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CBT for Anxiety in Autism Spectrum Disorder ASD



CBT for Anxiety in Autism Spectrum Disorder ASD 

Annette Hendley


The autism spectrum includes various disorders such as Asperger’s and different levels of childhood autism. The difficulties range from mild to severe autism.  Children with ASD struggle with information processing and social skills. Professor Jeffrey Wood, from UCLA, found that 35 percent or more children with ASD also battle with anxiety.

Cognitive Behaviour Therapy or CBT is a very popular treatment for anxiety in children and adults. Wood tested CBT on children with ASD and high levels of anxiety, and found it to be a highly successful treatment.

CBT is a talking therapy where the child’s thinking processes are analysed by the therapist as well as the child. Certain triggers are identified and also how the child reacts to these triggers. The idea is to change the way the child thinks. The process works differently for different people and it is necessary that the child cooperates.


I have used CBT successfully with a couple of children who struggled with anger issues. I usually begin the process with a timeline which is divided into years. For more in-depth analysis, it can be divided into months or for more recent periods into weeks. We then track their happiness through the years. Then we discuss negative dips in the timeline. They are able to see that the times when they were involved in fights and received detentions or were excluded from class were the times that they indicated as unhappy times. The visual presentation is quite valuable and the tangible image helps a lot to show the reality of their situation. After that we do a SWOT-analysis and look at Strengths, Weaknesses, Opportunities and Threats. They sometimes struggle with this as many of them have never thought about their strengths and weaknesses. Once we have discussed the timeline and analysis we start identifying triggers and how these triggers make them feel. The last part is to change their behaviour and the way they think about these triggers.  It is not a quick fix and it can sometimes be very intense, but most of the boys I am working with at the moment have been anger-free for quite a while.

The only time the therapy doesn’t work is when a child refuses to admit that he was wrong. I have one boy who has altercations with students and teachers nearly on a daily basis, but he refuses to admit that he is ever wrong. It is always the other party. Unfortunately, CBT hasn’t worked for him up to now, but we are not giving up.

In his research paper Wood refers to two separate cases where CBT worked very well for children with ASD and anxiety.  The first boy had high-functioning autism, OCD and generalised anxiety. He refused to go to school and had severe compulsive rituals. During the times when he went to school he constantly followed a couple of girls, who didn’t care for his company, and insisted on having lunch at their table. Wood refers to it as ‘stalking’. After the CBT treatment he made friends of his own, got rid of the rituals and had no issue about going to school.

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The second boy has the same profile but he struggled with separation anxiety and perfectionism. Homework and schoolwork became a nightmare as he constantly fell behind due to his insistence on doing everything perfectly. During his treatment the therapist asked him to do ‘pretend’ assignments for school and he had to make intentional mistakes. He also used to spend hours on making to-do lists. After the treatment he cut down on making lists until he could go for weeks without making any lists. He was rewarded for taking part in other activities during the times he would have made lists. His separation anxiety got so much better that he was able to sleep in his own room without a night light.

Wood found that CBT helps children with ASD to reduce their anxiety and he believes that significant social and academic progress can be made by these children which might not have been possible without the treatment.

Many therapists combine CBT with mindfulness. Matt Killingworth found that mindfulness leads to people being happier most of the time. There are various self-help books and ample free resources on the Internet for CBT and mindfulness:





About the Author

 Annette Hendley

Sen Tutor at Ilford Country High/Marketing & Management

Find out more about Annette Hendley at www.annettehendley.com.

Annette Hendley image




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