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By Alyssa Safran, LMFT

As the national discussion on autism continues to progress, so too does the debate over best practices and treatment options for individuals with an autism spectrum diagnosis. Today, 1 in 59 American children is diagnosed with an autism spectrum disorder each year (Autism Speaks, 2018). The DSM V describes an autism spectrum disorder as “persistent deficits in social communication and social interaction across multiple contexts, manifested by deficits in social-emotional reciprocity, nonverbal communicative behaviors, and deficits in developing, maintaining, and understanding relationships” (DSM V, 2013). Though autism occurs on a spectrum with symptoms ranging from mild to severe, the majority of all individuals with an ASD, regardless of severity, report feeling challenged by their own cognitive rigidity. This lack of flexibility impacts many areas of life including: communication, pragmatics, relationships, and coping skills. When children are younger, cognitive rigidity often presents as difficulty working through frustration, meltdowns, perseveration on limited topics of conversation, or adverse behaviors. As children age, cognitive rigidity not only impacts pragmatic skills, but can also lead to excessive negative thoughts about self and the world around him/her. Many studies (Chandrasekhar, 2015; Hammond, 2014; Strang, 2012) show an especially high correlation between children with autism and a diagnosis of anxiety and/or depression. The science behind this finding suggests that humans have a tendency to pay more attention to negative events versus positive events. For individuals on the autism spectrum who are already contending with a higher level of cognitive rigidity than most, negative thoughts are especially detrimental, in that they can exacerbate negative views of self and reinforce isolation from others. This article seeks to explore the benefits of Cognitive Behavioral Therapy as an acceptable treatment modality for older children, adolescents, and adults on the autism spectrum.

 

While there is no “cure” for autism, various therapies exist to minimize and manage symptoms. For many parents, determining the “right” therapy for their child can prove to be a challenging quest. After the initial diagnosis of an autism spectrum disorder, parents are usually encouraged to pursue behavioral therapy to target the most “outward” signs of autism (self injurious or aggressive behavior, communication challenges, inability to regulate emotions, food aversion, etc). Applied Behavioral Analysis (ABA), is the most commonly recommended therapy for younger children on the spectrum. This evidence based intervention is designed to reduce unwanted behaviors and to promote the growth of foundational concepts in communication, social skills, and independent living. ABA tends to provide structure and routine, and primes the child for social and emotional growth. Once foundational communication, social, and coping skills are learned and maintained, behavioral therapy is reduced. As children on the spectrum age, the focus of treatment often shifts from managing behaviors, to improving social skills. Towards the end of the elementary school years, children on the spectrum often report an increased awareness of social difficulties, and a distinct feeling of differentness from peers. Adolescence can prove to be a particularly challenging time, as individuals on the spectrum become increasingly aware of challenges to “fitting in” socially with peers.

Research affirms Cognitive Behavioral Therapy (CBT) as an effective and acceptable treatment modality for pre-teens, adolescents, and young adults with an autism spectrum disorder. This particular modality of therapy combines talk therapy and behavioral therapy, and operates under the assumption that an individual’s thoughts can evoke positive/negative emotions, which drive behaviors. The ultimate goal of CBT is to replace negative thoughts with positive, realistic thoughts, which ultimately impact an individual’s ability to respond to challenging situations.

Participants in therapy are taught to understand the impact of their thoughts on behavior and learn to reframe negative thoughts in order to avoid falling into negative thinking patterns.

 

Individuals with an autism spectrum disorder tend to respond well to CBT, as this modality targets cognitive rigidity and concrete thinking. For many individuals on the spectrum, the world is viewed from a very “black and white” perspective, and can ultimately lead to negative thoughts about the self or world around them. Common negative thoughts such as “If I try to fit in, I’ll fail;” “If I stay away from people, I won’t get hurt;” or “I can’t understand what is going on in [my] world” are often reported by individuals with an ASD. Negative beliefs can become self-fulfilling prophesies and pose serious challenges to the individual forming positive relationships and achieving personal goals.  Research shows that not only do negative thoughts tend to “stick in our memory longer than positive thoughts” but also can change the way the neurons fire in the brain. Each time a negative thought is formed, a new network between neurons is created. The more times an individual accesses a negative thought, the stronger the bond between neurons becomes. Over time, negative thoughts lead to subconscious habits.

