Notes on Cognitive Behavioral Therapy and Autism Spectrum Disorders (Emmett)

People often get stuck in patterns of thinking and responding that are not helpful, partly because they filter everything that happens through a “meaning-making system” that is skewed or inaccurate. Therefore, one way to change people’s feelings or behavior is to target distorted thoughts they have about themselves and their lives. This helps them shift the way they interpret situations, how they feel about those situations, and how they respond to them. It is an extremely powerful intervention, and has been proven effective in the treatment of many conditions, including depression, generalized anxiety disorder, panic disorder, and post-traumatic stress disorder (Anderson).

One challenge was to find out whether children with ASD have the skills necessary to succeed at CBT. Fortunately, it appears they do. A study published in 2012 evaluated the cognitive skills of children with ASD and compared them to those of typical children. The children with ASD had the skills required for CBT in almost every instance. They were able to distinguish thoughts, feelings, and behaviors, and to work on altering their thoughts. Their only area of difficulty was in recognizing emotions (Anderson).

In addition, traditional CBT tends to require strong linguistic and abstract thinking abilities, and these can be a challenge for individuals on the autism spectrum. Realizing this, researchers have worked to develop modifications to CBT that render it more ASD-friendly, such as making it more repetitive, as well as visual and concrete.

For example, instead of merely asking children to verbally rate their anxiety on a scale of 1 to 10, the therapist might have a thermometer showing anxiety from low to high and have the participants point to the prop to illustrate how high their anxiety is around a certain situation (Anderson).

Researchers have found that one issue that can be particularly tough for parents of children with ASD is how much to shield or protect them from potentially negative experiences. The children often have a history of emotional and behavioral challenges and of real and painful failures in the world. Parents are reluctant to expose their child to any more failure, and may unwittingly limit exposure to experiences that are necessary to help the child become more independent and less anxious (Anderson).

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