CBT for Autism

Spectrum Disorders
KERRIE SMEDLEY, PHD
Adjunct Faculty

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 Dr. Aaron T. Beck developed CBT at the
University of Pennsylvania in the 1960s.
In 1994, Dr. Beck and his daughter, Dr.
Judith Beck, established Beck Institute.

Beck Institute is a leading international

source for training, therapy, and
resources in Cognitive Behavior Therapy
(CBT) and Recovery-Oriented Cognitive
Therapy (CT-R).

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 About Beck Institute

Our mission is to improve lives worldwide

through excellence and innovation in
Cognitive Behavior Therapy training,
practice, and research.

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 Financial Disclosures
I have no financial relationships to
disclose.

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 Acknowledgements

Sofia Chernoff, Beck Institute

My colleagues at Annville Psychological

Services

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 INTRODUCTION

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 What to Expect
• A little about myself
• Structure of training
• Start and stop time
• Exercises and questions

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 About this Presentation
Intended audience: Providers who work with
youth with ASD

Limitations on generalizations: This presentation

will apply to individuals who have ASD and
require low levels of support. Those needing
substantial or higher levels of support will not be
covered.

Intended setting: Outpatient practices, school

settings

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 Training Objectives
1. Identify key features of autism spectrum
disorders
2. Understand the rationale for using CBT for
autism spectrum disorders
3. Identify the challenges of using CBT for
autism spectrum disorders
4. Develop effective modifications of CBT for
autism spectrum disorders

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 Case Examples
1. Write down 2-3 cases that have been
challenging and that pertain to this
presentation. I will ask you to consider cases
often, so please keep them in mind.

2. When discussing cases in this workshop, I will

use de-identified cases. Please be sure to
remove any references to information that
may reveal the identity of your client.

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 What is CBT?
Cognitive Behavior Therapy (CBT) is a diverse
set of approaches to psychological
treatment situated within a unifying model.

Cognitive: interventions that focus on

identifying and modifying thoughts (words or
images)
Behavior: interventions that focus on
identifying and modifying behaviors

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 The Basics of the Cognitive Model

Situation

Automatic Thoughts
and Images

Reaction

Physiological
Emotion Behavior
Response

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 The Cognitive Model in Action
Situation Thought Reactions (emotion,
behavior, physiological
response)
You planned to meet a
friend for lunch. She is
20 minutes late and has
not contacted you.

You planned to meet a

friend for lunch. She is
20 minutes late and has
not contacted you.

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 It’s the Thought that Counts!

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 However, intervening at any point in
the cognitive model can facilitate
change.

Cognition Behavior Emotion Physiological

Response

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14
 AUTISM SPECTRUM
DISORDERS

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 Questions:
What first comes to mind when thinking
about clients with ASD?

In your experience, how is working with

autism different from working with other
issues?

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 What is Autism?
Key Features of Autism Spectrum Disorders
A. Persistent deficits in social communication and social
interaction
• Problems with reciprocal interactions such as a back-
and-forth conversation, failure to respond as
expected to interactions, and reduced sharing of
emotions and interests
• Problems using typical nonverbal communication,
such as eye contact or body language, making
friends, and understanding relationships

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 B. Restricted, repetitive patterns of behavior, interests, or
activities.
• Repetitive movement or use of objects, inflexible
adherence to routines and problems adjusting to
changes
• Very focused, narrow, and intense interests,
• High sensory reactivity

American Psychiatric Association. (2013). Diagnostic and statistical manual of

mental disorders (5th ed.).

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 A Bit About Terminology
Prior to the latest edition of the diagnostic
criteria-the Diagnostic and Statistical
Manual (DSM), Edition 5 (2013)-there was
no clear agreement on the multiple
diagnostic categories in the family of
developmental disorders that we now
call ASD.

