Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: a systematic review and meta-analysis, 2021, Laws et al

rvallee

rvallee

Senior Member (Voting Rights)
Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: a systematic review and meta-analysis
https://link.springer.com/article/10.1186/s40359-021-00658-8

Background
Anxiety is common in youth on the autism spectrum and cognitive behavioural therapy (CBT) has been adapted to address associated symptoms. The aim of the current systematic review and meta-analysis was to examine the efficacy of CBT for reducing anxiety in autistic youth.

Method
Searches of PubMed and Scopus databases were undertaken from January 1990 until December 2020. Studies were included if they consisted of randomised controlled trials (RCTs) using CBT to reduce anxiety in autistic youth. Separate random effects meta-analyses assessed anxiety ratings according to informant (clinician; parent; child), both at end-of-trial and at follow-up.

Results
A total of 19 RCTs met our inclusion criteria (833 participants: CBT N = 487; controls N = 346). Random effects meta-analyses revealed a large effect size for clinician rated symptoms (g = 0.88, 95% CI 0.55, 1.12, k = 11), while those for both parent (g = 0.40, 95% CI 0.24, 0.56; k = 18) and child-reported anxiety (g = 0.25, 95% CI 0.06, 0.43; k = 13) were smaller, but significant. These benefits were not however maintained at follow-up. Moderator analyses showed that CBT was more efficacious for younger children (for clinician and parent ratings) and when delivered as individual therapy (for clinician ratings). Using the Cochrane Risk of Bias 2 tool, we found concerns about reporting bias across most trials.

Conclusions
The efficacy of CBT for anxiety in autistic youth was supported in the immediate intervention period. However, substantial inconsistency emerged in the magnitude of benefit depending upon who was rating symptoms (clinician, parent or child). Follow-up analyses failed to reveal sustained benefits, though few studies have included this data. It will be important for future trials to address robustness of treatment gains overtime and to further explore inconsistency in efficacy by informant. We also recommend pre-registration of methods by trialists to address concerns with reporting bias.
 
Older but wasn't posted before. Interesting, and predictable, to notice that clinicians massively overrate efficacy, as CBT and psychobehavioral treatments appear to mainly target their beliefs and perception, rather than the patients'.
They analysed raters separately, with effect sizes of 1.21, 1.19 and 0.68 for clinicians (k = 5), parents (k = 6) and child (k = 5) respectively. These effect sizes were reduced with the removal of one extreme outlier in each analysis to 0.89, 0.57 and 0.17 respectively.
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Which makes this doubly interesting: how third-party rating of subjective experience is obviously invalid, expertise is irrelevant in this context, while there are additional significant issues with excessive biases from a few studies tipping an otherwise irrelevant evidence base into appearing relevant by barely crossing over the bare minimum. Also here using tiny numbers that obviously should not amount to enough for a systematic review. So many compounding problems with this industry, none of which ever get addressed.

Over the years we have noticed many such 'systematic' (most of them partial but whatever) reviews resting their entire significance in a single study. Although we have recently seen the even more problematic issue of reviews that depend on a single trial, which shows that the field is moving in a direction of even more bias and deceit over time.
 
rvallee said:
Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: a systematic review and meta-analysis
https://link.springer.com/article/10.1186/s40359-021-00658-8

Background
Anxiety is common in youth on the autism spectrum and cognitive behavioural therapy (CBT) has been adapted to address associated symptoms. The aim of the current systematic review and meta-analysis was to examine the efficacy of CBT for reducing anxiety in autistic youth.

Method
Searches of PubMed and Scopus databases were undertaken from January 1990 until December 2020. Studies were included if they consisted of randomised controlled trials (RCTs) using CBT to reduce anxiety in autistic youth. Separate random effects meta-analyses assessed anxiety ratings according to informant (clinician; parent; child), both at end-of-trial and at follow-up.

Results
A total of 19 RCTs met our inclusion criteria (833 participants: CBT N = 487; controls N = 346). Random effects meta-analyses revealed a large effect size for clinician rated symptoms (g = 0.88, 95% CI 0.55, 1.12, k = 11), while those for both parent (g = 0.40, 95% CI 0.24, 0.56; k = 18) and child-reported anxiety (g = 0.25, 95% CI 0.06, 0.43; k = 13) were smaller, but significant. These benefits were not however maintained at follow-up. Moderator analyses showed that CBT was more efficacious for younger children (for clinician and parent ratings) and when delivered as individual therapy (for clinician ratings). Using the Cochrane Risk of Bias 2 tool, we found concerns about reporting bias across most trials.

Conclusions
The efficacy of CBT for anxiety in autistic youth was supported in the immediate intervention period. However, substantial inconsistency emerged in the magnitude of benefit depending upon who was rating symptoms (clinician, parent or child). Follow-up analyses failed to reveal sustained benefits, though few studies have included this data. It will be important for future trials to address robustness of treatment gains overtime and to further explore inconsistency in efficacy by informant. We also recommend pre-registration of methods by trialists to address concerns with reporting bias.
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Masking sounds like it wasn’t controlled fir hence they’ve been taught how to perform fir the clinician then get home and have been exhausted by it

and the same thing again with the short term vs follow up . Had they just been taught (how) to mask it. But the dam can only hold for so long as faking it doesn’t leading to making it if the therapy is not effective underneath the social pressure and influences to just rate better/say the right thing/behave the right way. Ie changing behaviour doesn’t lead to changing the underlying issue

Part of which could be due to others behaving inappropriately towards them / social society issues - so I can imagine that CBT could be walking a sticky line on gaslighting potential if people are being questioned fir being anxious but actually yes people around them are going to be unforgiving or rude etc.

I mean you can try and tell humans ‘who cares about other people’ when it’s not everyone who matters and significantly affecting important or prospects but it doesn’t make continual rejection or being hurt not be harmful, just as it would and should get to anyone if it’s all day every day.
 
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