COGNITIVE BEHAVIOURAL THERAPY (CBT)

[vicbee]

Hi, my daughter may be offered CBT to help in her treatment of her 'fear of choking' on solid food. I am a little concerned that this may not help as generally from what I have heard about CBT, a person has to 'imagine' a different outcome to their current fear and also use probability. Both of these things do not come naturally to someone with ASD. Has anyone had any experience of this therapy with their ASD child?

[Sally44]

I don't know. I had heard that too. Our children's thought processes can be very different. They can be rigid and repetitive and literal, and as you've said there can be difficulties with imagination.

I would raise your concerns with them about how they are going to present this. Firstly, I presume that it isn't going to all be verbal dialogue. They may present it in picture storybook form.

Sometimes just having the process explained through from start to finish can help an awful lot with anxiety. Eg. explain to her about swallowing and where it goes and that there are two pipes ie. to the stomach and to the lungs, and what makes a person choke, and what the body does to stop that. I have found that when I completely explain it to my son, there are many things that he then gets and isn't anxious about any more.

[aleph_nought]

I'm currently getting CBT. Obviously the way it works with adults may be different, but I've not found that I've been asked to 'imagine' things in a way that I find difficult. Basically the idea is to develop a variety of techniques (some of which will work better for some people than others, whether NT or on the spectrum) to help change patterns of thinking which have been causing problems. In my case, for example, I'm addressing an automatic tendency to think catastrophically. If anything, I would think people on the spectrum are more likely to warm to CBT than NT people, since the methods used tend to play to our strengths - thinking things through in a logical, systematic way.

 

As I say, it is no doubt slightly different with children, but I hope this helps.

[vicbee]

Thank you for your reply. I have recently discussed things again with the team and they are going to use boardmaker with her to give her visual representation to aid the therapy. I am looking forward to getting things started but not pinning my hopes on this therapy alone doing the trick...we will see!!

[aleph_nought]

Sounds like the right attitude. Hope it goes well.

[Karen A]

Hi, my daughter may be offered CBT to help in her treatment of her 'fear of choking' on solid food. I am a little concerned that this may not help as generally from what I have heard about CBT, a person has to 'imagine' a different outcome to their current fear and also use probability. Both of these things do not come naturally to someone with ASD. Has anyone had any experience of this therapy with their ASD child?

 

Hi.CBT is I think the therapy most likely to be recommended for people with ASD.It does not have to involve the things you mention.CBT is probably more likely to be helpful if the specialist has an understanding of ASD.However it is certainly worth giving it a try.My elder [NT] was supported very briefly by a CAMHS psychologist who used CBT.J suffered from anxiety and panic attacks.The CBT approach helped him a lot.Karen.

 

[Sally44]

It might be worth asking for a therapist that has experience of treating children on the spectrum. I tend to find that when you ask it generally happens. But if you don't ask you don't get.

[vicbee]

Thanks for the positive feedback, I'm cautiously optimistic!!!

[Sally44]

I have a sibling who was recently turned down for CBT because they said he has rigid concrete thinking consistent with autism and therefore it would not work for him as he has held onto these rigid beliefs for too long. (although he is not diagnosed, as he doesn't have enough difficulties to warrant a diagnosis). However that seems to run completely against the other posts. They also said that he would have to be at a stage where he accepted that the beliefs he holds are not true, and I can't see that ever happening. But I also don't see why he would need to be at that stage, surely that is what the CBT would be trying to achieve?

[Karen A]

I have a sibling who was recently turned down for CBT because they said he has rigid concrete thinking consistent with autism and therefore it would not work for him as he has held onto these rigid beliefs for too long. (although he is not diagnosed, as he doesn't have enough difficulties to warrant a diagnosis). However that seems to run completely against the other posts. They also said that he would have to be at a stage where he accepted that the beliefs he holds are not true, and I can't see that ever happening. But I also don't see why he would need to be at that stage, surely that is what the CBT would be trying to achieve?