CBT is effective in helping the individual to  identify ways in which their patterns of thinking, feeling, or behaving may be more or less helpful (or accurate) and can dramatically improve one’s interactions with peers, family, and the world around him/her.

 

Many therapists are trained in the techniques of CBT and are able to offer as a modality of treatment. For parents who are unable to afford therapy sessions but are still interested in helping their child address negative thoughts, a variety of online, interactive programs exist. Coping Cat and Go Zen offer affordable, interactive, and family friendly materials. For more information about CBT services offered at the OAS Center, check out our website at https://oascenter.wpengine.com.

While there is no known cure for autism, autism is treatable and a variety of therapies exist to help minimize symptoms. Autism can impact a child in many ways: communication, eye contact, social skills, emotional regulation, and behavior are frequently affected. Such challenges can lead to difficulties accomplishing independent developmental tasks, navigating social situations, and remaining in the general education setting. Autism research points to the effectiveness of behavioral therapy as one of themost effective interventions for children with an autism spectrum disorder.

What is Applied Behavioral Analysis?

Applied Behavioral Analysis therapy (ABA) is often the most recommended therapy for a child who has been newly diagnosed with an autism spectrum disorder.ABA is a behavioral intervention that aims to assist a child with developing essential skills related to social interaction, communication, and self care through the use of positive reinforcement. Children are taught various concepts through play-based activities and tasks, then rewarded for responding with positive behavior. Treatment goals range from encouraging meaningful play (reciprocal play), to enhancing communication. Some children with autismhave difficulty expressing themselves effectively and appropriately. ABA therapy teaches important communication skills such as requesting versus demanding and conversational turn taking.Other common treatment goals include developing a self care routine(eating neatly, brushing teeth, toilet training, etc.) and working towards independence on various tasks. ABA is most often the starting point for the treatment of autism, as it creates foundational building blocks for the child to utilize when participating in other therapies such as speech or occupational therapy. ABA therapy is effective in supporting the child through various developmental stages. It’s often started when the child is a toddler and then goals are continually modified to match the child’s changing developmental needs.

How does ABA work?

Most often, children and parents receive ABAsupport from a Behavior Interventionist in the family home setting. Not only is this a convenient option for the parent, but ensures consistent weekly participation and practice of treatment goals. Another benefit of ABA therapy is observing the child in his/her natural environment, which allows the Behavioral Interventionistto observe the child within their family dynamic but also to effectively work on developmental skills such as feeding, toilet training, and other self help skills. Parents are usually encouraged to observe or participate in their child’s session, in order to understand the goals their child is working on and learn the necessary skills to support their child in practicing tasks between sessions. Once a task has been mastered “in-home” it’s common for ABA therapists to take the child and parent on community outings to practice the task in a public setting, which enables the child to generalize the new task. ABA service time depends on the severity of theautism spectrum disorder and the age of the child. Some children only require three hours per week, while other receive upwards of 40 hours per week. A typical amount of ABA support is usually about six hours per week.  Once a child has reached school age, in-home support might be reduced in order to accommodate the child’s academic support needs. Children with autism are provided with free IEPs(Individualized Education Plan) and Behavior Intervention is usually a typical service available to children with autism.

Who can practice ABA?

Behavior Interventionists work with children, adolescents, and occasionally adults with developmental disabilities to facilitate positive behaviors and to decrease negative, unhealthy, or destructive behavior. Behavior Interventionists may work in many settings such as a community clinic, in the client’s home, or in schools. Behavioral Interventionists work directly with the child and also build relationships with the parents, teachers, and any other treatment provider in the child’s life. Most Behavioral Interventionists understand the importance of collaboration between treatment providers and will often develop goals related to behavior and social interactions that may be worked on in a variety of settings. Behavior Interventionists must possess a bachelors degree. Supervisors of Behavior Interventionists are called Board Certified Behavior Analysts (BCBA) and have completed a masters degree, supervised experience, and have passed a certification exam.

