By Alyssa Safran, LMFT
As the national discussion on autism continues to progress, so too does the debate over best practices and treatment options for individuals with an autism spectrum diagnosis. Today, 1 in 59 American children is diagnosed with an autism spectrum disorder each year (Autism Speaks, 2018). The DSM V describes an autism spectrum disorder as “persistent deficits in social communication and social interaction across multiple contexts, manifested by deficits in social-emotional reciprocity, nonverbal communicative behaviors, and deficits in developing, maintaining, and understanding relationships” (DSM V, 2013). Though autism occurs on a spectrum with symptoms ranging from mild to severe, the majority of all individuals with an ASD, regardless of severity, report feeling challenged by their own cognitive rigidity. This lack of flexibility impacts many areas of life including: communication, pragmatics, relationships, and coping skills. When children are younger, cognitive rigidity often presents as difficulty working through frustration, meltdowns, perseveration on limited topics of conversation, or adverse behaviors. As children age, cognitive rigidity not only impacts pragmatic skills, but can also lead to excessive negative thoughts about self and the world around him/her. Many studies (Chandrasekhar, 2015; Hammond, 2014; Strang, 2012) show an especially high correlation between children with autism and a diagnosis of anxiety and/or depression. The science behind this finding suggests that humans have a tendency to pay more attention to negative events versus positive events. For individuals on the autism spectrum who are already contending with a higher level of cognitive rigidity than most, negative thoughts are especially detrimental, in that they can exacerbate negative views of self and reinforce isolation from others. This article seeks to explore the benefits of Cognitive Behavioral Therapy as an acceptable treatment modality for older children, adolescents, and adults on the autism spectrum.
While there is no “cure” for autism, various therapies exist to minimize and manage symptoms. For many parents, determining the “right” therapy for their child can prove to be a challenging quest. After the initial diagnosis of an autism spectrum disorder, parents are usually encouraged to pursue behavioral therapy to target the most “outward” signs of autism (self injurious or aggressive behavior, communication challenges, inability to regulate emotions, food aversion, etc). Applied Behavioral Analysis (ABA), is the most commonly recommended therapy for younger children on the spectrum. This evidence based intervention is designed to reduce unwanted behaviors and to promote the growth of foundational concepts in communication, social skills, and independent living. ABA tends to provide structure and routine, and primes the child for social and emotional growth. Once foundational communication, social, and coping skills are learned and maintained, behavioral therapy is reduced. As children on the spectrum age, the focus of treatment often shifts from managing behaviors, to improving social skills. Towards the end of the elementary school years, children on the spectrum often report an increased awareness of social difficulties, and a distinct feeling of differentness from peers. Adolescence can prove to be a particularly challenging time, as individuals on the spectrum become increasingly aware of challenges to “fitting in” socially with peers.
Research affirms Cognitive Behavioral Therapy (CBT) as an effective and acceptable treatment modality for pre-teens, adolescents, and young adults with an autism spectrum disorder. This particular modality of therapy combines talk therapy and behavioral therapy, and operates under the assumption that an individual’s thoughts can evoke positive/negative emotions, which drive behaviors. The ultimate goal of CBT is to replace negative thoughts with positive, realistic thoughts, which ultimately impact an individual’s ability to respond to challenging situations.
Participants in therapy are taught to understand the impact of their thoughts on behavior and learn to reframe negative thoughts in order to avoid falling into negative thinking patterns.
Individuals with an autism spectrum disorder tend to respond well to CBT, as this modality targets cognitive rigidity and concrete thinking. For many individuals on the spectrum, the world is viewed from a very “black and white” perspective, and can ultimately lead to negative thoughts about the self or world around them. Common negative thoughts such as “If I try to fit in, I’ll fail;” “If I stay away from people, I won’t get hurt;” or “I can’t understand what is going on in [my] world” are often reported by individuals with an ASD. Negative beliefs can become self-fulfilling prophesies and pose serious challenges to the individual forming positive relationships and achieving personal goals. Research shows that not only do negative thoughts tend to “stick in our memory longer than positive thoughts” but also can change the way the neurons fire in the brain. Each time a negative thought is formed, a new network between neurons is created. The more times an individual accesses a negative thought, the stronger the bond between neurons becomes. Over time, negative thoughts lead to subconscious habits.
CBT is effective in helping the individual to identify ways in which their patterns of thinking, feeling, or behaving may be more or less helpful (or accurate) and can dramatically improve one’s interactions with peers, family, and the world around him/her.
Many therapists are trained in the techniques of CBT and are able to offer as a modality of treatment. For parents who are unable to afford therapy sessions but are still interested in helping their child address negative thoughts, a variety of online, interactive programs exist. Coping Cat and Go Zen offer affordable, interactive, and family friendly materials. For more information about CBT services offered at the OAS Center, check out our website at https://oascenter.wpengine.com.