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School-Based Application of the Brief Coping Cat Program for Children with Anxiety and Autism Spectrum Disorder

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Anxiety commonly co-occurs in children with autism spectrum disorder (ASD) and contributes to the difficulties students experience at school. Few school-based interventions demonstrate strong empirical data for successfully treating anxiety in children with ASD at school. The factors that are important to maximizing school-based intervention outcomes are not well studied in this population. The present study examined the effectiveness of a modified version of the Brief Coping Cat, a cognitive behavioral therapy (CBT) intervention with three students identified with ASD and anxiety. Using a multiple-baseline design, students participated in an 8-week intervention designed to teach them how to recognize signs of anxious arousal and use learned strategies to manage the symptoms at school. The intervention was delivered in the classroom with direct and intentional teacher involvement. Intervention outcomes were measured with student self-reported weekly ratings of anxiety and teacher observational data, and moderate effects were found. Implications for the delivery of anxiety interventions in a flexible format at school for youth with autism spectrum disorder (ASD) are discussed.

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

  • Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind?” Cognition, 21(1), 37–46.

    Article  PubMed  Google Scholar 

  • Benjamin, C., O’Neil, K., Crawley, S., Beidas, R., Coles, M., & Kendall, P. (2010). Patterns and predictors of subjective units of distress in anxious youth. Behavioural and Cognitive Psychotherapy, 38(4), 497–504.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chiu, A. W., McLeod, B. D., Har, K., & Wood, J. J. (2009). Child–therapist alliance and clinical outcomes in cognitive behavioral therapy for child anxiety disorders. Journal of Child Psychology and Psychiatry, 50, 751–758.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F. (2007). Modular cognitive-behavioral therapy for childhood anxiety disorders. Guilford Press.

    Google Scholar 

  • Chorpita, B. F., Taylor, A. A., Francis, S. E., Moffitt, C., & Austin, A. A. (2004). Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behavior Therapy, 35, 263–287.

    Article  Google Scholar 

  • Clarke, C., Hill, V., & Charman, T. (2017). School based cognitive behavioural therapy targeting anxiety in children with autistic spectrum disorder: A quasi-experimental randomised controlled trial incorporating a mixed methods approach. Journal of Autism and Developmental Disorders, 47, 3883–3895.

    Article  PubMed  Google Scholar 

  • Crawley, S. A., Kendall, P. C., Benjamin, C. L., Brodman, D. M., Wei, C., Beidas, R. S., ..., & Mauro, C. (2013). Brief cognitive-behavioral therapy for anxious youth: Feasibility and initial outcomes. Cognitive and Behavioral Practice, 20(2), 123–133.

  • Drmic, I. E., Aljunied, M., & Reaven. (2017). Feasibility, acceptability and preliminary treatment outcomes in a school-based CBT intervention program for adolescents with ASD and anxiety in Singapore. Journal of Autism and Developmental Disorders, 47, 3909–3929.

    Article  PubMed  Google Scholar 

  • Ehrenreich-May, J., Storch, E. A., Queen, A.H., …, Wood, J. J. (2014). An open trial of cognitive-behavioral therapy for anxiety disorders in adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 29(3), 145–155.

  • Friedberg, R. D., McClure, J. M., & Garcia, J. H. (2009). Cognitive therapy techniques for children and adolescents. Guilford.

    Google Scholar 

  • Fujii, C., Renno, P., McLeod, B. D., Eney Lin, C., …, Wood, J. J. (2013). Intensive cognitive behavioral therapy for anxiety disorders in school-aged children with autism: A preliminary comparison with treatment-as-usual. School Mental Health, 5, 25–27.

  • Hays, S. A., Hope, D. A., & Heimberg, R. G. (2008). The pattern of subjective anxiety during in-session exposures over the course of cognitive-behavioral therapy for clients with social anxiety disorder. Behavior Therapy, 39, 286–299.

    Article  Google Scholar 

  • Hillman, K., Dix, K., Ahmed, K., Lietz, P., Trevitt, J., O’Grady, E., Uljarević, Vivanti, G., & Hedley, D. (2020). Interventions for anxiety in mainstream school-aged children with autism spectrum disorder: A systematic review. Campbell Systematic Reviews, 16, 1–35.

    Article  Google Scholar 

  • Kendall, P. C., & Hedtke, K. A. (2006). The Coping Cat program workbook (2nd ed.). Workbook Publishing.

    Google Scholar 

  • Kendall, P. C., Crawley, S. A., Benjamin, C. L., & Mauro, C. F. (2013). The Brief Coping Cat: Therapist manual for the 8-session workbook. Workbook Publishing Inc.

    Google Scholar 

  • Kerns, C. M., & Kendall, P. C. (2012). The presentation and classification of anxiety in autism spectrum disorder. Clinical Psychology: Science & Practice, 19(4), 323–347.

    Article  Google Scholar 

  • Kester, K. R., & Lucyshyn, J. M. (2018). Co-creating a school-based Facing Your Fears anxiety treatment for children with autism spectrum disorder: A model for school psychology. Psychology in the Schools, 56, 824–839.

    Article  Google Scholar 

  • Kratochwill, T. R., Hitchcock, J., Horner, R. H., Levin, J. R., Odom, S. L., Rindskopf, D. M., & Shadish, W. R. (2010). Single-case designs technical documentation. Retrieved from:

  • Lang, R., O’Reilly, M. F., Sigafoos, J., Machalicek, W., Rispoli, M., Shogren, K., Chan, J. M., Davis, T., Lancioni, G., & Hopkins, S. (2010). Review of teacher involvement in the applied intervention researcher for children with autism spectrum disorders. Education and Training in Autism and Developmental Disabilities, 45(2), 268–283.

