The Effect of Cognitive-Behavioral Therapy Versus Treatment as Usual for Anxiety in Children With Autism Spectrum Disorders: A Randomized, Controlled Trial

Storch, Eric A.; Arnold, Elysse B.; Lewin, Adam B.; Nadeau, Joshua M.; Jones, Anna M.; Nadai, Alessandro S. De; Mutch, P. Jane; Selles, Robert R.; Ung, Danielle; Murphy, Tanya K.

doi:10.1016/j.jaac.2012.11.007

Cited by 212 publications

(201 citation statements)

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“…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).…”

Section: Parent-rated Anxietymentioning

confidence: 85%

“…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.…”

Section: Study Selectionmentioning

confidence: 99%

“…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.…”

Section: Child-reported Anxietymentioning

confidence: 99%

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

et al. 2013

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BACKGROUND: Anxiety is a common and impairing problem in children and adolescents with autism spectrum disorder (ASD). There is emerging evidence that cognitive-behavioral therapy (CBT) could reduce anxiety in children with high-functioning ASD.OBJECTIVE: To systematically review the evidence of using CBT to treat anxiety in children and adolescents with ASD. Methods for this review were registered with PROSPERO (CRD42012002722). METHODS:We included randomized controlled trials published in English in peer-reviewed journals comparing CBT with another treatment, no treatment control, or waitlist control. Two authors independently screened 396 records obtained from database searches and hand searched relevant journals. Two authors independently extracted and reconciled all data used in analyses from study reports.RESULTS: Eight studies involving 469 participants (252 treatment, 217 comparison) met our inclusion criteria and were included in metaanalyses. Overall effect sizes for clinician-and parent-rated outcome measures of anxiety across all studies were d = 1.19 and d = 1.21, respectively. Five studies that included child self-report yielded an average d = 0.68 across self-reported anxiety.CONCLUSIONS: Parent ratings and clinician ratings of anxiety are sensitive to detecting treatment change with CBT for anxiety relative to waitlist and treatment-as-usual control conditions in children with high-functioning ASD. Clinical studies are needed to evaluate CBT for anxiety against attention control conditions in samples of children with ASD that are well characterized with regard to ASD diagnosis and co-occurring anxiety symptoms. Pediatrics 2013;132: e1341-e1350 AUTHORS:

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Section: Parent-rated Anxietymentioning

confidence: 85%

Section: Study Selectionmentioning

confidence: 99%

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

et al. 2013

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“…An independent clinical evaluator (ICE) who was not involved in data collection or in direct implementation of the intervention, reviewed de-identified copies of each participant's ADIS-P-IV and BASC-2 summary sheets at pre-and post-treatment to complete the CGI-S and CGI-I ratings. This method is similar to the methods described in previous studies (e.g., Storch et al, 2013). Participants obtaining a CGI-I of 0, 1, or 2 were considered to be positive treatment responders.…”

Section: Blind Rater Outcome Measurementioning

confidence: 99%

“…Given these emotional difficulties, and evidence that ER ability serves protective factors such as prosocial peer engagement (Jahromi, Bryce, & Swanson, 2013), there has been increased interest in assessing the effectiveness of cognitive behavior therapy (CBT) in youth with ASD, which until now has focused almost exclusively on anxiety (e.g., Ehrenreich-May et al, 2014;Reaven, Blakeley-Smith, Culhane-Shelburne, & Hepburn, 2012;Sofronoff, Attwood, & Hinton, 2005;Storch et al, 2013;Wood, Fujii, Renno, & Dyke, 2014). Although research exists documenting deficits in ER in individuals with ASD compared to peers (Mazefsky et al, 2013), empirical evaluations of ER interventions are needed (Sofronoff, Beaumont, & Weiss, 2014).…”

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confidence: 99%

Brief Report of Preliminary Outcomes of an Emotion Regulation Intervention for Children with Autism Spectrum Disorder

