Adapted Cognitive Behavioural Therapy for Asperger’s patients
by Dr Ascione
CBT covers a vast array of approaches; however the core principles of CBT still remain prevalent throughout each approach (1). These principles include a very much goal directed, time limited programme that is structured around the individual’s needs with Asperger’s Condition. CBT focuses on the here and now from which its principles of limited time and set gaols can be measured for success.
Research (2) does suggest that CBT can help to reduce the symptoms of anxiety within patients on the Asperger’s and autistic spectrum. Throughout the CBT process the approach discusses the ways in which the individual’s thinking correlates with their behaviour. Some people within the spectrum have unhelpful and negative correlations between the two, such as polarised thinking where situations are ‘black or white’ or ‘either, or’ there is no middle ground. Also ‘all or nothing’ thinking can be a common trait of Asperger’s patients and in turn very unhelpful, for example they may have to be great at everything all the time, or the best at a certain topic or interest or not try it at all. CBT aims to help individuals understand their thoughts, and make more positive correlations between their thinking and behaviour, how they affect the way they act and different ways of changing them.
Gaus (2007) (3) recognises the majority of research within Asperger’s patients is limited to children, however understanding the syndrome’s presentation in adulthood is still an ongoing process. Individuals with Asperger’s on the whole have normal to high intelligence and were often highly successful academically; leading to the assumption that CBT would automatically be successful. However misdiagnoses of being ‘shy’, ‘odd’, ‘awkward’ in social situations has led to adults with Asperger’s being treated for depression, anxiety or distress as a cover for Asperger’s itself.
Conventional CBT itself requires the patient to have a certain set of skills in order for it to be effective, abilities such as a good understanding of verbal cues and dialect but also the ability to use abstract and theoretical thinking within the therapy are required. These requirements can be a challenge for patients with Asperger’s, in which case CBT needed to be adapted to allow for its effectiveness within Asperger’s patients. Adapted CBT for patients with Asperger’s could include more repetition, more visual cues rather than verbal, more sociably friendly such as working in groups or with parents and also more concrete, black or white rather than hypothetical or theoretical examples (4).
Adapted CBT can therefore be delivered in a variety of ways, such as one to one, family intervention and group. To help combat the challenges and stressors faced by Asperger’s patients group intervention offers an opportunity for social support, build rapport and friendships, and even overcome common issues and problems faced with other Asperger’s patients within the group.
A further adaption to CBT to increase its effectiveness with Asperger’s patients is to adapt the structure of the delivery around the individuals’ interests, skills and specific abilities or hobbies (5). This strategy increases motivation and maintains rules of engagement, the time limited aspect of the delivery would also have to consider frequent comfort breaks to allow the patient to move away from that environment and regain their attention and concentration.
Research into the effectiveness of adapted CBT with Asperger’s adults is limited, however it is well recognised that early intervention is crucial. CBT and its variety of adaptations will be a major intervention to help support and combat the challenges faced by Asperger’s patients, aiming to improve the quality of life from childhood through to adulthood.
- Dobson, K. S. (Ed.). (2010). Handbook of cognitive-behavioral therapies (3rd ed.). New York, New York: The Guilford Press
- Gaus, V (2007) Cognitive-Behavioral Therapy for Adult Asperger Syndrome Guilford Press,
- White, S. W., Albano, A. M., Johnson, C. R., Kasari, C., Ollendick, T., Klin, A., et al. (2010). Development of a cognitive-behavioral intervention program to treat anxiety and social deficits in teens with high-functioning autism. Clinical Child and Family Psychology Review, 13(1), 77-90
- Chalfant, A. M., Rapee, R., & Carroll, L. (2007). Treating anxiety disorders in children with high functioning autism spectrum disorders: A controlled trial. Journal of Autism and Developmental Disorders, 37(10), 1842-1857.