Clinical Round Table 9 - Maybe It’s Not Simply Rigidity: A Trauma-informed Lens for Utilizing CBT to Treat Autistic Adolescents

Autistic teens often present for treatment with symptoms related to anxiety, depression, and OCD. In the course of treating these symptoms with CBT, clinicians often encounter resistance (e.g., shutdown, avoidance), heightened emotional reactions or “unusual” narratives of seemingly common experiences (e.g., magnified response to common forms of peer rejection or sensory stimuli; fixation on one part of an interaction). Responses may often be viewed as normative sequelae of autism: rigidity, emotion dysregulation, perseveration, and social misperception. What if, however, these reactions are not simply “just autism” but, instead, arise from repeated adverse experiences in the face of minimal choice or control by the autistic individual? In other words, what if they are trauma responses? 

This roundtable, composed of autism and trauma professionals and an autistic self-advocate, will introduce a novel framework for using CBT with autistic teens through the lens of respecting their often unique experiences of trauma. We will discuss how to identify when responses in session may/may not indicate a trauma history. We will address how this framework can help to reconsider case formulation (e.g., teen are not exaggerating/misperceiving past negative interactions but are accurately reflecting reality as they experienced it, behaviors are not compulsive but rather attempts at interoceptive regulation/masking). We will then provide strategies for incorporating this case formulation into clinical decision making: validating the trauma experience articulated by the teen on their own terms, providing opportunities for choice and control to engage in behavioral interventions (to act against a history of lack of such choice), capitalizing on intense interests rather than reducing them, and identifying common CBT strategies that may be less useful in the face of this framework (e.g., behavioral activation around an avoided trigger; identifying all negative thoughts as cognitive distortions). We will discuss how to utilize trauma-informed CBT approaches (e.g., a trauma narrative) as well as collaborative goal-setting to embrace, validate, and address trauma reactions that may drive clinical referrals for a range of presenting problems in Autism.