Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: a randomized, controlled trial. Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial. Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: a randomized, controlled trial. A randomized controlled trial of cognitive-behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety. Effects of Cognitive-Behavioral Therapy on Anxiety in Children with Autism Spectrum Disorders: A Randomized Controlled Trial Randomized Controlled Trial: Multimodal Anxiety and Social Skill Intervention for Adolescents with Autism Spectrum Disorder Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study Group therapy for anxiety in children with autism spectrum disorder Cognitive behavior therapy for comorbid obsessive-compulsive disorder in high-functioning autism spectrum disorders: a randomized controlled trial. Reducing Specific Phobia/Fear in Young People with Autism Spectrum Disorders (ASDs) through a Virtual Reality Environment Intervention Mindfulness-based therapy in adults with an autism spectrum disorder: a randomized controlled trial. Improving emotion regulation with CBT in young children with high functioning autism spectrum disorders: a pilot study. Efficacy of an internet-based CBT program for children with comorbid High Functioning Autism Spectrum Disorder and anxiety: A randomised controlled trial. Group and individual cognitive-behavioral therapy for childhood anxiety disorders: a randomized trial. Brief Report: Effects of Cognitive Behavioral Therapy on Parent-Reported Autism Symptoms in School-Age Children with High-Functioning Autism A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome.
Clinical ly elevated anxiety is a common , impairing feature of autism spectrum disorders ( ASD ) . A modular CBT program design ed for preteens with ASD , Behavioral Interventions for Anxiety in Children with Autism ( BIACA ; Wood et al. , 2009 ) was enhanced and modified to address the developmental needs of early adolescents with ASD and clinical anxiety . Thirty-three adolescents ( 11 - 15 years old ) were r and omly assigned to 16 sessions of CBT or an equivalent waitlist period . The CBT model emphasized exposure , challenging irrational beliefs , and behavioral supports provided by caregivers , as well as numerous ASD-specific treatment elements . Independent evaluators , parents , and adolescents rated symptom severity at baseline and posttreatment/postwaitlist . In intent-to-treat analyses , the CBT group outperformed the waitlist group on independent evaluators ' ratings of anxiety severity on the Pediatric Anxiety Rating Scale ( PARS ) and 79 % of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment , as compared to only 28.6 % of the waitlist group . Group differences were not found for diagnostic remission or question naire measures of anxiety . However , parent-report data indicated that there was a positive treatment effect of CBT on autism symptom severity . The CBT manual under investigation , enhanced for early adolescents with ASD , yielded meaningful treatment effects on the primary outcome measure ( PARS ) , although additional developmental modifications to the manual are likely warranted . Future studies examining this protocol relative to an active control are needed 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 behavioral 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 r and omizedto 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 , 10 of 20 children ( 50 % ) in the CBT group had a clinical ly meaningful positive treatment response , compared to 2 of 23 children ( 8.7 % ) in the TAU group . CONCLUSIONS Initial results from this r and omized , design ed treatment study suggest that agroup 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 BACKGROUND Children with autism spectrum disorders often present with comorbid anxiety disorders that cause significant functional impairment .  This study tested a modular cognitive behavioral therapy ( CBT ) program for children with this profile . A st and ard CBT program was augmented with multiple treatment components design ed to accommo date or remediate the social and adaptive skill deficits of children with ASD that could pose barriers to anxiety reduction . METHOD Forty children ( 7 - 11 years old ) were r and omly assigned to 16 sessions of CBT or a 3-month waitlist ( 36 completed treatment or waitlist ) . Therapists worked with individual families . The CBT model emphasized behavioral experimentation , parent-training , and school consultation . Independent evaluators blind to treatment condition conducted structured diagnostic interviews and parents and children completed anxiety symptom checklists at baseline and posttreatment/postwaitlist . RESULTS