Therapeutic alliance in youth with autism spectrum disorder receiving cognitive-behavioral treatment for anxiety.

Alliance was assessed only at post-treatment, so it is impossible to determine if strong alliance led to better outcomes or if better outcomes led to higher alliance ratings. There was no comparison group of children without autism to contextualize the alliance ratings. Social desirability bias may have inflated alliance scores, particularly for parents, as this was not explicitly measured. The study relied on self-report measures for alliance without observational data. Data was missing for some participants, although those with and without data did not differ significantly on key characteristics.

The study was supported by the National Institute of Mental Health and the National Institute of Child Health and Human Development. No specific commercial conflicts of interest were reported in the provided text.

Do not assume that building a strong therapeutic alliance will directly cause better anxiety outcomes in children with autism. The association found here is correlational and measured after the fact; it is equally likely that children who improved felt more connected to their therapist at the end of treatment.