The DOI matches its Crossref record; 53 of the 54 references it cites were found in a registry or an index.
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, 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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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
In the citing paper
“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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“1993); (5) systematic reviews and opinion papers about CBT for people with ASD (including Anderson and Morris 2006; Rossiter and Holmes 2013; Spain et al. 2015; Ung et al. 2015; Weston et al. 2016); (6) Delphi studies focusing on CBT with other clinical populations (Morrison and Barratt 2010); and (7) clinical experie…”
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Autism Spectrum Disorders: Translating human deficits into mouse behavior
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“Previous meta-analyses looking at interventions for anxiety in autistic people have focused on children and adolescents, and have examined specific interventions such as CBT (Kreslins et al., 2015; Perihan et al., 2020; Sukhodolsky et al., 2013; Ung et al., 2015), school-based interventions (Perihan et al.”
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“Following previous studies (Sukhodolsky et al. 2013; Ung et al. 2015), we hypothesized that youth will exhibit a significant reduction in anxiety following treatment.”
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“To date, these interventions have primarily been delivered in clinic settings (e.g., Reaven et al. 2012; Ung et al. 2014), limiting access for high risk and underserved youth who cannot access therapeutic services from outpatient clinic venues.”
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“Thus far, 12 randomized controlled trials (RCTs) have examined the efficacy of CBT for anxiety in youth with ASD (Ung et al., 2015).”
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“Evidence in adults may shed more light on how age uniquely influences these associations across the developmental period, help to prevent comorbid anxiety in adults at risk, and improve interventions mostly focusing on social skills (Ung et al., 2015).”
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“High rates of co-occurring anxiety seen in ASD (Ung et al. 2015; van Steensel et al. 2011) increase the likelihood that children with ASD will develop food neophobia, a fear of eating new foods.”
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Graf‐Kurtulus, S., & Gelo, O. C. G. (2025) · Counselling and Psychotherapy Research · doi:10.1002/capr.12874 · Cited by 34
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“Finally, research supports the utility of Cognitive Behavior Therapy (CBT; Beck & Beck, 2020) with ASD specific modifications, to help reduce symptoms of anxiety in youth with autism in individual and group formats, yielding short term and longer term gains (Storch et al., 2015; Ung et al., 2015).”
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“Another recent meta-analysis (Ung et al., 2015) that included 511 children, in 14 studies, including both RCTs and open trials, yielded a small effect size (g =−0.”
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“[57,58] CBT appears to be effective regardless of whether the treatment is delivered in a group or individual format.[39] Group formats have demonstrated large effect sizes [39] and may have the added benefit of normalizing anxiety symptoms in the presence of other affected children and providing socialization and sup…”
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“Three separate meta-analyses, however, have indicated that CBT demonstrates at least moderate effects on anxiety in adolescents with ASD, when relying on parentreport of symptom change (Kreslins et al. 2015; Sukhodolsky et al. 2013; Ung et al. 2015), though very little research has examined the secondary effects of CB…”
BackgroundTreatment of anxiety in autistic adults: A systematic review
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Self-citationCognitive-behavioral approaches for children with autism spectrum disorder: A trend analysis
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“Finally, based on applied practice, Maich and Belcher (2012) outlined 10 principles for choosing bibliotherapy resources (picture books) to”
BackgroundMethodPittenger, C., Brennan, B. P., Koran, L. M., Mathews, C. A., Nestadt, G., Pato, M. T., Phillips, K. A., Rodríguez, C. I., Simpson, H. B., Skapinakis, P., et al. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113853 · Cited by 22
Self-citationHallett, V., Mueller, J., Breese, L., Hollett, M., Beresford, B., Irvine, A. L., Pickles, A. R., Slonims, V., Scott, S., Charman, T., et al. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04442-2 · Cited by 26
Zukerman, G., Yahav, G., & Ben‐Itzchak, E. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04632-y · Cited by 23
Carey, M., Sheehan, D., Healy, S., Knott, F. J., & Kinsella, S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095471 · Cited by 27
“approach for anxiety is cognitive behavioral therapy (CBT), which has been shown to reduce anxiety in children with mild to moderate symptoms of ASD [17].”
