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CBT for people with autism

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GinaGomez
GinaGomez

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I'm really interested in how we can adapt psychological therapies such as CBT for people with autism. There are a few really useful articles so far on Network Autism (e.g. Professor Ann Ozivandijan's presentation and Tim Lacey's article on treating depresson, but I'm really keen to hear other people's professional experience. What aspects of CBT are useful for people on the spectrum? What needs to be adapted? What research needs to be done in future? What has worked for you?
 

Edited on February 23, 2017 - 9:20am

September 20, 2012 - 1:05pm

It gets worse!

I find CBT to be flawed and an ablist/normalising perspective on mental ill-health - I would much prefer ideas such as the personal construct theory of George Kelly and a mutual negotiation and respect be seen as potentially useful rather than behavioural modification.

October 02, 2012 - 9:19am

Hi

Dawn or anyone who has the resources- are you able to give full references for the CBT for ASC articles mentioned? I am keen to read them and any others people know of.

The ones mentioned by dawn are:

Traditional CBT, which relies heavily upon good linguistic and abstract thinking skills (Reaven, 2009), needs to be modified to take into account the specific needs of CYP with ASC (White et al., 2009).  Instances of this include: a more visual and concrete approach, use of practical activities, incorporation of specific interests, and use of ASC specific hierarchies (Moree & Davis III, 2010; Reaven, 2009).  The various studies of CBT and ASC highlight successful elements of this to different degrees, but summary tables  have been provided in 3 recent papers (see Donoghue, Stallard, & Kucia, 2011; Lang et al., 2010; and Rotheram-Fuller & MacMullen, 2011), and  the full paper by Moree & Davis III (2010) considers the various modifications.

 

Thank you

 

Lisa

Dawn

October 07, 2012 - 10:32am

Hi Lisa

Here you go:

Donoghue, K., Stallard, P., & Kucia, J. (2011). The clinical practice of Cognitive Behavioural Therapy for children and young people with a diagnosis of Asperger’s Syndrome. Clinical child psychology and psychiatry, 16(1), 89–102. doi:10.1177/1359104509355019

Lang, R., Regester, A., Lauderdale, S., Ashbaugh, K., & Haring, A. (2010). Treatment of anxiety in autism spectrum disorders using cognitive behaviour therapy: A systematic review. Developmental neurorehabilitation, 13(1), 53–63. doi:10.3109/17518420903236288

Moree, B. N., & Davis III, T. E. (2010). Cognitive-behavioral therapy for anxiety in children diagnosed with autism spectrum disorders: Modification trends. Research in Autism Spectrum Disorders, 4(3), 346–354. doi:10.1016/j.rasd.2009.10.015

Reaven, J. (2009). Children with High-Functioning Autism Spectrum Disorders and Co-occurring Anxiety Symptoms: Implications for Assessment and Treatment. Journal for Specialists in Pediatric Nursing, 14(3), 192–199.

Rotheram-Fuller, E., & MacMullen, L. (2011). Cognitive-behavioral therapy for children with autism spectrum disorders. Psychology in the Schools, 48(3), 263–271. doi:10.1002/pits

Sze, K. M., & Wood, J. J. (2007). Cognitive Behavioral Treatment of Comorbid Anxiety Disorders and Social Difficulties in Children with High-Functioning Autism: A Case Report. Journal of Contemporary Psychotherapy, 37(3), 133–143. doi:10.1007/s10879-007-9048-y

White, S. W., Ollendick, T., Scahill, L., Oswald, D., & Albano, A. M. (2009). Preliminary Efficacy of a Cognitive-Behavioral Treatment Program for Anxious Youth with Autism Spectrum Disorders. Journal of autism and developmental disorders, 1652–1662. doi:10.1007/s10803-009-0801-9

Dawn

October 07, 2012 - 10:53am

Are any of these critical of a cognitive behavioural paradigm in any way - or do any of them seriously consider the views of user-groups?

