Cognitive Behavioural Therapy for Anxiety Disorders in Children with Autism Spectrum Disorder: A Randomized Controlled Trial.

Background: Autism spectrum disorder (ASD) is found in approx. 1-2% of the population and includes core symptoms that affect general and social development. A high risk of developing co-morbid disorders is prominent. It is thought that up to 60% of children with ASD suffer from different anxiety disorders which can further negatively influence educational, social and general development together with quality of life.

Objectives: The main goal of this study is to examine the effectiveness of a manualised cognitive behavioural therapy program (CBT) adapted to children with ASD in a non-English general psychiatric hospital setting.

Methods: The study is a randomized controlled trial with intention to treat analysis. Forty-nine children with ASD and anxiety, aged 8 to 13 years from a public child psychiatric health clinic are randomly assigned to either an intervention group or a waitlist control group. After the waitlist period the control group will receive intervention as well.

The group based manualised CBT intervention consist of The Cool Kids Anxiety Program: Autism Spectrum Disorder Adaptation, 2nd edition (Cool Kids ASD).

Outcome measures are collected pre, post-treatment and at 3 month follow up and include scores from a semi-structured diagnostic anxiety interview, together with parent, child and teacher questionnaires on children's anxiety symptoms, life interference, children's automatic thoughts, and social and adaptive skills.

Results: This is an ongoing study and final results will be available for presentation at the conference. However, results from a prior feasibility study showed that 55.5% of the children participating recovered and no longer met the criteria for their primary anxiety diagnosis after the treatment. This number rose to 77.7% at follow-up. Compliance to the program was high and 88.8% of the families found the program to be useful and would recommend it to other families in a similar situation.

Conclusions: This feasibility study suggests that the transition of the group program 'Cool Kids ASD' from research environments to non-English standard child psychiatric clinical settings is possible. The randomized study might confirm this efficiency and efficacy of the program in a larger sample.

Structured intervention like the manualised CBT group program might not only improve the main presenting difficulty, but also other aspects of the participants' functioning such as peer relationships. Training anxiety reduction skills and thus, decreasing anxiety in children with ASD using the manualised CBT program has the potential of preventing relapse and ensuring better psychosocial development for the child in general.