Clinical Grand Round 2 - A Live Demonstration of CBT with Autistic Clients: Adapting Exposure Therapy and Promoting Caregiver Coaching

One in 36 children are identified as autistic, the number of autistic youth who present to mental health clinics is even greater, and autistic youth exhibit higher rates of anxiety disorders and OCD compared to the general population.  Despite an increased risk for experiencing mental health disorders, autistic youth are often unable to access mental health treatment, especially cognitive behavioral therapy (CBT). Many providers do not believe they have the tools to treat autistic youth and lack confidence in working with this population. It is well-established that CBT with ERP, when modified and tailored for autistic youth with and without co-occurring intellectual disability, is efficacious in treating anxiety and OCD. Exposure has been shown to be the active ingredient in treating these conditions, and caregiver involvement is recommended when doing exposure work with youth. When autistic youth do find the rare provider with experience with both autism and CBT, there is often a session cap. Practically, therapy will be discontinued before an exposure hierarchy can be completed. When conducting exposures for Anxiety/OCD, many autistic clients do not  experience habituation in session. While not necessary for treatment progress, this experience along with limited generalization of distress tolerance and inhibitory learning from exposure to exposure can result in a slower pace of treatment. In order to gain momentum and address the aforementioned factors, caregiver involvement in session and caregiver training to act as out of session exposure coaches can be  an essential component of therapy for this population. In two live demonstrations, clinicians will work in teams to show how exposure therapy with autistic clients and caregiver “exposure coach” training can simultaneously happen. Individuals who are autistic will participate in the demonstrations to play the roles of clients. The first case example will illustrate phobia treatment in a young autistic child. The second case example will illustrate working with an autistic teen and their family to aid in differentiating between OCD compulsions/avoidance and autism related needs/preferences and how to collaborate with the family  to engage in opposite action when OCD-related.