Thomson

Riosa

Weiss

2015

J Autism Dev Disord

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Children with autism spectrum disorder (ASD) often present with comorbid psychopathology including problems with emotion regulation. The goal of the present research was to investigate the feasibility of a multicomponent manualized cognitive behavior therapy treatment program for improving emotion regulation in youth with ASD 8 to 12 years of age. Thirteen males and their parents participated in the intervention, reporting high satisfaction with the activities and program overall, and attending all sessions. Preliminary outcomes regarding emotion regulation and psychopathology, and feasibility of the intervention, are summarized and discussed.Keywords. Emotion regulation, autism spectrum disorder, cognitive behavior therapy, intervention, individual therapy. EMOTION REGULATION INTERVENTION IN ASD 3 Brief Report of Preliminary Outcomes of an Emotion Regulation Intervention forChildren with Autism Spectrum Disorder Children diagnosed with autism spectrum disorder (ASD) have difficulty with sociocommunicative functioning and restricted or repetitive behaviors or interests (American Psychiatric Association, 2013) and often present with significant levels of emotional difficulties. For example, in a sample of 5 to 16-year olds with ASD and no intellectual disability, 74% had clinically significant emotional difficulties, such as anger, sadness or anxiety, compared to 18% of typically developing peers (Totsika, Hastings, Emerson, Lancaster, & Berridge, 2011). Approximately 40% to 50% of youth with ASD (as per DSM-IV-TR criteria) are estimated to meet criteria for two or more psychiatric disorders, often combining externalizing problems, such as ADHD, with internalizing problems, such as anxiety disorders (Leyfer et al., 2006;Simonoff, et al., 2008), leading many to conceptualize emotional problems as involving underlying difficulties with emotion regulation (Mazefsky et al., 2013;Mazefsky & White, 2014). Emotion regulation (ER) can be defined as ''the extrinsic and intrinsic processes responsible for monitoring, evaluating, and modifying emotional reactions, especially their intensive and temporal features, to accomplish one's goals' ' (Thompson, 1994, pp. 27-28).Considerable evidence has related poor ER to emotional problems in children with ASD, such as anxiety (e.g., Fuji et al., 2013;Wood & Gadow, 2010) One pilot study reported promising outcomes of a modified CBT program to address ER in a small sample of young children with ASD (5 in the treatment group and 6 in a delayed treatment control), 6 to 8 years of age, measured by child reported coping strategies in response to vignettes, parent reported negativity/lability and emotion regulation, and parent reported outbursts (Scarpa & Reyes, 2011). Changes though were assessed using one-tailed comparisons, potentially inflating the likelihood of finding significance.More research is needed to assess how cognitive behavioral interventions can improve ER in children with ASD. The purpose of the present study was to evaluate the preliminary clinical utility (fea...

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Cognitive Behavioral Treatments for Anxiety in Children With Autism Spectrum Disorder

et al. 2020

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IMPORTANCE Anxiety is common among youth with autism spectrum disorder (ASD), often interfering with adaptive functioning. Psychological therapies are commonly used to treat school-aged youth with ASD; their efficacy has not been established.OBJECTIVE To compare the relative efficacy of 2 cognitive behavioral therapy (CBT) programs and treatment as usual (TAU) to assess treatment outcomes on maladaptive and interfering anxiety in children with ASD. The secondary objectives were to assess treatment outcomes on positive response, ASD symptom severity, and anxiety-associated adaptive functioning. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial began recruitment in April 2014 at 3 universities in US cities. A volunteer sample of children (7-13 years) with ASD and maladaptive and interfering anxiety was randomized to standard-of-practice CBT, CBT adapted for ASD, or TAU. Independent evaluators were blinded to groupings. Data were collected through January 2017 and analyzed from December 2018 to February 2019. INTERVENTIONSThe main features of standard-of-practice CBT were affect recognition, reappraisal, modeling/rehearsal, in vivo exposure tasks, and reinforcement. The CBT intervention adapted for ASD was similar but also addressed social communication and self-regulation challenges with perspective-taking training and behavior-analytic techniques. MAIN OUTCOMES AND MEASURESThe primary outcome measure per a priori hypotheses was the Pediatric Anxiety Rating Scale. Secondary outcomes included treatment response on the Clinical Global Impressions-Improvement scale and checklist measures. RESULTSOf 214 children initially enrolled, 167 were randomized, 145 completed treatment, and 22 discontinued participation. Those who were not randomized failed to meet eligibility criteria (eg, confirmed ASD). There was no significant difference in discontinuation rates across conditions. Randomized children had a mean (SD) age of 9.9 (1.8) years; 34 were female (20.5%). The CBT program adapted for ASD outperformed standard-of-practice CBT (mean [SD] Pediatric Anxiety Rating Scale score, 2.13 [0.91] [95% CI, 1.91-2.36] vs 2.43 [0.70] [95% CI, 2.25-2.62]; P = .04) and TAU (2.93 [0.59] [95% CI,]; P < .001). The CBT adapted for ASD also outperformed standard-of-practice CBT and TAU on parent-reported scales of internalizing symptoms (estimated group mean differences: adapted vs standard-of-practice CBT, −0.

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The Effect of Cognitive-Behavioral Therapy Versus Treatment as Usual for Anxiety in Children With Autism Spectrum Disorders: A Randomized, Controlled Trial

Cited by 212 publications

References 29 publications

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

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

Brief Report of Preliminary Outcomes of an Emotion Regulation Intervention for Children with Autism Spectrum Disorder

Cognitive Behavioral Treatments for Anxiety in Children With Autism Spectrum Disorder

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