Effectiveness of Cognitive Behavioral Therapy in Reducing Anxiety in Children with Autism

Adriana José da Fonseca; José Roberto Rosler

doi:10.59471/ijhsc2025212

Authors

Adriana José da Fonseca Universidad Abierta Interamericana, Facultad de Medicina y Ciencias de la Salud, Carrera de Medicina. Buenos Aires, Argentina Author
José Roberto Rosler Universidad Abierta Interamericana, Facultad de Medicina y Ciencias de la Salud, Carrera de Medicina. Buenos Aires, Argentina Author

DOI:

https://doi.org/10.59471/ijhsc2025212

Keywords:

Autism spectrum disorder, Anxiety, Cognitive-behavioural therapy, Paediatric psychology, Evidence-based practice

Abstract

Background: Anxiety is a prevalent comorbidity in children with autism spectrum disorder (ASD), significantly impacting their quality of life and presenting important challenges in their clinical and therapeutic management. Understanding the relationship between ASD and anxiety is crucial to developing effective intervention strategies. This paper describes a systematic review that evaluates the effectiveness of cognitive behavioral therapy (CBT) in reducing anxiety in children with ASD, based on randomized controlled trials (RCTs). Material and methods: An exhaustive literature search was conducted in databases such as PubMed and Cochrane Library, focusing on RCTs published in the last 20 years. Studies that evaluated the effectiveness of CBT in reducing anxiety in children with ASD were included. Data were extracted and analyzed using descriptive statistical techniques and meta-analysis, as appropriate. Results: A total of 12 studies meeting the inclusion criteria demonstrated that CBT is effective in reducing anxiety symptoms in children with ASD. Key factors for successful intervention included consistency in session frequency, conducting therapy in a structured setting, and continuity with the same therapists, which facilitated a more stable therapeutic process. Gradual exposure to social situations resulted in progressive adaptation to anxiety-inducing stimuli. Additionally, interventions were tailored to the specific needs of children with autism, improving session effectiveness. Both group and individual Behavioral Therapy modalities were effective, with studies indicating that higher session frequency was associated with faster and sustained improvement in reducing anxiety symptoms. Conclusion: Cognitive Behavioral Therapy (CBT) is an effective intervention for reducing anxiety in children with ASD, also improving their quality of life. Future research should focus on optimizing the frequency and duration of interventions, as well as exploring the viability of online CBT sessions.

References

Simonoff E, Pickles A, Charman T, Chandler S, Loucas T, Baird G. Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry. 2008;47(8):921–9. doi:10.1097/CHI.0b013e318179964f.

White SW, Oswald D, Ollendick T, Scahill L. Anxiety in children and adolescents with autism spectrum disorders. Clin Psychol Rev. 2009;29(3):216–29. doi:10.1016/j.cpr.2009.01.003.

van Steensel FJ, Bögels SM, Dirksen CD. Anxiety and quality of life: clinically anxious children with and without autism spectrum disorders compared. J Clin Child Adolesc Psychol. 2012;41(6):731–8. doi:10.1080/15374416.2012.703123.

Leyfer OT, Folstein SE, Bacalman S, Davis NO, Dinh E, Morgan J, et al. Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. J Autism Dev Disord. 2006;36(7):849–61. doi:10.1007/s10803-006-0123-0.

Sukhodolsky DG, Bloch MH, Panza KE, Reichow B. Cognitive-behavioral therapy for anxiety in children with high-functioning autism: a meta-analysis. Pediatrics. 2013;132(5). doi:10.1542/peds.2013-1193.

Chalfant AM, Rapee RM, Carroll L. Treating anxiety disorders in children with high functioning autism spectrum disorders: a controlled trial. J Autism Dev Disord. 2007;37(10):1842–57. doi:10.1007/s10803-006-0314-6.

Sung M, Shin S, Cho J. The effect of cognitive-behavioral therapy on anxiety in children with autism spectrum disorder: a systematic review and meta-analysis. J Autism Dev Disord. 2011;41(3):261–73. doi:10.1007/s10803-010-1043-4.

Reaven J, Blakeley-Smith A, Culhane-Shelburne K, Hepburn S. Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial. J Child Psychol Psychiatry. 2012;53(4):410–9. doi:10.1111/j.1469-7610.2011.02486.x.

Ung D, Wood JJ, Ehrenreich-May J, Arnold EB. Parent-child interaction therapy for the treatment of autism spectrum disorder: a pilot study. J Clin Child Adolesc Psychol. 2014;43(3):478–90. doi:10.1080/15374416.2014.886255.

Lickel A, MacLean WE Jr, Blakeley-Smith A, Hepburn S. Assessment of the quality of life in children with autism spectrum disorder: a pilot study. Autism. 2011;16(6):632–46. doi:10.1177/1362361311415101.

van Steensel FJ, Bögels SM. CBT for anxiety disorders in children with and without autism spectrum disorders. J Am Acad Child Adolesc Psychiatry. 2015;54(6):527–36. doi:10.1016/j.jaac.2015.04.002.

van Steensel FJA, Heeman EJ. Anxiety levels in children with autism spectrum disorder: a meta-analysis. J Child Fam Stud. 2017;26(7):1753–67. doi:10.1007/s10826-017-0687-7.