Psychotherapeutic Management

of
Autism Spectrum Disorder

Habibur Rahaman Sajib

[Link]. (Part-1) & M.S. in Clinical Psychology, DU
[Link]. in Psychology
Child Psychologist at Shishu Bikash Kendra,
Hospital Services Management, DGHS, Dhaka-1212
Symptoms of
ASD
 A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or
by history (examples are illustrative, not exhaustive, see text):

Symptoms of ASD 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-
forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal
Autism is characterized by a range of and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of
symptoms, which can vary widely between gestures; to a total lack of facial expressions and nonverbal communication.
individuals. Common symptoms include: 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior
to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
• Delayed language and movement skills.
Specify current severity: Severity is based on social communication impairments and restricted repetitive patterns of behavior.
• Difficulty with social interactions, such B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history
as making eye contact and (examples are illustrative, not exhaustive; see text):
understanding others' feelings.
4. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping
• objects, echolalia, idiosyncratic phrases).
Anxiousness in social situations.
5. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme
• Repetitive behaviors or restricted distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat
interests. food every day).

6. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with
• Unique sensitivities to sensory input unusual objects, excessively circumscribed or perseverative interest).
(lights, sounds, tastes, textures).
7. Hyper- or hyperreactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent
• Hyperactivity, impulsivity, or indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects,
visual fascination with lights or movement).
inattentiveness.
Specify current severity: Severity is based on social communication impairments and restricted, repetitive patterns of behavior.
It's important to note that symptoms can
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited
manifest differently in each person. For a capacities or may be masked by learned strategies in later life).
formal diagnosis, consult a healthcare
professional. D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental
delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder
and intellectual disability, social communication should be below that expected for general developmental level.
Theories of ASD
Theories of ASD
Cognitive theories
• Theory of mind: This theory suggests
that people with autism have difficulty
understanding what others are thinking,
feeling, or intending.
• Weak central coherence: This theory
suggests that people with autism have
good attention to detail but have difficulty
understanding the most important parts of
a concept.
• Executive dysfunction: This theory
suggests that people with autism have
difficulty devising strategies.
Theories of ASD
Social theories
• Mirror neuron system: This theory is a social theory of
autism.
• Social motivation theory: The SMT proposes that
people with ASD have diminished social motivation,
which means they find social stimuli less rewarding than
people without ASD. This can lead to a number of issues,
including:
o Social learning: Children with ASD may pay less
attention to social information, such as faces and gaze
direction, which can limit their opportunities for social
learning.
o Social skills: This can lead to disrupted social skill and
social cognitive development.
o Social engagement: People with ASD may have a
diminished desire to maintain and strengthen
relationships.
Environmental theories
These theories suggest that environmental factors, such as
exposure to pollutants, tobacco, and metals, may play a role
in autism.
Theories of ASD
Hereditary or parental factors
These theories suggest that autism may be caused
by hereditary or parental factors.
Serotonin
This theory suggests that serotonin, a brain
chemical that's also linked to depression, may be
involved in autism.
Broadband and Narrowband Theory
The Broadband and Narrow Band theory of autism
refers to the differences in communication
bandwidth among various cortical areas in
individuals with autism spectrum disorder (ASD).
The theory suggests that there is a significantly
lower communication bandwidth, particularly
between frontal and posterior brain areas, which
may lead to altered functioning and information
processing in individuals with ASD.
Treatment Plan
of ASD
A treatment plan for Autism Spectrum Disorder (ASD)
usually involves a combination of therapies tailored to the
individual's needs, as there is no one-size-fits-all approach.
Common treatment options include:

