A cognitive help or hindrance? A systematic review of cognitive behavioural therapy to treat anxiety in young people with autism spectrum disorder

Abstract

Objective

Anxiety rates amongst autistic youth range from 11% to 84%. While Cognitive Behavioural Therapy (CBT) is an effective treatment of anxiety in neurotypical youth, there are concerns autistic youth lack the cognitive resources necessary to effectively engage with CBT. It is also unclear whether standard or adapted CBT is more effective. This review aims to compare the effects of standard and adapted CBT in the treatment of anxiety in autistic youth.

Methods

Articles were searched across three online databases. 24 articles were selected for final review. All articles were published between 2008 and 2024. Total sample size was 1,140 and participant age ranged from 4–18 years. Various designs, settings, and CBT formats were incorporated.

Results

When treating anxiety in autistic youth, standard CBT is effective although CBT adapted to accommodate the autism-related needs of the youth appears more effective, with gains maintained up to 26 months post-treatment. Statistical analysis was not significant.

Conclusions

Standard and adapted CBT are effective treatments of anxiety in autistic youth. To optimise outcomes, it may be important to consider the common cognitive styles associated with autism and adapt the therapeutic intervention accordingly. However, there is not yet statistical evidence for this hypothesis.

Plain Language Summary

A review of studies investigating the use of Cognitive Behavioural Therapy to treat anxiety in young people with Autism Spectrum Disorder: Why was this review done? Up to 84% of autistic youth have anxiety. Cognitive Behavioural Therapy (CBT) is often used to treat anxiety in youth without autism. However, there are concerns autistic youth lack the thinking processes necessary to effectively engage with CBT. It is also unclear whether standard or adapted CBT is more effective. This review therefore aims to compare the effects of standard and adapted CBT in the treatment of anxiety in autistic youth. What did the researchers do? Three online databases were used to find relevant studies for review. 24 studies were included in the final review. All studies were published between 2008 and 2024 and involved 1,140 participants overall. Participant age ranged from 4-18 years. Different study designs, settings, and CBT formats were included. What did the researchers find? CBT can help reduce anxiety in autistic young people. Greatest treatment effects may be found when the CBT has been adapted to suit the specific autism-related needs of the youth, and these effects can last up to 26 months post-treatment. Statistical analysis between standard and adapted CBT however did not show any significant differences. What do the findings mean? CBT helps to reduce anxiety in autistic youth. To achieve the greatest treatment effects, it may be important to adapt the CBT to suit the thinking processes of the autistic young people. However, there is not yet statistical evidence for this hypothesis.