Cognitive-behavioral therapy (CBT) has been developed and modified to treat anxiety symptoms in youth with high-functioning autism spectrum disorders (ASD) but has yielded varying findings. The present report is a systematic review and meta-analysis examining the efficacy of CBT for anxiety among youth with ASD. A systematic search identified 14 studies involving 511 youth with high-functioning ASD. A random effects meta-analysis yielded a statistically significant pooled treatment effect size (g) estimate for CBT (g = -0.71, p < .001) with significant heterogeneity [Q (13) = 102.27, p < .001]. Removal of a study outlier yielded a statistically significant pooled treatment effect size, (g = -0.47, p < .001). Anxiety informant and treatment modality were not statistically significant moderators of treatment response. Findings suggest that CBT demonstrates robust efficacy in reducing anxiety symptoms in youth with high-functioning ASD.