- Autism & Developmental Services
Autism & Developmental Services
Written By: Jules Glowinski, BT
Reviewed By: Melanie Bren, BCBA, LBA
Cognitive behavioral therapy (CBT) is a common type of talk therapy that includes working with a mental health counselor in a structured setting. The goal of CBT is to help people become aware of inaccurate or negative thinking so they can view challenging situations with more clarity and respond to them effectively. CBT is an effective tool to help anyone learn how to manage stressful life situations.
Multiple studies have shown that the introduction alone of CBT to children with high-functioning autism have a positive effect on decreasing anxiety symptoms. High-functioning autism is not a medical diagnosis but a classification of an ASD individual with a milder level of severity on the autism spectrum.
Those referred to as high functioning typically fell into the old diagnosis of Asperger syndrome or PDD diagnostic classification. Children with high functioning autism have the verbal and intellectual skills to effectively participate in CBT.
As defined by Autism Speaks, the adjective high-functioning simply means that the individuals “have average or above average intelligence but may struggle with issues related to social interaction and communication.” One common trait of those with high-functioning autism is that they usually do not show significant delay in language development, whereas low-functioning children with autism usually do.
Typically, children with high-functioning autism tend to have more behavioral issues than intellectual ones. They may have occasional difficulties in social situations or struggle with uncommon behaviors or interests, but their intellectual capacity is generally fully capable of managing and engaging with life.
Cognitive behavior therapy is structured into specific phases of treatment. It is also individualized to patients’ strengths and weaknesses. Anxiety symptoms are one of the most common mental health conditions in childhood. Children and adolescents with ASD are at risk for developing mental health symptoms and anxiety in particular, especially when compared with their peers.
Studies have shown that psychological issues are common in autistic children, with anxiety disorders affecting around 40% of children with autism, often accompanied by anger, depression, ADHD, or oppositional defiant disorder (ODD).
Cognitive behavior therapy has been identified as the treatment of choice in addressing anxiety symptoms in the general population, and modified CBT for youth with ASD can be effective in reducing anxiety symptoms. Researchers have found that using CBT can help ease anxiety and redirect avoidant behavior in children with autism.
During cognitive behavioral therapy sessions, a child will work with a therapist who will help them identify and analyze challenging behaviors and their harmful aspects. A clear understanding of the behavior will make it easier to recognize it later on and react appropriately. The therapist will also teach a child how thoughts, feelings, and behaviors are related, how they influence each other and provide strategies to approach difficult situations in a more constructive way.
Identifying troubling situations or challenging behaviors in a child’s life is the first step in cognitive behavior therapy. This step is an assessment for the therapist to find what problems a child faces and which goals to focus on. This could range from putting off an unpreferred task such as math homework to coping with parents divorcing.
Once any problem situation or challenging behaviors have been identified the next step would be to become aware of inner thoughts, emotions and beliefs about these situations. This could be a difficult step for a child with ASD and may need assistance in identifying their inner emotions through the use of other tools such as visual aids, social stories or writing prompts.
The therapist may explain how to cope with fear and anxiety while at the same time gradually exposing the child to the same situation that triggers their negative emotions. Role playing can also help a child gain perspective in a situation and also help practice positive behaviors.
Reshaping negative or inaccurate thinking can be the final step in CBT and the most difficult to manage for anyone especially those with ASD. This step focuses on viewing the challenging situation in one’s life and reassessing the thoughts and changing any behavior patterns that do not serve the end goal for the client’s well-being.
This could include helping a child who avoids or puts off activities due to fear or anxiety, to establish a routine to make it easier to follow through with the task. Another technique that is used in CBT, is to visualize all the steps and potential risks before getting engaged in an activity to help reduce stress and anxiety.
The therapist may have the child practice relaxation techniques and may train the parents to promote these techniques such as deep breathing, and guided imagery at home.
Cognitive behavioral therapy tends to require strong linguistic and abstract thinking abilities, which can represent a challenge for children on the autism spectrum. That is why therapists often need to introduce modifications to make CBT techniques more appropriate for autistic children.
They may resort to more concrete, repetitive, and visual tactics, and focus on a child’s special interests to keep them engaged and motivated. Therapists may have to incorporate frequent movement breaks or sensory activities for children who have problems with attention or sensory under- or over-reactivity.
Cognitive behavioral therapy has been shown to decrease anxiety in children with ASD through the use of modified CBT techniques. It is encouraged by professionals that CBT be paired with other therapies to increase the benefits of the overall well-being of a child with ASD. When looking for a CBT therapist for a child with autism that has anxiety or phobias, parents should reach out to their child’s other care providers for references.
Children with autism at increased risk for several mental health conditions. Healio. (n.d.). Retrieved February 15, 2022, from https://www.healio.com/news/psychiatry/20201229/children-with-autism-at-increased-risk-for-several-mental-health-conditions
Ekman, E., & Hiltunen, A. J. (2015). Modified CBT using visualization for autism spectrum disorder ( ASD ), anxiety and avoidance behavior – a quasi-experimental open pilot study. Scandinavian Journal of Psychology, 56(6), 641–648. https://doi.org/10.1111/sjop.12255
Mayo Foundation for Medical Education and Research. (2019, March 16). Cognitive behavioral therapy. Mayo Clinic. Retrieved February 15, 2022, from https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
What is asperger syndrome? Autism Speaks. (n.d.). Retrieved February 15, 2022, from https://www.autismspeaks.org/types-autism-what-asperger-syndrome
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