Effects of Stepped Cognitive Behavioral Therapy on Child Depressive and Externalizing Symptoms in Autistic Children With Anxiety.

de Jonge et al. (2025) tested a stepped care plan for autistic children who also had anxiety. First, parents read a CBT workbook at home. Next, a therapist added weekly CBT sessions. The team asked: do the extra therapist visits shrink depression or behavior problems more than the book alone?

They tracked kids for three months after the stepped plan ended. No one got a fake treatment; everyone got some form of help.

Both groups showed only small drops in depression and externalizing scores. The added therapist sessions did not beat the parent-book alone.

At the three-month check, the scores looked the same across groups.

Chalfant et al. (2007) saw big anxiety cuts after 12 weeks of family group CBT. McConachie et al. (2014) also found small anxiety gains with group CBT. Both used full therapist time from the start, unlike the stepped plan.

Floyd et al. (2004) compared CBT book only to full therapy in older adults. They also saw no extra gain from added sessions by three months. The child data now echo that adult pattern.

Coffey et al. (2021) used ABA instead of CBT and still cut problem behavior in autistic kids with anxiety. The new CBT data are weaker, but the kids in Coffey had severe problem behavior, not just mild depression.

If a family is willing to read a CBT workbook, you may not need to rush in a therapist for mild depression or acting-out. Save your scarce therapy hours for kids who do not respond to the book first. Track scores monthly; if they stall, then step up.