CONTEXT: In several studies, authors have reported on cognitive behavioral therapy (CBT) for children and adolescents with autism spectrum disorders (ASDs), but inconsistent treatment effectiveness was revealed from these studies.
OBJECTIVE: To evaluate the effectiveness of CBT on the symptoms of ASD and social-emotional problems in children or adolescents with ASD by using a meta-analytic approach.
DATA SOURCES: Data sources included PubMed, Embase, and the Cochrane Library.
STUDY SELECTION: We selected randomized controlled trials (RCTs) in which authors reported effectiveness of CBT on the symptoms of ASD and social-emotional problems in children or adolescents with ASD from database inception to May 2019.
DATA EXTRACTION: For each study, 2 authors extracted data on the first author's surname, publication year, country, sample size, mean age, CBT target, intervention, outcome measurement, follow-up duration, and investigated outcomes.
RESULTS: Forty-five RCTs and 6 quasi RCTs of 2485 children and adolescents with ASDs were selected for the final meta-analysis. There was no significant difference between CBT and control for symptoms related to ASD based on self-reported outcomes (standard mean difference: -0.09; 95% confidence interval: -0.42 to 0.24; P = .593), whereas CBT significantly improved the symptoms related to ASD based on informant-reported outcomes, clinician-rated outcomes, and task-based outcomes. Moreover, the pooled standard mean differences indicated that CBT has no significant effect on symptoms of social-emotional problems based on self-reported outcomes.
LIMITATIONS: The quality of included studies was low to modest, significant heterogeneity among the included studies for all investigated outcomes was detected, and publication bias was inevitable.
CONCLUSIONS: These findings indicate that CBT may significantly improve the symptoms of ASD and social-emotional problems in children or adolescents with ASD.
LAY ABSTRACT: Cognitive behavioral therapy is a common treatment for emotional problems in people with autism. Most studies of cognitive behavioral therapy and autism have focused on efficacy, meaning whether a treatment produces results under "ideal" conditions, like a lab or research setting. Effectiveness trials, by contrast, investigate whether a treatment produces results under "real-world" conditions, like a community setting (e.g. hospital, community mental health center, school). There can be challenges in bringing a cognitive behavioral therapy treatment out of a lab or research setting into the community, and the field of implementation science uses frameworks to help guide researchers in this process. In this study, we reviewed efficacy and effectiveness studies of cognitive behavioral therapy treatments for emotional problems (e.g. anxiety, depression) in children and youth with autism. Our search found 2959 articles, with 33 studies meeting our criteria. In total, 13 studies were labelled as effectiveness and 20 as efficacy. We discuss how the effectiveness studies used characteristics of an implementation science framework, such as studying how individuals learn about the treatment, accept or reject it, how it is used in the community over time, and any changes that happened to the individual or the organization (e.g. hospital, school, community mental health center) because of it. Results help us better understand the use of cognitive behavioral therapy in the community, including how a framework can be used to improve effectiveness studies.
