Acceptance and commitment therapy: autism

What is acceptance and commitment therapy?

Acceptance and commitment therapy is a psychological therapy that helps people learn to face challenging situations in healthy and flexible ways.

People doing acceptance and commitment therapy learn how to:

observe and accept difficult feelings and thoughts
live in the present moment
choose how they think, feel and act
recognise what matters to them – that is, their values
do things that match their values.

Acceptance and commitment therapy is sometimes called ACT.

Who is acceptance and commitment therapy for?

Acceptance and commitment therapy can be used with autistic children aged 8 years and older, autistic teenagers and autistic adults, including those with an intellectual disability.

Acceptance and commitment therapy is also used more widely.

What is acceptance and commitment therapy used for?

Acceptance and commitment therapy is used with autistic children and teenagers to encourage positive behaviour and improve mental health and wellbeing.

Acceptance and commitment therapy might help with:

stress
sleeping problems
mental health conditions like anxiety, depression, eating disorders and psychosis
aggressive behaviour and irritability
acceptance of change.

Where does acceptance and commitment therapy come from?

Acceptance and commitment therapy was developed by Dr Steven Hayes and was first used in the mid-1980s.

Acceptance and commitment therapy was initially designed for adults with various mental health conditions and for children and teenagers with challenging emotions and behaviour.

Acceptance and commitment therapy was later adapted to support the wellbeing of parents of autistic children and to help autistic adults with mental health conditions and sleep problems. More recently, it has been adapted for autistic children and teenagers.

Acceptance and commitment therapy is a type of behavioural therapy. It’s based on ideas from mindfulness practice and cognitive behaviour therapy.

What is the idea behind acceptance and commitment therapy?

Acceptance and commitment therapy is based on the idea that it’s natural for people to have difficult thoughts and feelings when they’re facing challenging experiences. This therapy encourages people to recognise and accept these thoughts and feelings, rather than ignoring or trying to change them. This acceptance can make it easier for people to focus on what matters to them and work towards their values and goals.

What does acceptance and commitment therapy involve?

Acceptance and commitment therapy involves helping autistic children and teenagers:

understand why they avoid certain situations
identify their values – for example, a value might be ‘friendship’
make goals based on these values – for example, ‘I want to make friends by getting to know people in my class’
learn to observe their thoughts and feelings – for example, the thought ‘People will think I’m stupid if I talk to them’ or the feeling ‘I feel nervous about talking to people’
learn to respond to their thoughts and feelings in flexible ways that match their values – for example, ‘I can feel this way and do it anyway’
practise mindfulness
build a strong self-identity.

Acceptance and commitment therapy typically involves weekly one-hour sessions with a health professional who practises this therapy, usually a psychologist. Sessions might be one on one or in a group, and a program of sessions might go for 5-16 weeks. There might also be one or more follow-up sessions to check on progress and continue support.

Does acceptance and commitment therapy help autistic children?

High-quality research shows that acceptance and commitment therapy has positive effects in non-autistic adults and children. Therefore this therapy looks promising for autistic children and teenagers.

There has been some research on the use of acceptance and commitment therapy with autistic children aged 8 years and older. This research has shown the therapy has positive effects, but more high-quality studies are needed.

There’s currently no research on whether acceptance and commitment therapy can help autistic children under 8 years.

Children need certain language and communication skills to try acceptance and commitment therapy. You can ask your child’s speech pathologist or a professional trained in acceptance and commitment therapy to check whether your child has the skills they need for this therapy.

Who practises acceptance and commitment therapy?

Some psychologists are experienced in working with acceptance and commitment therapy. Occasionally, psychiatrists, mental health nurses, social workers or other health professionals might also practise this therapy.

It’s a good idea to choose professionals who are trained in acceptance and commitment therapy and have experience working with autistic children and teenagers.

Where can you find a practitioner?

You can find psychologists by going to:

If you’re interested in acceptance and commitment therapy, it’s a good idea to talk about this therapy with your GP or a health or educational professional working with your child. You could also talk about it with your NDIA planner or local area coordinator, if you have one.

Parent education, training, support and involvement

If your child is taking part in acceptance and commitment therapy, you’ll be actively involved. This might include:

taking your child to appointments
attending sessions with your child
working with the psychologist or other health professional to develop your child’s program and customise it to your child’s values, needs and strengths
learning how to help your child practise the therapy at home
completing questionnaires about your child’s behaviour to track your child’s progress.

Cost considerations

The costs of acceptance and commitment therapy are usually the cost of sessions with a psychologist or other health professional. These costs vary across professionals and can depend on whether sessions are one on one or in a group.

Your child might be eligible for Medicare rebates through a formal mental health treatment plan.

You can contact the NDIS to find out whether you can include the cost of acceptance and commitment therapy in your child’s NDIS plan.

Therapies and supports for autistic children range from behavioural therapies and developmental approaches to medicines and alternative therapies. When you understand the main types of therapies and supports for autistic children, it’ll be easier to work out the approach that will best suit your child.