CO-OCCURRING ASD & OCD: TREATMENT IMPLICATIONS - REBECCA SACHS PHD ABPP
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CO-OCCURRING ASD & OCD: TREATMENT IMPLICATIONS REBECCA SACHS PHD ABPP INFO@CBTSPECTRUM.COM
• Autistic
• On the Spectrum
AUTISM • Person with Autism
SPECTRUM
DISORDERS • Asperger’s Syndrome/Aspie
https://autisticadvocacy.org/about-asan/identity-first-
language/
https://www.autism.org.uk/about/what-is/asperger.aspx
AUTISM SPECTRUM DISORDERS
Developmental Spectrum & severity Deficits in social- Restricted, repetitive
Disorder- Lifelong level rating: how much communication & social patters of behavior,
support is needed interaction interests
Social-emotional reciprocity Repetitive motor movements,
Nonverbal communication use of speech
Developing, maintaining & Insistence on sameness,
understanding routines & rituals
relationships/social contexts Highly restrictive, fixated
interests, abnormal in
intensity/focus
Sensory sensitivities
Children with ASD Become Adults with ASD
Children & Adults with ASD Have Similar Mental
Health Problems as Typical Adults
WHY WE ARE
TALKING Children & Adults with ASD experience
Psychopathology at Higher Rates
ABOUT THIS
People with ASD Can Benefit from
Psychotherapy
Symptoms of Autism Can Present in People Who
Have Strong Cognitive & Verbal Abilities
Teach new cognitive & behavioral skills that
were never learned (including those to
decrease/prevent OCD, such as ERP and other
co-occurring mental health problems)
PHILOSOPHY OF
Teach compensatory strategies for
CHANGE deficits/differences that cannot be changed
(including self-advocacy)
Facilitate self-acceptance
SEVERITY LEVEL SOCIAL COMMUNICATION RRB
Level 3: Requiring very Severe deficits in verbal and Inflexibility of behavior, extreme difficulty coping
substantial support nonverbal social communication with change, or other rrb that markedly interfere
that causes severe impairment in with functioning in all spheres. Great
functioning. distress/difficulty changing focus/action.
Level 2: Requiring substantial Marked deficits in verbal and Inflexibility of behavior, difficulty coping with
support nonverbal social communication; change, or other RRB that appear frequently
impairments apparent even with enough to be obvious and interfere with
supports in place. functioning in a variety of contexts.
Distress/difficulty changing focus/action.
Level 1: Requiring support Without supports in place, deficits Inflexibility of behavior causes significant
in social communication cause interference with functioning in one or more
noticeable impairments. contexts. Difficulty switching between activities.
Problems of organization and planning hamper
independence.From: Cognitive Behavioral Therapy for Adults with Autism Spectrum Disorder: 2nd Ed., Guilford Press by Valerie L. Gaus
SMART GOALS & PAYOFF MATRIX
Specific (clear, concrete, well defined)
Measurable (observed and tracked over time)
Attainable (can actually be achieved)
Relevant (important & meaningful to you)
Time-bound (specific amount of time when something is
going to happen)WHY DO A FUNCTIONAL
ASSESSMENT?FUNCTION &
REINFORCEMENT
• All behaviors are functional
• Behaviors happen and are maintained
for a reason
• Not manipulative. Rather, they “work”
or serve a purpose
• Sensory
• Escape
• Attention
• Tangible
• (Medical)MOTIVATION Negative Reinforcement • Getting out of something bad/escape May be atypical • “Don’t you want to ….” Positive Reinforcement • Getting something wanted May be atypical • Social motivation may be different.
ASSESSMENT OF SKILLS &
CHALLENGESFrom: https://www.aa ne.org/asperge r-profile-big- picture- challenges/
ADAPTIVE SKILLS CHALLENGES • Need for increased independence in terms of self-care, daily living skills and community skills • Money management • Medical care • Access to services and support • Travel Readiness • Perspective taking & understanding the value of effective strategies in terms of impact upon professional and social functioning
KEEP ACCOUNTABLE & SLOW THE PACE
Antecedents Consequences
Communicating Expectations Incorporating RF
• Visual agenda- keeping tasks & • Labeled praise/Tangible/Privilege
expectations concrete & visual • Get out of something*
• Draw on your CBT • Reinforcement should serve
experiences (like scheduling similar function of behavior
behavior activation & behavioral (attention, tangible, escape,
contracts) sensory)CONSISTENT METAPHORS & INCORPORATING
PREFERRED INTEREST
Incorporating preferred
interests (therapist may
Use consistent metaphors
need need to do their
week to week
“HW” on this) but keep it
balanced
You can capitalize on the
Remember your goal is to special interest *it can be so
approach vs. avoid
powerful!ESCAPE: “I CAN’T HANDLE IT”
DEALING WITH EMOTIONS…
This Photo by Unknown Author is licensed under CC BY This Photo by Unknown Author is licensed under CC BYFrom: Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents Oxford by Ehrenreich-May et al.
ACCESSING THE RIGHT SUPPORTS
(ALL THE FUNCTIONS)Premack’s Principle (Grandma’s Rule)
Asking for help
SKILLS TO Problem Solving
TEACH & Self Advocacy & Assertive Communication
MODEL • Fact-Feeling- Fair Request
• When I see/hear _____, I feel ______, because ______. So I
would like ________
Reflective Listening
• What I’m hearing you say is _________. Did I understand
you?FAMILY ACCOMMODATION VS ADVOCACY
RESOURCES • https://www.spectrumnews.org • https://www.aane.org • https://www.socialthinking.com Books • Spectrums • Autism: What Does It Mean to Me?: A Workbook Explaining Self Awareness and Life Lessons to the Child or Youth with High Functioning Autism or Asperger A Workbook Explaining Self Awareness and Life Lessons to the Child or Youth with High Functioning Autism or Aspergers • Living Well on the Spectrum: How to Use Your Strengths to Meet the Challenges of Asperger Syndrome/High-Functioning Autism How to Use Your Strengths to Meet the Challenges of Asperger Syndrome/High-Functioning Autism • The Hidden Curriculum for Understanding Unstated Rules in Social Situations for Adolescents and Young Adults • Uniquely Human: A Different Way of Seeing Autism • Cognitive-Behavioral Therapy for Adults with Autism Spectrum Disorder, Second Edition Second Edition
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