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 Terminology
• Research evidence over time has resulted in a
more streamlined set of criteria and diagnoses,
eliminating the use of Asperger's and Pervasive
Developmental Disorder in the DSM
• High Functioning Autism is not an actual
diagnosis but describes a person with ASD who
has average or above average intelligence
* The ICD 10 still includes Asperger’s Syndrome

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 Support Levels
Currently, the ASD diagnosis involves a
consideration of the level of severity in each of
the core symptoms (social
communication/interaction and restricted
interests and behaviors)
Level 1 means the client requires support
Level 2 indicates need for substantial support
Level 3 requires very substantial support

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 Etiology of Autism
ASD is a neurodevelopmental disorder with
both genetic and environmental
contributors
• Genetic: Heritability is .88-.97
• Environment: Prenatal infections, parental
age, zinc deficiency, toxic chemical
exposure, maternal diabetes
Bölte, S., Girdler, S. & Marschik, P.B. (2019) The contribution of environmental exposure to the etiology of autism
spectrum disorder. Cell. Mol. Life Sci. 76, 1275–1297
Taylor MJ, Rosenqvist MA, Larsson H, et al. Etiology of Autism Spectrum Disorders and Autistic Traits Over Time. JAMA
Psychiatry. 2020;77(9):936–943.

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 Current Prevalence Rates
• About 1 in 44 children has been identified with ASD
according to estimates from CDC’s Autism and
Developmental Disabilities Monitoring (ADDM)
Network
• Overall, ASD prevalence is similar across racial and
ethnic groups, although white majority groups have
greater access to early diagnosis and services
• ASD is more than 4 times more common among
males, with caveats
https://www.cdc.gov/ncbddd/autism/data.html
Christensen, D. L., Bilder, D. A., Zahorodny, W., Pettygrove, S., Durkin, M. S., Fitzgerald, R. T., Rice, C., Kurzius-Spencer,
M., Baio, J., & Yeargin-Allsopp, M. (2016). Prevalence and Characteristics of Autism Spectrum Disorder Among 4-
Year-Old Children in the Autism and Developmental Disabilities Monitoring Network. Journal of developmental and
behavioral pediatrics : JDBP, 37(1), 1–8. https://doi.org/10.1097/DBP.0000000000000235

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 Development of ASD
• Most common “red flag” indicators are
lack of normal language development,
limited smiling, and strong interest in
unusual objects or activities
• Other mental health diagnoses are
often given first (ADHD, social anxiety,
disruptive behavior disorders)

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 For Individuals with Milder ASD
• Behavioral and emotional
dysregulation are often the first warning
signs (anger/rage,“meltdowns”)
• Problems often intensify in adolescence
and transition to adulthood
• A critical incident or stressor often
triggers a decline in functioning

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 Autism and Mental Health Challenges
Individuals with ASD are 4-5x more likely to
experience mental health disorders

Diagnostic Overshadowing: Reduced

sensitivity to other diagnoses when an
individual has ASD

Totsika V, Hastings RP, Emerson E, Lancaster GA, Berridge DM. (2011). A population-based investigation of
behavioural and emotional problems and maternal mental health: associations with autism spectrum disorder and
intellectual disability. J Child Psychol Psychiatry, 52, 91-99.

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 ASD is Highly Co-Morbid with Other
Issues
• ADHD (27-85%)
• Anxiety (30-80%)
• OCD (17%)
• Depression (30-50%)
• Suicidal thinking (66%), serious plan (33%),completion
(7%)- about 3x higher
• Bipolar Disorder (7%)
Kirsch, A. et al. (2019). Association of comorbid mood and anxiety disorders with autism spectrum disorder. JAMA
Pediatr, 174, 63-70.
Leitner Y. (2014). The co-occurrence of autism and attention deficit hyperactivity disorder in children - what do we
know?. Frontiers in human neuroscience, 8, 268.
Muris, P., Steerneman, P., Merckelbach, H., Holdrinet, I., & Meesters, C. (1998). Comorbid anxiety symptoms in children
with pervasive developmental disorders. Journal of anxiety disorders, 12(4), 387–393.

