By Rebecca McNally Keehn, M.A.
Many children and adolescents with autism spectrum disorder (ASD) experience higher levels of anxiety than their typically developing peers. Children with anxiety may worry about being away from their parents, upcoming events, their performance, meeting new people, interacting with peers, and their health. Anxiety in children with ASD is associated with increased behavior problems, social skills deficits, and negative life experiences, which without treatment has been shown to persist into adulthood. Finding appropriate treatments to help reduce anxiety in children with ASD is an important avenue of research.
Cognitive-behavioral therapy (CBT) has been found to be an effective treatment for typically developing children with anxiety. However, little research has been conducted on effective treatments for children and adolescents with both ASD and anxiety.
The purpose of this study was to examine the effectiveness of Coping Cat for treating anxiety in children with ASD. Coping Cat is a 16-session CBT program developed by Dr. Phillip Kendall and colleagues for typically developing children with anxiety. The aim of Coping Cat is to teach children to identify unwanted signs of anxiety and to let these signs cue them to implement anxiety management strategies. Children are taught to identify emotions, physical sensations, and thoughts associated with anxiety as well as coping skills such as relaxation and use of positive thinking strategies.
They then practice these coping skills in real life anxiety provoking situations. To adapt this program for use in children with ASD, several modifications were made including increasing the amount of parent training and participation, integrating children’s specific interests, making sensory and motor accommodations, and individualizing reinforcement for participation.
Twenty-two children between the ages 8 – 14, along with their families, have participated in this study, which was conducted at Alliant International University and the Center for Autism Research, Evaluation, and Service. Study participants had a diagnosis of ASD and significant difficulties with separation anxiety, social phobia, and/or generalized anxiety. Half of the children received the Coping Cat treatment upon entering the study and the other half served as a wait-list control group; children put on the wait-list were offered the CBT treatment following the 16-week waiting period.
Results have shown that children who participated in the Coping Cat CBT program experienced a reduction in the severity of their anxiety. In fact, 58% of children who received CBT no longer met criteria for their anxiety diagnosis at post-treatment as compared to 0% of children in the wait-list group. In addition, 40% of children who participated in the Coping Cat program remained free of clinically significant anxiety at two-month follow-up.
These results provide preliminary evidence that CBT, and the Coping Cat program in particular, may be an effective treatment for children and adolescents with ASD and anxiety. Currently, data is being collected from those children who opted to participate in treatment following the wait-list. This information will allow us to further examine characteristics of children with ASD who may benefit from this type of treatment.
It is our hope that this project will be a small step towards helping others with autism discover the benefits of effective and accessible interventions. We would like to thank the children and families who participated in this project as well as NFAR for helping to make this project possible.