 

Hi.Views regarding talking therapies and ASD do vary widely amongst professionals.

We have weekly psychotherpy [OH and myself].Ben also has weekly psychotherpy.We have had provision through CAMHS for the last two years.Our CAMHS quite often offer a trial of psychotherapy following a diagnosis of AS.Many other very well respected professionals would say that people with AS are not able to develop the therapeutic relationship that is central to psychotherapy and so it is not worthwhile investing the time and money in attempting psychotherapy [although the input is funded by CAMHS child psychotherapists are extremely well qualified and the work is long term].I have to say that OH and myself have found the support extremely helpful.Ben has done very well generally despite at times having very little support in school.Although Ben was diagnosed with AS and to be honest we had hoped psychotherapy would make such a difference he would not meet the criteria I am sure Ben has benefited.

Psychotherapy is a lot more controversial than CBT for children with ASD.As far as I can gather there is currently little solid evidence to demonstrate that it is effective.

CBT however is certainly more widely recognised as being of potential benefit in helping with anxiety,phobias and panic attacks which can be comorbid difficulties for those with ASD.

It is I think very difficult to judge without knowing all of the details.However I think that one thing that is cental in any talking therapy is for an individual to be flexible enough to consider other ways of looking at things and to engage in the work to change .If an individual whether they have ASD or not has had fixed beliefs which they have held over a long period of time then they may not actually be able to engage in the process of CBT and so may not benefit.

All of the professionals I have worked with would say that in order to change an individual would at the least need to have some awareness that what they believed was an area of difficulty for them and that there might be another way of looking at things.If an individual considers that what they believe is true and it is not an issue for them [however much other people might think it should be] then they are very unlikely to be willing to work on changing. Karen.

[Karen A]

Hi.Views regarding talking therapies and ASD do vary widely amongst professionals.

We have weekly psychotherpy [OH and myself].Ben also has weekly psychotherpy.We have had provision through CAMHS for the last two years.Our CAMHS quite often offer a trial of psychotherapy following a diagnosis of AS.Many other very well respected professionals would say that people with AS are not able to develop the therapeutic relationship that is central to psychotherapy and so it is not worthwhile investing the time and money in attempting psychotherapy [although the input is funded by CAMHS child psychotherapists are extremely well qualified and the work is long term].I have to say that OH and myself have found the support extremely helpful.Ben has done very well generally despite at times having very little support in school.Although Ben was diagnosed with AS and to be honest we had hoped psychotherapy would make such a difference he would not meet the criteria I am sure Ben has benefited.

Psychotherapy is a lot more controversial than CBT for children with ASD.As far as I can gather there is currently little solid evidence to demonstrate that it is effective.

CBT however is certainly more widely recognised as being of potential benefit in helping with anxiety,phobias and panic attacks which can be comorbid difficulties for those with ASD.

It is I think very difficult to judge without knowing all of the details.However I think that one thing that is cental in any talking therapy is for an individual to be flexible enough to consider other ways of looking at things and to engage in the work to change .If an individual whether they have ASD or not has had fixed beliefs which they have held over a long period of time then they may not actually be able to engage in the process of CBT and so may not benefit.

All of the professionals I have worked with would say that in order to change an individual would at the least need to have some awareness that what they believed was an area of difficulty for them and that there might be another way of looking at things.If an individual considers that what they believe is true and it is not an issue for them [however much other people might think it should be] then they are very unlikely to be willing to work on changing. Karen.

 

Gosh,having reread that I do sound like I have been in psychotherapy too long.There is more psychobabble there than our therapist talks....

Edited April 22, 2009 by Karen A

[vicbee]

Hi.Views regarding talking therapies and ASD do vary widely amongst professionals.

