Skip to main content
SpringerLink
Log in

The Coping Cat Program for Children with Anxiety and Autism Spectrum Disorder: A Pilot Randomized Controlled Trial

  • Original paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

The purpose of this pilot study was to evaluate whether a modified version of the Coping Cat program could be effective in reducing anxiety in children with autism spectrum disorder (ASD). Twenty-two children (ages 8–14; IQ ≥ 70) with ASD and clinically significant anxiety were randomly assigned to 16 sessions of the Coping Cat program (cognitive-behavioral therapy; CBT) or a 16-week waitlist. Children in the CBT condition evidenced significantly larger reductions in anxiety than those in the waitlist. Treatment gains were largely maintained at two-month follow-up. Results provide preliminary evidence that a modified version of the Coping Cat program may be a feasible and effective program for reducing clinically significant levels of anxiety in children with high-functioning ASD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Albano, A. M., & Kendall, P. C. (2002). Cognitive behavioral therapy for children and adolescents with anxiety disorders: Clinical research advances. International Review of Psychiatry, 14, 129–134.

    Article  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.: Text Revision.

    Google Scholar 

  • Anderson, S. & Morris, J. (2006). Cognitive behavior therapy for people with Asperger syndrome. Behavioural and Cognitive Psychotherapy, 34, 293–303.

    Article  Google Scholar 

  • 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 

  • Barrett, P., Dadds, M. R., & Rapee, R. M. (1996a). Family treatment of childhood anxiety: A controlled trial. Journal of Consulting and Clinical Psychology, 64(2), 333–342.

    Article  PubMed  Google Scholar 

  • Barrett, P., Rapee, R. M., Dadds, M. R., & Ryan, S. M. (1996b). Family enhancement of cognitive style in anxious and aggressive children. Journal of Abnormal Child Psychology, 24(2), 187–203.

    Article  PubMed  Google Scholar 

  • Bauminger, N., & Kasari, C. (1999). Brief report: Theory of mind in high-functioning children with autism. Journal of Autism and Developmental Disorders, 29(1), 81–86.

    Article  PubMed  Google Scholar 

  • Bellini, S. (2004). Social skills deficits and anxiety in high-functioning adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 19(2), 78–86.

    Article  Google Scholar 

  • Bellini, S. (2006). The development of social anxiety in adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 21(3), 138–145.

    Article  Google Scholar 

  • Chalfant, A. M., Rapee, R. M., & Carroll, L. (2007). Treating anxiety disorders in children with high functioning autism spectrum disorders: A controlled trial. Journal of Autism and Developmental Disorders, 37(10), 1842–1857.

    Article  PubMed  Google Scholar 

  • Cicchetti, D. V., Koenig, K., Klin, A., Volkmar, F. R., Paul, R., & Sparrow, S. (2010). From Bayes through marginal utility to effect sizes: A guide to understanding the clinical and statistical significance of the results of autism research findings. Journal of Autism and Developmental Disorders, 41(2), 168–174.

    Google Scholar 

  • Farrugia, S., & Hudson, J. L. (2006). Anxiety in adolescents with Asperger syndrome: Negative thoughts, behavioral problems, and life interference. Focus on Autism and Other Developmental Disabilities, 21(1), 25–35.

    Article  Google Scholar 

  • Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191.

    Article  PubMed  Google Scholar 

  • Gillott, A., Furniss, F., & Walter, A. (2001). Anxiety in high-functioning children with autism. Autism, 5(3), 277–286.

    Google Scholar 

  • Gillott, A., & Standen, P. J. (2007). Levels of anxiety and sources of stress in adults with autism. Journal of Intellectual Disabilities, 11(4), 359–370.

    Article  PubMed  Google Scholar 

  • Happe, F. (1995). The role of age and verbal ability in the theory of mind task performance of subjects with autism. Child Development, 66(3), 843–855.

