Question 1

What are some unique challenges that teens with ASD face?

Caitlin Conner · Accepted Answer

Being a teenager is challenging enough if you are neurotypical. Teens on the autism spectrum can have some additional challenges. Social-emotional maturity can lag behind their peers, which complicates friendships and peer relationships. Co-occurring psychiatric conditions like depression and anxiety are also common. I study emotion regulation issues, so I often see teens who, despite level of functioning, are experiencing emotional meltdowns or outbursts.

Question 2

Question 3

When working with neuro-atypical/neuro-diverse populations such as with ASD, are there aspects of CBT that should definitely NOT be used, or that should be altered?

Caitlin Conner · Accepted Answer

There’s no alterations I can think of that applies to ALL of those with ASD. ASD has the word ‘spectrum’ in it purposely- the heterogeneity of individuals is huge. Maybe having a more structured session (a checklist of what topics/activities to be completed in session, either written out or visual)? Although I think that’s helpful for everyone!

Question 4

Question 5

Do CBT interventions for ASD target core ASD symptoms or comorbidities or both?

Caitlin Conner · Accepted Answer

Both. There are evidence-based programs like the Secret Agent Society, PEERS, and Unstuck and On Target that use CBT-based skills like role-plays, didactic instruction, and skill scaffolding in treatment of core ASD symptoms. CBT has also been used to target co-occurring conditions in ASD, with most of the research on treating co-occurring anxiety. Other conditions or symptoms treated with CBT include anger, depression, OCD, and emotion regulation impairment. Third wave CBT (mindfulness- and acceptance-based therapies) also have research supporting their use for individuals with ASD.

Question 6

Has research or your experience identified common beliefs that teens with ASD have about themselves and others?

Caitlin Conner · Accepted Answer

No- teens with ASD are as unique and individual as all other teens! That being said, there are some things I see more often in people on the autism spectrum, like a strong sense of right and wrong and social justice, a respect for honesty, and a great sense of humor or wit. Unfortunately, with the teens with emotional difficulties that I see, negative self-thoughts are common too.

Question 7

Can CBT help with the development of perspective taking?

Caitlin Conner · Accepted Answer

CBT skills can definitely be useful for teaching perspective taking. Social and emotional awareness often go hand-in-hand. For instance, a therapist could discuss common cognitive distortions using language and examples of same-aged peers, clearly stating that different people have different thoughts and responses to the same situation. Psychoeducation about emotions can consist of discussing social vignettes or video examples that demonstrate how people have different emotional experiences.

Question 8

What modifications to standard CBT intervention is usually done for teens with ASD?

Caitlin Conner · Accepted Answer

Manualized CBT treatments and research studies describe a handful of modifications for ASD no matter the age of the client. These modifications mostly concern adapting treatment for ASD cognitive styles, things like using a concrete schedule, increasing visual supports, adding social skills when treating a condition that is related (e.g., social anxiety), incorporating the person’s restricted interests into the therapy, and managing attention or executive functioning difficulties (e.g., taking breaks, providing a checklist instead of generating ideas, planning exactly when and how to complete therapy homework).
	Specific to teens, how or whether to incorporate caregivers is an important consideration. Comparatively, teens with ASD are likely to rely more on their parents, and parents are also a key way to ensure that skills learned in therapy generalize outside of the therapy room. For this reason, it’s optimal if caregivers can act as a ‘coach’ to employing new skills.

Question 9

What are some key strategies to help ASD teens with emotion regulation difficulties?

Caitlin Conner · Accepted Answer

Many teens with ASD may need more psychoeducation about emotions, including recognizing their own physiological and situational emotion cues. A subset of people on the autism spectrum struggle with awareness of their own emotions (alexithymia). Also, distinguishing between different emotions may not be as important as learning emotional intensity. Clients that I have worked with need help recognizing when they are getting upset before a meltdown occurs, not whether they were ‘angry’ vs. ‘frustrated.’ Developing a common language to talk about intensity is helpful, like an emotion thermometer or a SUDS scale.
	It is often helpful to work “in the field” where emotionally arousing situations occur, like bringing in a caregiver to discuss a hot topic, to practice a coping skill. Relatedly, many teens with ASD seem to have difficulties recalling and describing their emotional experiences, so it is important to ask caregivers and get multiple informants to understand the issue.

Question 10

Can CBT help with sensory overload?

Caitlin Conner · Accepted Answer

I haven’t seen sensory sensitivities specifically targeted in CBT.

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