CBT intervention adapted for autism proves efficacious

Cognitive behavioral therapy may be efficacious for treating anxiety in children with autism spectrum disorder, according to results of a randomized clinical trial published in JAMA Psychiatry. Researchers noted additional advantages with an adapted CBT approach.

“Historically, practitioners may have assumed that psychotherapy would not be helpful for children with autism,” Jeffrey J. Wood, PhD, of the department of psychiatry at the University of California, Los Angeles, told Healio Psychiatry. “This study provided the therapists with training and supervision, and in a parallel study funded by the NIMH, we have concurrently developed an automated training and clinical guidance app that is free of charge. This means that mental health practitioners can go online at meya.ucla.edu to access an interactive version of the CBT treatment manual used in this trial with video models and therapy materials to teach themselves how to do this treatment session by session.”

According to Wood and colleagues, youth with ASD often experience anxiety that interferes with adaptive functioning, and although psychological therapies are commonly used in this patient population, their efficacy has not been established. In the present study, they compared the relative efficacy of two CBT programs and treatment as usual. The standard-of-practice CBT featured affect recognition, reappraisal, modeling/rehearsal, in vivo exposure tasks and reinforcement. The ASD-adapted CBT intervention was similar but also addressed social communication and self-regulation challenges with perspective-taking training and behavior-analytic techniques, according to the researchers.

Participants were aged 7 to 13 years and diagnosed with ASD and maladaptive and interfering anxiety. Of 214 initially enrolled, 145 participants completed treatment after being randomly assigned to one of the three interventions. Across conditions, the researchers reported no significant difference in discontinuation rates. The ASD-adapted CBT program outperformed standard-of-practice CBT (mean Pediatric Anxiety Rating Scale score, 2.13 [95% CI, 1.91-2.36] vs. 2.43 [95% CI, 2.25-2.62]) and treatment as usual (2.93; 95% CI, 2.63-3.22). The ASD-adapted version also outperformed standard-of-care CBT and treatment as usual on parent-reported scales of internalizing symptoms, ASD-associated social-communication symptoms and anxiety-associated social functioning. The researchers noted that both CBT interventions achieved higher rates of positive treatment response than treatment as usual.

“Through a collaborative effort with CBT researchers around the United States, we have been able to make progress towards promoting success and well-being among children with autism,” Wood said. – by Joe Gramigna

Disclosures: Wood reports grants from the National Institute of Child Health and Human Development and the NIMH. Please see the study for all other authors’ relevant financial disclosures.