In intent-to-treat analyses , 78.5 % of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment , as compared to only 8.7 % of the waitlist group . CBT also outperformed the waitlist on diagnostic outcomes and parent reports of child anxiety , but not children 's self-reports . Treatment gains were maintained at 3-month follow-up . CONCLUSIONS The CBT manual employed in this study is one of the first adaptations of an evidence -based treatment for children with autism spectrum disorders . Remission of anxiety disorders appears to be an achievable goal among high-functioning children with autism OBJECTIVE To examine the efficacy of a modular cognitive-behavioral therapy ( CBT ) protocol relative to treatment as usual ( TAU ) among children with high-functioning autism spectrum disorders ( ASD ) and clinical ly significant anxiety .  METHOD A total of 45 children ( 7 - 11 years of age ) with high-functioning ASD and clinical ly significant anxiety were r and omized to receive 16 sessions of weekly CBT or TAU for an equivalent duration . After screening , assessment s were conducted at baseline , post-treatment , and 3-month follow-up . Raters were blind to treatment condition . RESULTS Youth receiving CBT showed substantial improvement relative to TAU on primary anxiety outcomes . Of 24 children r and omized to the CBT arm , 18 ( 75 % ) were treatment responders , versus only 3 of 21 children ( 14 % ) in the TAU arm . Gains were generally maintained at 3-month follow-up for CBT responders . CONCLUSIONS Relative to usual care , CBT adapted for anxious youth with high-functioning ASD demonstrates large effects in reducing anxiety symptoms . This study contributes to the growing literature supporting adapted CBT approaches for treating anxiety in youth with ASD OBJECTIVE Examine the efficacy of a personalized , modular cognitive-behavioral therapy ( CBT ) protocol among early adolescents with high-functioning autism spectrum disorders ( ASDs ) and co-occurring anxiety relative to treatment as usual ( TAU ) . METHOD Thirty-one children ( 11 - 16 years ) with ASD and clinical ly significant anxiety were r and omly assigned to receive 16 weekly CBT sessions or an equivalent duration of TAU . Participants were assessed by blinded raters at screening , posttreatment , and 1-month follow-up . RESULTS Youth r and omized to CBT demonstrated superior improvement across primary outcomes relative to those receiving TAU . Eleven of 16 adolescents r and omized to CBT were treatment responders , versus 4 of 15 in the TAU condition . Gains were maintained at 1-month follow-up for CBT responders . CONCLUSIONS These data extend findings of the promising effects of CBT in anxious youth with ASD to early adolescents We compared the effects of a 16-week Cognitive-Behavioral Therapy ( CBT ) program and a Social Recreational ( SR ) program on anxiety in children with Autism Spectrum Disorders ( ASD ) . Seventy children ( 9–16 years old ) were r and omly assigned to either of the programs ( nCBT = 36 ; nSR = 34 ) . Measures on child ’s anxiety using the Spence Child Anxiety Scale — Child ( SCAS-C ) and the Clinical Global Impression — Severity scale ( CGI-S ) were administered at pre- , post-treatment , and follow-ups ( 3- and 6-month ) . Children in both programs showed significantly lower levels of generalized anxiety and total anxiety symptoms at 6-month follow-up on SCAS-C. Clinician ratings on the CGI-S demonstrated an increase in the percentage of participants rated as “ Normal ” and “ Borderline ” for both programs . Findings from the present study suggest factors such as regular sessions in a structured setting , consistent therapists , social exposure and the use of autism-friendly strategies are important components of an effective framework in the management of anxiety in children and adolescents with ASD Anxiety is common among adolescents with autism spectrum disorders ( ASD ) and may amplify the core social disability , thus necessitating combined treatment approaches . This pilot , r and omized controlled trial evaluated the feasibility and preliminary outcomes of the Multimodal Anxiety and Social Skills Intervention ( MASSI ) program in a sample of 30 adolescents with ASD and anxiety symptoms of moderate or greater severity . The treatment was acceptable to families , subject adherence was high , and therapist fidelity was high . A 16 % improvement in ASD social impairment ( within-group effect size = 1.18 ) was observed on a parent-reported scale . Although anxiety symptoms declined by 26 % , the change was not statistically significant . These findings suggest MASSI is a feasible treatment program and further evaluation is warranted Youth with autism spectrum disorders frequently experience significant symptoms of anxiety .  