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 Misdiagnosis is Common and Consequential

• Many symptoms of ASD overlap with other

disorders, and few clinicians are well-trained
to differentiate
• 80% of women with ASD are undiagnosed or
misdiagnosed by age 18
• Fears about stigma vs. missed opportunities
for support

McCrossin R. (2022) Finding the true number of females with autistic spectrum disorder by estimating the biases in initial
recognition and clinical diagnosis. Children. 9(2), 3-18. https://doi.org/10.3390/children9020272

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 Reasons for Comorbidities
• Shared genetic/neurological pathways
• Social difficulties isolation and loneliness
• Feelings of rejection fuel negative core
beliefs
• High levels of aversive sensory experiences
• Socializing can be depleting
• Miss early cues of emotion difficulties and
have a ”sudden flood” of emotion
Wood, J. & Gadow, K. (2010).Exploring the nature and function of anxiety in youth with autism spectrum disorders.
Clinical Psychology; Science and Practice, 17, 281-292.

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 Why CBT is Well- Suited to Working with ASD
• CBT is problem-focused
• It is backed by hundreds of research studies
• It can be adapted based on the functional
level and presentation of clients
• It emphasizes skills that can be practiced
across settings
• Individuals with ASD often respond well to the
structure of CBT sessions

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 CBT for Youth with ASD
Meta-analysis of 14 studies examined the
efficacy of CBT for anxiety among youth
with ASD.
511 youth with high-functioning ASD.
CBT demonstrates strong effect of
reducing anxiety symptoms in youth with
high-functioning ASD.
Ung D, Selles R, Small BJ, Storch EA. (2015) A Systematic Review and Meta-Analysis of Cognitive-Behavioral Therapy for
Anxiety in Youth with High-Functioning Autism Spectrum Disorders. Child Psychiatry Hum Dev, 46. 533-47.

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 CBT for Adults with ASD
Only a handful of empirical studies have been
published for CBT with adults with ASD. In a
literature review…
• CBT interventions, including mindfulness-based
techniques, were moderately effective with
participants with ASD
• Several studies reported adaptations to CBT
including an increase in the number of sessions,
or accommodation of core ASD characteristics

Spain, D., Sin, J., Chalder, T., Murphy, D., & Happe, F. (2015). Cognitive behaviour therapy for adults with autism
spectrum disorders and psychiatric co-morbidity: A review. Research in Autism Spectrum Disorders, 9, 151-162.

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 Case Example: 17-Year-Old Celia
• Early development: Full-term pregnancy, milestones within
normal range
• Speech was developmentally precocious
• Minor delays in coordination
• Problem list includes
• No ”real” friends, not invited to things, teased often
• Often argues with teachers about the “right” answers
• Has been diagnosed with ADHD but did not respond well to
stimulants
• Often fixates on her favorite animals, horses and dogs,
sometimes pretending to be a dog or horse
• Emotionally, very sensitive and will become overwhelmed
easily followed by “meltdowns”
• Academically successful but avoided college applications
and has high anxiety over “no plan B”

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 Case Formulation is Critical
1. Ties together your different interventions
2. Increases the flexibility of your work with
students
3. Allows you to gauge what is working and
what is not
4. Helps you to troubleshoot when things are
not working
5. The Beck Case Conceptualization Diagram
(CCD) is an excellent place to start

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 Components of CCD
Automatic Thoughts, Emotions, and Behaviors
(Basic Thought Record)
Situation Automatic Emotions Behavior
Thought

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 Components of the CCD
Core Beliefs
• Early developing, persistent beliefs about the
self, the world, and the future
Intermediate Beliefs
• Beliefs or attitudes (If….then beliefs)that
guide thoughts and behaviors
Coping Strategies
• Attempts to manage the impact of the
painful core beliefs
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 For a click-and-fil
l v ersion of this worksheet, please visit: beckinstitut e.org/ diagram.

