Cognitive Behavioral Therapy for Autism

Cognitive behavioral therapy is used to treat children with autism spectrum disorder who suffer from additional mental health issues, such as anxiety, depression, and ADHD.  This type of therapy has been proven effective in teaching autistic children how to avoid negative emotions and change unwanted behaviors. 

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a form of therapy designed to treat mental health disorders by identifying and changing unhealthy and harmful behaviors. It is based on the idea that behaviors are learned and that, as a result, they can be changed.  As its name suggests, cognitive behavioral therapy relates to both cognition or thinking and behavior. One of the core principles of CBT is that thoughts and feelings are not determined by the situation but rather by the interpretation of the situation. Therefore, negative behaviors are often caused by unrealistic thoughts that set off false feelings and emotions. Through cognitive behavioral therapy, patients can learn different strategies to help them change the way they interpret and respond to a situation. CBT has been proven effective in treating a broad range of psychological disorders such as anxiety, panic disorders, depression, eating disorders, post-traumatic stress, obsessive-compulsive disorder, psychosis, and bipolar disorder. More recently, it has also been used to treat other conditions including autism spectrum disorder.

Techniques used in CBT

Cognitive behavioral therapy encourages patients to challenge their thoughts and beliefs using a variety of techniques. As they gain new coping skills, they are exposed to increasingly difficult situations in a process called graded exposure.Some of the most frequently used techniques in cognitive behavioral therapy include: 

Cognitive restructuring

This method involves identifying and reframing negative thought patterns. Once patients are aware of their thoughts, they can learn to reframe them into something more positive and productive.

Guided discovery

Patients are asked questions that challenge their beliefs and assumptions. In the process, they will start seeing things from other perspectives and eventually choose a more helpful way to deal with challenging situations.

Exposure therapy

Patients are gradually exposed to whatever provokes their fear or anxiety, while the therapist provides guidance on how to cope with the situation. Eventually, patients will start feeling less vulnerable and more confident as they confront the feared object, activity, or situation.

Relaxation techniques

Progressive relaxation techniques, such as deep breathing exercises, visualization, muscle relaxation, and guided imagery, are helpful techniques used for dealing with phobias and social anxieties.

Journaling

Patients are asked to write down both negative and positive thoughts and record any new behaviors that occur between two therapy sessions. This practice helps recognize distorted thought patterns and move away from negative thoughts.

Behavioral experiments

This technique is used for patients with anxiety disorders that involve catastrophic thinking. Before they face a situation that makes them anxious, patients are asked what they think is the worst thing that can happen. After the experiment, they can test the validity of their belief by estimating to what extent their prediction was correct.

Activity scheduling 

Patients are required to write down all the activities that they need to complete and schedule them in an orderly manner in order to lower the level of stress and anxiety.

Role play

Role playing can help patients understand other perspectives, through visualizing and practicing different ways of handling challenging situations. This technique is successfully used in dealing with social phobias, improving communication and problem-solving skills, and increasing confidence levels.

Successive approximation

This CBT exercise helps patients tackle difficult situations by taking tasks that are perceived as overwhelming and breaking them into smaller, more achievable steps. 

Using CBT for Autistic Children

Children with autism spectrum disorder typically suffer from additional conditions, such as anxiety and depression. 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 behavioral therapy is an effective tool in treating the common conditions associated with an autism diagnosis. Researchers have found that using CBT can help ease anxiety and redirect avoidant behavior in children with autism. A study has also shown that after only sixteen CBT sessions over three months, 78% of autistic children have seen improvement in their condition. 

Benefits of CBT for children with autism

Cognitive behavioral therapy can equip children with autism and their families with coping skills that will help them understand and manage emotional distress, and any accompanying physical symptoms, negative thoughts, and problematic behaviors.Cognitive behavioral therapy has multiple benefits for children with autism:

• It can help them cope with and manage anxiety and other emotional issues.
• It helps them deal with stress and fear, making it easier to face dreaded situations. 
• It allows them to change irrational and negative thoughts.
• It may help older children improve their relationships with others. A study on children with high-functioning autism has shown that CBT enables gradual improvement in communication and other social skills.

What does a CBT session for autism look like?

