Functional Behavior-Based Cognitive-Behavioral Therapy for Obsessive Compulsive Behavior in Children with Autism Spectrum Disorder: A Randomized Controlled Trial.

Vause et al. (2020) tested a new twist on CBT. They started with a full functional behavior assessment, then built the CBT skills around each child’s triggers.

Kids were verbal, aged 7-13, with high-functioning autism and daily obsessive routines. Half got the new Fb-CBT; half got the usual school counseling.

Therapists taught the kids to spot their own “warning thoughts,” swap in replacement actions, and self-reward. Parents joined the last ten minutes of every session.

The Fb-CBT group showed large drops in repetitive rituals and time stuck in routines. Gains stayed strong six months later.

The control group barely changed. Large, significant difference.

Perihan et al. (2020) pooled 23 CBT anxiety trials and saw only moderate effects. Tricia’s study got larger change by aiming CBT at OCBs instead of worry.

Sofronoff et al. (2007) used plain CBT for anger in Asperger kids and saw small, slow gains. Adding a full FBA first, like Tricia did, looks like an upgrade.

Byiers et al. (2025) later tried letting parents pick the top three goals. Their modular CBT beat standard CBT for anxiety. Tricia’s paper helped open the door for that next step.

If you run CBT for autistic learners, start with an FBA. Map the exact cue-behavior-payoff loop, then teach cognitive skills that match that loop. You can keep the same session length and still get bigger, faster drops in rituals.