A Systematic Review and Meta-Analysis of Cognitive-Behavioral Therapy for Anxiety in Youth with High-Functioning Autism Spectrum Disorders
Abstract
Cognitive-behavioral therapy (CBT) has been developed and modified to treat anxiety symptoms in youth with high-functioning autism spectrum disorders (ASD) but has yielded varying findings. The present report is a systematic review and meta-analysis examining the efficacy of CBT for anxiety among youth with ASD. A systematic search identified 14 studies involving 511 youth with high-functioning ASD. A random effects meta-analysis yielded a statistically significant pooled treatment effect size (g) estimate for CBT (g = -0.71, p < .001) with significant heterogeneity [Q (13) = 102.27, p < .001]. Removal of a study outlier yielded a statistically significant pooled treatment effect size, (g = -0.47, p < .001). Anxiety informant and treatment modality were not statistically significant moderators of treatment response. Findings suggest that CBT demonstrates robust efficacy in reducing anxiety symptoms in youth with high-functioning ASD.
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Fourteen randomized-control and 2 open-label trials of CBT, modified for school-age children with ASD, support its efficacy in reducing anxiety in this age group.
“Fourteen randomized-control and 2 open-label trials of CBT, modified for school-age children with ASD, support its efficacy in reducing anxiety in this age group, with most studies reporting medium effect sizes and remission rates ranging from 38.0% to 71.4% [44, 46].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [44]
Remission rates in CBT trials for school-age children with ASD range from 38.0% to 71.4%.
“remission rates ranging from 38.0% to 71.4% [44, 46].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [44]
Most studies of CBT for school-age children with ASD report medium effect sizes.
“with most studies reporting medium effect sizes”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [44]
Ung et al. (2015) found significant pooled effect sizes for anxiety reduction in autistic youths, despite notable heterogeneity.
“Ung et al. (2015) found significant pooled effect sizes for anxiety reduction in autistic youths, despite notable heterogeneity.”
From Rethinking psychological interventions in autism: Toward a neurodiversity‐affirming approach. (2025) · cites this paper as Ung et al., 2015
One-to-one and group-based CBT leads to moderate-to-large reductions in anxiety in autistic youths and adults, similar to effects in the general population.
“One-to-one and group-based CBT, for example, has been shown to lead to moderate-to-large reductions in anxiety in autistic youths and adults, similar to the effects observed in the general population (for reviews, see Lang et al., 2010; Spain et al., 2015; Ung et al., 2015).”
From Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools. (2020) · cites this paper as Ung et al., 2015
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- Authors
- Ung, D., Selles, R., Small, B. J., & Storch, E. A.
- Affiliations
- University of South Florida (US)
- Corresponding author
- Ung, Danielle
- Venue
- Child Psychiatry & Human Development
- Published
- 2014-09-23
- Volume
- 46
- Issue
- 4
- Pages
- 533-547
- ISSN
- 0009-398X (ISSN-L)
- 1573-3327
- OpenAlex
- W2081456881
- Cited by
- 231
- References
- 54
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 26 · 2023: 22 · 2022: 17 · 2021: 31 · 2020: 35 · 2019: 19 · 2018: 22 · 2017: 20 · 2016: 6 · 2015: 7
- FWCI
- 1.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Child Psychiatry & Human Development (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Psychological Association of Graduate Students
- American Psychological Association
- International OCD Foundation
- Tourette Association of America
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy, autism spectrum disorder, high-functioning autism, anxiety, youth, treatment efficacy, anxiety symptoms, treatment moderators
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Anxiety Disorders, Child, Child Development Disorders, Pervasive, Family Therapy, Female, Humans, Intelligence, Male, Psychotherapy, Group, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome
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