Facing Your Fears in Secondary School: A Cognitive Behavioural Therapy Programme for Young People with Autism Spectrum Disorder and Anxiety

A systematic literature review explored group and individual Cognitive Behavioural Therapy (CBT) programmes for young people between the ages of 10 and 19 with Autism Spectrum Disorder (ASD) and co-occurring anxiety.

Using the adapted protocol from the Task Force on Evidence-Based Interventions in School Psychology (Kratochwill, 2003) and Harden and Gough's (2012) 'Weight of Evidence Framework', the twelve included studies which used group and individual study designs revealed markedly different scoring patterns across parent, clinician and child informants.

Moderate support was found for the Behavioural Interventions for Anxiety in Children with Autism (BIACA).

However, the overall weight of evidence suggested that the other six examined protocols (Building Confidence, Exposure and Response Therapy, Facing Your Fears – Adolescent Version (FYF – A), Homunculi Approach to Social and Emotional Wellbeing, Multimodal Anxiety and Social Skills Intervention and Standard CBT with modifications) were less effective in ameliorating anxiety.

Implications for practice and future research are discussed in light of these findings.

While the evidence base for the reviewed FYF – A intervention is still emerging, the traditional FYF intervention designed for youth aged 8 to 14 has been shown to effectively reduce anxiety in a number of clinic based studies within North America.

However, its utility within other cultural and applied treatment contexts has yet to be examined.

Likewise, there is a relative dearth of work examining secondary outcomes, such as executive function (EF), which has been speculated to develop in tandem with CBT.

The current study therefore sought to investigate the impact of a modified FYF school-based CBT programme in pupils with ASD and comorbid anxiety (ages 11-14 years, n = 4) using a clinical case-series design.

At the conclusion of the intervention, student rated anxiety was found to significantly decline for three of the four participants.

Likewise, favourable mood and behavioural changes were reported for most participants on the teacher rated Strengths and Difficulties Questionnaire.

EF skills were similarly found to significantly improve for three participants on the teacher and pupil rated behaviour regulation measure at the four week follow-up.

However, parent reported changes in anxiety were at odds with these two other informants and mixed results were obtained for parent rated EF and the weekly behavioural measures.

Limitations, future directions and implications for practice are discussed in relation to these findings.