The Autism Society Event and Education Recordings Archive

Children and teens with autism spectrum disorders often experience social and emotional difficulties that may lead to significant mental health issues. Research indicates that CBT is an effective approach in the treatment of social and emotional difficulties in the general population. Using case presentations and materials from our clinic program, this session will focus on the key components of CBT and how they may be adapted for use with individuals with ASDs. What is cognitive behavioral therapy?                                                                                                                                                                                                                                                           Cognitive behavioral therapy (CBT) is an evidence based form of psychotherapy that is structured and goal oriented. It was initially developed for the treatment of depression but has been successfully adapted for the treatment of a wide range of issues, including anxiety, social skills deficits, and anger management. Although originally developed for adults, CBT has been shown to be highly effective in the treatment of children and teens. CBT focuses on the thoughts, feelings, and behaviors that contribute to an individual’s distress. By focusing on the connection between thoughts, feelings, and behaviors CBT teaches children and teens to develop more effective coping skills. CBT also targets social skills deficits by directly teaching social norms and expectations as well as strategies for successful social interactions and relationship development. Several studies as well as anecdotal evidence support the use of cognitive behavioral therapy in autism spectrum disorders (Sze & Wood, 2007; Gaus, 2007; Anderson & Morris, 2006).

How can CBT help individuals with ASDs?                                                                 
Children and teens with ASDs have significant social skills deficits and tend to have difficulty identifying and modulating their emotional reactions. They are also likely to experience social rejection. As a result, high functioning children and teens with ASDs are at risk for developing impaired self esteem, anxiety and depression, particularly as they become more aware of their own social deficits. CBT may be used to directly teach social skills, alleviate social anxiety and improve self-esteem and self-confidence. CBT approaches may also be used to develop the ability to identify and communicate emotions and recognize the emotions of others. Additionally, CBT facilitates the development of adaptive coping skills to modulate emotional reactions and reduce depressive and anxious symptomatology. This session will highlight the process by which, at varying points in the therapeutic process, CBT can effectively target these areas of difficulty for children and teens with ASDs.

How do we modify traditional CBT when working with individuals with autism spectrum disorders?
When deciding how to adapt CBT for use with an individual client with an ASD, it is important to assess the individual’s particular strengths, weaknesses, interests, and preferred learning style. For example, many individuals with ASDs report that information presented visually is easier for them to process and retain. The CBT approach typically utilizes visually presented information and worksheets and these tools should be emphasized with the ASD population. Additionally, an individual’s special interests may be used to increase motivation and facilitate the therapeutic process. This session will outline specific ways to adapt components of cognitive behavioral therapy to best fit an individual’s needs based on a comprehensive understanding of the individual’s cognitive and developmental level, areas of strength and weakness, preferred learning style, interests and presenting difficulties. These factors help to determine where therapy needs to begin and how to best teach new skills, as well as set initial goals.

How does CBT progress for an individual with ASDs?
CBT for children and teens with ASDs must be adapted to take into account their individual strengths, weaknesses, and needs. Typically, this first requires an assessment of existing skills and identification of areas of skill deficit. Additionally, it is important to set specific and identifiable goals in collaboration with the individual and with parents when appropriate and to continuously evaluate progress made toward these goals. It is also essential to periodically reassess goals, as the individual’s needs may change, especially as he or she matures and is faced with new expectations and challenges. Following the assessment and goal setting, it is essential to lay a basic groundwork that includes the development of an emotional vocabulary to identify and communicate feelings. Due to the deficits in social and emotional understanding and communication associated with ASDs, we have found that this requires a slower pace with more repetition than one would expect of traditional CBT. This session will walk participants through the general phases of CBT with a child or teen with an ASD. Additionally, typical goals at various points in the therapeutic process will be presented.

Examples of phases of CBT which will be discussed are:

·         Rapport building

·         Labeling emotions in self and others

·         Connecting emotions to situations

·         Identifying thoughts

·         Understanding the connection between thoughts, feelings, and behaviors

·         Discriminating between helpful and unhelpful thoughts

·         Correcting unhelpful thoughts and using coping skills

·         Assessing social skills deficits and directly teaching skills

Participants in this session will learn that the CBT model, when adapted appropriately, can be a highly effective approach for reducing social and emotional difficulties and improving the overall functioning of children and teens with ASDs. The importance of utilizing an individual’s strengths and interests to individualize therapy and create therapeutic goals will be highlighted. To illustrate these techniques and strategies, we will share case examples of applications from our center’s cognitive behavioral therapy program.

Learning Objectives: