Family-Centered Cognitive Behavioral Therapy for Anxiety in Very Young Children with Autism Spectrum Disorder
Abstract
To address the paucity of cognitive-behavioral therapy (CBT) protocols available to treat anxiety in preschoolers with ASD, we piloted a family-centered CBT protocol in a series of 16 children aged 3-7 years with ASD and anxiety disorders and explored its feasibility and efficacy. Children were assessed at baseline, post-treatment (PT), and 4-month follow-up (FU) using diagnostic interviews and parent questionnaires. Fourteen children completed at least 10 sessions (mean 14). At PT, 81% were rated "very much-" or "much-improved" on the CGI-Anxiety. Children displayed significant decreases on clinician- and parent-rated anxiety, and improved family function and coping. Gains were maintained at FU. Parent-child CBT is feasible for young children with ASD plus anxiety that shows potential for similar efficacy as with neurotypical children.
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Only four anxiety treatment studies have been conducted in children under 6 years old.
“Only four anxiety treatment studies have been conducted in children under 6 years old”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [9]
Two of the studies examine the efficacy of two CBT protocols, Being Brave and Fun with Feelings, for children who are actively experiencing either anxiety disorders or symptoms.
“Two of the studies examine the efficacy of two CBT protocols, Being Brave and Fun with Feelings, for children who are actively experiencing either anxiety disorders or symptoms [8, 9].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [9]
Children participating in Being Brave exhibited significant decreases in anxiety.
“children participating in Being Brave exhibited significant decreases in anxiety”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [9]
Both Being Brave and Fun with Feelings were deemed feasible and acceptable by participating parents.
“and were deemed feasible and acceptable by participating parents [8, 9].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [9]
Being Brave is a parent-child anxiety treatment that was originally designed for school-age, neurotypical children and adapted for a younger population.
“Being Brave is a parent-child anxiety treatment that was originally designed for school-age, neurotypical children and adapted for a younger population [9, 17, 19].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [9]
Children participating in Being Brave had an 82% remission rate of any anxiety disorder at 4-month follow-up.
“with 40% and 82% remission rates of any anxiety disorder at post-treatment and 4-month follow-up, respectively [9].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [9]
Both Being Brave and Fun with Feelings include the core CBT components of psychoeducation, coping skills, and exposure.
“Both protocols include the core CBT components of psychoeducation, coping skills, and exposure”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [9]
Of the four anxiety treatment studies in children under 6 years old, three utilized CBT approaches.
“of which three utilized CBT approaches [3, 8, 9, 26].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [9]
Preliminary findings from anxiety treatment studies in children under 6 years old suggest that CBT may be effective for this age range.
“Preliminary findings from these studies suggest that CBT may be effective for this age range; however, further study is needed.”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [9]
Children participating in Being Brave had a 40% remission rate of any anxiety disorder at post-treatment.
“with 40% and 82% remission rates of any anxiety disorder at post-treatment and 4-month follow-up, respectively [9].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [9]
All three of these treatments include adaptations that account for the developmental level of the young child.
“All three of these treatments include adaptations that account for the developmental level of the young child [3, 8, 9]”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [9]
The PAS-R has been used in other anxiety treatment studies for children with ASD.
“The PAS-R is a 30 item parent-report measure of anxiety in preschool aged children that includes items assessing generalized anxiety, social anxiety, separation anxiety, obsessive-compulsive disorder, and physical injury fears and has been used in other anxiety treatment studies for children with ASD [9].”
From DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD (2021) · cites this paper as [9]
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- Authors
- Driscoll, K., Schonberg, M., Stark, M. F., Carter, A. S., & Hirshfeld-Becker, D.
- Affiliations
- Boston Children's Hospital (US)
- Harvard University (US)
- University of Massachusetts Boston (US)
- Corresponding author
- Driscoll, Katherine
- Venue
- Journal of Autism and Developmental Disorders
- Published
- 2020-03-07
- Volume
- 50
- Issue
- 11
- Pages
- 3905-3920
- ISSN
- 0162-3257 (ISSN-L)
- 1573-3432
- OpenAlex
- W3009934866
- Cited by
- 39
- References
- 71
- Citations by year
- 2026: 2 · 2025: 10 · 2024: 12 · 2023: 3 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 1
- FWCI
- 1.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Autism and Developmental Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Deborah Munroe Noonan Memorial Research Fund
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
- Keywords
- autism spectrum disorder, childhood anxiety, cognitive behavioral therapy, family-centered therapy, preschool children, parent-child therapy, treatment feasibility, family functioning, anxiety maintenance
- MeSH terms
- Autism Spectrum Disorder, Anxiety, Child, Child, Preschool, Family Therapy, Feasibility Studies, Female, Follow-Up Studies, Humans, Male, Parents, Pilot Projects, Surveys and Questionnaires, Cognitive Behavioral Therapy, Treatment Outcome
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