Accessing ABA Therapy

Children with autism (ages 0-3) are entitled to free early intervention behavioral therapy services (in-home intervention) though the San Diego Regional Center. School aged children are also able to access free behavioral intervention support services through their IEP (Individualized Education Plan).Another option for ABA therapy includes private therapy through a clinic. Some insurance plans cover private ABA therapy, if a child has a documented diagnosis of an autism spectrum disorder. If you are interested in learning more about options for accessing ABA therapy for your child with autism we would encourage you to contact the OAS Center for more information at 619-431-5049. The Autism Speaks (auitismspeaks.org) and theSan Diego Regional Center (sdrc.org) websites offer great support to parents and both websites are easy to navigate. We would also encourage you to contact the OAS Centerat 619-431-5049 for more information.

Autism does not have a cure. However, behavioral interventions for children with autism, is one of the most effect interventions used that can profoundly diminish the symptoms of autism and help a child with autism lead a productive and fulfilling life. A child with autism can experience both social and educational challenges. When behavior therapy is used as a treatment plan, can help alleviate the challenges that many children with autism face. After all, no one wants to see their child become frustrated in school or life and then feel helpless. The most important thing to remember is that no one plan is the end all be all for treating autism, each child has unique needs and it is important that parents find a treatment that works for their child.

Overall, the most generally accepted and successful treatment approach for children with autism is behavior therapy. This is an effective approach for children across the autism spectrum, not just for children with behavioral issues. Behavior therapy is widely implemented as a tool to help develop social skills for children with autism.

As a parent, it may be confusing deciding which treatment is best for your child with autism. Schools may tell you one thing and you may hear something else from a parent group. There is no one right answer. One thing that has been proven is that the earlier the intervention the better. The sooner your child begin behavioral therapy the easier it will be for your child to learn age-appropriate social skills and better transition into society.

One of the most effect and used behavior support for students with autism is applied behavior analysis (ABA).  This type of behavior intervention is safe, flexible, and when used, has proven effective. Parents continuously report that ABA has had tremendous positive results for their child with autism. Whether a child is three years old or seventeen years old, ABA is one of the most reliable ways for a child to develop social, communication, academic, life skills, and emotional skills that will make them successful in the classroom and in life.

So what is applied behavior analysis (ABA)?

ABA is a behavior intervention that focuses on developing social skills, language, and self-help abilities through positive reinforcement. A behavior interventionist will either, go to a child’s house or school, and work one-on-one with the child to develop these skills. Some things a behavior interventionist might do is intervening on problem behavior such as aggression or defiance and then teach them a positive replacement behavior. The child is essentially rewarded for the positive behavior. An ABA therapist might work with a child on turn-taking skills. Instead of always interrupting the other person in a conversation, a behavior interventionist might teach a child to learn to wait until the appropriate time in the conversation before interjecting.

During a session with a child, an ABA therapist will introduce new skills to the child. An overwhelming amount of research has proven that ABA is highly effective in reducing problematic behavior of a child with autism. The ABA therapist will teach the child through modeling and role-playing activities. The child will be able to watch the therapist use the appropriate behaviors and then try the behavior with the support of the therapist.

There are many skills that a child may not be interested in learning or may not see the value in learning. For example, a child might not be interested in having eye contact when they talk to someone. An ABA therapist would work with that child on learning to have eye contact anyways because of the value of that skill in the long run. Whether it is for a casual conversation or a job interview, making eye contact with a person while they are talking to you is a skill that is important in the work place and in social situations.

ABA therapists are trained to assess the child and create sessions that individually benefit the child. What one child needs to work on could be completely different from what another child needs to work on in life. Some children need as many as 30-40 hours per week in ABA therapy and other children may only need 4 hours a week. When children begin to practice these positive behaviors and their social skills start to improve, ABA will continue to help the child in maintaining and cementing those life-long skills.

The number of children diagnosed with autism continues to increase each year. Autism can impact a child in many different areas of life such as communication and social interaction and can have a considerable effect on a child’s participation and performance in the classroom. Children with autism often experience difficulty processing sensory information, and this can lead to feeling overstimulated (too much energy) or lethargic (difficulty maintaining attention), ultimately impacting academic participation and socialization with peers. When problems related to sensory processing occur in the classroom, children are more likely to experience acting out behaviors, lower self esteem, or withdrawn behavior. Aside from behavioral and speech/ language support, children with an autism spectrum disorder may also benefit from occupational therapy.