PLAIN LANGUAGE SUMMARY: Cognitive behavioural therapy for anxiety in school-aged children with autism spectrum disorder can reduce anxiety Cognitive behavioural therapy interventions to reduce the level of anxiety in students with autism spectrum disorder are moderately effective. What is this review about? Anxiety is a common problem in school-aged children with autism spectrum disorder (ASD). Cognitive behavioural therapy (CBT) and other psychosocial interventions have been developed as alternatives to pharmacological intervention to treat anxiety in students with ASD. What is the aim of this review? This Campbell systematic review examines the effects of interventions for reducing anxiety in school-aged children with autism spectrum disorder, compared to treatment-as-usual. The review summarises evidence from 24 studies using an experimental or quasi-experimental design. What studies are included? Twenty-four studies, involving 931 school-aged children with ASD (without co-occurring intellectual disability) and clinical anxiety, are summarised in this review. The studies were experimental or quasi-experimental control-treatment trials, deemed to be of sufficient methodological quality and with reduced risk of bias. Studies spanned the period 2005 to 2018 and were mostly carried out in Australia, the UK and the USA. Examined interventions ranged across clinical, school-based, or home-based settings, with group or individual treatment formats. Twenty-two of the studies used a CBT intervention. One study used peer-mediated theatre therapy and one study examined the benefits of Thai traditional massage for reducing anxiety. Most interventions involved parents/caregivers and were conducted face-to-face. What are the main findings of this review? Overall, the effects of interventions on anxiety show a statistically significant moderate to high effect, compared to waitlist and treatment-as-usual control conditions at post-treatment. However, effects differ depending on who reports on the student’s anxiety. Clinician reports indicate a very high statistically significant effect, parent reports indicate a high significant effect, and self-reports indicate only a moderate significant effect on the reduction of anxiety in students with ASD. There are larger effects for treatments that involve parents than for student-only interventions. Effects are also larger for individual one-on-one interventions compared to treatments delivered in a group with peers. There are several risk-of-bias issues in most studies included in the review, mainly due to the unavoidable limitation that participants cannot be blinded to the treatment group, which may upwardly bias the estimated effects. There are also limitations in the description of randomisation in a third of the studies, so findings should be treated with caution. What do the findings of this review mean? The findings provide evidence in support of interventions, particularly CBTs, designed to reduce anxiety symptoms in school-aged children with ASD. These findings accord with and build upon the findings of previous systematic reviews into the effectiveness of interventions to reduce anxiety in children and youth with ASD. However, because of the risk of bias in current findings, it would be useful to have further studies with larger sample sizes and to reduce potential biases where possible. How up-to-date is this review? The review authors searched for studies up to the end of 2018.
In this comprehensive systematic review and meta-analysis of group design studies of nonpharmacological early interventions designed for young children with autism spectrum disorder (ASD), we report summary effects across 7 early intervention types (behavioral, developmental, naturalistic developmental behavioral intervention [NDBI], TEACCH, sensory-based, animal-assisted, and technology-based), and 15 outcome categories indexing core and related ASD symptoms. A total of 1,615 effect sizes were gathered from 130 independent participant samples. A total of 6,240 participants, who ranged in age from 0-8 years, are represented across the studies. We synthesized effects within intervention and outcome type using a robust variance estimation approach to account for the nesting of effect sizes within studies. We also tracked study quality indicators, and report an additional set of summary effect sizes that restrict included studies to those meeting prespecified quality indicators. Finally, we conducted moderator analyses to evaluate whether summary effects across intervention types were larger for proximal as compared with distal effects, and for context-bound as compared to generalized effects. We found that when study quality indicators were not taken into account, significant positive effects were found for behavioral, developmental, and NDBI intervention types. When effect size estimation was limited to studies with randomized controlled trial (RCT) designs, evidence of positive summary effects existed only for developmental and NDBI intervention types. This was also the case when outcomes measured by parent report were excluded. Finally, when effect estimation was limited to RCT designs and to outcomes for which there was no risk of detection bias, no intervention types showed significant effects on any outcome. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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 involvement 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.