• Behavioral Management Therapy: Techniques such as

Applied Behavior Analysis (ABA) aim to reinforce
positive behaviors and reduce undesired behaviors.
• Speech and Language Therapy: Helps improve
communication skills, essential for social interaction.
• Cognitive Behavioral Therapy (CBT): Aids in
addressing negative thought patterns and developing
coping strategies.
• Early Intervention Services: These are provided to
infants and toddlers to enhance development from an
early age.
• Educational and School-Based Support: Custom
educational plans and accommodations in school
settings to help with learning and social skills.
ABA Therapy
ABA Applied Behavior Analysis (ABA) is a scientific therapy that helps
people of all ages and abilities improve their behavior and learning:
Goal: ABA aims to improve a person's quality of life and
independence by helping them learn and apply new skills. ABA
“Applied Behavior Analysis is the uses a variety of strategies, including positive reinforcement and
process of systematically applying data-driven approaches, to help people develop new skills and
interventions based upon the principles habits.
of learning theory to improve socially Benefits: ABA can help people with a range of challenges, including-
significant behaviors to a meaningful • Improving communication, social skills, and academic performance
degree, and to demonstrate that the • Improving focus and attention
interventions employed are responsible • Reducing challenging behaviors like tantrums and self-injury
for the improvement in behavior”.
How it's used :ABA is often used to treat people with autism and
Cooper, Heron and Heward (2009) other developmental disorders.
Principles: ABA is based on principles of behaviorism and focuses
on how learning takes place and how the environment and
consequences influence actions.
Methodologies: Some methodologies used in ABA include task
analysis, chaining, prompting, fading, thinning, and generalization.
ABC analysis

Antecedent: The event or activity that

occurs just before a behavior. This can
be a verbal command, a physical Antecedent Behavior Consequence
object, or an internal thought or
feeling.
Behavior: The response to the
antecedent, which can be an action, a
verbal response, or something else.
Consequence: The event that happens
directly after the behavior, which can
be positive reinforcement or no
reaction.
Utilizing the ABC ABA interventions focus on understanding and altering the
environment to change behavior using the A-B-C contingency
Contingency
Naturally occurring contingencies result in learning all the time,
but can specifically control contingencies to purposely create
The three-term contingency is the learning- This is ABA
foundation of operant conditioning,
which is the process by which
environmental factors change behavior. Increase desirable behaviors - teach skills by creating
opportunities using the A-B-C format
ABA specialists use the three-term
contingency to:
• Understand behavior patterns Decrease undesirable behaviors - reduce disruptive or
• Create personalized interventions maladaptive behaviors by understanding and altering the
• Encourage positive behaviors, and existing A-B-Cs of a behavior
Reduce challenging behaviors
Basic Principles of ABA Reinforcement- Increase the future frequency of behavior

Positive Reinforcement: ADD a stimulus to environment.

Ex: “Great job!” or giving access to a preferred item

Negative Reinforcement: REMOVE a stimulus from environment.

Ex: Aversive situation is removed

Punishment- Decrease the future frequency of behavior

Positive Punishment: ADD stimulus to environment.

Ex: “No! Stop that!” or giving a timeout

Negative Punishment: REMOVE stimulus from environment.

Ex: taking away a preferred toy

Extinction-Removing specific reinforcement that was previously available decrease

the likelihood that the behavior will occur in the future.
Ex. No longer providing attention to child when he is engaging in inappropriate attention
seeking behaviors
Skill Acquisition: Increasing Teaching a new behavior
Appropriate Behaviors
• Cues are purposely used to increase behavior that is not
already happening Antecedent: Creating an
instruction/opportunity, situation, or indication that a behavior
Example: Teaching A New Behavior should take place What is the child’s cue to engage in the
• Antecedent: Parent and child are in behavior?
front of a closed door and parent
prompts child to say “open”
• Behavior: Teaching the right behavior (increase desirable
• Behavior: Child says “open” behaviors and decrease undesirable behaviors)What response
• Consequence: Parent opens the door should take place, given the antecedent?