What is occupational therapy?

Occupational Therapy (OT) is a treatment modality designed to treat injured, ill, or individuals with developmental disabilities through the therapeutic use of everyday activities (American Occupational Therapy Association, 2018). Examples include: helping children with fine motor difficulties to learn to tie their shoes, grasp a pencil correctly, button their shirt, etc. Occupational therapy is usually sensory based, with interventions designed to help children develop awareness around their sensory systems and mange sensory input appropriately. Occupational therapy for children is often play-based, and hands on, and might involve deep touch, massage, use of a swings, stability balls, etc. based on the child’s sensory needs. Occupational therapy is particularly effective in not only helping children with autism to refine gross and fine motor skills, but to also filter information and manage environmental stimuli. Most individuals on the autism spectrum experience difficulty with sensory processing. Such children often report concentration difficulties in the classroom. This is due to the extra challenge they face of filtering out background noises, managing their own sensory needs, and ignoring classroom distractions in order to focus on the instructor. Participation in occupational therapy allows children with autism to manage sensory information more effectively with the use of specific strategies, ultimately increasing focus and regulation.

What are Occupational Therapists?

Occupational therapists (OTs) help individuals become proficient, independent, and  successful at accomplishing everyday tasks, specifically when the individual has a disability (such as autism). Occupational therapists create activities designed to strengthen different muscle groups, improve coordination, and manage sensory input through the practice of everyday activities such as brushing teeth, tying one’s shoe, or writing.  Occupational therapists are trained to understand the specific ways a disability may affect a child’s physical and emotional functioning or disrupt regular routines, and are able to tailor treatment goals to the individual needs of the child. Occupational therapists may work in many settings such as a clinic, hospital, or school. Occupational therapists work directly with the child and also build relationships with the parents, teachers, and any other treatment provider in the child’s life. Most Occupational therapists understand the importance of collaboration between treatment providers and will often develop goals related to behavior and social interactions that may be worked on at home and at school. Occupational therapists determine each child’s service time based on the child’s needs and the impact of their disability.

Children with Autism and Occupational Therapy

It is estimated that 80% of children with autism have sensory processing problems (American Occupational Therapy Association, 2018). Occupational therapy offers many benefits for children with autism ranging from improved attention, enhanced social problem solving and cooperation, improved emotional regulation, and/or  increased independence in daily task completion.

When initially evaluating a child’s eligibility for occupational therapy, the Occupational therapist will observe the child participating in challenging motor tasks or in the setting where difficulties commonly arise. Data gathered from observation is then used to develop treatment goals, and will help the Occupational therapist to determine if goals should focus on attention and sensory regulation, social interactions, or developmental tasks. For children struggling to maintain attention in the classroom due to sensory dys-regulation, OT’s are able to suggest modifications to the child’s learning environment and strategies to use throughout the school day obtain sensory input appropriately. Examples include replacing a chair with a Bossa ball for children who have difficulty sitting still, playing a theraband between chair legs so children have a place to expend their energy without disrupting their peers, or providing children with visual reminders of strategies they can practice throughout the school day (ex:asking for a break, drinking water, taking deep breaths, hands to self, etc). Occupational therapists regularly consult with teachers and school staff to determine if suggested strategies are effective, or if new strategies could be implemented. Occupational therapists are also able to utilize play based interventions to assist children with improving social interactions. Examples include acting out common social challenges through role play or pretend play, determining behaviors that would be viewed appropriate and inappropriate by peers, and practicing socially acceptable regulation strategies (ex: hands to self versus touching peers). If a child’s difficulties arise during developmental tasks such as brushing hair or eating neatly, treatment activities will focus on practicing such activities until the child is able to perform task independently.

Accessing Occupational Therapy

Children with autism are entitled to free occupational therapy though their public school, via their IEP (Individualized Education Plan). Another option for occupational therapy includes private therapy through a clinic. Many insurance plans cover private occupational therapy if a child has a documented diagnosis of an autism spectrum disorder. If you are interested in learning more about options for accessing Occupational Therapy for your child with autism we would encourage you to contact the OAS center for more information at 619-431-5049