Skip to main content

School based cognitive behavioural therapy targeting anxiety in children with autistic spectrum disorder: a quasi-experimental randomised controlled trail incorporating a mixed methods approach

Journal of Autism and Developmental Disorders volume 47, pages 3883–3895 (2017)Cite this article

Abstract

Children with a diagnosis of autism are more likely to experience anxiety than their typically developing peers. Research suggests that Cognitive Behavioural Therapy (CBT) could offer a way to help children with autism manage their anxiety but most evidence is based on clinical trials. This study investigated a school-based CBT programme using a quasi-experimental design incorporating the child and parent versions of the Spence Children’s Anxiety Scale (Spence, J Abnorm Psy 106(2):280–297, 1997) and the Coping Scale for Children and Youth (Brodzinsky et al., J Appl Dev Psychol 13:195–214, 1992). Interview data was incorporated to help understand the process of change further. Children in the experimental condition had lower levels of anxiety, maintained at follow-up and changes were found in coping behaviours such as lower behavioural avoidance strategies but increased problem solving strategies at follow-up. Limitations of the research together with future directions are also discussed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

Notes

  1. Although the American Psychiatric Association released the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V: American Psychiatric Association 2013) which changed the definition of ASD this research and the cited references were all conducted prior to its release so the DSM-IV definition has been retained.

References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, Text revision (DSM-IV-TR) (4th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  • Ashburner, J., Ziviani, J., & Rodger, S. (2010). Surviving in the mainstream: Capacity if children with autism spectrum disorder to perform academically and regulate their emotions and behavior at school. Research in Autism Spectrum Disorder, 4(1), 18–27.

    Article  Google Scholar 

  • Attwood, T. (2004). Exploring feelings: Cognitive behavioural therapy to manage anxiety. Arlington, TX: Future Horizons.

    Google Scholar 

  • Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., & Charman, T. (2006). Prevalence of disorder of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). Lancet, 368, 179–181.

    Article  Google Scholar 

  • Baron-Cohen, S., Scott, F. J., Allison, C., Williams, J., Bolton, P., Matthews, F. E., & Brayne, C. (2009). Prevalence of autism-spectrum conditions: UK school-based population study. The British Journal of Psychiatry, 194, 500–509.

    Article  PubMed  Google Scholar 

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.

    Article  Google Scholar 

  • Brodzinsky, D. M., Elias, M. J., Steiger, C., Simon, J., Gill, M., & Hitt, J. C. (1992). Coping scale for children and youth: Scale development and validation. Journal of Applied Developmental Psychology, 13, 195–214.

    Article  Google Scholar 

  • Chalfant, A. M., Rapee, R., & Carroll, L. (2007). Treating anxiety disorders in children with high functioning autism spectrum disorders: A controlled trial. Journal of Autism and Developmental Disorders, 37, 1842–1857.

    Article  PubMed  Google Scholar 

  • Chu, B. C., & Harrison, T. L. (2007). Disorder-specific effects of CBT for anxious and depressed youth: A meta-analysis of candidate mediators of change. Clinical Child and Family Psychology Review, 10, 352–372.

    Article  PubMed  Google Scholar 

  • Cohen, L., Manion, L., & Morrison, K. (2007). Research methods in education (6th ed.). Oxford: Routledge.

    Google Scholar 

  • Compas, B. E., Connor-Smith, J. K., Saltzman, H. Harding, Thomsen, A., & Wadsworth, M. E. (2001). Coping with stress during childhood and adolescence: Problems, progress and potential in theory and research. Psychological Bulletin, 127, 87–127.

    Article  PubMed  Google Scholar 

  • Constantino, J. N. (2002). The Social Responsiveness Scale. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Constantiono, J. N., Davis, S. A., Todd, R. D., Schindler, M. K., Gross, M. M., Brophy, S. L., et al. (2003). Validation of a brief quantitative measure of autistic traits: Comparison of the social responsiveness scale with the autism diagnostic interview-revised. Journal of Autism and Developmental Disorders, 33(4), 427–433.

    Article  Google Scholar 

  • Department for Children, Schools and Families. (2008). Targeted mental health in schools project. London: DCSF Publications.

