Cognitive behavior therapy may improve symptoms of autism spectrum disorder and social-emotional outcomes for children and adolescents with autism spectrum disorder, a systematic review and meta-analysis suggests. Researchers examined data from 51 randomized trials with a total of 2,485 children and adolescents with autism spectrum disorder (ASD). All the trials included in the analysis evaluated the effectiveness of cognitive behavior therapy (CBT) on autism symptoms and social-emotional problems in children and adolescents. In the subset of trials that measured self-reported outcomes, there was no statistically significant difference between CBT and control groups (standard mean difference -0.09), the analysis found. However, CBT did significantly improve ASD symptoms based on informant-reported outcomes (SMD -0.57) in trials that delivered CBT through individual or group sessions. "The take-home message for clinicians is that there is considerable research evidence supporting the use of CBT with children and adolescents on the autism spectrum, particularly for improving social skills and reducing anxiety," said Denis Sukhodolsky, a clinical psychologist and associate professor in the Child Study Center at Yale University School of Medicine in New Haven, Connecticut. "This meta-analysis also underscores the need for careful assessment and comprehensive treatment planning in order to select developmentally appropriate and clinically meaningful treatment targets for CBT," Sukhodolsky, who wasn't involved in the study, said by email. In particular, CBT appeared to improve ASD symptoms based on clinician-reported outcomes when the intervention target was something other than anxiety, the study team reports in Pediatrics. CBT also appeared to improve symptoms of social-emotional problems based on clinician-reported outcomes. CBT was also associated with significantly reduced task-based symptoms of ASD, and with significantly reduced symptoms of social-emotional problems based on informant-reported outcomes. One limitation of the analysis is that the included studies had low to modest quality, the study team notes. The investigated outcomes were also assessed using a wide variety of measurement scales, which may have influenced the effect estimates between control groups and groups that underwent CBT. Senior study author Dr. Yan Hao of the department of pediatrics at Tongji Hospital and Tongji Medical College at Huazhong University of Science and Technology in Wuhan, China, didn't respond to requests for comment. The study results are consistent with previous research showing that CBT can be an effective intervention for its primary target - anxiety - said Philip Kendall, a psychology professor at Temple University in Philadelphia who wasn't involved in the current study. "ASD is not the primary target of CBT, the anxiety is the target," Kendall said by email. "For some youth with anxiety and ASD, there may be benefit for additional social skills efforts but that remains to be evaluated further." —Lisa Rapaport Source
