Cognitive behavioral remedy could also be solely mildly efficient for anxious, autistic kids | Spectrum
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According to a meta-analysis of 19 randomized clinical trials, children with autism tend to find cognitive behavioral therapy (CBT) less effective than their parents and clinicians in managing their anxiety.
The result, which is based on data from 833 autistic children up to the age of 18, gives cause for concern about how clinical studies measure anxiety in young people and who benefits from CBT.
“The basic question we have to ask ourselves is, if it works, who will it work for?” Says Principal Investigator Shivani Sharma, Head of Psychology at the University of Hertfordshire in the UK. “Because it’s really strange that there should be such a difference between the doctor’s ratings, the parents’ ratings, and then the person’s ratings, their own ratings.”
Studies show that talk therapy is effective in treating anxiety and depression in non-autistic children. In the UK, CBT is recommended as first-line therapy for children with social anxiety. It was also specially adapted for autistic children, but with mixed results.
The meta-analysis confirms that CBT reduces anxiety on average in autistic children. However, it also underlines the wide range of variation in effect sizes between the studies.
In a study from 2009, for example, clinicians rated CBT with an effect size of 2.5 as highly effective. Any value greater than 0.8 indicates a large effect, while a value of 0.5 indicates a medium effect and a value of 0.2 indicates a small effect. Self-rated scores from children in the same study favored control treatment.
In another study published in 2013, children’s ratings indicated that CBT had a large effect of 0.76, while ratings by parents and clinicians were wrong with effect sizes of 0.48 and 1.14, respectively, on either side .
Clinician scores for CBT averaged 0.88 across the 19 studies. Parent and child scores averaged 0.4 and 0.25, respectively. Even if the study from 2009 is excluded and treated as an outlier, the clinic-related effect sizes are on average 0.4 points higher than the effect sizes calculated from the children’s ratings.
Sharma found that the high scores given by parents and clinicians were primarily influenced by age. Parents and clinicians rated CBT as significantly more likely to be effective at treating anxiety in younger children.
Most of the studies in the meta-analysis included assessments from parents and clinicians, and 12 also included the child’s self-assessment. The results were published in BMC Psychology in October.
The big differences between the studies could also be due to how the researchers measured anxiety. Most of the studies used the Spence Children’s Anxiety Scale, a questionnaire completed by either a child or their parents. Non-autistic children and their parents usually agree on their ratings on this scale, but a previous study found that autistic children and their parents are less likely to agree. Other studies used different assessment tools and there was no consensus on a “gold standard” for measuring anxiety in children with autism.
“It’s pretty clear that everyone uses a customized form of CBT, but there’s no single way we measure treatment benefit,” says Sharma. “With our results, we are trying to say that there are methodologically some things that we as a scientific community can do better.”