The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: a randomized, controlled trial

J Am Acad Child Adolesc Psychiatry. 2013 Feb;52(2):132-142.e2. doi: 10.1016/j.jaac.2012.11.007. Epub 2013 Jan 2.


Objective: To examine the efficacy of a modular cognitive-behavioral therapy (CBT) protocol relative to treatment as usual (TAU) among children with high-functioning autism spectrum disorders (ASD) and clinically significant anxiety.

Method: A total of 45 children (7-11 years of age) with high-functioning ASD and clinically significant anxiety were randomized to receive 16 sessions of weekly CBT or TAU for an equivalent duration. After screening, assessments were conducted at baseline, post-treatment, and 3-month follow-up. Raters were blind to treatment condition.

Results: Youth receiving CBT showed substantial improvement relative to TAU on primary anxiety outcomes. Of 24 children randomized to the CBT arm, 18 (75%) were treatment responders, versus only 3 of 21 children (14%) in the TAU arm. Gains were generally maintained at 3-month follow-up for CBT responders.

Conclusions: Relative to usual care, CBT adapted for anxious youth with high-functioning ASD demonstrates large effects in reducing anxiety symptoms. This study contributes to the growing literature supporting adapted CBT approaches for treating anxiety in youth with ASD.

Trial registration: NCT01178385.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anxiety* / diagnosis
  • Anxiety* / etiology
  • Anxiety* / psychology
  • Anxiety* / therapy
  • Behavioral Symptoms / diagnosis
  • Behavioral Symptoms / therapy
  • Child
  • Child Behavior* / drug effects
  • Child Behavior* / psychology
  • Child Development Disorders, Pervasive / complications*
  • Child Development Disorders, Pervasive / diagnosis
  • Child Development Disorders, Pervasive / psychology
  • Cognitive Behavioral Therapy / methods*
  • Female
  • Humans
  • Male
  • Psychiatric Status Rating Scales
  • Psychotropic Drugs / therapeutic use*
  • Treatment Outcome


  • Psychotropic Drugs

Associated data