BackgroundReaven, J., Meyer, A. T., Pickard, K. E., Boles, R. E., Hayutin, L. G., Middleton, C., Reyes, N., Hepburn, S., Tanda, T., Stahmer, A. C., et al. (2021) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2021.1941430 · Cited by 23
“Youth with Autism Spectrum Disorder (ASD) are at particular risk for developing clinically interfering anxiety; that is, as many as 50% of youth with ASD may develop significant anxiety symptoms (Ung et al., 2015).”
BackgroundJubenville, T. M., Nicholas, D. B., Weiss, J. A., & Cairns, S. L. (2023) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2023.2278858 · Cited by 28
“Unlike research with autistic youth which has multiple systematic reviews supporting the efficacy of treatments for anxiety (e.g., Ung et al., 2015; Vasa et al., 2014), the evidence is less clear for autistic adults.”
MethodKemeny, B., Burk, S., Hutchins, D., & Gramlich, C. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05136-z · Cited by 22
Hillman, K., Dix, K., Ahmed, K., Lietz, P. N., Trevitt, J., O’Grady, E. A., Uljarević, M., Vivanti, G., & Hedley, D. (2020) · Campbell Systematic Reviews · doi:10.1002/cl2.1086 · Cited by 27
“Similarly, if a study reported more than one outcome measure for a respondent, then both outcomes have been reported, rather than presenting an average score as previous systematic reviews have done (e.g., Kreslins et al., 2015; Lang, Regester, Lauderdale, Ashbaugh, & Haring, 2010; Perihan et al., 2019; Sukhodolsky et…”
A Cognitive Behavioral Intervention for Driving for Autistic Teens and Adults: A Pilot Study
Baker-Ericzén, M. J., Smith, L., Tran, A., & Scarvie, K. M. (2020) · Autism in Adulthood · doi:10.1089/aut.2020.0009 · Cited by 19
“16 Research shows that cognitive behavioral therapy (CBT) is successful in addressing anxiety overall 17 and may be particularly applicable for reducing driving anxiety.”
Pemovska, T., Loizou, S., Appleton, R., Spain, D., Stefanidou, T., Kular, A., Cooper, R. E., Greenburgh, A., Griffiths, J., Barnett, P., et al. (2024) · Psychological Medicine · doi:10.1017/s0033291724001089 · Cited by 23
“Inconsistencies in effect sizes with previous meta-analyses may be attributed to methodological differences such as inclusion criteria (e.g. some included non-adapted generic CBT (Sharma et al., 2021) and non-randomized controlled trials (Perihan et al., 2020; Ung, Selles, Small, & Storch, 2015)) or favoring different…”
BackgroundKeefer, A., Kreiser, N. L., Singh, V., Blakeley-Smith, A., Reaven, J., & Vasa, R. A. (2018) · Behavior Therapy · doi:10.1016/j.beth.2017.12.002 · Cited by 18
Ollendick, T., Muskett, A., Radtke, S. R., & Smith, I. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04582-5 · Cited by 16
Wise, J. M., Cepeda, S. L., Ordaz, D. L., McBride, N. M., Cavitt, M. A., Howie, F. R., Scalli, L., Ehrenreich-May, J., Wood, J. J., Lewin, A. B., et al. (2019) · Child Psychiatry & Human Development · doi:10.1007/s10578-018-0817-5 · Cited by 18
“At present, several clinical trials have demonstrated the efficacy of CBT for anxiety in children and early adolescents with ASD [27], including eight pilot studies examining the use of CBT protocols with youth with comorbid anxiety and autism which have demonstrated positive outcomes across individuals who received t…”
BackgroundSelf-citationParent-Led Cognitive Behavioural Therapy for Children with Autism Spectrum Conditions. A Pilot Study
Byrne, G., Ghráda, Á. N., & O’Mahony, T. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05424-2 · Cited by 22
