Personalized Cognitive Behavioral Therapy for Core Autism Symptoms in High Functioning Children

Background: Cognitive behavioral therapy (CBT) is increasingly used in treating mood dysregulation in children with autism spectrum disorder, but to date, little evidence has accrued regarding the effects of CBT on core autism symptoms. This study compared personalized CBT with enhanced community care.

Objectives: To test whether CBT has a measureable impact on core autism symptoms as assessed by direct observational methods.

Methods: Twenty children with autism spectrum disorders (6-11 years old) were randomly assigned to 32 sessions of CBT or enhanced community care (ECC). The CBT program is based on the memory retrieval competition model and emphasizes the development of perspective-taking through guided behavioral experimentation supplemented with reflective Socratic discussion and supported by parent training and school consultation to promote generalization of social communication and emotion regulation skills. Trained observers blind to treatment condition observed each child at baseline and posttreatment, using the POPE, a structured behavioral observation system that generates frequency scores for observed social communication-related autism symptoms.

Results: CBT outperformed ECC at posttreatment on the primary observational outcome measure, quality of engagement state. At posttreatment, children in CBT exhibited less self-isolation, more time with peers, engaged more positively and appropriately with peers, and received more positive or appropriate peer responses than children in ECC, with a large effect size (p < .05).

Conclusions: CBT, when modified for children with ASD and targeted at core autism symptoms, may be beneficial for improving ASD-related social communication deficits. Data on the effects of CBT on other measures of ASD symptoms will further elucidate the extent of this positive effect.