Social Responsiveness as a Mediator in Adapted Cognitive Behavioral Therapy for Autistic Youth with Maladaptive and Interfering Anxiety.

In 30 seconds

This secondary mediation analysis of a multisite randomized clinical trial examined whether improved social responsiveness helped explain outcomes with adapted cognitive behavioral therapy (BIACA) in autistic youth aged 7–13 with maladaptive and interfering anxiety (N = 167). BIACA was compared with standard-of-practice CBT and treatment as usual. The analysis found a statistically significant indirect effect: adapted CBT’s effect on anxiety was mediated by social responsiveness. Youth assigned to adapted CBT also had better overall mental health at posttreatment than those in the other conditions, with this effect likewise mediated by improved social responsiveness.

Key findings

• The effect of adapted CBT on anxiety was mediated by social responsiveness, with a statistically significant indirect effect.
• Adapted-CBT participants had better overall mental health at posttreatment than participants in the other conditions.
• Improved social responsiveness also mediated the adapted CBT effect on overall mental health.

Why it matters

The findings suggest that social responsiveness may be one pathway through which CBT adapted to autistic youths’ social needs relates to anxiety and broader mental health outcomes. This highlights the potential relevance of social supports within CBT, including for navigating stressful situations such as group activities, while the mediation analysis does not establish that social responsiveness alone caused the benefits.

What to keep in mind

This was a secondary mediation analysis of a randomized trial; the abstract does not report the size of the indirect effects or establish that changes in social responsiveness caused the outcomes.