    Google Scholar 

  • Department for Education. (2014). Mental health and behaviour in schools. London: DFE Publications.

    Google Scholar 

  • Graham, P. (2005). Cognitive behaviour Therapy for children and families (2nd ed.). Cambridge: Cambridge University Press.

    Google Scholar 

  • Harcourt Assessment. (1999). WASI manual. San Antonia: Harcourt Assessment.

    Google Scholar 

  • Humphrey, N. (2008). Including pupils with autistic spectrum disorders in mainstream schools. Support for Learning, 23(1), 41–47.

    Article  Google Scholar 

  • Ishikawa, S-i, Okajima, I., Matsuoka, H., & Sakano, Y. (2007). Cognitive behavioural therapy for anxiety disorders in children and adolescents: A meta-analysis. Child and Adolescent Mental Health, 12, 164–172.

    Article  Google Scholar 

  • Kazdin, A. E. (2000). Developing a research agenda for children and adolescence psychotherapy. Archives of General Psychiatry, 57, 829–835.

    Article  PubMed  Google Scholar 

  • Kerns, C. M., & Kendall, P. C. (2012). The presentation and classification of anxiety in autism spectrum disorders. Clinical Psychology: Science and Practice, 19, 323–347.

    Google Scholar 

  • Kussikko, S., Pollock-Wurman, R., Jussila, K., Carter, A. S., Lattila, M.-L., Ebeling, H., et al. (2008). Social anxiety in high-functioning children and adolescents with autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 38, 1697–1709.

    Article  Google Scholar 

  • McConachie, H., McLaughlin, E., Grahame, V., Taylor, H., Honey, E., Tavernor, L., et al. (2014). Group therapy for anxiety in children with autism spectrum disorder. Autism, 18(6), 723–732.

    Article  PubMed  Google Scholar 

  • Ollendick, T. H., Langley, A. K., Jones, R. T., & Kephart, C. (2001). Fear in children and adolescents: Relations with negative life events, attributional style, and avoidant coping. Journal of Child Psychology and Psychiatry, 42, 1029–1034.

    Article  PubMed  Google Scholar 

  • Osler, A., & Osler, C. (2002). Inclusion, exclusion and children’s rights: A case study of a student with Asperger syndrome. Emotional and Behavioural Difficulties, 7, 35–54.

    Google Scholar 

  • Prins, P. J. M., & Ollendick, T. H. (2003). Cogntive change and enhanced coping: Missing mediational links in cogntive behaior therapy with ansiety-disordered children. Clinical Child and Family Psychology Review, 6(2), 87–105.

    Article  PubMed  Google Scholar 

  • Reaven, J., Blakeley-Smith, A., Culhane-Shelburne, K., & Hepburn, S. (2012). Group cognitive behaviour therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial. Journal of Child Psychology and Psychiatry, 53(4), 410–419.

    Article  PubMed  PubMed Central  Google Scholar 

  • Reynolds, C. R., & Richmond, B. O. (1978). What I think and feel: A revised measure of children’s manifest anxiety. Journal of Abnormal Psychology, 6(2), 271–280.

    Google Scholar 

  • Simonoff, E., Jones, C. R. G., Baird, G., Pickles, A., Happe, F., & Charman, T. (2012). The persisitence and stability of psychiatric problems in adolescents with autism spectrum disorders. The Journal of Child psychology and Psychiatry, 54(2), 186–194.

    Article  PubMed  Google Scholar 

  • Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal American Academic Child and Adolescent Psychiatry, 47(8), 921–929.

    Article  Google Scholar 

  • Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46(11), 1152–1160.

    Article  PubMed  Google Scholar 

  • Spence, S. H. (1997). Structure of anxiety symptoms among children: A confirmatory factor-analytic study. Journal of Abnormal Psychology, 106(2), 280–297.

    Article  PubMed  Google Scholar 

  • Sze, K. M., & Wood, J. J. (2007). Cognitive behavioural treatment of comorbid anxiety disorders and social difficulties in children with high-functioning autism: A case report. Journal of Contemporary Psychotherapy, 37, 133–143.

    Article  Google Scholar 

  • van Steensel, F. J. A., Bogels, S. M., & Perrin, S. (2010). Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clinical Child Family Psychology Review, 14, 302–317.

