This chapter explores the adaptation of cognitive behavioral therapy (CBT) for children with autism spectrum disorder (ASD), with a focus on the theoretical foundations that support its application, the unique treatment adaptations required, and evidence-based programs specifically developed for this population. Traditional CBT, a widely recognized approach for addressing anxiety and other emotional challenges, must be tailored for children with ASD to account for differences in communication, social understanding, and cognitive flexibility. We examine specific adaptations to the core components of exposure-based CBT, including assessment, psychoeducation, goal setting, exposure and response prevention, treatment termination, and telehealth adaptations, to better align with the needs of children with ASD. Additionally, we highlight several modular programs accessible to clinicians to address anxiety symptoms in children with ASD.