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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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Cognitive behavioural therapy for anxiety disorders in children and adolescents
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Autism Spectrum Disorder: Classification, diagnosis and therapy
Sharma, S., Gonda, X., & Tarazi, F. I. (2018) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2018.05.007 · Cited by 745
“ing increased irritability, disruptive behaviors, inattention, and decreased functionality (Ung et al., 2015).”
Cognitive behavioural therapy for anxiety disorders in children and adolescents
James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013162.pub2 · Cited by 344
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“Within the current meta-analysis, and those completed previously which focused on the treatment of anxiety amongst children and adolescents (Kreslins et al., 2015; Sukhodolsky et al., 2013; Ung et al., 2014), there are substantial differences in treatment efficacy dependent upon the type of outcomemeasure includedwith…”
BackgroundMethodInfluential
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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