Empirically supported psychosocial interventions exist , yet access is limited , especially for families in rural areas .  Telehealth ( i.e. videoconferencing ) has potential to reduce barriers to access to care ; however , little is known about the feasibility or efficacy of directly intervening with youth with autism spectrum disorders through this modality . This study details the pilot testing of a telehealth version of an empirically supported intervention targeting anxiety in youth with autism spectrum disorders . The primary focus of this study is on feasibility , with evaluation of outcomes as a starting point for future r and omized trials . In all , 33 families of youth with autism spectrum disorders and significant anxiety symptoms participated in this study ( Telehealth Facing Your Fears ( FYF ) Intervention : n = 17 ; Wait-list control : n = 16 ) . Youth of all functioning levels were included .  Acceptability was strong ; however , the usability of the technology was problematic for some families and impeded some sessions significantly . Fidelity of the telehealth version to the critical elements of the original , in vivo version was excellent . More work is needed to improve delivery of exposure practice s and parent coaching . Preliminary efficacy analyses are promising , with improvements observed in youth anxiety over time ( relative to a comparison group waiting for live intervention ) and parent sense of competence ( within group ) . Clearly , stronger design s are necessary to evaluate efficacy sufficiently ; however , this study does provide support for further investigation of clinic-to-home videoconferencing as a direct intervention tool for youth with autism spectrum disorders and their parents Aim : To investigate the acceptability and feasibility of adapted group therapy for anxiety in children with autism spectrum disorder in a pilot r and omised controlled trial . Method : A total of 32 children aged 9–13 years were r and omised to immediate or delayed therapy using the ‘ Exploring Feelings ’ manual ( Attwood , 2004 ) . Child and parent groups were run in parallel , for seven weekly sessions , under the supervision of experienced psychologists . The primary blinded outcome measures addressed change in overall functioning and in severity of the primary anxiety diagnosis after 3 months . Results : Children met diagnostic criteria for 1–6 anxiety disorders ( median 3 ) . At end point , both parents and children in the immediate therapy group were more likely to report a reduction in anxiety symptoms . Fidelity of delivery of the group therapy was high , and attendance was 91 % . Conclusions : This pilot trial established that children and families were willing to be recruited and r and omised , the outcome measures were acceptable , the format and content of the groups were feasible within UK child and adolescent mental health services , the intervention was appreciated by families and attrition was very small BACKGROUND High rates of anxiety disorders , particularly obsessive compulsive disorder ( OCD ) are reported in people with Autism spectrum disorders ( ASD ) .  Group cognitive behavioral treatment ( CBT ) has been found effective for anxiety in young people with ASD but not been OCD specific . One uncontrolled pilot study of individual CBT for OCD for adults with ASD showed good treatment efficacy . METHODS Forty-six adolescents and adults ( mean age 26.9 years , 35 Males ) with ASD and comorbid OCD were r and omized to CBT for OCD or anxiety management ( AM ) , a plausible control treatment . Treatments were matched in duration ( mean of 17.4 sessions CBT ; 14.4 sessions AM ) , the Yale-Brown Obsessive Compulsive Severity Scale ( YBOCS ) as primary outcome measure and evaluations blind to treatment group . Treatment response was defined as > 25 % reduction in YBOCS total severity scores . RESULTS Both treatments produced a significant reduction in OCD symptoms , within-group effect sizes of 1.01 CBT group and 0.6 for the AM group . There were no statistically significant differences between the two groups at end of treatment , although more responders in the CBT group ( 45 versus 20 % ) . Effect sizes for self-rated improvement were small ( 0.33 CBT group ; -0.05 AM group ) . Mild symptom severity was associated with improvement in the AM but not the CBT group . Family/carer factors were important for both groups , in that increased family accommodation was associated with poorer outcome . CONCLUSIONS Evidence -based psychological interventions , both AM and CBT , were effective in treating comorbid OCD in young people and adults with ASD Anxiety is common in children with autism spectrum disorders ( ASD ) , with specific fears and phobias one of the most frequent subtypes . Specific fears and phobias can have a serious impact on young people with ASD and their families . In this study we developed and evaluated a unique treatment combining cognitive behaviour therapy ( CBT ) with graduated exposure in a virtual reality environment ( VRE ) .  