    Google Scholar 

  • Luxford, S., Hadwin, J. A., & Kovshoff, H. (2017). Evaluating the effectiveness of a school-based cognitive behavioral therapy intervention for anxiety in adolescents diagnosed with autism spectrum disorder. Journal of Autism & Developmental Disorders, 47, 3896–38908.

    Article  Google Scholar 

  • March, J. S. (2013). Multidimensional anxiety scale for children (2nd ed.). Multi-Health Systems.

    Google Scholar 

  • McCormack, C. C., Mennies, R. J., Silk, J. S., et al. (2020). How anxious is too anxious? State and trait physiological arousal predict anxious youth’s treatment response to brief cognitive behavioral therapy. BMC Psychology, 8(1), 48.

  • McLoone, J., Hudson, J. L., & Rapee, R. M. (2006). Treating anxiety disorders in a school setting. Education and Treatment of Children, 29(2), 220–242.

    Google Scholar 

  • McNally- Keehn, R., Lincoln, A., Brown, M., & Chavira, D. (2013). The Coping Cat program for children with anxiety and autism spectrum disorder: A pilot randomized controlled trial. Journal of Autism & Dev Disorders, 43(1), 57–67.

    Article  Google Scholar 

  • Mertens, D. M. (2015). Research and evaluation in education and psychology: Integrating diversity with quantitative, qualitative, and mixed methods. Sage.

    Google Scholar 

  • Michael, K. D., Payne, L. O., & Albright, A. E. (2012). An adaptation of the Coping Cat program: The successful treatment of a 6-year-old boy with generalized anxiety disorder. Clinical Case Studies, 11(6), 426–440.

    Article  Google Scholar 

  • Nebel-Schwalm, M., & Worley, J. (2014). Other disorders frequently comorbid with autism. In T. E. Davis, S. W. White, & T. H. Ollendick (Eds.), Handbook of autism and anxiety (pp. 47–60). Springer Publishing.

    Chapter  Google Scholar 

  • Owens, J. S., & Murphy, C. E. (2004). Effectiveness research in the context of school-based mental health. Clinical Child and Family Psychology Review, 7, 195–209.

    Article  PubMed  Google Scholar 

  • Pegg, S., Hill, K., Argiros, A., Olatunji, B. O., & Kujawa, A. (2022). Cognitive behavioral therapy for anxiety disorders in youth: Efficacy, moderators, and new advances in predicting outcomes. Current Psychiatry Reports, 24, 853–859.

    Article  PubMed  PubMed Central  Google Scholar 

  • Perihan, C., Bicer, A., & Bocanegra, J. (2022). Assessment and treatment of anxiety in children with autism spectrum disorder in school settings: A systematic review and meta-analysis. School Mental Health, 14, 153–164.

    Article  PubMed  Google Scholar 

  • Reaven, J., Blakeley-Smith, A., Nichols, S., & Hepburn, S. (2011). Facing your fears: Group therapy for managing anxiety in children with high-functioning autism spectrum disorders. Paul Brookes Publishing.

    Google Scholar 

  • Reaven, J., Meyer, A. T., Pickard, K., Boles, R. E., Hayutin, L., Middleton, C., Reyes, N. M., Hepburn, S. L., Tanda, T., Stahmer, A., & Blakeley-Smith, A. (2022). Increasing access and reach: Implementing school-based CBT for anxiety in students with ASD or suspected ASD. Evidence-Based Practice in Child and Adolescent Mental Health, 7, 56–75.

    Article  Google Scholar 

  • Shaker-Naeeni, H., Govender, T., & Chowdhury, U. (2014). Cognitive behavioural therapy for anxiety in children and adolescents with autism spectrum disorder. British Journal of Medical Practitioners, 7(3), a723.

    Google Scholar 

  • Van Steensel, F. J., Bogels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14(3), 302–317.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vasa, R. A., Keefer, A., McDonald, R. G., Hunsche, M. C., & Kerns, C. M. (2020). A scoping review of anxiety in young children with autism spectrum disorder. Autism Research, 000, 1–20.

    Article  Google Scholar 

  • White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229.

    Article  PubMed  PubMed Central  Google Scholar 

  • White, S. W., Ollendick, T., Albano, A. M., Oswald, D., Johnson, C., Southam-Gerow, M. A., et al., (2013). Randomized controlled trial: Multimodal anxiety and social skill intervention for adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(2), 382–394.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wolpe, J. (1973). The practice of behavior therapy. Pergamon Press.

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Wood, J. J., Klebanoff, S., Renno, P., Fujii, C., & Danial, J. (2017). Individual CBT for anxiety and related symptoms in children with autism spectrum disorders. In C. M. Kerns, P. Renno, E. A. Storch, P. C. Kendall, & J. J. Wood (Eds.), Anxiety in children and adolescents with autism spectrum disorder: Evidence-based assessment and treatment (pp. 123–141). Academic Press.

    Chapter  Google Scholar 

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We would like to thank the teacher, students, and parents who participated in our study.

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Authors and Affiliations



Both the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by C. O’N. The first draft of the manuscript was written by E. B. and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Elana R. Bernstein.

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Ethics Approval and Consent to Participate

The University Institutional Review Board (IRB) approved this study prior to recruitment and data collection. Consent was obtained from the school principal and participating teacher, followed by parent consent for each of the three participants.

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Not applicable; no identifying information included.

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The authors declare no competing interests.

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Bernstein, E.R., O’Neal, C. School-Based Application of the Brief Coping Cat Program for Children with Anxiety and Autism Spectrum Disorder. Contemp School Psychol (2023).

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