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In 2019, OAR awarded a $2,000 Graduate Research Grant to Stephanie Joseph, a doctoral student at the University of Oregon studying special education. Her study examined the effectiveness of an intervention to reduce anxiety in elementary school-aged autistic children.   

Anxiety disorders are one of the most commonly re-occurring comorbid diagnoses of children with autism, affecting approximately as many as 84% of autistic children as opposed to 13% of neurotypical children. Cognitive behavioral therapy (CBT) is an evidence-based treatment for anxiety disorders in both autistic and neurotypical children. CBT has been used effectively in a school setting, but little research has been done to determine if it is effective for autistic children in a school setting. 


St. Joseph used Coping Cat, a CBT program with a manual that she adapted for autistic children with symptoms of elevated anxiety. Dr. St. Joseph used an eight-week (vs. 16-week) version of the program and included parents in the intervention.  

The primary goal of Coping Cat is to teach children to recognize signs of anxiety and then use techniques they were taught through Coping Cat to manage the symptoms. The adaptations addressed specific support needs such as using concrete language and visual materials and integrating the students’ specific interests. Additionally, the program focused on behavioral change because autistic individuals often have problems with cognitive inflexibility and executive functioning.  

She recruited three autistic children at risk for anxiety for the study: 

  • A 12-year-old boy also diagnosed with Crohn’s syndrome 
  • An 11-year-old boy also diagnosed with ADHD
  • An 8-year-old girl also diagnosed with obsessive-compulsive disorder  

During the initial education sessions, the children were taught how to: 

  • Use physical reactions as a cue to be aware of anxiety  
  • Recognize anxious self-talk
  • Modify anxious self-talk to coping self-talk
  • Reward themselves, even for partial success 

Beginning with session four, exposure tasks were integrated into the session’s lesson, starting with situations that cause low levels of anxiety. Within each session, as well as throughout the entire program, the targeted level of anxiety was gradually increased.  

The weekly after-school sessions for each child continued with an additional session that included the parent. St. Joseph followed a treatment manual and the students used a workbook to guide completion of weekly exercises and to aid involvement and skill acquisition.  


While analysis of the results showed a relation between the intervention and a decrease in externalizing behaviors related to anxiety, scores on pre/post-test rating scales did not show consistent results across participants. Although evaluation indicated that the results of the intervention were inconclusive, the social validity questionnaires indicated that children and their caregivers valued and liked the intervention. 

Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.