Meta-analysis of cognitive behavioral therapy for improving anxiety symptoms in patients with autism spectrum disorder

CHENG Yichao; SHI Jiaxin; WANG Jiacheng; JIANG Zhimei

doi:10.11852/zgetbjzz2024-0542

PDF(3004 KB)

Chinese Journal of Child Health Care ›› 2025, Vol. 33 ›› Issue (4) : 431-438. DOI: 10.11852/zgetbjzz2024-0542

Meta Analysis

Meta-analysis of cognitive behavioral therapy for improving anxiety symptoms in patients with autism spectrum disorder

CHENG Yichao^1,2,3,4,5, SHI Jiaxin^1,2,3,4,5, WANG Jiacheng^1,2,3,4,5, JIANG Zhimei⁵

Author information +

History +

Abstract

Objective To analyze the therapeutic effect of cognitive behavioral therapy (CBT) on anxiety symptoms in patients with autism spectrum disorder by Meta-analysis. Methods Seven Chinese and foreign databases, including CNKI, Wanfang Data, China Biology Medicine (CBM), PubMed, Cochrane Library, Web of Science, and Embase, were searched for relevant literature published from the inception of the databases to May 1st, 2024. Two researchers independently assessed the quality of the included studies according to the relevant criteria in the Cochrane evaluation tool. The outcome indicators included the Spence Children's Anxiety Scale-Child/Parent version (SCAS-C/P), Pediatric Anxiety Rating Scale (PARS), Anxiety Disorders Interview Schedule (ADIS), Multidimensional Anxiety Scale for Children-Parent version (MASC-P), and State-Trait Anxiety Inventory (STAI). The included literature data were analyzed using RevMan 5.4 and Stata 17.0 software. Results A total of 11 foreign language articles were included in the Meta-analysis, with a total sample size of 483.Meta-analysis showed that the anxiety symptom-related assessment scale scores in the experimental group after treatment were better than those in the control group (SMD=-0.69,95%CI:-0.88~-0.50,P＜0.001), and there was a statistically significant difference in treatment outcomes between the experimental and control groups. The subgroup analysis results showed that the improvements in anxiety symptoms was the most obvious in PARS scale (SMD=-0.98, 95%CI:-1.30 to -0.66, P<0.001). CBT specifically tailored for ASD (BIACA) had the most significant effect on improving anxiety symptoms compared to other types of CBT (SMD=-0.98, 95%CI:-1.30 to -0.66, P<0.001). The best improvement in the severity of anxiety symptoms was observed with a treatment duration of over 14 weeks (SMD=-0.87, 95%CI:-1.16 to -0.58, P<0.001). Conclusions CBT has a good therapeutic effect on improving anxiety symptoms in children with ASD. However, its effectiveness may be influenced by factors such as outcome indicators, types of CBT, and treatment duration. Appropriate treatment duration with BIACA can better improve anxiety symptoms in patients with ASD.

Key words

cognitive behavioral therapy / autism spectrum disorder / anxiety / Meta-analysis

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

CHENG Yichao, SHI Jiaxin, WANG Jiacheng, JIANG Zhimei. Meta-analysis of cognitive behavioral therapy for improving anxiety symptoms in patients with autism spectrum disorder[J]. Chinese Journal of Child Health Care. 2025, 33(4): 431-438 https://doi.org/10.11852/zgetbjzz2024-0542

