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Cognitive Behavioural Therapy and Autism Ranking: Very strong positive evidence

Status Research

There is a reasonable amount of high quality research studies on cognitive behavioural therapy as an intervention for people on the autism spectrum. However there are a number of limitations to all of the research studies published to date. For example

  • Some of the studies (such as Fitzpatrick, 2004; Greig and MacKay, 2005; Sze, 2008) had a single participant.  Other studies (such as Ooi et al, 2008; Schmidt et al, 2011; Storch et al, 2015) had less than 10 participants.
  • Some of the studies (such as Bauminger, 2002; Reaven et al, 2015; Weiss J. A. et al, 2015) were open label trials with no comparison control group.
  • Some of the controlled studies (such as Chalfant et al, 2007; Puleo and Kendall, 2011; Reaven et al, 2009) were non-randomised.
  • Some of the randomised controlled studies (such as Andrews et al, 2013; Hesselmark et al, 2014; Sofronoff et al (2007) were non-blinded.
  • Some of the controlled and randomised controlled trials (such as Andrews et al, 2013; Drahota et al, 2011; Fujii et al, 2013) used a waitlist or treatment as usual as a control condition rather than an active intervention.
  • Some of the studies (such as Drahota et al, 2011; Fujii et al, 2013; Vause et al, Epub) were undertaken by researchers who were not independent of the intervention being studied.  Those researchers may therefore have been biased towards the intervention, however unconsciously.
  • Very few of the studies looked at the following groups on the autism spectrum: females, individuals with a verbal IQ of less than 70, individuals from minority ethnic groups.
  • Very few of the studies looked at implementing CBT in real world settings (such as the home, at school or at work).
  • There was wide variability in reporting the age of initial onset of mental health co-morbidity, or the duration and trajectory of these symptoms.
  • There was wide variability in reporting of concomitant treatments including medication and psychoeducational and interventions.
  • There was wide variability in the choice of outcomes measures, which ranged from child self-report to parent and/or teacher reports of improvements and objective clinical ratings.
  • The fact that many of the studies investigated multi-component CBT programmes makes it difficult to be sure which of those components were the most effective.
  • There were only a few studies (such as Maddox et al, 2016; Selles et al, 2015) which followed up previous studies in order to evaluate the long term effects of the intervention.

For a comprehensive list of potential flaws in research studies, please see ‘Why some autism research studies are flawed’

Updated
31 Oct 2017
Last Review
01 Mar 2017
Next Review
01 Mar 2020