CBT for Anxiety Disorders In Children with An Autism Spectrum Disorder

Background: Children with autism spectrum disorder (ASD) often suffer from co-morbid disorders such as anxiety disorders, depression or behavior problems. Prevalence rates of anxiety disorders in children with ASD range from 17 to 84 percent. Anxiety disorders in ASD, however, can be misdiagnosed easily due to the considerable overlap in symptoms between anxiety and ASD, and because separating the two disorders can be very hard. Nonetheless, anxiety disorders seem to contribute to children’s functional impairment over and above the functional deficits of ASD. Cognitive behavioral therapy (CBT) has proven effective in children with anxiety disorders, however, only a few studies examined CBT for anxiety disorders in children with ASD.

Objectives:  The current study has two main aims: (1) to explore if anxiety disorders in children with ASD are different compared to anxiety-disordered children, and (2) to examine the effect of CBT for the treatment of anxiety disorders in children with ASD.

Methods: Children of 8-18 years (N is about 120) with anxiety disorders, with and without ASD, and their parents were asked to participate in the study. The children were referred to a mental health centre because of anxiety or ASD problems. Children were treated for their anxiety disorders with a short, standard individual CBT program. The CBT program involved 12 sessions with the child and three sessions with the parents in a time period of approximately three months. Children’s anxiety disorders, anxiety symptoms, autism spectrum symptoms, other child psychopathology, parental rearing behavior, and quality of life were measured using clinical interviews (ADIS-C/P) and questionnaires (e.g. SCARED). Pre- and post measurements were conducted, and a follow-up assessment three months after treatment took place. 

Results:  Anxiety disorders in children with ASD were highly similar to anxiety-disordered children, although specific phobias were more common in children with ASD compared to anxiety-disordered children. The mean number of anxiety disorders in children with ASD was significantly higher compared to the anxiety-disordered children based on parent reports, but not according to child reports. The effect of CBT was examined with repeated measures MANOVA’s. A significant time effect was found for anxiety severity (ADIS) and anxiety symptoms (e.g. SCARED), however no significant interaction effects were found. Additional effects were found for quality of life, ASD symptoms and parental rearing behavior.

Conclusions:  Children with ASD have anxiety disorders highly similar to anxiety-disordered children. Compared to anxiety-disordered children, CBT was found equally effective for anxiety disorders in children with ASD. Furthermore, CBT has several additional effects such as the improvement of quality of life, a decrease in ASD symptoms and a change in parental rearing behavior. Adaptations to the CBT program for the special needs of children with ASD will be discussed.