Example
Celia
Name: of CCD: Celia
Date: Diagnosis: ASD

RELEVANT LIFE HISTORY and PRECIPITANTS

Parents describe her as difficult to soothe, "obsessed" with dogs and horses
from an early age, not being very interested in cuddling, no interest in socializing
with peers, becomes overwhelmed and has "meltdowns".

CORE BELIEF(S) (during current episode)

I am defective , I am incompetent

INTERMEDIATE BELIEFS: ASSUMPTIONS/ ATTITUDES/ RULES (during current episode)

If I don't know something, then others will think I am defective
My only value is my intelligence
If I talk to others, they will see I don't know as much as I pretend to
I am unable to tolerate strong sensations

COPING STRATEGIES (during current episode)

Speak up often in class to show what I know, don't talk to others, escape into
special interests, avoidance of strong sensory input

beckinstitute.orgSITUATION #1 SITUATION # 2 SITUATION # 3

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Teased in class for acting
 Example of CCD:to show whatCelia
COPING STRATEGIES (during current episode)
Speak up often in class I know, don't talk to others, escape into
special interests, avoidance of strong sensory input

SITUATION # 1 SITUATION # 2 SITUATION # 3

Teased in class for acting
Getting ready for school like a dog Fire drill at school

AUTOMATIC THOUGHT(S) AUTOMATIC THOUGHT(S) AUTOMATIC THOUGHT(S)

I hate school, other kids are I am different, people don't I can't handle this, need to
stupid like me escape

MEANING OF A.T. MEANING OF A.T. MEANING OF A.T.

I am defective I am defective I am incompetent

EMOTION EMOTION EMOTION

depression depression anxiety

BEHAVIOR BEHAVIOR BEHAVIOR

Dismiss others as stupid,
Try to answer all of the shut down, try to avoid Try to avoid school on drill
questions school days, hold ears

© 2018. Adapted from J. Beck (2020) Cognitive Behavior Therapy: Basics and Beyond, 3r d edition.
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 Research-Supported Interventions for ASD

Behavior therapy
CBT for teens and adults
Social skills and communication practice
Support services
Speech, occupational therapy
Other medical services
Coordination with schools
Parent and client support groups

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 Example: Behavior Therapy
https://www.youtube.com/watch?v=pSG
Vb60-BSw

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 Assessment: Screening Measures
• Checklist for ASD (CASD; Mayes, 2010)
• Social Responsiveness Scale (SRS; Constantino &
Gruber, 2005)

• Autism Screening Questionnaire (ASSQ;

Ehlers, Gillberg, & Wing, 1999)

• Autism Quotient (AQ; Baron-Cohen, Wheelwright, Skinner,

Martin, & Clubley, 2001)

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 AQ-10
Autism Spectrum Quotient (AQ)

A quick referral guide for adults with suspected autism who do not have a learning disability .

Definitely Slightly Slightly Definitely

Please tick one option per question only: Agree Agree Disagree Disagree
I often notice small sounds when others do
1
not
I usually concentrate more on the whole
2
picture, rather than the small details
I find it easy to do more than one thing at
3
once
If there is an interruption, I can switch back to
4
what I was doing very quickly
I find it easy to ‘read between the lines’ when
5
someone is talking to me
I know how to tell if someone listening to me
6
is getting bored
When I’m reading a story I find it difficult to
7
work out the characters’ intentions
I like to collect information about categories of
8 things (e.g. types of car, types of bird, types
of train, types of plant etc)
I find it easy to work out what someone is
9
thinking or feeling just by looking at their face

10 I find it difficult to work out people’s intentions

SCORING: Only 1 point can be scored for each question. Score 1 point for Definitely or
Slightly Agree on each of items 1, 7, 8, and 10. Score 1 point for Definitely or Slightly
Disagree on each of items 2, 3, 4, 5, 6, and 9. If the individual scores 6 or above, consider
referring them for a specialist diagnostic assessment.