Melesse, T. G., Chau, J., & Ma, N. (2022) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2022.110805 · Cited by 17
Improving Cognitive Behaviour Therapy for Autistic Individuals: A Delphi Survey with Practitioners
Spain, D., Milner, V. L., Mason, D., Iannelli, H., Attoe, C., Ampegama, R., Kenny, L., Saunders, A., Happe, F. G. E., & Marshall‐Tate, K. (2022) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-022-00452-4 · Cited by 20
Reaven, J., Reyes, N., Pickard, K. E., Tanda, T., & Morris, M. A. (2019) · School Mental Health · doi:10.1007/s12310-019-09351-z · Cited by 18
Clark, M., & Adams, D. (2020) · Clinical Psychologist · doi:10.1111/cp.12223 · Cited by 16
White, S. W., Conner, C. M., Beck, K. B., & Mazefsky, C. A. (2021) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2020.1796551 · Cited by 20
“…of the literature and treatment experience suggests that EBI for ER impairment in ASD is associated with clinical benefit, although effects are often a bit diminished (e.g., smaller effect size) relative to treatment effects seen with clients without ASD (Kreslins et al., 2015; Ung et al., 2015).”
ResultCultivating Self-Compassion to Improve Mental Health in Autistic Adults
Cai, R. Y., & Brown, L. (2020) · Autism in Adulthood · doi:10.1089/aut.2020.0034 · Cited by 19
“Much of the CBT research in autism has focused on children and adolescents (see reviews by Ung et al. 22 and Vasa et al. 23 ).”
Cognitive behavioural therapy for anxiety disorders in children and adolescents
James, A. C., Reardon, T. C., Soler, A., James, G., & Creswell, C. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013162 · Cited by 18
Losinski, M. L., Hughey, J. K., & Maag, J. W. (2016) · Beyond Behavior · doi:10.1177/107429561602500105 · Cited by 16
CBT for Childhood Anxiety: Reviewing the State of Personalised Intervention Research
Bertie, L., & Hudson, J. L. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.722546 · Cited by 17
Palmer, M. L., Tarver, J., Perez, J. P., Cawthorne, T., Romeo, R., Stringer, D., Hallett, V., Mueller, J., Breese, L., Hollett, M., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-029959 · Cited by 16
Lim, J. M. (2019) · Advances in Autism · doi:10.1108/aia-12-2018-0050 · Cited by 15
Klein-Tasman, B., Young, B. N., Levine, K., Rivera, K. M., Miecielica, E. J., Yund, B. D., & French, S. E. (2021) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2021.1950080 · Cited by 16
An Emotional Skills Intervention for Elementary Children with Autism in China: A Pilot Study
Lee, G. T., Xu, S., Feng, H., Lee, G. K., Jin, S., Li, D., & Zhu, S. (2018) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-018-0295-5 · Cited by 17
Dellapiazza, F., Michelon, C., Picot, M., & Baghdadli, A. (2022) · Scientific Reports · doi:10.1038/s41598-022-15165-y · Cited by 13
Psychological Comorbidities in Autism Spectrum Disorder
Shaltout, E., Al-Dewik, N. I. E., Samara, M. M., Morsi, H. M., & Khattab, A. (2020) · Advances in neurobiology · doi:10.1007/978-3-030-30402-7_6 · Cited by 14
van Rijn, S. (2018) · PLoS ONE · doi:10.1371/journal.pone.0200882 · Cited by 13
“However, in addition to assessing potential positive effects of hormonal intervention, we also need to address efficacy of other types of interventions such as cognitive behavioral therapies (CBT), as such psychosocial interventions have shown positive effects in terms of reducing (social) anxiety in other vulnerable…”
Background
Metadata
- 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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