Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial
Open accessAbstract
Background: Children with autism spectrum disorders often present with comorbid anxiety disorders that cause significant functional impairment. This study tested a modular cognitive behavioral therapy (CBT) program for children with this profile. A standard CBT program was augmented with multiple treatment components designed to accommodate or remediate the social and adaptive skill deficits of children with ASD that could pose barriers to anxiety reduction. Method: Forty children (7–11 years old) were randomly assigned to 16 sessions of CBT or a 3‐month waitlist (36 completed treatment or waitlist). Therapists worked with individual families. The CBT model emphasized behavioral experimentation, parent‐training, and school consultation. Independent evaluators blind to treatment condition conducted structured diagnostic interviews and parents and children completed anxiety symptom checklists at baseline and posttreatment/postwaitlist. Results: In intent‐to‐treat analyses, 78.5% of the CBT group met Clinical Global Impressions‐Improvement scale criteria for positive treatment response at posttreatment, as compared to only 8.7% of the waitlist group. CBT also outperformed the waitlist on diagnostic outcomes and parent reports of child anxiety, but not children’s self‐reports. Treatment gains were maintained at 3‐month follow‐up. Conclusions: The CBT manual employed in this study is one of the first adaptations of an evidence‐based treatment for children with autism spectrum disorders. Remission of anxiety disorders appears to be an achievable goal among high‐functioning children with autism.
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Together, the clinical trials consulted indicate that CBT intervention is promising as a treatment for anxiety in autistic children and adolescents.
“De forma conjunta, los ensayos clínicos consultados (Attwood, 2004;Wood et al., 2015;Wood et al., 2009) indican que la intervención TCC es prometedora como tratamiento para la ansiedad en niños y adolescentes autistas.”
From Ansiedad y trastornos del espectro del autismo: notas para la intervención psicoeducativa (2022) · cites this paper as Wood et al., 2009
The Abstract (Method) describes a randomized trial in autistic children aged 7–11, and the Discussion says its results suggest CBT may help treat anxiety in children with ASD. This paper supports the claim for children, but its trial did not include adolescents. (LLM, conf=0.85)
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“…& Hepburn, 2012; Sofronoff, et al., 2005; Wood et al., 2009), visual materials and reward systems (Chalfant, et al. 2007) and the teaching of friendship skills (Wood et al., 2009), relaxation exercises, emotional regulation and cognitive self-control (Sofronoff et al., 2005; Sung et al., 2011).”
BackgroundInfluentialTop Jr., D. N., Luke, S. G., Stephenson, K. G., & South, M. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00783 · Cited by 36 · see citing works
Accommodation of Anxiety in Youth with Autism Spectrum Disorder: Results from the TAASD Study
Frank, H. E., Kagan, E. R., Storch, E. A., Wood, J. J., Kerns, C. M., Lewin, A. B., Small, B. J., & Kendall, P. C. (2022) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2020.1759075 · Cited by 33 · see citing works
Self-citationImpact of the COVID-19 pandemic on daily life: diverse experiences for autistic adults
Maljaars, J., Gijbels, E., Evers, K., Spain, D., Rumball, F., Happé, F., & Noens, I. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05437-x · Cited by 30 · see citing works
Mechanisms of Change in Behavioral Activation: Adapting Depression Treatment for Autistic People
Bal, V. H., Wilkinson, E., Glascock, V., Hastings, R. P., & Jahoda, A. (2023) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2022.03.006 · Cited by 24 · see citing works
Elsaesser, M., Herpertz, S., Piosczyk, H., Jenkner, C., Hautzinger, M., & Schramm, E. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-057672 · Cited by 19 · see citing works
Murphy, D., Glaser, K., Hayward, H., Eklund, H., Cadman, T., Findon, J., Woodhouse, E., Ashwood, K., Beecham, J., Bolton, P., et al. (2018) · Programme Grants for Applied Research · doi:10.3310/pgfar06020 · Cited by 18 · see citing works
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 · see citing works
Reduced anxiety following pivotal response treatment in young children with autism spectrum disorder
Lei, J., Sukhodolsky, D. G., Abdullahi, S. M., Braconnier, M. L., & Ventola, P. (2017) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2017.09.002 · Cited by 18 · see citing works
Kerns, C. M., Moskowitz, L. J., Rosen, T., Drahota, A., Wainer, A., Josephson, A. R., Soorya, L., Cohn, E., Chacko, A., & Lerner, M. D. (2019) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2017.1410826 · Cited by 18 · see citing works
Self-citationWalsh, C. E., Moody, E., Blakeley-Smith, A., Duncan, A., Hepburn, S., Keefer, A., Klinger, L., Meyer, A., O’Kelley, S., & Reaven, J. (2018) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-018-9380-4 · Cited by 10 · see citing works
Cooper, K., & Russell, A. (2025) · Autism · doi:10.1177/13623613241275468 · Cited by 11 · see citing works
“CBT has been shown to be effective in reducing anxiety for autistic young people if adapted to meet their needs (Wood et al., 2009).”
Evans, R., Hill, C., O'Brien, D., & Creswell, C. (2019) · Child and Adolescent Mental Health · doi:10.1111/camh.12274 · Cited by 10 · see citing works
Prasanna, N. V. T., & Nayak, M. (2024) · Discover Psychology · doi:10.1007/s44202-024-00311-6 · Cited by 3 · see citing works
Ansiedad y trastornos del espectro del autismo: notas para la intervención psicoeducativa
Sánchez-Cueva, M. S., Alcantud Marín, F., & Alonso-Esteban, Y. (2022) · Siglo Cero: Revista Española sobre Discapacidad Intelectual · doi:10.14201/scero2022534930 · Cited by 1 · see citing works
“…obtenidos en poblaciones neurotípicas (Chalfant et al., 2006; Kilburn et al., 2019) Otros programas han sido diseñados específicamente para niños y niñas autistas, como el programa BIACA [Intervenciones Conductuales para la Ansiedad en Niños con Autismo (Wood y Drahota, 2005; Wood et al., 2009)].”
Background
- Authors
- Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A.
- Affiliations
- University of California, Los Angeles (US)
- Corresponding author
- Wood, Jeffrey J.
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2009-03
- Volume
- 50
- Issue
- 3
- Pages
- 224-234
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- PMC
- PMC4231198
- OpenAlex
- W2094853561
- Cited by
- 666
- References
- 11
- Citations by year
- 2026: 30 · 2025: 29 · 2024: 25 · 2023: 23 · 2022: 32 · 2021: 39 · 2020: 41 · 2019: 27 · 2018: 49 · 2017: 46 · 2016: 42 · 2015: 38 · 2014: 60 · 2013: 62 · 2012: 49
- FWCI
- 11.84
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Autism Speaks (ASCN5022)
- National Institute of Mental Health (F31MH073213, MH075806, R03MH075806)
- 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 › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- cognitive behavioral therapy, autism spectrum disorder, childhood anxiety, comorbid anxiety disorders, treatment adaptation, parent training, school consultation, treatment response, high-functioning children
- MeSH terms
- Anxiety Disorders, Autistic Disorder, Child, Female, Health Education, Humans, Male, Parents, Severity of Illness Index, Teaching, Comorbidity, Cognitive Behavioral Therapy, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders
About these checks
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