This test is recommended in ‘Autism: recognition, referral, diagnosis and management of adults on
the autism spectrum’ (NICE clinical guideline CG142). www.nice.org.uk/CG142
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Key reference: TherapyC, Auyeung B, and Baron-Cohen S, (2012) Journal of the American Academy
42
 Assessment: Comprehensive Evaluation
• Follows positive screener
• Clinical interview
• Full cognitive/IQ testing
• Assessment of adaptive behavior
• Assessment of social skills and social
cognition
• Receptive and expressive communication
• May include theory of mind measures
• Assessment of other mental health issues

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 Strengths-Based Assessment
Assess for client and family strengths
• Resilience, patience, advocacy,
community support, coping
• Include goals, aspirations, and values
to enhance motivation and expand
case formulation
• Special interests and knowledge are
often great sources of strength and
protective factors
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 Questions:
What are the strengths you have
witnessed in your clients with ASD?

How can those strengths be helpful in

treatment?

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 “While working with adults with ASD, there
is a particularly delicate balance
between the need to target aspects of
their functioning that interfere with their
sense of well-being, and the need to
preserve those parts of themselves that
constitute unique strengths and assets.”

--Valerie Gaus (2019)

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 Planning for Treatment
The initial assessment and case conceptualization
inform treatment. For ASD, the focus is often:
1. Co-occurring mental health issues
2. Social communication
3. Managing social challenges: rejection, bullying,
relationships, and social expectations/rules
4. Supporting and educating family members
5. Healthy emotion regulation strategies
6. Self-understanding and self-acceptance

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 Therapeutic Skills for Working with ASD
• Patience
• Humility
• Respect
• Flexibility and creativity
• Structure and expectations
• Being specific, direct, and concrete
• Providing and eliciting constructive feedback
• Model personal scientist approach toward therapy
and life
• Strengths-based approach

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 The Importance of Psychoeducation
Educate client and family in a developmentally
appropriate way about
• The neurodevelopmental basis of ASD
• That poor parenting, stress, bad teachers,
etc. do not cause ASD
• Core symptoms and problem areas
• Strengths and positive exceptionalities
• Support resources

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 Target Problem: Anxiety
CBT Model of Anxiety

Temporary
relief/increased Trigger
sensitivity to
trigger

Anxiety-
Avoidance/ thoughts and
Escape body
sensations

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 Decision Making About Anxiety Interventions

Problem Intervention
Anxiety Cognitive
Persistent • Identify and evaluate automatic thoughts
unhelpful • Identify distortions
thoughts, • Develop a repertoire of helpful alternative
worries, and thoughts
beliefs Behavioral
• Experiments to test out thoughts
• Exposures
Family support
• Identifying and evaluating their own automatic
thoughts and beliefs
• Coaching how to respond to client’s thoughts

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 Decision Making About Anxiety Interventions

Problem Intervention
Anxiety Cognitive
Intense body • Identify and evaluate automatic thoughts about
sensations sensations
• Develop a repertoire of helpful alternative
thoughts about sensations
Behavioral
• Experiments to test out thoughts
• Exposures to uncomfortable body sensations
Family support
• Coaching how to respond to sensitivities
• Family coping skills for client’s intense emotions

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 Decision Making About Anxiety Interventions

Problem Intervention
Anxiety Cognitive
avoidance • Identify and evaluate automatic thoughts about
behaviors facing fears
• Identify distortions about facing fears
• Develop helpful alternative thoughts about facing
fears
Behavioral
• Experiments to test out thoughts about exposures
• Exposures

Parent support
• Coaching how to support exposures

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 Target Problem: Depression
Early Experiences
Rejection, loss, significant stress

Dysfunctional Core Beliefs

I am unlovable/worthless

Dysfunctional Assumptions
It’s better to not try than to risk failing
I will never be accepted for myself

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 Critical Incident
Bad grade on a test
Being teased by peers

