction is also correlated with an increased risk of other psychiatric and neurodevelopmental disorders [ 9 ], an adjustment in physical health [ 10 ], lower life satisfaction [ 11 ], and early death [ 12 ].…”