SPARK Research Match Summary Report: Parent-Led, Therapist-Assisted Behavioral Therapy for Children with Autism and Anxiety

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SPARK Research Match Summary Report: Parent-Led, Therapist-Assisted Behavioral Therapy for Children with Autism and Anxiety

Date Published: January 2023

This is a SPARK Research Match Summary Report. It describes results from newly published research using data from SPARK participants.

Study title

Stepped-Care Cognitive Behavioral Therapy in Children on the Autism Spectrum with Co-occurring Anxiety

What was the study about?

Researchers wanted to see if a two-step approach to therapy, called stepped care, would help autistic children who have anxiety. They tested cognitive behavioral therapy, called CBT, an anxiety treatment for autistic youth that has been shown to work when done by a therapist. The treatment helps a person change the way they think about their fears and develop ways to cope. Parents led the treatment in step 1, with guidance from a CBT therapist.

How was the research done?

Researchers enrolled 76 autistic children aged 4 to 14 who also had significant levels of anxiety. The children did not have intellectual disability. In step 1 of the study, parents received treatment materials, including the book “Helping Your Anxious Child,” to use with their child for 12 weeks. A therapist met with the parent and child four times during step 1 to guide the treatment. If the children’s anxiety improved, they began a 12-week maintenance program run entirely by a parent. The children who did not improve from parent-led therapy stepped up to 12 weeks of family-based CBT for their second step. A therapist led 10 sessions with each child and parent together during step 2.

What did the researchers learn?

This is a chart that describes the percentage of autistic youth who improved during this study

  • Eighteen youth (28 percent) who finished the parent-led therapy in step 1 improved. They moved to a parent-run program to maintain their improvements. These children had lower levels of anxiety and fewer anxiety-related problems at the start than the children who did not get better after the parent-led therapy.
  • Forty-four youth did not significantly improve after step 1. They were stepped up to CBT led by a therapist, with their parent actively involved, for step 2.
  • Forty percent of the participants dropped out of the study before it was completed, particularly around the beginning of the COVID-19 pandemic in 2020, when services and schools were disrupted. Therapy switched from in-person to telehealth at that time.
  • Eighty percent of the children who completed both parts of the program saw reductions in anxiety and fewer impairments in their functioning that were caused by anxiety.

What was new and innovative about the study?

This is the first study to examine the effectiveness of a two-step approach to treating anxiety in autistic children that used parent-led and therapist-led CBT. Parents learned skills for helping their child with anxiety. “The innovation is that you’re giving everyone the dose of therapy they need. Not everyone needs to see a therapist for 12 weeks. Some just need their parents to get some guidance on how to help them,” says Eric A. Storch, Ph.D., who led the study.

What do the findings mean?

Almost a third of the autistic children, particularly those with less severe anxiety, benefited from a parent-led intervention that needed only limited support from a therapist. This intervention could help families who cannot access and do not need traditional CBT with a therapist. Most of the children with more severe anxiety improved after family CBT that was led by a therapist.

What are people saying?

Study participant:

My [child] really enjoyed the study and asked to do more.”

Study researcher Eric A. Storch, Ph.D., clinical psychologist and professor, Baylor College of Medicine:

“When you think of CBT for anxiety, the critical treatment component involves having the child face their fears. Whether a child has autism or not, we typically want to have parents in sessions, so they can learn skills to reduce accommodating behaviors of anxiety and learn how to support their child.”

What’s next?

Storch’s team is studying CBT for anxiety at different dose levels, using telehealth, and using an internet program. Making treatment accessible to everyone is a goal. He is collaborating on a project to deliver CBT to people with autism through community mental health centers. “If at the end of the day we can’t take it from the clinic into the real world, then what’s the point?” Storch asks.


  1. Storch E.A. et al. J. Autism Dev. Disord. Epub ahead of print (2022) PubMed

About SPARK Research Match

This SPARK program matches participants with research studies that they may want to join. These studies have been evaluated for scientific merit and approved by a scientific committee at SPARK. The program is free to researchers and participants. SPARK does not endorse or conduct these studies. Participants choose if they want to take part in a particular study.