As well as reading material by people working within certain paradigms - I'd also recommend reading the work of people being critical of such ideologies and methods - such as in 'critical disability studies'.

Just some words of warning I guess!

Damian

October 08, 2012 - 11:33am

Hi

This is my first post on the site, and I have found this thread very interesting.  I am a student counsellor and  I am currently writing a research project on the effectiveness of Integrative Counselling for young people with AS.  My project is based upon the idea that Aspergers is so far removed from being a condition where 'one diagnosis fits all' that maybe a wide based counselling approach will be more beneficial to clients.

I have only just started my research, so I will keep members informed of my progress.  I would also like to hear from people in a similar field for their experiences.  When I first started counselling I believed that I would not work with clients with AS; my daughter has it and it felt too close to home for me.  However, now that she has moved up to high school, and with puberty looming, I can certainly see the benefits, and the need,for counselling for young people on the spectrum.

LISA

October 08, 2012 - 11:49am

Hello Lisa,

Have you read much George Kelly or stuff on 'personal construct theory'?  If not, I think it is worth a look at.  You are certainly right about the diversity of those on the spectrum and the variety of needs someone may have - and also the style of counselling one might need to take would be diverse in order to meet such diverse needs.  Following my own diagnosis I specifically asked that I would not be offered CBT or social skills training - on the report I received it both were recommended...so I have ended up with nothing in the way of support.

Damian

Dawn

October 08, 2012 - 9:21pm

Hi Damian,

These articles I referenced discuss use of CBT as per Lisa's request, however as with any peer reviewed journal article they should discuss this from a critical perspective, although I appreciate that is often limited.  There are articles available that provide critique of such approaches and proffer other alternative approaches.  However, as the thread was about the potential benefits of CBT, that is why I  put these particular articles forward.

As with many approaches and articles, they do not research well enough the views of ‘user-groups’.   However, it also also something that is true of most other approaches or ‘therapies’.  Personally, any research or practice I have carried out using these (or other approaches) myself has always centred on the views of the individual and the proposal that I intended to carry out looking at CBT focussed specifically around this. 

CBT is not something that I specifically advocate for all autistic individuals, but simply that it may be useful for some autistic individuals. I also believe that many other approaches may be useful for autistic individuals and can be integrated as Lisa mentions.  However, I find that, of approaches that are put out there, CBT is one that I personally have found in practice to be least about changing the nature of an autistic person, but more about supporting them to question their negativity toward themselves and to celebrate their positive attributes. Some approaches, seem to be far more centred around changing the autism, but it all very much depends upon who is working with the person and their belief systems around autism as either a way of being or as a so called ‘disorder’.  

CBT, when used  appropriately, is not about directly modifying behaviour as you mention in an earlier comment, but about helping the individual to change their thinking so it is not as self-destructive, which consequently may result in changes in behaviours that cause the individual difficulty or distress.  If using CBT as an approach, I do not go in with the approach of “here is a person with autism how can I change them?”.  It is not about addressing the autism, for me it is about the person and their specific anxieties.  However, the approach needs to be tailored to ensure it suits their autistic way of functioning.  If it is an individual who is struggling with anxiety, depression, or such like, that is causing them distress,  I would focus on how we can work together to see what THEY want to change to make their life less stressful.  I would not aim to change autistic behaviours or thinking, but to consider alternatives to thinking that cause them potential harm which they wish to address.  For instance, negative thinking and self doubt that can end up leading to severe depression or suicidal thoughts.  I focus very much on exploring the strengths of individuals and encouraging them to explore their autism and what it means to them in a positive way. 

When used appropriately, CBT is also based on a mutual negotiation and respect, which you mention in reference to PCP in your previous post, and does not need to be separate from the grounding of theories such as Kelly’s.  In fact CBT emerged from Kelly’s theory on how humans ‘construct’ reality (Kelly, 1955).  Those whom I have worked with using CBT want to change some of their thinking or behaviours with regards to anxiety as they find it holds them back and causes considerable distress.  For me, this does not equate to changing their autistic behaviours/thinking, or the nature of who they are.