BACKGROUND: Progress in diagnostic assessment made it possible to diagnose ASD at a young age. Concurrently, intervention research for toddlers with ASD has increased since the past decade. METHOD: In this study, we report on a five-level meta-analysis of 34 single-subject experimental studies, intended to offer a better insight into what types of interventions are effective for toddlers under the age of three with or at risk for ASD. RESULTS: The analysis revealed a significant positive overall effect size. We found that interventions at home were significantly more effective compared to those in other settings. Other significant moderators regarding intervention characteristics were the agent of intervention and duration in weeks. No moderator effects of study and child characteristics were found. CONCLUSIONS: On average, interventions for toddlers with or at risk for ASD are successful. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
The Early Start Denver Model (ESDM) has been gaining popularity as a comprehensive treatment model for children ages 12 to 60 months with autism spectrum disorders (ASD). This article evaluates the research on the ESDM through an analysis of study design and purpose; child participants; setting, intervention agents, and context; density and duration; and overall research rigor to assist professionals with knowledge translation and decisions around adoption of the practices. Ten research studies are included in this systematic review. Findings indicate variability in methodologies, participant and intervention characteristics, and research rigor. The ESDM shows promise as an evidence-based practice for young children with ASD and there is preliminary evidence to support implementation of the ESDM. Children are progressing with ESDM intervention and fidelity of implementation has been achieved in community-based settings. The extent to which child improvements are due to the ESDM intervention alone is not fully known. Additional studies are needed including replication by independent researchers to determine “active ingredients,” level of effectiveness, and whether the ESDM is better than other treatment options. This review highlights research opportunities to expand professionals’ knowledge of the ESDM’s effectiveness. Clinical decisions around adoption and feasibility of implementation in communities will be enhanced with greater knowledge and understanding.
ABSTRACT: The aims of this study were to undertake a meta-analytic and systematic appraisal of the literature investigating the effectiveness of cognitive behavioural therapy (CBT) when used with individuals who have autistic spectrum disorders (ASDs) for either a) affective disorders, or b) the symptoms of ASDs. Following a systematic search, 48 studies were included. CBT, used for affective disorders, was associated with a non-significant small to medium effect size, g=0.24, for self-report measures, a significant medium effect size, g=0.66, for informant-report measures, and a significant medium effect size, g=0.73, for clinician-report measures. CBT, used as a treatment for symptoms of ASDs, was associated with a small to medium non-significant effect size, g=0.25, for self-report measures, a significant small to medium effect size, g=0.48, for informant-report measures, a significant medium effect size, g=0.65, for clinician-report measures, and a significant small to medium effect size, g=0.35, for task-based measures. Sensitivity analyses reduced effect size magnitude, with the exception of that based on informant-report measures for the symptoms of ASDs, which increased, g=0.52. Definitive trials are needed to demonstrate that CBT is an empirically validated treatment for use with people who have ASDs.
In several studies, authors have reported on cognitive behavioral therapy (CBT) for children and adolescents with autism spectrum disorders (ASDs), but inconsistent treatment effectiveness was revealed from these studies.
OBJECTIVE:
To evaluate the effectiveness of CBT on the symptoms of ASD and social-emotional problems in children or adolescents with ASD by using a meta-analytic approach.
DATA SOURCES:
Data sources included PubMed, Embase, and the Cochrane Library.
STUDY SELECTION:
We selected randomized controlled trials (RCTs) in which authors reported effectiveness of CBT on the symptoms of ASD and social-emotional problems in children or adolescents with ASD from database inception to May 2019.
DATA EXTRACTION:
For each study, 2 authors extracted data on the first author's surname, publication year, country, sample size, mean age, CBT target, intervention, outcome measurement, follow-up duration, and investigated outcomes.
RESULTS:
Forty-five RCTs and 6 quasi RCTs of 2485 children and adolescents with ASDs were selected for the final meta-analysis. There was no significant difference between CBT and control for symptoms related to ASD based on self-reported outcomes (standard mean difference: -0.09; 95% confidence interval: -0.42 to 0.24; P = .593), whereas CBT significantly improved the symptoms related to ASD based on informant-reported outcomes, clinician-rated outcomes, and task-based outcomes. Moreover, the pooled standard mean differences indicated that CBT has no significant effect on symptoms of social-emotional problems based on self-reported outcomes.
LIMITATIONS:
The quality of included studies was low to modest, significant heterogeneity among the included studies for all investigated outcomes was detected, and publication bias was inevitable.
CONCLUSIONS:
These findings indicate that CBT may significantly improve the symptoms of ASD and social-emotional problems in children or adolescents with ASD.
