Group cognitive behavior therapy for children with high‐functioning autism spectrum disorders and anxiety: a randomized trial

Abstract

Background Children with high-functioning autism spectrum disorders (ASD) are at high risk for developing significant anxiety. Anxiety can adversely impact functioning across school, home and community environments. Cognitive behavior therapies (CBT) are frequently used with success for children with anxiety symptoms. Modified CBT interventions for anxiety in children with ASD have also yielded promising results. Methods Fifty children with high-functioning ASD and anxiety were randomized to group CBT or Treatment as Usual (TAU) for 12 weeks. Independent Clinical Evaluators, blind to condition, completed structured interviews (Anxiety Disorders Interview Schedule – Parent Version; ADIS-P) pre- and post-intervention condition. Results Forty-seven children completed either the CBT or TAU condition. Results indicated markedly better outcomes for the CBT group. Significant differences by group were noted in Clinician Severity Ratings, diagnostic status, and clinician ratings of global improvement. In the intent-to-treat sample, ten of 20 children (50%) in the CBT group had a clinically meaningful positive treatment response, compared to 2 of 23 children (8.7%) in the TAU group. Conclusions Initial results from this rigorously designed treatment study suggest that a group CBT intervention specifically developed for children with ASD may be effective in decreasing anxiety. Limitations of this study include small sample size, lack of an attention control group, and use of outcome measures normed with typically developing children.

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

“…34,[40][41][42][43] As shown in Fig 3, CBT was superior to control conditions for anxiety in children with ASD as reported by the clinicians (random effects model ES = 1.21; 95% CI, 0.50 to 1.97; z = 3.36, P = .001; fixed effect model ES = 1.10). Again, 1 study 40 had an ES estimate (d = 2.53) that was much larger than that of the other studies (range, d = 0.33-1.40).…”

“…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).…”

“…Thus, we combined waitlist-controlled studies with studies that used TAU-controlled conditions because these 2 types of control conditions in studies of children with autism appear to be essentially the same. We note that there was considerable heterogeneity among the studies in describing concomitant treatments including providing no information, 35,39 reporting a number of REVIEW ARTICLE PEDIATRICS Volume 132, Number 5, November 2013 e1347 subjects receiving concomitant medication, 41,43,44 and reporting medication, psychological, and school-based services. 34,42 Careful characterization of concomitant treatments including medication and psychoeducational and behavioral interventions in future randomized controlled studies will enable estimating the effects of these concomitant treatments on the magnitude of response to CBT for anxiety.…”

“…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.…”

A Systematic Review of Effective Modifications to Cognitive Behavioural Therapy for Young People with Autism Spectrum Disorders

“…Study designs included controlled trials and RCTs (Chalfant et al 2007;Fuji et al 2013;McNally Keehn et al 2013;Reaven et al 2012a;Reaven et al 2009;Sofronoff et al 2005;Storch et al 2013;Sung et al 2011;Wood et al 2009a;Wood et al 2015). The majority of participants were male (n = 353 or 83.5 %; 70 females), which broadly equates to the ratio of males to females diagnosed with ASD (4:1; Baron-Cohen et al 2001).…”