1. Debra Myers, School Psychologist/BCBA
Using Cognitive Behavior Therapy Techniques with Individuals with Autism Spectrum Disorders
Presented by
Michelle Antle, Ed.S. &
Debra Myers, School Psychologist/BCBA

2. Objectives
Participants will understand the definition of Cognitive Behavioral Intervention (CBI).
Participants will understand the strengths and limitations of using these strategies.
Participants will be given several examples of CBI strategies designed for individuals with autism.

3. Cognitive behavioral intervention (CBI)
New EBP in 2014 identified by the National Professional Development Center on Autism Spectrum Disorders
One of the twenty-seven evidence-based practices.

4. Relaxation Exercises Deep breathing

5. Let’s Practice Get comfortable Dim the lights
Listen to the instructions
See handouts

6. What is Cognitive Behavior Intervention? (CBI)

7. CBI Defined
Instruction on management or control of cognitive processes that lead to changes in overt behavior (Wong, Odem, Hume, Fettig, Kurcharzyk, Plavnick, Feury, & Schultz 2014)
Based on belief that behavior is mediated by cognitive processes. Intervention will emphasize teaching individuals to monitor and mange their own thoughts, feelings, and behaviors.

8. It is based on the belief that behavior is mediated by cognitive processes.
Learners are taught to examine their own thoughts and emotions, recognize when negative thoughts and emotions are escalating in intensity, and then use strategies to change their thinking and behavior.
Tend to be used with learners who display problem behavior related to specific emotions or feelings, such as anger or anxiety
Are often used in conjunction with other evidence-based practices including social narratives, reinforcement, and parent-implemented interventions
Brock, M. E. (2013). Cognitive behavioral intervention (CBI) fact sheet. Chapel Hill: The University of North Carolina,
Frank Porter Graham Child Development Institute, The National Professional Development Center on Autism
Spectrum Disorders.

9. Age Range:
CBI has been effective for elementary school-age learners (6-11 years) to high school-age learners (15-18 years) with ASD.
Outcomes:
CBI can be used effectively to address social, communication, behavior, cognitive, adaptive, and mental health outcomes.
Brock, M. E. (2013). Cognitive behavioral intervention (CBI) fact sheet. Chapel Hill: The University of North Carolina,
Frank Porter Graham Child Development Institute, The National Professional Development Center on Autism
Spectrum Disorders.

10. Cognitive Behavior Therapy
Typically used for people with anxiety, depression, anger management issues
Research also supports its use with mood disorders, anxiety disorders, personality disorders, eating disorders, substance abuse disorders, sleep disorders and psychotic disorders
Examines the relationships between thoughts, feelings and behaviors.
Considered to be an “Active” intervention because individuals must work and practice outside of therapy sessions
National Association of Cognitive-Behavioral Therapists (2014)

11. Five Common Guiding Principles
Collaborative effort between client and therapist
Promotes self-efficacy to tolerate emotions & change behavior.
Short-term & directive.
Present focused & goal oriented.
Monitors progress toward goal.

12. Historical bases for CBI
Cognitive therapy (Bandura, Ellis, Beck)
Behavior therapy (Pavlov, Thorndike, Skinner)
Adult intervention

13. Considerations Functioning level Comprehension abilities
Age/Developmental level
Willingness to change behavior
Motivation
Parent involvement

14. Tips for Using CBI with Kids
Concrete & tangible
Match methods to intellectual abilities
Incorporating lessons into play routines
Use of visual supports “See it before they believe it”
Have the child summarize frequently to gauge level of understanding
Modeling, behavioral rehearsal, & Cognitive Rehearsal
Practice more than weekly

15. CBI Strategies Cognitive restructuring Coping skills Problem-solving
Maladaptive thoughts leads to negative reactions; therefore, the goal is to replace them with more appropriate/adaptive beliefs
Coping skills
Self-control, relaxation, stress inoculation training
Problem-solving
Identify the problem, clarifying goals, generate possible solutions, evaluate possible outcomes, & implement solutions
Exposure-based strategies
Systematic desensitization, response prevention

16. CBI Strategies
Some need more explicit training in order to implement as an intervention
Others can be implemented within the school setting
Mainly one-on-one implementation
Need for generalization to be planned