We have weekly psychotherpy [OH and myself].Ben also has weekly psychotherpy.We have had provision through CAMHS for the last two years.Our CAMHS quite often offer a trial of psychotherapy following a diagnosis of AS.Many other very well respected professionals would say that people with AS are not able to develop the therapeutic relationship that is central to psychotherapy and so it is not worthwhile investing the time and money in attempting psychotherapy [although the input is funded by CAMHS child psychotherapists are extremely well qualified and the work is long term].I have to say that OH and myself have found the support extremely helpful.Ben has done very well generally despite at times having very little support in school.Although Ben was diagnosed with AS and to be honest we had hoped psychotherapy would make such a difference he would not meet the criteria I am sure Ben has benefited.

Psychotherapy is a lot more controversial than CBT for children with ASD.As far as I can gather there is currently little solid evidence to demonstrate that it is effective.

CBT however is certainly more widely recognised as being of potential benefit in helping with anxiety,phobias and panic attacks which can be comorbid difficulties for those with ASD.

It is I think very difficult to judge without knowing all of the details.However I think that one thing that is cental in any talking therapy is for an individual to be flexible enough to consider other ways of looking at things and to engage in the work to change .If an individual whether they have ASD or not has had fixed beliefs which they have held over a long period of time then they may not actually be able to engage in the process of CBT and so may not benefit.

All of the professionals I have worked with would say that in order to change an individual would at the least need to have some awareness that what they believed was an area of difficulty for them and that there might be another way of looking at things.If an individual considers that what they believe is true and it is not an issue for them [however much other people might think it should be] then they are very unlikely to be willing to work on changing. Karen.

 

 

Karen A, with reference to your last paragraph here, this is very interesting as my daughter really does want to be able to eat properly again. She said that the first thing she will eat when she is better is macaroni cheese - which used to be one of her favourites. Obviously the fear has just taken hold and she cannot just get over it without help. She smells things like bacon butties and drools at the mouth and says she'd love to have a bite, and even attempts to put her mouth around it but just cannot take that bite. The last time she ate proper solid food, such as a piece of bread was around a year ago. So I am really really hopeful that because she has the desire to change and the motivation is there, then we could get somewhere...fingers crossed!!

[Karen A]

Karen A, with reference to your last paragraph here, this is very interesting as my daughter really does want to be able to eat properly again. She said that the first thing she will eat when she is better is macaroni cheese - which used to be one of her favourites. Obviously the fear has just taken hold and she cannot just get over it without help. She smells things like bacon butties and drools at the mouth and says she'd love to have a bite, and even attempts to put her mouth around it but just cannot take that bite. The last time she ate proper solid food, such as a piece of bread was around a year ago. So I am really really hopeful that because she has the desire to change and the motivation is there, then we could get somewhere...fingers crossed!!

 

<'> I hope that the CBT is helpful.

I don't know if you saw any of the series ''Freaky Eaters '' that has just finished on TV.If not you might find them interesting if you can catch any on the internet or elswhere.Although the series did not cover ASD as such there were some people featured who had severe eating difficulties.The psychologist in the programme appeared to use a lot of CBT type methods in his work.He also works in the NHS.So it might be helpful to watch if you can find any of the series.Karen.

 

[vicbee]

<'> I hope that the CBT is helpful.

I don't know if you saw any of the series ''Freaky Eaters '' that has just finished on TV.If not you might find them interesting if you can catch any on the internet or elswhere.Although the series did not cover ASD as such there were some people featured who had severe eating difficulties.The psychologist in the programme appeared to use a lot of CBT type methods in his work.He also works in the NHS.So it might be helpful to watch if you can find any of the series.Karen.

 

 

Yes, i watched all of the last series and especially the 2 young lads in their 20's were particularly interesting - the one who only eats chips and the other who ate only chips and beans. I cried all the way through both of those ones, I really felt for them!

[LizK]

CBT can be less effective on children with asd because of the theory of mind issues. If a child is particularly concrete or rigid CBT will be hard wrok especially the cognitive aspect. The behavioural aspect may be more successful. Depends on the individual child though and how much they struggle with theory of mind.

 

Lx