I am aware that this approach is not suitable for all autistic individuals. One does not fit all, and this approach is helpful to some people but may not be for others such as you.  There are autistic individuals who have written about personally finding these approaches beneficial though (e.g. Nick Dubin).   However, as you say, other approaches such as Personal Construct Psychology (PCP) or Solution Focused approaches can suit some individuals. 

Many of us practitioners will always endeavour to work with autistic individuals using a variety of approaches to suit their individual needs and that are negotiated with them, depending upon what they are seeking support with and determined by their individual belief systems.

Lisa, if you haven’t already, the following may be useful.

For a solution focused view:

Bliss, E. V., & Edmonds, G. (2007). A Self-determined Future with Asperger Syndrome: Solution Focused Approaches. London: Jessica Kingsley Publishers.

For PCP with autistic children:

Moran, H. (2006). A very personal assessment: Using a Personal Construct Psychology assessment technique (Drawing the Ideal Self) with young people with ASD to explore the child’s view of self. Good Autism Practice, 7(2), 78–86.

Moran, H. (2006). Where anger rules. Counselling children and young people, (December), 6–9.

Procter, H. G. (2001). Personal Construct Psychology and Autism. Journal of Constructivist Psychology, 14(2), 107–126. doi:10.1080/10720530125885

For an overview of counselling approaches (although the second one I personally find takes more of an ‘impairment’ stance):

Dubin, N. (2009). Asperger Syndrome and Anxiety: A Guide to Successful Stress Management. London: Jessica Kingsley Publishers.

Paxton, K. (2007). Counselling People on the Autism Spectrum: A Practical Manual. London: Jessica Kingsley.

Kind regards

Dawn

October 08, 2012 - 10:25pm

Hi Damien - Thanks for the info.  I will have a look at George Kelly over the next few weeks.  As mentioned, today is day one of my research.  I am hoping for a really balanced overview of counselling for AS, and the varying comments on this tread alone show that there are a range of views to be considered.  Thanks again - I hope to pick your brain again in the coming weeks.

Hi Dawn - Thanks for your reply and the list of publications.  I have been compiling a list of books to buy today and I have not come across some you mentioned. This is really helpful. 

I do not know what the outcome of my research will be and I really appreciate the views of everyone here.  I am just starting my literature review and already I can see how wide ranging people's views are.  The reason I have chosen this topic for my research is because in my geographical area I have heard a lot of negativity surrounding the effectiveness of counselling for AS clients and some practitioners offer only CBT because they feel it is the only approach that will work.  Already I can feel the focus of my project shifting away from the clients and on to the practitioners to see what their feelings on the subject are.  It will be interesting to find out what experiences they have in working with AS clients and to see what barriers others have to it. 

Thanks again. LISA

October 09, 2012 - 7:35am

Hello Dawn,

If all you say is true about CBT (as a general practice) - than why was I offered it following diagnosis when I specifically asked not to have it?  Answer - because either the psychologist in question thought that they knew what was best for me - or simply they didn't have anything else to offer and it was a standard approach.

As you say - any kind of therapy needs to be taking the views of the client as of paramount importance.  It is the emphasis on 'negative thinking' and 'change' and so on - that I don't like (especially if one has no issue with the way one thinks and behaves).  As for approaches that are less person-centred - what would you say these were? 

October 09, 2012 - 7:47am

Also - if someone is having self-doubt and anxious/depressive thoughts - it focuses mainly on the individual and not the social nexus within which they find themselves in.  It focuses (mainly) on the cognitive and not the social and how the two interact.  Therefore these reactions may be purposeful and even useful in some situations, but could be deemed a 'negative reaction' - even by the person themselves if told often enough.

Mutuality is crucial - and as you say whether someone sees autism as a disorder from the outset - or as a difference.  A lot of CBT literature I've seen assumes autistic dysfunctional processing in need of change, or to ground it in deficit models such as ToM theory.

p.s. I did quite like Bliss and Edmonds work that you listed above.

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