Cognitive behavior therapy to treat anxiety among children with autism spectrum disorders: A systematic review

Background: Children with an autism spectrum disorder (ASD) are at risk for developing co-morbid mental health disorders, with anxiety being the most common. Anxiety symptoms significantly interfere with a child's ability to participate in school and community settings. Over the past 17 years, there has been an increase in empirical evidence of Cognitive Behavioral Therapy (CBT) as a treatment for anxiety in children with ASD. The purpose of this systematic review was to evaluate this body of research to determine whether CBT could be classified as an empirically supported treatment (EST) for this population. A secondary purpose was to identify the extent to which schools have been involved in this line of research. Method: A systematic review of group comparison and single case research was conducted. Each study was evaluated using quality indicators recommended by the Council for Exceptional Children (CEC), including an evaluation of study effects. Information regarding school involve. ment was also extracted. Results: A total of 30 studies were included in the analysis. Results indicated that modified CBT interventions for children with ASD met CEC criteria for an EST. Among the studies evaluated, only two (6%) involved a school setting in which educators participated in the intervention. Conclusion: The results of this review offer empirically support for modified CBT for children with autism as an EST. Findings also indicate that little research has included the school context when implementing CBT treatments for children with autism and anxiety. Implications for dissemination and future research are presented.