Autism Therapy Services

Adapted Cognitive Behaviour Therapy (CBT) For Autistic young people & their families

I work therapeutically on Mondays and Tuesdays in central London. Although there is growing evidence that when parents are involved cognitive behaviour therapy can help children younger than 7, it is usually easier for children aged 7+ to access. I work with children aged 6/7 up to young adults. My approach is family focused and at least one family member has to be involved in all sessions when I work with children. I use a CBT framework, but within this framework, I use a wide range of different approaches and everything I do is adapted for neurodivergent individuals. My approach is very holistic.
 
My sessions are an hour and I write up a summary of what we did so that parents have a record of this. A lot happens in each session, and it can be hard to remember. The summaries help process what we talked about and use ideas at home and in other settings.
 
I work remotely in emergency situations and when I do parent consultations, but I do not work remotely with young people therapeutically. I think that it is easier to connect, to engage with and enjoy sessions face-to-face.

What is Cognitive Behaviour Therapy?

Cognitive Behaviour Therapy is an evidence-based approach that helps children and young people to understand the link between thoughts, feelings, and behaviours, and this can help them to manage their responses to situations and to have more control over what they do.

This can help children and young people to manage a range of different mental health conditions that are commonly associated with autism, e.g., anxiety, depression, obsessive compulsive disorder, phobias. It can help them to become more aware of how they are feeling, to learn to regulate their emotions more effectively, to communicate how they are feeling to others, to understand themselves and feel more confident about who they are.

How I work – what to expect if you work with me

I work with children aged 6 up to young adults using bespoke CBT for each young person and their family. I work with children and at least one parent in sessions for the following reasons:

• To help children / young people and parents understand each other and learn to work as a team.

• To help parents become co-therapists and use strategies to support their child.

• To help children / young people generalise what they are learning to other situations and take ownership of new skills and information that they are learning.

• To raise awareness of support at home and provide parents with a toolbox that they can use to help their child.

• To consider what adaptations are in place at home, what is working, what is not and how we can target support so that it is more effective.

• I have a flexible approach to the number and frequency of sessions depending on the family’s situation, how much support they want and feel that they need and how they respond to intervention.

My goal is to empower families by increasing their understanding of themselves and each other and to help parents to develop their skills as CBT co-therapists so that they can take increasing ownership of support. As parents start to take on this role more and more, they reduce sessions with me and return as and when they need more help.

I involve parents with young people, but on their terms, and if families give permission, I talk to schools, too.

For information on my experience and training click here.

Does CBT work for autistic children and young people?

Yes, but only if it is adapted for autistic differences. It was not designed with autistic people in mind, it was designed for neurotypical people and research has found it does not work unless adapted.

The National Autistic Society and Mind have produced a very informative and helpful free Good Practice Guide for autism and therapy.

Adaptations for CBT for autistic children and young people

Autistic children and young people process information differently to some of their neurotypical peers, which means, for example, that there are differences in the thinking style, recognising and regulating emotions and processing auditory information. Therapy needs to be adapted for these differences, BUT the differences are NOT the same in everyone. Although research recommends areas of therapy that need to be adapted for autistic children and young people, adaptations will vary depending on the person. It is really important to get to know the young person well, and to gradually discover what helps, what does not, and to experiment with adaptations to find the best approaches, strategies and resources to help them.

Examples of areas of therapy, and recommended adaptations for autism:

• Visual support, e.g., pictures, stories, bookmarks to help remember information, summaries of sessions, checklists.

• Language, e.g., monitoring, and often reducing, use of language, giving the child/young person time to formulate what they want to say, reducing use of questions if this is increasing anxiety.

• Emotions, e.g., many autistic children and young people have difficulty recognising what emotions feel like inside their bodies, discriminating between similar feelings, working out how they are feeling and using language to communicate this to others. It is important to find out as much as possible about recognising and regulating emotions in therapy in order to make appropriate adaptations.

• Thinking styles, e.g., common areas of difference are attention, flexible thinking, managing uncertainty and grey areas, a focus on details, which is often strength but can make it hard to put information together to see the bigger picture, a strong sense of right and wrong, which can be a strength but can make it difficult to see situations from other people’s perspective.

• Generalising information, e.g., this is a recognised difference that impacts on the success of therapy. Autistic children/young people find it hard to transfer what they learn in one situation to others. This means that although they might do brilliantly in the therapy session, they might not be able to use the strategies anywhere else. Therapy needs to think about how to support this difference, or it will not be effective.

• Involving parents. This is recommended as a way of helping children/young people to generalise work carried out in therapy and it helps parents to understand their child and vice versa.

• Sensory differences. It is really important to be aware of the sensory environment and to find out about sensory processing differences and use sensory strategies and resources, such as vibrating cushions, sensory toys to squeeze, fiddle with.

• Special interests. Using special interests can help autistic children/young people engage in tasks and therapeutic work.

• Structure, e.g., using the same format, using visual support to show children/young people what they are going to do in the session, having a structure that becomes familiar.

• Being flexible. Therapist’s need to adapt what they are doing flexibly throughout sessions depending on the response to make sure that it is appropriate and accessible for the child/young person.

• Have fun! Sessions should always be fun, no matter how serious the content is.  

Examples of Approaches and Resources that I often use in therapy:

• Zones of Regulation
• Social Thinking
• Comic Strip Conversations & Social Stories
• Mindfulness
• Visual support, e.g. thinking glasses, thinking hats, squishy brains to squeeze, scales and counters to balance negative and positive thoughts, rating scales, pie charts, bookmarks to help remember strategies, stories.

I use ACT (Acceptance Commitment Therapy) with young people where appropriate, which is an approach that focuses on shifting attention from thoughts that take you away your goals and values, to thoughts that move you towards these.

My knowledge of language, social communication, and interactions from my work as a speech and language therapist is very helpful when I work therapeutically with autistic children/young people and their families.

Intervention is respectful of, and celebrates, difference. All of my work strives to reduce stigma.

“Autists are the ultimate square pegs, and the problem with pounding a square peg into a round hole is not that the hammering is hard work. It’s that you’re destroying the peg.”

Paul collins