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Research Summary

The Coping Cat Program Can Help Children With Autism and Anxiety

Suzanne Robinson | York University
This article summarizes a study that found many young people with autism experience higher rates of anxiety. Cognitive behavioural therapy program may offer benefit in reducing anxiety for some children with autism.

What you need to know?

A manualized individual cognitive behaviour therapy program may be an efficient and practical way to help children with autism spectrum disorder (ASD) manage feelings of anxiety.

What is the research about?

Many children with ASD experience higher rates of anxiety than children without ASD. This anxiety can have wide reaching effects for children and can last into adulthood, but little is known about effective treatments for children with ASD and anxiety. Cognitive behaviour therapy is based on the idea that individuals can be assisted to develop strategies and/or a way to change their thinking patterns or behaviour. This article specifically discusses the Coping Cat program, a manualized CBT program for children and which has been used with typically developing children for many years, as a potentially helpful treatment for reducing symptoms of anxiety in children with ASD.

What did the researchers do?

Researchers randomly divided 22 children with ASD and anxiety into two groups.  One group received 16-sessions of the individual Coping Cat program and the second group was placed on a waitlist for comparison. During the first eight weeks of the Coping Cat program, researchers taught participants anxiety management skills, such as how to recognize their own symptoms of anxiety, to develop a coping plan, to evaluate their own performance and coping skills and to administer positive reinforcement. The second eight week period was dedicated to exposing the participants to increasingly anxiety-producing situations. Homework in the Coping Cat workbook was a weekly expectation. Parent input and cooperation with the program was also a component of the intervention. The program was modified to better suit the learning style of children with ASD. The researchers examined participant changes compared to children with ASD who did not participate in the treatment.​

What did the researchers find?

After treatment, over half of the children in the treatment group no longer qualified for an anxiety disorder diagnosis. None of the children on the waitlist had this level of improvement. After 2 months, many of the children who participated in the program continued to be free from their previous anxiety disorder diagnosis.

After treatment, over half of the children in the treatment group no longer qualified for an anxiety disorder diagnosis. None of the children on the waitlist had this level of improvement.

How can you use this research?

This study suggests that children with ASD and anxiety can benefit from cognitive behaviour therapy to treat anxiety. This study provides evidence for the usefulness of the Coping Cat program. Future research is needed to expand on these findings, but this adds evidence that CBT may be a possible first line treatment for children with ASD and anxiety.

About the researchers

Rebecca H. McNally Keehn, Alan J. Lincoln, Milton Z. Brown and Denise A. Chavira are all researchers in ASD and Developmental Disabilities.

Rebecca H. McNally Keehn is a San Diego Clinical Psychology PhD student.

Dr. Alan J. Lincoln is a Professor of Clinical Psychology for Alliant International University and Director of the Center for Autism Research, Evaluation and Service.


McNally Keehn, R.H., Lincoln, A.J., Brown, M.Z. & Chavira, D.A. (2013). The Coping Cat program for children with anxiety and autism spectrum disorder: A pilot randomized controlled trial. Journal of Autism and Developmental Disorders, 43(1), 57-67.

This research summary was written by Suzanne Robinson for the Chair in Autism Spectrum Disorders Treatment and Care Research. This research summary, along with other summaries, can be found on our blog and at

 Reproduced with the permission of Dr. Jonathan Weiss (York University). This research summary was developed with funding from the Chair in ASD Treatment and Care Research. The Chair was funded by the Canadian Institutes of Health Research in partnership with Autism Speaks Canada, the Canadian Autism Spectrum Disorders Alliance, Health Canada, Kids Brain Health Network (formerly NeuroDevNet) and the Sinneave Family Foundation. This information appeared originally in the Autism Mental Health Blog (

 Photo by Tong Nguyen van on Unsplash 

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