Negative Automatic Thoughts

I will always be a failure
No one likes me
I am too different to find friends

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 Decision Making About Depression Interventions
Problem Intervention
Depression Cognitive
Persistent • Identify and evaluate automatic thoughts
negative and • Identify distortions
unhelpful • Develop a repertoire of helpful alternative
thoughts and thoughts
beliefs Behavioral
• Activity scheduling/behavior activation to shift
negative thinking and mood
• Safety planning
Family support
• Identifying and evaluating their own unhelpful
thoughts
• Coaching how to respond to client’s thoughts

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 Decision Making: Depression Interventions
Problem Intervention
Depression Behavioral
Social • Social skills and social problem solving
withdrawal • Behavior Activation: Social activities
and isolation • Small steps toward avoided situations
Cognitive
• For older teens and adults, identifying and
evaluating automatic thoughts about socializing
• Developing helpful alternative thoughts
Family support
• Coaching how to structure and encourage activity
and socializing

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 Applications and Adaptations of CBT
for Autism
1. Emotional difficulties
2. Cognitive inflexibility
3. Language deficits
4. Executive functioning issues
5. Cognitive biases
6. Strong drive toward consistency
7. Sensory issues
8. Social communication deficits
Scarpa, A., White, S., & Attwood, T. (2013). CBT for children and adolescents with high functioning autism. New York:
Guilford.

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 Emotion Difficulties
Difficulty with identifying emotions of self and others
(AKA “mind blindness”), limited emotion repair skills
• Spend more time on self-awareness practice,
labeling, tracking, rating, and emotion words
• Rely heavily on pictures and videos, not abstract
discussions of thoughts and feelings
• Practice a variety of “rules” for identifying emotions
and “guessing” for self and others
• Educate about needing to balance practice with
socializing and “recharging batteries” with alone
time

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 Emotion Difficulties
• Focus on specific body symptoms vs.
subjective feelings
• Practice rating and scaling emotions-
recognizing subtle negative emotions is
protective
• Practice skills for repairing strong
emotion states

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 Emotion Difficulties
• Educate on idea of “emotion masking”
and practice “taking off the mask”
• Educate on “emotion suppression” and
provide small steps to practice
expression
• Increasing physical exercise has
significant benefits for anxiety and
depression

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 Inflexibility
Difficulties with set shifting,
learning from mistakes, generalizing skills, and
single mindedness
• Practice with “what else could you do?”
• Practice stopping before finishing a task
100%
• Provide multiple choice options rather than
open-ended questions
• Practice relaxation as it increases flexibility

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 Inflexibility
• Focus on the power of “learning more from
mistakes than from successes” to decrease
perfectionism
• Deliberately make mistakes as an exposure
• Recognize that apparent “arrogance” is often a
compensation strategy for fear of making
mistakes or failure
• Practice in session, imaginally, and in real life
using multiple modalities to improve
generalization of skills

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 Speech and Language Deficits
Overly literal use of language (not reading
between the lines) and difficulty converting
experiences into words
• Use pictures and videos when possible
• Explicitly practice inference and instruct on
metaphorical language
• Allow clients to write or type answers if face-
to-face conversation is falling short
• Language Pragmatics (more in social skills
section)
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 Executive Functioning Issues
Trouble sustaining and shifting attention,
memory, organization, and planning
• Shorter sessions with breaks
• Assignments broken into smaller units
• Use reward systems
• Impose significant structure
• Use written records of sessions and tangible
reminders

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 Cognitive Biases
• Overly focused on detail vs. big picture
• Over-attending to negative information
• All or nothing thinking
• Difficulty with drawing inferences

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 Strategies to Address Cognitive Biases
• Teach about automatic thoughts and how
to identify them
• Differentiate thoughts and emotions
• Identify thought distortions
• Practice skepticism about thoughts
• Model and experiment (show, don’t tell)
• Point out, redirect or use differential attention
for tangents
• Provide scaffolded support for thought
record
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 Scaffolding Support: Partial Record
Date Situation Automatic Thoughts

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 Scaffolding Support

Situation Automatic Emotion Behavior

Thought

Supervisor Embarrassed Left work and

criticized me in called off next
front of day
coworkers

Lost my My boss and

paycheck she’ll think I am
an idiot and I’ll
lose my job

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 Common Maladaptive Core Beliefs
with ASD
Helpless/Powerless
Inadequate
Defective
Incompetent
Unwanted/unlovable
Different/weird
Bound to be alone

Gaus, V. (2019). Cognitive behavioral therapy for adults with autism spectrum disorder. New York: Guilford Press.

