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; <i>P</i> = .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. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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.
There is a growing number of young people, diagnosed with an autism-spectrum disorder (ASD), transitioning to adulthood. Among this number, individuals without an intellectual disability have significant adaptive deficits and need individualized care and support services to better target vocational, social, and educational prospects and outcomes. Group-based interventions, including patient education, social-skills training, and cognitive-behavioral therapy, are widely used in clinical settings to improve the daily life and prospects of ASD individuals facing the challenge of transitioning to adulthood. We performed a systematic review of studies concerning the efficiency of group-based educational interventions with a focus on the transition to adulthood for young, ASD individuals without intellectual disability (ID). As a result of this systematic search, 21 studies out of 163 were found to be eligible for inclusion. We observed considerable heterogeneity across the studies, in terms of effect sizes and intervention design, delivery, and the comparison of controls. Strong evidence was found in favor of social-skills training and cognitive-behavioral therapy interventions. Professionals should consider group-based psychoeducational intervention to be an appropriate and relevant service for young subjects with ASD without ID transitioning to adulthood. Further research is needed on larger samples using multicentric designs to validate efficacy before generalization.
