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’

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