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 The Continuum Technique
Targets dichotomous thinking

1. Identify the thought or belief and rate it

“I am a failure in relationships” (9/10)

2. Break the global belief into specific

criteria
“I have talked to someone I am attracted to, gone on
a date, etc.”

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 The Continuum Technique
3. Rate each of the specific criteria
I have talked to someone I am attracted to in the last
month (10/10)
I have created a dating profile (10/10)
I have had interested people contact me (5/10)

4. Use the individual ratings to re-evaluate

the global statement
“I am a failure in relationships” (6/10)

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 Another Continuum Technique
Total Total
Failure Success

If not a total failure, why not?

What kept you from rating the extreme of either
end?
What evidence would move you toward higher
success?

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 Other Ways to Evaluate Beliefs
Evidence in Favor of my Belief Evidence Against my Belief

Balanced Belief

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 Need for Consistency
Individuals with ASD thrive on consistency and certainty
• Use visual, concrete schedules or expectations
• Maintain structure to sessions
• Respect and empathize with this need, but practice
tolerating deviations
• Uncertainty practice (examples, model,
experiment)
• Build skills to cope with unexpected changes
• Use prior experiences and “what if” practice
• Practice “change in plans”

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 Sensory Issues
Sensory issues can affect emotion regulation
and success of interventions
• Be aware of client’s specific sensitivities
• Teach ways to manage sensitivities that are
less stigmatizing, disruptive, or distracting
• Have multiple coping tools available in case
preferred coping is not available
• Allow for some sensory soothing if possible
during sessions

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 How to Use Special Interests in CBT
Special interests function to enhance positive feelings
and block negative feelings, and can
• Build esteem and confidence
• Facilitate rapport, connection, and community
• Enhance treatment if used effectively
• Serve as a reward for participation or a “brain
break” during session

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 Social Communication Difficulties
1. Clients with ASD typically need help labeling,
inferring, and responding to emotional cues
2. They may appear to lack empathy, but in reality,
many struggle to identify emotions
3. May need explicit “rules” for interacting with others
4. Will often need help regarding how/when/how
much to discuss special interests
5. Will benefit from support for how to talk to others
about autism
6. Most will need help with assertiveness skills
7. Group practice of social skills is ideal

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 Exercise:
Consider Celia’s Case Conceptualization.

What were the major presenting

problems?

What specific interventions would you

choose?

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 Additional Resources

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 Beck Institute CBT Certification

Get Beck Certified!

Learn more at
https://beckinstitute.org/certification/

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 Visit www.beckinstitute.org to learn
more about CBT and:

• View Beck Institute’s COVID-19 resources

• Download CBT worksheets
• Read blogs and articles by Dr. Aaron Beck,
Dr. Judith Beck, and Beck Institute Faculty
• Watch free webinars and video clips
• And more

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 CBT Training through Beck Institute
• Virtual Workshops (future workshops may be
held onsite in Philadelphia)
• Training for Organizations (online or at your
location)
• Supervision & Consultation
• Certification
• Online Training (beckinstitute.org/online-
training)
For more information email [email protected]

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 Get social with Beck Institute on its
social channels
/beck-institute-for-cognitive-behavior-therapy/
@beckinstitute (Facebook)
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youtube.com/BeckInstitute

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 Join the CBT Conversation

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 National Suicide Prevention Lifeline

https://suicidepreventionlifeline.org/

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 Crisis Text Line

https://www.crisistextline.org/

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