Cognitive Behavioral Therapy for Autistic People

The concept that a person can be both autistic and struggle with mental health disorders is relatively new in the social sciences. This is due in part to the practice of housing autistic people in institutions and denying them the right to be full members of society, and in part due to the recognition of only the most impacted individuals as being autistic until more recent versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). After the deinstitutionalization movement, which started in the 1960s, and the evolution in understanding of what it means to be autistic, it became clear that not only do autistic people struggle with mental health conditions, they do so at a much higher rate than the general population. For example, a recent meta study found that 70% of autistic individuals qualify for at least one mental health diagnosis and 50% qualify for two or more. Research also shows that untreated anxiety in autistic individuals leads to long-term, negative outcomes

Because the concept that autistic individuals can struggle with their mental health is relatively new, there are no fully evidenced-based interventions for treating mental health diagnoses in autistic individuals. This has led to debates within the autistic and mental health communities due to the lack of clarity regarding what treatment modalities are effective and should be utilized in treatment. The use of cognitive behavioral therapy (CBT) for neurodivergent individuals, or those who are developing outside of what is considered to be the norm, has been questioned by advocates and mental health professionals in regards to its efficacy. An example of this is a popular book written by an autistic clinical psychologist, that states twice that CBT may not be as effective for autistic people as it is for neurotypical people and cites two articles to make this case. Due to the author being both a professional and autistic, these statements about CBT are very powerful. However, by only using two articles, these statements do not fully account for what current research has found regarding the use of CBT with autistic individuals.

So, what does the research say? After reviewing more than two dozen articles on the topic and writing a 26-page paper on the topic of using CBT to treat autistic children with co-occurring anxiety disorders, I found that CBT has been identified as a promising intervention for treating autistic individuals with co-occurring anxiety disorders, but had not had enough time or research to be designated it as being “evidence-based.” The research shows that interventions should include modifications that meet the specific needs of the autistic client population in order to increase the benefits of this modality. While research reflects that modifications are needed, there is no specific data regarding what modifications should be prioritized, and there are few curricula available that have been created specifically for autistic children or adults. There are many additional gaps in the literature, and as a scholar practitioner, I commit to continuing my research in order to provide the best possible mental healthcare for the individuals that I serve. 

References

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Fuselier, M.N., Guzick, A.G., Bakhshaie, J., Wood, J. J., Kendall, P. C., Kerns, C. M., Small, B. J., Goodman, W. K., Storch, E. A., (2023). Examining the relationship between anxiety severity and autism-related challenges during cognitive behavioral therapy for children with autism. Journal of Autism & Developmental Disorders. https://doi-org.ezproxy.simmons.edu/10.1007/s10803-023-05912-z

Guzick, A. G., Schneider, S. C., Kendall, P. C., Wood, J. J., Kerns, C. M., Small, B. J., Park, Y. E., Cepeda, S. L., & Storch, E. A. (2022). Change during cognitive and exposure phases of cognitive–behavioral therapy for autistic youth with anxiety disorders. Journal of Consulting and Clinical Psychology, 90(9), 709–714. https://doi-org.ezproxy.simmons.edu/10.1037/ccp0000755

Hollocks, M. J., Wood, J. J.,  Storch, E. A.,  Cho, A., Kerns, C. M., & Kendall, P. C.,  (2022) Reward sensitivity predicts the response to cognitive behavioral therapy for children with autism and anxiety, Journal of Clinical Child & Adolescent Psychology. DOI: 10.1080/15374416.2022.2025596

Jones, K., Chapman, A., Edwards, P., & Cook, M. (2022). Evaluation of an adapted form of CBT for young people with a diagnosis of autism spectrum disorder (ASD) and anxiety. Clinical Psychology Forum, 359, 29–34. https://doi-org.ezproxy.simmons.edu/10.53841/bpscpf.2022.1.359.29

Lai, MC, Kassee, C, Besney, R, Bonato, S, Hull, L, Mandy, W, Szatmari, P, & Ameis, SH (2019). Prevalence of co-occurring mental health diagnoses in the autism population: A systematic review and meta-analysis. Lancet Psychiatry.

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Pickard, K., Blakeley-Smith, A., Boles, R., Duncan, A., Keefer, A., O, K. S., & Reaven, J. (2020). Examining the sustained use of a cognitive behavioral therapy program for youth with autism spectrum disorder and co-occurring anxiety. Research in Autism Spectrum Disorders, 73. https://doi-org.ezproxy.simmons.edu/10.1016/j.rasd.2020.101532

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Wood J.J., Kendall P. C., Wood K. S., Kerns, K. M., Seltzer, M., Small, B. J., Lewin, A. B., Storch, E. A., (2020). Cognitive behavioral treatments for anxiety in children with autism spectrum disorder: A randomized clinical trial. JAMA Psychiatry, 77(5):474–483. doi:10.1001/jamapsychiatry.2019.4160