    Article  PubMed  Google Scholar 

  • Happe, F., & Frith, U. (2006). The weak coherence account: Detail-focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders, 36(1), 5–25.

    Article  PubMed  Google Scholar 

  • Hudson, J. L., Krain, A. L., & Kendall, P. C. (2001). Expanding horizons: Adapting manual-based treatments for anxious children with comorbid diagnoses. Cognitive and Behavioral Practice, 8, 338–346.

    Article  Google Scholar 

  • Kanner, L. (1943). Autistic disturbances of affective content. Nervous Child, 2, 217–250.

    Google Scholar 

  • Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62(1), 100–110.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindel, S. M., Southam-Gerow, M., Henin, A., & Warman, M. (1997). Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65(3), 366–380.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., & Hedtke, K. A. (2006a). Cognitive-behavioral therapy for anxious youth: Therapist manual (3rd ed.). Ardmore, PA: Workbook Publishing.

    Google Scholar 

  • Kendall, P. C., & Hedtke, K. A. (2006b). The coping cat program workbook (2nd ed.). Ardmore, PA: Workbook Publishing.

    Google Scholar 

  • Kendall, P. C., Safford, S., Flannery-Schroeder, E., & Webb, A. (2004). Child anxiety treatment: Outcomes in adolescence and impact on substance use and depression at 7.4-year follow-up. Journal of Consulting and Clinical Psychology, 72(2), 276–287.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., & Southam-Gerow, M. A. (1996). Long-term follow-up of a cognitive-behavioral therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64(4), 724–730.

    Article  PubMed  Google Scholar 

  • Kim, J. A., Szatmari, P., Bryson, S. E., Streiner, D. L., & Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4(2), 117–132.

    Article  Google Scholar 

  • Kraemer, H. C., Mintz, J., Noda, A., Tinklenberg, J., & Yesavage, J. A. (2006). Caution regarding the use of pilot studies to guide power calculations for study proposals. Archives of General Psychiatry, 63, 484–489.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2002). Autism diagnostic observation schedule. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Meyer, J. A., Mundy, P. C., Van Hecke, A. V., & Durocher, J. S. (2006). Social attribution processes and comorbid psychiatric symptoms in children with Asperger syndrome. Autism, 10(4), 383–402.

    Article  PubMed  Google Scholar 

  • Nauta, M., Scholing, A., Rapee, R. M., Abbott, M., Spence, S. H., & Waters, A. (2004). A parent-report measure of children’s anxiety: Psychometric properties and comparison with child-report in a clinic and normal sample. Behavior Research and Therapy, 42, 813–839.

    Article  Google Scholar 

  • Ollendick, T. H., & King, N. J. (1998). Empirically supported treatments for children with phobic and anxiety disorders: Current status. Journal of Clinical Child Psychology, 27(2), 156–167.

    Article  PubMed  Google Scholar 

  • Ooi, Y. P., Lam, C. M., Sung, M., Tan, W. T., Goh, T. J., Fung, D. S., et al. (2008). Effects of cognitive-behavioural therapy on anxiety for children with high-functioning autistic spectrum disorders. Singapore Medical Journal, 49(3), 215–220.

    PubMed  Google Scholar 

  • Reaven, J. A. (2009). Children with high-functioning autism spectrum disorders and co-occurring anxiety symptoms: Implications for assessment and treatment. Journal for Specialists in Pediatric Nursing, 14(3), 192–199.

    Article  PubMed  Google Scholar 

  • Reaven, J. A., Blakeley-Smith, A., Nichols, S., Dasari, M., Flanigan, E., & Hepburn, S. (2009). Cognitive-behavioral group treatment for anxiety symptoms in children with high-functioning autism spectrum disorders: A pilot study. Focus on Autism and Other Developmental Disabilities, 24(1), 27–37.

    Article  Google Scholar 

  • Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism diagnostic interview- revised. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Silverman, W. K., & Albano, A. M. (2004). Anxiety disorders interview schedule (ADIS-IV) child and parent interview schedules. New York: Oxford University Press.

