Abstract
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 randomly assigned to either of the programs (n CBT = 36; n SR = 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.
Similar content being viewed by others
References
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. APA, Washington, DC
Ghaziuddin M (2002) Asperger syndrome: associated psychiatric and medical conditions. Focus Autism Dev Disabil 17:138–144
Russell E, Sofronoff K (2005) Anxiety and social worries in children with Asperger syndrome. Aust N Z J Psychiatry 39:633–638
White SW, Oswald D, Ollendick T, Scahill L (2009) Anxiety in children and adolescents with autism spectrum disorders. Clin Psychol Rev 29:216–229
Howlin P (1998) Children with autism and Asperger syndrome: a guide for practitioners and carers. Wiley, Chichester
Thomas G, Barratt P, Clewley H, Joy H, Potter M, Whitaker P (1998) Asperger syndrome: practical strategies for the classroom. The National Autistic Society, London
Gillott A, Furniss F, Walter A (2001) Anxiety in high-functioning children with autism. Autism 5:277–286
Albano A, Kendall P (2002) Cognitive therapy for children and adolescents with anxiety disorders: clinical research advances. Int Rev Psych 14:129–134
Flannery-Schroeder EC, Kendall P (2000) Group and individual treatments for youth with anxiety disorders: a randomized clinical trial. Cogn Ther Res 24:251–278
Kendall PC (1994) Treating anxiety disorders in children: results of a randomized clinical trial. J Consult Clin Psychol 62:100–110
Robinson TR, Smith SW, Miller MD, Brownell MT (1999) Cognitive-behavior modification of hyperactivity-impulsivity and aggression: a meta-analysis of school-based studies. J Educ Psychol 91:195–203
Kendall PC (1985) Toward a cognitive-behavioral model of child psychopathology and a critique of related interventions. J Abnorm Child Psychol 13:357–372
Frith U (1989) Autism: explaining the enigma. Blackwell, Oxford
Chalfant AM, Rapee R, Carroll L (2007) Treating anxiety disorders in children with high functioning autism spectrum disorders: a controlled trial. J Autism Dev Disord 37:1842–1857
Ooi YP, Lam CM, Sung M, Tan WTS, Goh TJ, Fung DSS et al (2008) Effects of cognitive-behavioral therapy on anxiety for children with high-functioning autistic spectrum disorders. Singapore Med J 49:215–220
Sofronoff K, Attwood T, Hinton S (2005) A randomized controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. J Child Psychol Psychiatry 45:1–9
Wood JJ, Drahota A, Sze K, Har K, Chiu A, Langer DA (2008) Cognitive behavior therapy for anxiety in children with autism spectrum disorders: a randomized controlled trial. J Child Psychol Psychiatry 50:224–234
Favell JE, McGimsey JF, Schell RM (1982) Treatment of self-injury by providing alternate sensory activities. Anal Interv Dev Disabil 2:83–104
Modell SJ, Rider RA, Menchetti BM (1997) An exploration of the influence of educational placement on the community recreation and leisure patterns of children with developmental disabilities. Percept Mot Skills 85:695–704
Neulinger J (1974) The psychology of leisure. Charles C. Thomas, Springfield
Wilson A, Arnold M, Rowland ST, Burnham S (1997) Promoting recreation and leisure activities for individuals with disabilities: a collaborative effort. J Instruc Psychol 24:76–79
Zager D, Shamow N (2005) Teaching students with autism spectrum disorders. In: Zager D (ed) Autism spectrum disorders: identification, education, and treatment. Lawrence Erlbaum, Mahwah, NJ, pp 295–326
Lord C, Rutter M, DiLavore PC, Risi S (2002) Autism diagnostic observation schedule. Western Psychological Services, Los Angeles
Weschler D (2003) Manual for the Weschler intelligence scale for children, 4th edn. Psychological Corporation, Toronto, ON
Spence SH (1998) A measure of anxiety symptoms among children. Behav Res Ther 36:545–566
National Institute of Mental Health (1985) Special feature: rating scales and assessment instruments for use in paediatric psychopharmacology research. Psychopharmacol Bull 21:839–843
Research Units on Pediatric Psychopharmacology (RUPP) Autism Network (2005) Risperidone treatment of autistic disorder: longer-term benefits and blinded discontinuation after 6 months. Am J Psychiatry 162:1361–1369
Kendall PC (2000) Cognitive-behavioral therapy for anxious children: therapist manual, 2nd edn. Workbook Publishing, Ardmore, PA
Attwood T (2004) Exploring feelings: cognitive behavior therapy to manage anxiety. Future Horizons, Arlington, TX
Gray C (2000) Writing social stories™ with carol gray (video). Future Horizons, Arlington, TX
Nichols P (1999) Clear thinking: talking back to whispering shadows: a psychoeducational treatment. DC Heath, Lexington
Kenardy J, Dow M, Johnston D, Newman M, Thomson A et al (2003) A comparison of delivery methods of cognitive—behavioral therapy for panic disorder: an international multicenter trial. J Child Psychol Psychiatry 71:1068–1075
Jacobson NS, Truax P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 59:12–19
Chanen AM, Jackson HJ, McCutcheon LK, Jovev M, Dudgeon P, Yuen HP et al (2008) Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomized controlled trial. Brit J Psych 193:477–484
Khanna MS, Kendall PC (2009) Exploring the role of parent training in the treatment of childhood anxiety. J Consult Clin Psychol 77:981–986
Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Lancet 357(9263):1191–1194
Acknowledgments
This study was supported by the National Medical Research Council (NMRC) grant (Ref No.: NMRC/1002/2005). We would like to extend our heartfelt thanks to the participants and their parents. We would also like to extend thanks to Joel Low for proofreading the article.
Author information
Authors and Affiliations
Corresponding author
Appendix
Appendix
See Table 5.
Rights and permissions
About this article
Cite this article
Sung, M., Ooi, Y.P., Goh, T.J. et al. Effects of Cognitive-Behavioral Therapy on Anxiety in Children with Autism Spectrum Disorders: A Randomized Controlled Trial. Child Psychiatry Hum Dev 42, 634–649 (2011). https://doi.org/10.1007/s10578-011-0238-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10578-011-0238-1