Cognitive Behavioral Therapy for Autistic School-Aged Children with Interfering Anxiety: Impact on Caregiver-Defined Goals

Purpose: Autistic children and youth can experience both mental health and adaptive skill needs, making the assessment of high priority goals from the caregiver’s standpoint an important objective in psychological treatment planning. Modular cognitive behavioral therapy (CBT) tailored to each family’s goals may be optimally suited to addressing different treatment priorities in autistic youth with interfering anxiety. The present study investigated the effects of adapted, modular CBT as compared to standard-of-practice CBT and treatment-as-usual (TAU) on caregiver-defined treatment goals. Methods: A multisite randomized, controlled trial compared an adapted, modular CBT program with standard-of-practice CBT and TAU for autistic youth with interfering anxiety (N = 167; aged 7–13 years). At baseline, caregivers described their child’s three highest priority clinical needs in their own words and rated the severity of these problems on a Likert-type scale, using the Youth Top Problems (YTP) scale. A broad range of clinical needs (e.g., internalizing, externalizing, and autism-related needs) were described by caregivers on this measure. At each treatment session, these problems were rated by caregivers. Youth coping was rated by caregivers each month. Results: Youth randomized to adapted CBT exhibited more rapid reductions in total YTP ratings in comparison with the TAU and standard-of-practice CBT conditions over the course of 16 weeks. Increased youth coping partly mediated this effect. Conclusion: In adapted/modular CBT, the treatment emphasis can be readily adjusted to address caregiver-defined goals and this feature may contribute to its advantage in reducing scores on a personalized measure of treatment goals. Trial Registration number(s): ClinicalTrials.gov NCT02028247.