Considering efficacy and effectiveness trials of cognitive behavioral therapy among youth with autism: A systematic review.
Most CBT evidence for autistic youth comes from university labs, not real clinics, so check your own fidelity and outcomes before assuming it will work the same.
01Research in Context
What this study did
The team hunted for every CBT paper written for autistic kids and teens. They kept 33 studies. Twenty were tightly-controlled lab trials. Thirteen were real-world effectiveness trials.
They checked if the real-world trials used implementation-science tools. These tools track how well a treatment travels from lab to clinic.
What they found
Only 13 of 33 studies tested CBT in everyday clinics. Most still skipped key steps like staff training checks or cost logs.
The gap between lab and life is wide. We know CBT works at the university. We do not know if it works at your local agency.
How this fits with other research
Perihan et al. (2020) ran a meta-analysis inside the same 33 papers. They found CBT cuts anxiety by a medium amount. Payne et al. (2020) now show most of that evidence came from lab trials, not community ones.
Pickard et al. (2019) looked at who gets into these trials. Most kids were White and had richer parents. Put together, the three papers say: we have good lab data on a narrow group, but thin real-world data on everyone else.
Reichow (2012) and Howlin et al. (2009) did the same “efficacy vs effectiveness” count for early ABA years ago. Their pattern matches: lots of lab proof, little community proof. The CBT field is repeating history.
Why it matters
If you run CBT groups at school or clinic, you are flying with a partial map. Push your team to log fidelity, cost, and parent voice. These items turn your session notes into the next effectiveness study the field needs.
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02At a glance
03Original abstract
Cognitive behavioral therapy is a common treatment for emotional problems in people with autism. Most studies of cognitive behavioral therapy and autism have focused on efficacy, meaning whether a treatment produces results under "ideal" conditions, like a lab or research setting. Effectiveness trials, by contrast, investigate whether a treatment produces results under "real-world" conditions, like a community setting (e.g. hospital, community mental health center, school). There can be challenges in bringing a cognitive behavioral therapy treatment out of a lab or research setting into the community, and the field of implementation science uses frameworks to help guide researchers in this process. In this study, we reviewed efficacy and effectiveness studies of cognitive behavioral therapy treatments for emotional problems (e.g. anxiety, depression) in children and youth with autism. Our search found 2959 articles, with 33 studies meeting our criteria. In total, 13 studies were labelled as effectiveness and 20 as efficacy. We discuss how the effectiveness studies used characteristics of an implementation science framework, such as studying how individuals learn about the treatment, accept or reject it, how it is used in the community over time, and any changes that happened to the individual or the organization (e.g. hospital, school, community mental health center) because of it. Results help us better understand the use of cognitive behavioral therapy in the community, including how a framework can be used to improve effectiveness studies.
Autism : the international journal of research and practice, 2020 · doi:10.1177/1362361320918754