17. How will this work for individuals with Autism?

18. Consider what we know about individuals with Autism
Very literal and concrete
Detail-oriented
Visual Learners
Difficulty with comprehension
Difficulty with problem-solving
Difficulty with generalization

19. Strengths of CBT Very instructive Shorter-term Structured
Can be researched
Can be adapted

20. Limitations
Need to commit yourself to the process. (A therapist can help and advise, but cannot make problems go away without co-operation)
Have to attend regular CBT sessions and carry out any extra work between sessions
As CBT can involve confronting emotions and anxieties, one may experience initial periods where they may be more anxious or emotionally uncomfortable.
CBT focuses on the individual’s capacity to change themselves (their thoughts, feelings and behaviors), and does not address wider problems in systems or families that often have a significant impact on an individual’s health and well-being.
National Association of Cognitive-Behavioral Therapists (2014)

21. Examples of CBI for Individuals with Autism Spectrum Disorders

22. Cognitive Restructuring
Procedure
Assumes that maladaptive thoughts lead to negative reactions; therefore, these thought patterns are challenged and the goal is to replace the thoughts with more appropriate and adaptive beliefs.

23. Meaning or Interpretation
Examples
Event
Meaning or Interpretation
Reaction
Lose car keys
“I am such an idiot!”
Feelings:
Depressed
Embarrassed
Frustrated
Coworkers did not invite to lunch
“They don’t like me”
Rejected
Angry
Paranoid
Some irrational thought can be productive.

24. There is always another point of view

25. Coping Skills

26. What is a Social Narrative?
Short stories that define a social situation
Uses child-friendly vocabulary
Suggests a more appropriate response than the current inappropriate behavior being exhibited by the child
Presents situations to the child that
can be more easily understood.

27. Carol Gray coined and marketed the term “Social Story”
Gray describes Social Stories as:
“a process that results in a product.”
“Process” = a better social understanding and consideration of the child’s perspective
“Product” = the Social Story that defines situations, concepts, or social skills

28. Picture the Goal Purpose is to share relevant social information
Use visual or concrete references to explain abstract concepts
Remember:
The goal is to change the response of the child to a more appropriate response
Share meaningful information in a way that he/she can comprehend

29. “Using My Words”
Many kids like to spend time with their Mom and friends. They like it when I talk to them using my words instead of my hands. When I’m with my Mom or friends, I will try to keep my hands to myself and use my space ruler. When I want them to look at me I will try to say “Excuse me.” This is a good idea. My friends and my Mom like it when I give them their space and use my words.

30. Paper Fortune Tellers Exploring Upsetting Emotions
All or Nothing Paper
Anxiety
Social Anxiety
Conversation & Social Skills
Conversation Starters
Emotions
Compliments
Teasing

31. To make them:
Use this print setting: Fit
Cut out all four sides of the perimeter of the Fortune Teller.
Fold them. This young girl on YouTube can show you how:
Start folding with the printed side facing down.

32. Relaxation Techniques

33. Type of Relaxation
Brief Description
Diaphragmatic Breathing or Deep breathing
the practice of expanding your diaphragm as you breath, so that your stomach rises and falls, instead of your chest
Progressive Muscle Relaxation
Alternating between tense and relaxed muscles help to induce full-body relaxation
Autogenic Training
A technique similar to mediation, where you repeat a series of statements to yourself about different parts of your body o influence the functioning of your autonomic nervous system, which includes your heart rate
Guided Imagery
Involves using all of your senses to imagine yourself in a relaxed setting. Your body, in turn, enters a relaxed state

34. Example Deep breathing

35. Examples Deep breathing
( 3 minutes)
Progressive Muscle
(13 minutes)
Autogenic Training
(10 minutes)
Guided Imagery
Deep Relaxation through Guided Imagery and Relaxation Music (15 min)
Guided Imagery: Ocean Escape (WITH Music) (10 minutes)
Guided Imagery and Music Helps Kids who have Autism and Aspergers Relax and Fall Asleep (5 minutes)

36. Let’s Practice Get comfortable Dim the lights
Listen to the instructions
See handouts

37. Problem-solving Skills

38. SODA Method
1. Situation - look at the situation. (Describe the problem.)
2. Options - list as many choices as you can. (Ways to solve the problem)
List at least three.
3. Disadvantages - list as many disadvantages
(negative things that could happen) of each option as you can. List at least three.
4. Advantages - list as many advantages (positive things that could happen) of each option as you can.
5. Solution - based on the advantages and
disadvantages, select the best option

