A Systematic Review and Meta-Analysis of Cognitive-Behavioral Therapy for Anxiety in Youth with High-Functioning Autism Spectrum Disorders

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Web End = Child Psychiatry Hum Dev (2015) 46:533547

DOI 10.1007/s10578-014-0494-y

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Web End = SUBSTANTIVE/THEORETICAL REVIEW

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Web End = A Systematic Review and Meta-Analysis of Cognitive-Behavioral Therapy for Anxiety in Youth with High-Functioning Autism Spectrum Disorders

Danielle Ung Robert Selles Brent J. Small

Eric A. Storch

Published online: 23 September 2014 Springer Science+Business Media New York 2014

Abstract Cognitive-behavioral therapy (CBT) has been developed and modied to treat anxiety symptoms in youth with high-functioning autism spectrum disorders (ASD) but has yielded varying ndings. The present report is a systematic review and meta-analysis examining the efcacy of CBT for anxiety among youth with ASD. A systematic search identied 14 studies involving 511 youth with high-functioning ASD. A random effects meta-analysis yielded a statistically signicant pooled treatment effect size (g) estimate for CBT (g = -0.71, p \ .001)

with signicant heterogeneity [Q (13) = 102.27, p \ .001]. Removal of a study outlier yielded a statistically signicant pooled treatment effect size, (g = -0.47, p \ .001). Anxiety informant and treatment modality were not statistically signicant moderators of treatment response. Findings suggest that CBT demonstrates robust efcacy in reducing anxiety symptoms in youth with high-functioning ASD.

Keywords Treatment Efcacy Children

Adolescents Comorbid conditions Autism spectrum

disorder

Introduction

As many as 50 % of youth with autism spectrum disorders (ASD), a neurodevelopmental disorder characterized by social and/or communication decits and restrictive/repetitive behaviors [1], experience clinically signicant anxiety [25]. These youth appear more prone to experiencing anxiety symptoms than neurotypical youth, due to their signicant communication and social decits (e.g., difculty understanding social cues) [6], heightened sensory sensitivity [7] and difculty regulating emotions [6, 8]. In youth with ASD, clinically signicant anxiety symptoms are associated with increased irritability, sleep disturbance, disruptive behaviors, inattentiveness and health problems (e.g., frequent gastrointestinal problems) [912] that signicantly impair school, home, and family functioning above and beyond impairments associated with core ASD symptoms [9, 11, 1315]. Consequently, cognitive-behavioral treatments that specically target anxiety symptoms in youth with high-functioning ASD have been designed and evaluated.

Cognitive-Behavioral Therapy for Anxiety in Youth with ASD