Effectiveness of Cognitive-Behavioral Therapy for Children with Autism Spectrum Disorder and Anxiety

Background: Approximately 47 to 84 percent of children with autism spectrum disorder (ASD) experience clinically significant levels of anxiety (Gillott, Furniss, & Walter, 2001; Muris, Steerneman, Merckelbach, Holdrinet, & Meesters, 1998). Children with ASD may be at a greater risk for developing anxiety due to inhibited temperament, physiological hyperarousal (Bellini, 2006), and information processing biases (Happe & Frith, 2006). Despite the clear need for effective treatments for individuals with ASD and anxiety, few empirical studies exist. Cognitive-behavioral therapy (CBT) has been deemed the treatment of choice for typically developing children with anxiety disorders (Ollendick & King, 1998). Kendall and Hedtke’s (2006) Coping Cat CBT program is among the most empirically supported and widely disseminated treatment programs for anxiety disorders in youth and has garnered the distinction of “probably efficacious” (Ollendick & King, 1998). A small body of literature has demonstrated growing support for the use of CBT to treat anxiety in children with ASD (e.g., Chalfant, Rapee, & Caroll, 2007; Sofronoff, Attwood, & Hinton, 2005) though no studies to date have evaluated the effectiveness of this treatment package for reducing anxious symptoms in children with ASD.

Objectives: The aim of this study was to evaluate the effectiveness of an empirically supported, individually-based cognitive-behavioral treatment for reducing anxious symptoms in children with ASD using a randomized controlled trial design.

Methods: Participants to date are twenty-two 7 – 14 year-old children with a diagnosis of ASD and clinically significant anxiety difficulties consistent with Separation Anxiety Disorder, Generalized Anxiety Disorder, or Social Phobia. ASD diagnoses were confirmed by the ADOS and ADI-R. Anxiety disorder classifications were confirmed using the Anxiety Disorders Interview Schedule – Parent Version (ADIS-P). All participants scored ≥ 70 on measures of intellectual and language abilities. Participants were randomly assigned to either 16 sessions of CBT (n=12) or a 16-week waitlist (n=10). Kendall and Hedke’s (2006) sixteen-session Coping Cat program for anxious children was employed as the primary intervention. Outcome measures included ADIS-P Clinician Severity Ratings (CSR) made by independent evaluators blind to treatment condition, as well as parent and child ratings on the Multidimensional Anxiety Scale for Children (MASC) and Spence Children’s Anxiety Scale (SCAS).

Results: Preliminary findings suggest that some children who completed a 16-session CBT program evidenced clinically significant reductions in anxiety symptoms as measured by diagnostic outcomes and parent and child ratings of anxiety symptoms. Reductions in specific symptoms of anxiety such as subjective physiological arousal, catastrophic thinking, and avoidance of feared stimuli were found in children who completed CBT treatment. Individual differences contributed to considerable variability in responses to the intervention. Comparative outcomes for participants in the CBT and waitlist groups will be presented.

Conclusions: Preliminary evidence suggests that the Coping Cat CBT program may be an effective treatment for reducing anxious symptoms in some children with ASD and anxiety. Specific adaptations for applying a manualized cognitive-behavioral treatment to children with ASD will be discussed.