Examining the inclusion of diverse participants in cognitive behavior therapy research for youth with autism spectrum disorder and anxiety.
CBT lowers anxiety in autistic youth, but almost all proof comes from White, higher-SES kids, so check if your diverse clients need extra supports.
01Research in Context
What this study did
Pickard et al. (2019) looked at every published CBT-anxiety study for kids with autism. They asked one simple question: who actually gets into these trials?
The team coded race, income, and parent education for each study. They wanted to see if the research matches the real kids we serve.
What they found
Most trials were filled with White youth from higher-income homes. Low-income families and kids of color were barely included.
Your clinic caseload probably looks nothing like the evidence base you read about.
How this fits with other research
Perihan et al. (2020) pooled 23 of these same trials and proved CBT works for autism-anxiety. But the meta-analysis only confirms it works for the White, higher-SES slice Katherine found.
Mruzek et al. (2019) ran the exact CBT program in Nairobi schools and still saw big anxiety drops. This shows the treatment can succeed when we leave the usual sample.
Payne et al. (2020) counted 33 trials and warned most were lab-style efficacy studies, not real-world tests. Katherine adds the missing piece: even the 'real-world' trials leave out most families.
Why it matters
If you treat Black, Latino, or low-income kids with autism, the published CBT manuals may need tweaks for language, culture, or logistics. Check if parent handouts assume car access, paid time off, or certain school supports. Add flexible session times, bus vouchers, or translated materials. Track whether gains in your diverse caseload match the textbook data. When you share outcomes, note race and SES so the next review can include your kids.
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02At a glance
03Original abstract
Results of randomized controlled trials have demonstrated significant reductions in anxiety symptoms following cognitive behavior therapy participation. Although promising, the extent to which previous research has included families from low socioeconomic status or racially/ethnically diverse backgrounds is unknown. Aims of this study are as follows: (1) What is the race, ethnicity, and educational attainment of youth with autism spectrum disorder and their families who have participated in research examining the efficacy of cognitive behavior therapy for anxiety? and (2) How do the demographics of these participants compare to that of the United States census? A total of 14 studies were reviewed that included 473 participants. Chi-square analyses indicated that there are significant differences between the race/ethnicity of youth with autism spectrum disorder participating in cognitive behavior therapy research for anxiety and that of youth in the United States. Standard residuals indicated significant overrepresentation of White youth and significant underrepresentation of Black and Latino youth in cognitive behavior therapy research (all p-values <0.001). Similarly, there were significant differences in the educational attainment of caregivers participating in cognitive behavior therapy research, with a significant underrepresentation of caregivers from low socioeconomic status backgrounds ( p < 0.001). These findings have implications for the development of cognitive behavior therapy interventions for youth with autism spectrum disorder and anxiety that are both rigorous and inclusive.
Autism : the international journal of research and practice, 2019 · doi:10.1177/1362361318795678