    Article  Google Scholar 

  • Wechsler, D. (1991). Wechsler intelligence scale for children (3rd ed.). San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • White, S. W., Ollendick, T., Scahill, L., Oswald, D., & Albano, A. M. (2009). Preliminary efficacy of a cogntive-behavioural treatment program for anxious youth with autism spectrum disorder. Journal of Autism and Developmental Disorders, 39, 1652–1662.

    Article  PubMed  Google Scholar 

  • Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioural therapy for anxiety in children with autism spectrum disorders: a randomised, controlled trail. Journal of Child Psychology and Psychiatry, 50(3), 224–234.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wood, J. J., & Gadow, K. D. (2010). Exploring the nature and function of anxiety in youth with autism spectrum disorders. Clinical Psychology: Science and Practice, 17(4), 281–292.

    Google Scholar 

  • World Health Organisation (WHO). (1993). International classification of diseases and related health problems version 10. Geneva: World Health Organisation.

    Google Scholar 

Download references

Author Contributions

CC conceived the study and participated in the design and coordination of the study and performed the measurement, statistical analysis and drafted the manuscript. VH supported the conception and design of the study and analysis of qualitative data. TC supported the design and analysis. All authors contributed to the final manuscript.

Author information

Author notes

  1. Tony Charman

    Present address: Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK

Authors and Affiliations

  1. Kent Educational Psychology Service, Kroner House, Eurogate Business Park, Ashford, Kent, TN24 8XU, UK

    Chris Clarke

  2. UCL Institute of Education, London, UK

    Vivian Hill

Authors
  1. Chris Clarke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vivian Hill
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tony Charman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chris Clarke.

Appendix 1: Semi-structured Interview used with Children and Parent at Post-intervention

Appendix 1: Semi-structured Interview used with Children and Parent at Post-intervention

General Introduction

Introductions (me, my role and why I am speaking to them)

  • The right to withdraw at anytime

  • This is being recorded, do you consent/are you happy to proceed?

  • What we will do with the interview data

    • Transcribed

    • Analysed

    • Used in doctoral thesis

    • Securely stored

  • Check for understanding (Ask them, if necessary, to repeat back key points of what I have said; Based on what I have told you are you happy to proceed?)

Child

  • Talk to the child about different emotions they have had recently (try to get the child to talk about ‘good’ or ‘happy’ experiences as well)

  • Reflect on an experience they found difficult recently (what was different to the happy/good experiences?)

    • Physiological (sweating, pounding heart) reaction to the event

    • Thoughts about the event (What were they thinking? Did they think about any other options?)

    • What emotions were they experiencing?

      • What was the outcome? (What did they do? What options did they consider? Why did they choose this outcome?)

  • If this happened again, would they do anything differently?

  • Talk to the child about the classroom (where do you sit? who do you work with? what are your favourite subjects (why do you like them? What about subject?)) Develop this to find probing questions about their thoughts, feelings and emotions in the classroom and what strategies they use.

Parent

  • What is their understanding of ASD

    • Communication (sharing experiences, mannerisms)

    • Social interaction (friendships, social rules/etiquette)

    • Rigid behaviours (interests, other interests, taking part in other peoples’ games, rules)

  • Using their understanding, how does this impact on their child’s behaviours.

  • What sort of feelings/emotions do you see in your child.

    • How does he cope with these behaviours and feelings?

    • What does anxiety look like to the parent?

    • Physiological?

  • When has he done something which they thought would be difficult, but he was okay with (what was different? why was it surprising about it?)

    • What coping behaviours did they use (avoidance, etc.)

  • What is your understanding of his behaviours in school/classroom (what have you heard from teacher’s, your child’s friends, etc.)

  • Have you noticed any changes in child’s name recently?

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Clarke, C., Hill, V. & Charman, T. School based cognitive behavioural therapy targeting anxiety in children with autistic spectrum disorder: a quasi-experimental randomised controlled trail incorporating a mixed methods approach. J Autism Dev Disord 47, 3883–3895 (2017). https://doi.org/10.1007/s10803-016-2801-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-016-2801-x

Keywords

  • Autism
  • Cognitive behavioural therapy
  • Schools based interventions
  • Coping behaviours
  • Mixed methods