Therapies for Children With Autism Spectrum Disorders

samples. 169,176;170,171;174,175 Accounting for this potential overlap, it appears that at least four
independent studies of CBT interventions and three independent studies of parent training
address anxiety and anger in children with ASDs. All studies examining CBT treatments
included children ages seven and older, with means ranging from nine to eleven years of age. In
two studies examining CBT treatments, only children with an Asperger diagnosis were
included, 169,176 while the Wood et al. RCT enrolled children with an ASD and a comorbid
anxiety disorder. 170,171
Parent training studies included parents of children ranging from age four to twelve with
mean ages spanning seven to nine years. 172,174,175,178 In three of four parent training studies, only
parents of children with Asperger syndrome were included. 174,175,178 In the teacher training study,
children ranged in age from two to fifteen and all had diagnoses of autistic disorder. 173 Table 10
summarizes additional study details. Among all studies, six were fair quality and five were poor.
Summary of the literature. Among the studies assessing CBT approaches, one RCT examined
the efficacy of a modified version of the Building Confidence CBT program for treating
comorbid anxiety disorders (i.e., separation anxiety disorder, social phobia, or obsessive
compulsive disorder) in seven to eleven year-old children with ASDs. 170,171 This was the only
RCT in which CBT occurred at the individual level.
The intervention program consisted of sixteen 90-minute weekly sessions conducted by
clinical or educational psychologists or trainees in these programs. In the first report from the
study, 170,171 anxiety symptoms were assessed by evaluators blind to treatment condition using the
Anxiety Disorders Interview Schedule, Clinical Global Impression (CGI)–Improvement Scale,
and both parent and child versions of the Multidimensional Anxiety Scale for Children.
On the CGI, 92.9 percent of children in the intervention condition met criteria for positive
treatment response, while only 9.1 percent of children in the waitlist control group met the same
criteria; on the Anxiety Disorders Interview Schedule, 64.3 percent of children in the
intervention group no longer met criteria for any anxiety disorder, whereas only 9.1 percent of
children in the waitlist control group lost their anxiety disorder diagnosis at post-test.
Eight of ten children from the intervention group who returned for a three-month followup
did not meet criteria for any anxiety disorder at followup. Maintenance of treatment response
was also indicated by CGI and Multidimensional Anxiety Scale for Children scores at followup.
The second report from the study 171 included 58 percent of participants from the initial report
(42 percent new participants), and measured effects of the intervention on autism symptoms
using the Social Responsiveness Scale. Significant group differences were observed at outcome
in the Social Responsiveness Scale total score as well as the social communication, social
motivation, and social awareness subscales, with children in the intervention group showing
fewer autism symptoms post-treatment than children in the waitlist control group.
The remainder of CBT-based interventions (Table 13) were conducted in group settings or
directed toward parents. Reaven et al. 26 conducted a nonrandomized trial of a 12-week CBTbased
group intervention for high-functioning (i.e., IQ above 70) children ages eight to fourteen
years (mean = 11.83) with ASDs and comorbid anxiety disorders.
The authors created an original protocol, 27 and treatment involved both children and their
parents. Ten children received active treatment in this pilot study, while 23 served as a wait-list
control. Anxiety symptoms in children participating in the treatment group decreased over time,
while symptoms in the control group did not on the parent (but not child) version of the Kiddie-
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