During cognitive behavioral therapy sessions, your child will work with a specially trained therapist who will help them identify and analyze unwanted 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 your 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.To help your child learn necessary skills, a CBT therapist will use a variety of techniques, such as:

• • Asking the child about their thought processes in a difficult situation in order to identify any negative patterns. These patterns will then be reframed into positive and productive thoughts.
  • Explaining how to cope with fear and anxiety while at the same time slowly exposing your child to the same situation that triggers negative emotions. 
  • Helping a child who avoids or puts off activities due to fear or anxiety to establish a structure and a routine, which will make it easier to follow through with the task.
  • Visualizing all the steps and potential risks before getting engaged in an activity. This exercise will help reduce stress and anxiety.
  • Practicing relaxation techniques, such as deep breathing, mindfulness, and guided imagery. These techniques are particularly useful when dealing with anxieties and phobias.
  • Practicing positive behavior in difficult situations with the help of role play. 

CBT therapy for autistic children can be done either individually or in a group. Your therapist may also offer family therapy as well as parent coaching.

Challenges CBT therapists face when treating autistic children

Cognitive behavioral therapy is an effective and empirically supported treatment, however, therapists who work with autistic children may still encounter a number of challenges. To begin with, children with autism spectrum disorder need to have the necessary skills to ensure the success of the therapy. Although autistic children can usually distinguish thoughts, feelings, and behaviors, and even attempt to alter their thoughts, recognizing emotions is an area that can pose significant difficulties during therapy.In addition, 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 pertinent for autistic children. They may resort to more concrete, repetitive, and visual tactics, and focus on your child’s special interests to keep them engaged and motivated. Besides, therapists may have to incorporate frequent movement breaks or sensory activities for children who have problems with attention or sensory under- or over-reactivity.

How Often Should CBT Sessions Be Administered For Autistic Children?

Each child with autism is different and there is no one-size-fits-all CBT treatment schedule that will guarantee positive results. However, most children will need one session per week for a total of 12-16 sessions, with each treatment lasting between 30 and 60 minutes. 

What Is the Difference between CBT and ABA? 

Both cognitive behavioral therapy (CBT) and applied behavioral therapy (ABA) are considered to be evidence-based best practice treatments by the American Psychological Association. Depending on your child’s specific needs, either one or both of these therapies might be good options. However, you should keep in mind that while ABA is often the starting point in treating autistic children with more severe symptoms, CBT is recommended for children with milder symptoms of autism and those with high-functioning autism. Most children are between 2 and 6 years old when they begin ABA treatment. CBT is more appropriate for children above the age of 7 as well as teens and adults with autism spectrum disorder. ABA focuses on managing specific and immediate behavioral issues of autism spectrum disorder. At the same time, CBT takes a broader approach to address mental health problems that accompany autism, such as mood disturbances and anxiety. Finally, ABA therapists will often recommend as many as 40 hours a week of therapy, often in full-time, classroom-based programs. Your child will need anywhere between 25 to 45 hours a week of applied behavioral therapy for 1 to 3 years before you start seeing positive results. CBT, on the other hand, is time-restricted and it usually takes a few weeks to a few months to notice results.

The Best CBT Providers in the Atlanta Area

If you live in the Atlanta area, you may want to consider one of the following top-rated CBT providers for your child with autism: Atlanta CBTAtlanta CBT offers cognitive behavioral therapy for anxiety, obsessive compulsive disorder, and positive discipline, in addition to providing parent training where you can learn the necessary skills to guide your child. Anxiety Specialists of AtlantaA team of CBT specialists provides a variety of treatment techniques, with a focus on exposure therapy and exposure and response prevention for anxiety disorders, OCD, and related conditions. Thriveworks AtlantaThriveworks Atlanta CBT counselors and therapists are trained in child therapy and have extensive experience in dealing with various issues your child with autism may be facing. Cognitive AtlantaFounded in 1985, Cognitive Atlanta was the first treatment and training institute of its type in the Southeast. Their psychologists specialize in cognitive behavioral therapy for children, adolescents, and adults. Atlanta’s Children Center for Developmental and Behavioral HealthThis service offers family and individual therapy using cognitive behavioral strategies to help children with behavioral difficulties, anxiety, mood problems, and social skills. They specialize in treating autism, among several other conditions.Atlanta Specialized CareThe Atlanta Specialized Care therapists have years of experience using cognitive behavioral therapy and other techniques to treat autistic children and adolescents who are dealing with depression, anxiety, and ADHD.​​LifeStance Health This service allows you to find your nearest provider of CBT therapy in Atlanta and several other Georgia cities.