Nine verbally fluent boys with an ASD diagnosis and no reported learning disability , aged 7 to 13 years old , were recruited . Each had anxiety around a specific situation ( e.g. crowded buses ) or stimulus ( e.g. pigeons ) . An individualised scene was recreated in our ‘ wrap-around ’ VRE . In the VRE participants were coached by a psychologist in cognitive and behavioural techniques ( e.g. relaxation and breathing exercises ) while the exposure to the phobia/fear stimulus was gradually increased as the child felt ready . Each child received four 20–30 minute sessions . After participating in the study , eight of the nine children were able to tackle their phobia situation . Four of the participants completely overcame their phobia . Treatment effects were maintained at 12 months . These results provide evidence that CBT with VRE can be a highly effective treatment for specific phobia/fear for some young people with ASD . Trial Registration Controlled-Trials.com IS RCT N58483069 Research shows that depression and anxiety disorders are the most common psychiatric concern in autism spectrum disorders ( ASD ) . Mindfulness-based therapy ( MBT ) has been found effective in reducing anxiety and depression symptoms , however research in autism is limited . Therefore , we examined the effects of a modified MBT protocol ( MBT-AS ) in high-functioning adults with ASD . 42 participants were r and omized into a 9-week MBT-AS training or a wait-list control group . Results showed a significant reduction in depression , anxiety and rumination in the intervention group , as opposed to the control group . Furthermore , positive affect increased in the intervention group , but not in the control group . Concluding , the present study is the first controlled trial to demonstrate that adults with ASD can benefit from MBT-AS BACKGROUND AND AIMS This pilot study tested the efficacy of a developmentally modified CBT for young children with Autism Spectrum Disorders ( ASD ) to teach emotion regulation strategies for reducing anger and anxiety , commonly noted problems in this population . METHOD Eleven 5 - 7 year-old children participated in a CBT-group while parents participated in psychoeducation . Children were r and omly assigned to an experimental or delayed-treatment control group . RESULTS From pre- to post-treatment , all children had less parent reported negativity/lability , better parent reported emotion regulation , and shorter outbursts , and also generated more coping strategies in response to vignettes . Parents also reported increases in their own confidence and their child 's ability to deal with anger and anxiety . CONCLUSIONS This study suggests that young children with high functioning ASD may benefit from CBT to improve regulation of anger and anxiety , and parent training may improve parental self-efficacy . Future studies are needed to make conclusions about its efficacy BACKGROUND All trials conducted to date on BRAVE-ONLINE for youth anxiety disorders have excluded children with High Functioning Autism Spectrum Disorder ( HFASD ) and therefore it is unknown whether these programs might be beneficial to HFASD children . The aim of this study was to evaluate the efficacy of BRAVE-ONLINE in HFASD children with an anxiety disorder . METHODS Forty-two HFASD children , aged 8 - 12 years , with an anxiety disorder , and their parents , were r and omly assigned to either the BRAVE-ONLINE condition ( NET ) or a waitlist control ( WLC ) . Diagnostic interviews and parent/child question naires were completed at pre-treatment , post-treatment and 3-month follow-up . RESULTS At post- assessment , compared to children in the WLC condition , children in the NET condition demonstrated a significantly greater reduction in number of anxiety diagnoses , clinical severity of diagnosis , and self and parent reported anxiety symptoms , as well as significantly greater increases in overall functioning . However , loss of primary diagnosis in this sample was lower than in previous studies . LIMITATIONS The small sample size , coupled with attrition rates , makes it difficult to generalise the findings of the study to HFASD population and to conduct analyses regarding mediators , moderators and predictors of outcomes . CONCLUSIONS The BRAVE-ONLINE program may be useful in reducing anxiety symptoms  in HFASD children , although the effects are less strong than those found in