    Google Scholar 

  • Silverman, W. K., Saavedra, L. M., & Pina, A. A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of the American Academy of Child and Adolescent Psychiatry, 40(8), 937–944.

    Article  PubMed  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. (1998). A measure of anxiety symptoms among children. Behavior Research and Therapy, 36(5), 545–566.

    Article  Google Scholar 

  • Spence, S. H., Barrett, P., & Turner, C. (2003). Psychometric properties of the Spence Children’s Anxiety Scale with young adolescents. Anxiety Disorders, 17, 605–625.

    Article  Google Scholar 

  • Treadwell, K. R., Flannery-Schroeder, E., & Kendall, P. C. (1995). Ethnicity and gender in relation to adaptive functioning, diagnostic status, and treatment outcome in children from an anxiety clinic. Journal of Anxiety Disorders, 9(5), 373–384.

    Article  Google Scholar 

  • Velting, O. N., Setzer, N. J., & Albano, A. M. (2004). Update on advances in assessment and cognitive-behavioral treatment of anxiety disorders in children and adolescents. Professional Psychology: Research and Practice, 35(1), 42–54.

    Article  Google Scholar 

  • Walkup, J. T., Albano, A. M., Piacentini, J. C., Birmaher, B., Compton, S. N., Sherrill, J. T., et al. (2008). Cognitive behavioral therapy, Sertraline, or a combination in childhood anxiety. The New England Journal of Medicine, 359(26), 2753–2766.

    Article  PubMed  Google Scholar 

  • Wechsler, D. (1999). Wechsler Abbreviated Scale of Intelligence (WASI). San Antonio: Pearson Assessment.

    Google Scholar 

  • White, S. W., Albano, A., Johnson, C., Kasari, C., Ollendick, T., Klin, A., et al. (2010). Development of a cognitive-behavioral intervention program to treat anxiety and social deficits in teens with high-functioning autism. Clinical Child and Family Psychology Review, 13(1), 77–90.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009b). Preliminary efficacy of a cognitive-behavioral treatment program for anxious youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 1652–1662.

    Article  PubMed  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 

  • Yirmiya, N., Erel, O., Shaked, M., & Solomonica-Levi, D. (1998). Meta-analyses comparing theory of mind abilities of individuals with autism, individuals with mental retardation, and normally developing individuals. Psychological Bulletin, 124(3), 283–307.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This study was supported by grants awarded to RMK from the National Foundation for Autism Research and the Autism Society of America—San Diego County Chapter. We would like to thank the children and families who generously participated. Trial Registry Information: Clinicaltrials.gov database reference number: NCT01187784. Internet link: http://clinicaltrials.gov/ct2/show/NCT01187784.

Author information

Authors and Affiliations

  1. California School of Professional Psychology, Alliant International University, 10455 Pomerado Road, San Diego, CA, 92131, USA

    Rebecca H. McNally Keehn, Alan J. Lincoln & Milton Z. Brown

  2. Center for Autism Research, Evaluation and Service, San Diego, CA, USA

    Alan J. Lincoln

  3. Department of Psychiatry, University of California, San Diego, CA, USA

    Denise A. Chavira

  4. Child and Adolescent Services Research Center, Rady Children’s Hospital, San Diego, CA, USA

    Denise A. Chavira

Authors
  1. Rebecca H. McNally Keehn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alan J. Lincoln
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Milton Z. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Denise A. Chavira
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rebecca H. McNally Keehn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McNally Keehn, R.H., Lincoln, A.J., Brown, M.Z. et al. The Coping Cat Program for Children with Anxiety and Autism Spectrum Disorder: A Pilot Randomized Controlled Trial. J Autism Dev Disord 43, 57–67 (2013). https://doi.org/10.1007/s10803-012-1541-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-012-1541-9

Keywords

Search

Navigation