References

[1] Hirota T, King BH. Autism spectrum disorder: A review[J]. JAMA, 2023, 329(2):157-168.
[2] 赵亚楠,李智文,李琳,等.中国0～6岁儿童孤独症谱系障碍筛查患病现状[J].中国生育健康杂志,2023,34(5): 423-428.
Zhao YN, Li ZW, Li L, et al. Screening status of autism spectrum disorders in children aged 0 - 6 years in China[J]. Chin J Reproductive Health, 2023,34(5): 423-428.(in Chinese)
[3] Hossain MM, Khan N, Sultana A, et al. Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and Meta-analyses[J]. Psychiatry Res, 2020, 287:112922.
[4] Vasa RA, Keefer A, McDonald RG, et al. A scoping review of anxiety in young children with autism spectrum disorder[J]. Autism Res, 2020, 13(12):2038-2057.
[5] Andrews DS, Aksman L, Kerns CM, et al. Association of amygdala development with different forms of anxiety in autism spectrum disorder[J]. Biol Psychiatry, 2022, 91(11):977-987.
[6] Sukhodolsky DG, Bloch MH, Panza KE, et al. Cognitive-behavioral therapy for anxiety in children with high-functioning autism: A Meta-analysis[J]. Pediatrics, 2013, 132(5):e1341-e1350.
[7] Thoma N, Pilecki B, McKay D. Contemporary cognitive behavior therapy: A review of theory, history, and evidence[J]. Psychodyn Psychiatry, 2015, 43(3):423-461.
[8] Huey SJ, Park AL, Galán CA, et al. Culturally responsive cognitive behavioral therapy for ethnically diverse populations[J]. Annu Rev Clin Psychol, 2023, 19:51-78.
[9] 高胜利,李树峰,刘丽霞,等. 网络认知行为疗法对青少年抑郁症状疗效Meta分析[J]. 中国儿童保健杂志, 2024,32(7):778-784.
Gao SL, Li SF, Liu LX, et al. Meta-analysis of the efficacy of network cognitive behavioral therapy on adolescent depressive symptoms[J]. Chin J Child Health Care, 2024,32(7): 778-784.(in Chinese)
[10] Wood JJ, Drahota A, Sze K, et al. Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial[J]. J Child Psychol Psychiatry, 2009, 50(3):224-234.
[11] Brewin CR. Theoretical foundations of cognitive-behavior therapy for anxiety and depression[J]. Annu Rev Psychol, 1996, 47:33-57.
[12] American Psychiatric Association. Diagnostic and statistical manual of mental disorders-5[M]. Arlington: American Psychiatric Publishing, 2013.
[13] 师乐,李素霞,邓佳慧,等.《精神病学杂志》第5版中谱系障碍的变化[J].中国神经病学杂志,2015,41(4): 253-256.
Shi L, Li SX, Deng JH, et al. Changes in spectrum disorders in the 5th edition of the Chinese Journal of Psychiatry[J]. Chin J Neurol, 2015,41(4): 253-256.(in Chinese)
[14] Orgilés M, Fernández-Martínez I, Guillén-Riquelme A, et al. A systematic review of the factor structure and reliability of the Spence Children's Anxiety Scale[J].J Affect Disord, 2016, 190:333-340.
[15] Riddle MA, Ginsburg GS, Walkup JT, et al. The Pediatric Anxiety Rating Scale (PARS): development and psychometric properties[J].J Am Acad Child Adolesc Psychiatry, 2002, 41(9):1061-1069.
[16] Lyneham HJ, Abbott MJ, Rapee RM. Interrater reliability of the Anxiety Disorders Interview Schedule for DSM-Ⅳ: Child and parent version[J]. J Am Acad Child Adolesc Psychiatry, 2007, 46(6):731-736.
[17] Van GW, Ferdinand RF. Screening capacity of the Multidimensional Anxiety Scale for Children (MASC) for DSM-Ⅳ anxiety disorders[J]. Depress Anxiety, 2008, 25(12):1046-1052.
[18] Du Q, Liu H, Yang C, et al. The development of a Short Chinese Version of the State-Trait Anxiety Inventory[J]. Front Psychiatry, 2022, 13:854547.
[19] Sterne J,Savovic' J,Page MJ, et al. RoB 2:A revised tool for assessing risk of bias in randomised trials[J]. BMJ, 2019, 66:14898.
[20] Luxford S, Hadwin JA, Kovshoff H. Evaluating the effectiveness of a school-based cognitive behavioural therapy intervention for anxiety in adolescents diagnosed with autism spectrum disorder[J]. J Autism Dev Disord, 2017, 47(12):3896-3908.
[21] Clarke C, Hill V, Charman T. School based cognitive behavioural therapy targeting anxiety in children with autistic spectrum disorder: A quasi-experimental randomised controlled trail incorporating a mixed methods approach[J]. J Autism Dev Disord, 2017, 47(12):3883-3895.
[22] Conaughton RJ, Donovan CL, March S. Efficacy of an internet-based CBT program for children with comorbid high functioning autism spectrum disorder and anxiety: A randomised controlled trial[J]. J Affect Disord, 2017, 218:260-268.
[23] Theresa MK, Rosanna MR, et al. A replication and extension of the cool kids autism spectrum disorder anxiety program: Randomised controlled trial reducing anxiety in autistic adolescents[J]. Res Autism Spectr Disord, 2024, 102335.
[24] Wood JJ, Kendall PC, Wood KS, et al. Cognitive behavioral treatments for anxiety in children with autism spectrum disorder: A randomized clinical trial[J]. JAMA Psychiatry, 2020, 77(5):474-483.
[25] Storch EA, Arnold EB, Lewin AB, et al. The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: A randomized, controlled trial[J]. J Am Acad Child Adolesc Psychiatry, 2013, 52(2):132-142.e2.
[26] Storch EA, Lewin AB, Collier AB, et al. A randomized controlled trial of cognitive-behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety[J]. Depress Anxiety, 2015, 32(3):174-181.
[27] Wood JJ, Ehrenreich-May J, Alessandri M, et al. Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: A randomized, controlled trial[J]. Behav Ther, 2015, 46(1):7-19.
[28] Weiss JA, Thomson K, Burnham Riosa P, et al. A randomized waitlist-controlled trial of cognitive behavior therapy to improve emotion regulation in children with autism[J]. J Child Psychol Psychiatry, 2018, 59(11):1180-1191.
[29] 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].J Child Psychol Psychiatry, 2012, 53(4):410-419.
[30] Yang YJ, Chung KM. Pilot randomized control trial of an app-based cbt program for reducing anxiety in individuals with ASD without intellectual disability[J]. J Autism Dev Disord, 2023, 53(4):1331-1346.
[31] 陈海燕,崔蕾.家庭团体认知行为干预应用于孤独症中的效果观察:一项随机、对照、开放研究[J].安徽医药,2021,25(4): 736-739.
Chen HY, Cui L. Observation of the effect of family group cognitive behavioral intervention on autism: A randomized, controlled, open study[J]. Anhui Med,2021,25(4): 736-739.(in Chinese)
[32] 俞丽娜,朱春燕,李玉,等.头针联合行为疗法应用于孤独症患儿中的干预效果研究[J].中国社会医学杂志,2021,38(2): 236-239.
Yu LN, Zhu CY, Li Y, etc. Study on the intervention effect of scalp acupuncture combined with behavioral therapy in children with autism[J]. Chin J Soc Med, 2021,38(2): 236-239.(in Chinese)
[33] Knowles KA, Tolin DF. Mechanisms of action in exposure therapy[J]. Curr Psychiatry Rep, 2022, 24(12):861-869.
[34] Norris LA, Rabner JC, Storch EA, et al. Idiographic coping outcomes in youth with autism spectrum disorder and co-occurring anxiety: Results from the TAASD study[J]. J Autism Dev Disord, 2023, 53(12):4711-4718.