Stepped-Care Cognitive Behavioral Therapy in Children on the Autism Spectrum with Co-occurring Anxiety.
Eric A Storch, Sophie C Schneider, Sean M Olsen and 12 others
PMID 36239830WHAT IT FOUND
Stepped CBT helped autistic children with anxiety.
Twenty-four percent improved after brief parent-led therapy. Among those who also needed therapist-led sessions, fifty-two percent improved. High dropout occurred, but families reported good satisfaction with the program.
Key findings
01Twenty-four percent of participants improved after the first step of low-intensity, parent-led cognitive behavioral therapy.
02Among those who did not improve in step one and moved to therapist-led CBT, fifty-two percent were responders at post-treatment.
03Participants who responded to the first step showed more rapid improvement in anxiety severity than those who required the second step.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
High dropout rate (40%) limits confidence in the overall effectiveness. The study shifted from in-person to telehealth during the pandemic, which may have affected engagement and results. Children with intellectual disability were excluded, so findings do not apply to that group. The trial was underpowered to test if the stepped-care approach is non-inferior to standard CBT. Autistic girls were underrepresented in the sample.
Declared interests
The study was funded by the National Institute of Child Health and Human Development, the National Institute of Mental Health, and the Texas Higher Education Coordinating Board.
The easy way to misread this
Do not interpret the high responder rate in completers as general effectiveness. The study had a 40% dropout rate, and the intent-to-treat response rate was substantially lower, meaning many families did not finish the program.