This consequence increases the

likelihood that this child will say “open” • Consequence: Reinforcement Anything that is provided or
the next time they are at the door taken away that strengthens or maintenance the behavior
Learning has occurred!
Modifying Inappropriate Functional Behavioral Assessment
Behavior

Determine: Antecedents, behaviors, and consequences

• Develop hypotheses
• Confirm or modify hypotheses
Modify: Antecedents
• Consequences
• Environment
Teach: Replacement behaviors (e.g., what someone can do
instead)
• Additional skills to support overall functioning
Functions of Behavior
A-B-C contingencies tell us why a behavior is happening
Every behavior serves a function-
Example: What is the Function? • Attention (e.g., physical proximity)
Antecedent: Another child in the • Tangible (e.g., gaining access to some sort of preferred items or
activities)
classroom is present with food.
• Escape / Avoid
Behavior: Child grabs the food and eats • Automatic / Sensory
it.
Identifying function leads to interventions that focus on the
Consequence: Adults give the child
food to keep him from grabbing from underlying cause of the behavior
his peer again.
This positive outcome maintain the
grabbing behavior-
Grabbing to get item (food) Requesting for item (food)
Modifying Inappropriate A: Antecedent Strategies- Decrease the likelihood of the
Behavior behavior occurring
Ex: provide child and his peers with snacks at the same time;
provide child with ASD snacks first
B: Teaching Behaviors- Various teaching strategies are used to
teach replacement behaviors
Ex: teaching pointing or verbal requesting to ask for snacks
C: Consequence Strategies- Differentiating reinforcement
contingent on responding to eliminate inappropriate behavior
and increase behavior tied to the same function
Ex: if child grab snacks with hold snack and attention

When child uses new communication skill give snack and

attention
 Systematic
Desensitization
Systematic desensitization

Systematic desensitization is a behavioral therapy that

uses relaxation techniques and gradual exposure to
help people overcome phobias, anxiety, and other
behavioral issues:
Relaxation training: The patient learns to relax
through techniques like deep breathing, progressive
muscle relaxation, or visualization.
Fear hierarchy: The patient creates a list of their
fears, ranking them from least to most fearful.
Gradual exposure: The patient is gradually exposed
to the feared stimuli, starting with the least anxiety-
provoking situation.
Counterconditioning: The patient learns to associate
relaxation with the feared stimuli, rather than anxiety.
 Mindfulness
Based Therapy
Mindfulness
Mindfulness therapy is a type
of talk therapy that focuses on
learning how to be more
aware of thoughts, feelings,
emotions, surroundings, and
situations, and to reduce
automatic responses.
CBT Therapy
Cognitive behavioral Cognitive behavioral therapy (CBT) can be an effective
therapy (CBT) treatment for children and adolescents with autism
spectrum disorder (ASD):
Helps identify and change thoughts: CBT helps people
CBT is structured into specific phases of
treatment, but it is also individualized to with autism learn to identify and change thoughts that
patients' strengths and weaknesses. Some lead to negative feelings or behaviors.
modifications that can be made to CBT for Improves social skills: CBT can help people with autism
people with autism include:
cope with social situations and better recognize emotions.
• Providing samples of thinking traps and
coping thoughts Reduces anxiety: CBT can help improve anxiety symptoms
in children with autism.
• Using coping “stems” that the client can
personalize Helps manage stress: CBT can help people with autism
• Using special interests as an engagement
learn how to manage and problem-solve situations that
tool, a motivator, or a theme throughout involve uncertainty, change, and difficult peer
therapy relationships.
Helps define triggers: CBT aims to define the triggers of
certain behaviors so the child can identify the scenarios
themselves.
 Other ways to help children with ASD regulate
Emotion regulation (ER) their emotions include:
• Practicing deep breathing
Emotion regulation (ER) therapies for
autism spectrum disorder (ASD) can help • Establishing zones of regulation
people with ASD manage their emotions and
improve their overall well-being. Some • Discussing appropriate reactions
therapies that can help with ER include:
• Cognitive behavioral therapy (CBT): • Modeling appropriate behavior
Can help people change their thoughts
• Mindfulness: Can help people become • Communicating expectations calmly
more self-aware and relax
• Sensory management: Can help people • Acknowledging your child's feelings
manage their emotions
ER is important for people with ASD
• Practicing calming activities
because poor ER can lead to social
limitations, lower responsiveness, and an
• Preparing a special calming place
inability to recognize other people's
emotions
Thank You