Cognitive Behavioral Therapy May Help Kids with Autism, Including Fragile X, Manage Emotions

Cognitive behavioral therapy may help children with autism spectrum disorder, including fragile X syndrome, manage a range of emotional challenges such as anxiety, sadness, or anger, according to researchers.

Their study, “A randomized waitlist-controlled trial of cognitive behavior therapy to improve emotion regulation in children with autism,” was published in the Journal of Child Psychology and Psychiatry.

Patients with autism spectrum disorder (ASD) — of which fragile X accounts for the most common single genetic cause — often experience mental health problems.

Approximately 30–50% of children and adolescents with ASD without an intellectual disability have at least two psychiatric conditions, and 50–85% experience clinically significant emotional difficulties, such as anxiety, anger, or depression. In fact, there is a high co-occurrence among these conditions.

This is likely due to the fact that individuals with ASD often have impairments in emotional regulation — the processes responsible for monitoring, evaluating, and modifying emotional reactions to accomplish their goals.

Cognitive behavioral therapy (CBT) is a short-term, goal-oriented psychotherapy treatment that takes a practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are responsible for people’s difficulties.

CBT is considered a useful treatment for anxiety in children with autism spectrum disorder. But very few studies have applied CBT to address problems other than anxiety.

Transdiagnostic CBT (tCBT) — which refers to a single treatment despite different challenges across individuals — has been successfully used as a means to improve emotion regulation in children and adults without autism spectrum disorder.

“We can use this same intervention to improve children’s skills more broadly regardless of what emotional challenge they have,” Jonathan Weiss, lead author of the study, said in a press release. “We can make them more resilient to many emotional and mental health issues.”

Sixty-eight children from 8 to 12, and their parents, were randomly assigned to one of two groups — those who received 10 CBT sessions immediately, and those who were wait-listed (the control group).

The treatment consisted of time-limited spy-themed cognitive behavioral therapy involving a computer program, games, and tools to help build the child’s emotional toolkit.

During the intervention, parents also practiced what they learned with their children and served as co-therapists during the sessions.

Researchers tracked the children’s ability to regulate their emotions before and after treatment.

“We showed that children who received this treatment right away improved in their ability to manage their emotions, and in overall mental health problems, versus kids who were waiting for treatment,” Weiss said.

A clinician who didn’t know which children received treatment and which were controls rated 74% of children receiving treatment as improved, compared to only 31% of those in the wait-listed group.

Importantly, the benefits from treatment were maintained at the 10-week follow-up.

“The current findings are encouraging, supporting the hypothesis that CBT can be adapted to move beyond current anxiety-specific frameworks with a greater focus on underlying mechanisms, targeting multiple emotional problems at the same time,” researchers concluded.