neurotypical children for a variety of reasons OBJECTIVE To compare the efficacy of group and individual cognitive-behavioral therapy ( CBT ) in children with Axis I anxiety disorders . It was hypothesized that certain subgroups would respond preferentially to one modality . METHOD Seventy-eight children aged 8 - 12 years with diagnosed anxiety disorders were r and omly assigned to a 12-week , manual-based program of group or individual CBT , both with parental involvement . Outcomes included child anxiety ( child and parent report ) and global functioning as estimated by clinicians . Repeated- measures analyses of variance ( ANOVAs ) were done . The sample was then dichotomized by self-reported social anxiety ( high/low ) and parent-reported hyperactivity ( high/low ) using median splits , and diagnostically by generalized anxiety disorder versus phobic disorders . ANOVAs were repeated . RESULTS Children and parents reported significantly decreased anxiety and clinicians reported significantly improved global functioning regardless of treatment modality . Children reporting high social anxiety reported greater gains in individual treatment than in group treatment ( p < .01 ) . Parent reports of hyperactivity and diagnostic differences were not associated with differential treatment response by modality . CONCLUSIONS Children with anxiety disorders appear to improve with CBT , whether administered in a group or individual format . A subgroup of children reporting high social anxiety  may respond preferentially to individual treatment . Replication of these findings is indicated This pilot study tested the effect of cognitive behavioral therapy ( CBT ) on  parent-reported autism symptoms . Nineteen children with autism spectrum disorders and an anxiety disorder ( 7–11 years old ) were r and omly assigned to 16 sessions of CBT or a waitlist condition . The CBT program emphasized in vivo exposure supported by parent training and school consultation to promote social communication and emotion regulation skills . Parents completed a st and ardized autism symptom checklist at baseline and posttreatment/postwaitlist and 3-month follow-up assessment s. CBT outperformed the waitlist condition at posttreatment/postwaitlist on total parent-reported autism symptoms ( Cohen ’s d effect size = .77 ) . Treatment gains were maintained at 3-month follow-up . Further investigation of this intervention modality with larger sample s and broader outcome measures appears to be indicated BACKGROUND The aim of the study was to evaluate the effectiveness of a brief CBT intervention for anxiety with children diagnosed with Asperger syndrome ( AS ) . A second interest was to evaluate whether more intensive parent involvement would increase the child 's ability to manage anxiety outside of the clinic setting . METHODS Seventy-one children aged ten to twelve years were recruited to participate in the anxiety programme . All children were diagnosed with AS and the presence of anxiety symptoms was accepted on parent report via brief interview . Children were r and omly assigned to one of three conditions : intervention for child only , intervention for child and parent , wait-list control . RESULTS The two intervention groups demonstrated significant decreases in parent-reported anxiety symptoms at follow-up and a significant increase in the child 's ability to generate positive strategies in an anxiety-provoking situation . There were a number of significant differences between the two interventions to suggest parent involvement as beneficial . CONCLUSIONS The sample of children with AS in this study presented with a profile of anxiety similar to a sample of clinical ly diagnosed anxious children . The intervention was endorsed by parents as a useful programme for children diagnosed with Asperger syndrome and exhibiting anxiety symptoms , and active parent involvement enhanced the usefulness of the programme . Limitations of the study and future research are discussed
Clinician- and parent-reported outcome measures showed that psychosocial interventions were superior to waitlist and treatment-as-usual control conditions at post-treatment .
However , the results of self-reported outcome measures failed to reach significance .
The sensitivity analyses did not significantly change these results and the subgroup analysis indicated that individual treatment was more effective than group treatment .
Anxiety is a common problem in children and adolescents with autism spectrum disorder ( ASD ) .
This meta- analysis aim ed to systematic ally evaluate the evidence for the use of psychosocial interventions to manage anxiety in this population .
Cognitive behavioural therapy ( CBT ) was the primary intervention modality studied .