Treating Anxiety Disorders in Children with High Functioning Autism Spectrum Disorder: A Controlled Trial

Background:   Prevalence rates of anxiety symptomatology in children with High Functioning Autism Spectrum Disorder (HFASD) support the argument that anxiety is a core difficulty of many children who suffer with HFASD (e.g., Leyfer et al., 2006; Gillot, Furniss, & Walter, 2001; Muris et al., 1998).  Although, manualised Cognitive Behaviour Therapy (CBT) programs have widely demonstrated efficacy among typically developing, anxious children (without intellectual delay) (e.g., Albano, Chorpita, & Barlow, 2003), there is little published literature regarding the direct relevance of CBT models to children with HFASD.

Objectives:   To conduct a clinical trial investigating the effectiveness of a manualised CBT program for HFASD children who have a comorbid anxiety disorder.

Methods:   Forty-seven children aged 8–13 years (35 boys, 12 girls) were randomly assigned to either the CBT (n = 28) or WL condition (n = 19; offered treatment after the WL period).  Participants received a primary anxiety disorder diagnosis on the basis of structured clinical interviews conducted with the both the parent and the child using the Anxiety Disorders Interview Schedule’’ (ADIS).  The Revised Children’s Manifest Anxiety Scale (RCMAS), the Spence Children’s Anxiety Scale (SCAS), the Children’s Automatic Thoughts Scale (CATS), and the Strengths and Difficulties Questionnaire (SDQ) were also used as self, parent and teacher report measures of anxiety.  All measures were administered pre and post treatment.  Treatment involved 9 weekly treatment sessions and 3 monthly booster sessions with both the child and the parent.

Results:   At post-treatment, the percentage of children who no longer met DSM-IV-TR criteria for a current primary anxiety disorder was significantly more for the CBT condition (20 of 28 children or 71.4%) than for the WL (0 out of 19 children or 0%),  ^_X2 (1, N = 47) = 24.889, p < .05.  Comparisons between the two conditions also indicated significant reductions in anxiety symptoms as measured by self report, parent report, and teacher report.

Conclusions:   Manualised CBT might be a suitable treatment option for children with HFASD and their families, with the potential for treatment benefits to extend to both the home and school setting.  Further investigations could consider which treatment components are most effective for this group and what adaptations to traditional CBT are most beneficial for the learning styles of HFASD children.