39. Let’s Practice Get into pairs Identify a problem for one person
Apply the SODA method

40. What is the Incredible 5-Point Scale?

41. Where did this come from?
The Incredible 5-Point Scale was introduced in 2003 as a method of teaching social understanding to students with Autism Spectrum Disorders and similar challenges.
Since that time they have learned a lot more about why the scale works and how to use them in a variety of situations and environments.
A primary goal of the scale is to help students notice and respond to their own and others’ social behaviors.
Buron, Kari Dunn (2012). The Incredible 5-Point Scale. Shawnee Mission, KS: AAPC Publishing.

42. So ultimately it teaches INDEPENDENCE!!!!
The objective of this scale is to teach social and emotional information in a concrete, systematic, and non-judging way.
It can also be used to teach self regulation skills and perspective taking.
So ultimately it teaches INDEPENDENCE!!!!
People with Autism Spectrum Disorders appear to learn most effectively through predictable, visual systems.
**The 5-Point Scale is a predictable visual system**
Buron, Kari Dunn (2012). The Incredible 5-Point Scale. Shawnee Mission, KS: AAPC Publishing.

43. With this scale, parents have a simple, yet effective way to teach social rules and expectations and to problem-solve behavioral responses of others, troubleshoot past and future social scenarios, and create plans for self-management.
Buron, Kari Dunn (2012). The Incredible 5-Point Scale. Shawnee Mission, KS: AAPC Publishing.

44. STRENGTHS
Once a scale is developed, situations can be addressed across settings and across peoples so there is common vocabulary for all.
GENERALIZATION INDEPENDENCE
This concept can be used with verbal AND non-verbal students.
This concept can also be used in different sized steps also based on the skill being taught.

45. Incredible 5 Point Scale
Breaks down a concept / behavior into 5 concrete levels, 1 - 5, often differentiated by intensity.
There is mutual agreement to what each number represents.
Helps your child (& you) better understand what is being asked and how to adjust behavior accordingly

46. Buron, K. D. “A 5 Can Make Me Lose Control.”

47. Using Visual Supports

48. AutismTeachingStrategies.com
Here are dozens of free autism social skills teaching resources, most with free pdf downloads.  The resources vary in difficulty and can be used for children between age 6 and age 18. 

49. AutismTeachingStrategies.com Emotion Cards: ‪http://bit.ly/1cA6bBH
Simple CBT Picture Panels: ‪
Poison Thought Bubbles: ‪
CBT Worksheets: ‪
Mint New Thoughts: ‪
Help Upset Kid Activity: ‪
Filter Angry Thoughts: ‪
Worry Cards: ‪
Flexibility Cards / Panels: ‪

50. AutismTeachingStrategies.com Nonverbal Prompts: ‪http://bit.ly/Ke1ovE
Listening Prompt Sheets: ‪
Green Zone Worksheets: ‪
Pie Chart Visuals: ‪
Using balance for reciprocity: ‪
All About Me Signs: ‪
Chain & Building Visuals: ‪
Talk to Family Picture Sheets: ‪
Conversation Box: ‪
Validating Word Cards: ‪
Compliment Maker: ‪
Words Hurt / Words Help Sheets: ‪
Self-Control Meters: ‪
Dealing with Losing Panels: ‪

51. Guided Imagery Ocean Escape with Music (10 minutes)

52. Questions?

53. Resources Shaul, J. AutismTeachingStrategies.com
Briers, S. (2012). Brilliant Cognitive Behavioral therapy – Second Edition. New York: Pearson Publishers.
Brock, M. E. (2013). Cognitive behavioral intervention (CBI) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, The National Professional Development Center on Autism Spectrum Disorders.
Buron & Curtis. (2003). The incredible 5-point scale. Shawnee Mission, KS: Autism Asperger Publishing Company.
Scarpa, White,& Attwood (2013). CBT for children and adolescents with high-functioning autism spectrum disorders. New York: Guilford Press.
Wong, Odem, Hume, Cox, Fettig, Kurcharczyk, Brock, Plavnick, Fleury, & Schultz. (2014). Evidence-based practices for children, youth, & young adults with ASD. Chapel Hill: University of North Carolina, Frank Porter Graham Child Development Institute, Autism Evidence-based Review Group.