Cognitive behaviour therapy (CBT) & autism

What is cognitive behaviour therapy (CBT)?

Cognitive behaviour therapy (CBT) is a structured psychological treatment based on the idea that how we think and feel affects how we behave.

CBT helps people recognise unhelpful or unhealthy thoughts and behaviour. It also helps them identify the emotions related to the thoughts and behaviour. People learn to challenge unhelpful or unhealthy thoughts. They can then learn to respond to difficult situations and emotions in ways that improve their mental health and wellbeing.

Who is cognitive behaviour therapy (CBT) for?

Cognitive behaviour therapy (CBT) is mainly used with people aged 7-8 years and above, including autistic children and teenagers. There are some cognitive behaviour programs for parents of young children with anxiety as well.

CBT is a ‘talking therapy’, so people need to be able to understand and use language to do it.

What is cognitive behaviour therapy (CBT) used for?

Cognitive behaviour therapy (CBT) is used to reduce many mental health difficulties and conditions in autistic children and teenagers. These difficulties include stress, worry, anxiety and low mood or depression.

CBT can also improve wellbeing by helping autistic children and teenagers learn how to:

identify, express and respond to emotions in safe and helpful ways, including strong emotions like frustration
identify and challenge unhelpful thoughts so they can look at situations in more helpful ways
manage and problem-solve situations that involve uncertainty, change, difficult peer relationships and so on.

For example, if your autistic child is being teased or excluded, they might feel lonely. They might think that nobody likes them and they’ll never have friends. They might stop taking part in activities that involve other people.

CBT could help your child explore their thoughts and feelings about this situation and look at it differently. For example, ‘It’s not my fault people don’t understand my autism. I’ll be able to find friends who like me for who I am, even though it’s hard now’. CBT would then help the child to problem-solve – for example, by seeking out kind and accepting peers or joining a club that has people with similar interests.

CBT can also help to reduce behaviour that has negative effects on autistic children and teenagers and other people around them. This behaviour includes aggression.

CBT can help children learn some useful social skills, but it shouldn’t be used to encourage autistic children and teenagers to behave in more ‘typical’ ways to fit in. This is called masking. When children and teenagers use a lot of masking behaviour, it can be tiring and stressful for them.

Where does cognitive behaviour therapy (CBT) come from?

Cognitive behaviour therapy (CBT) was developed in the 1960s and 1970s by US psychiatrist Dr Aaron Beck at the University of Pennsylvania.

Dr Beck brought cognitive therapies and behavioural therapies together during his research on depression. He later applied this therapy to many other conditions, including anxiety. CBT has since been adapted and modified for children, including autistic children.

What is the idea behind cognitive behaviour therapy (CBT)?

Cognitive behaviour therapy (CBT) is based on these key ideas:

Our thoughts, feelings and behaviour are interlinked.
Unhelpful ways of thinking and reacting to distressing experiences can increase distress and mental health difficulties.
Challenging unhelpful thoughts and finding more helpful ways of thinking can reduce distress and improve mental health.

What does cognitive behaviour therapy (CBT) for autistic children and teenagers involve?

In cognitive behaviour therapy (CBT) for autistic children and teenagers, a CBT therapist and your autistic child will work together to:

understand your child’s current emotional difficulties, needs, strengths, interests and experiences
set therapy goals that meet your child’s needs
help your child understand how emotional difficulties develop and why sometimes they don’t improve on their own
help your child notice their emotions, thoughts and behaviour, and how they influence one another
build your child’s skills and confidence through safe practice in real-life situations
help your child learn how to identify and challenge unhelpful thoughts and use more helpful thoughts and responses
help your child learn other strategies and skills like problem-solving, relaxation and mindfulness.

CBT is usually offered as individual weekly one-hour sessions for a few weeks or months. For example, your child might do 8-20 sessions.

CBT programs might also be offered in a small group format with 4-8 young people together, usually for 1.5-2 hours once a week for a few weeks or months.

CBT is usually offered in public or private clinics, but it’s sometimes available in schools or other settings. Some practitioners might offer CBT to autistic children and teenagers via telehealth or online. There is currently limited research in this area, but the few studies to date suggest that online CBT is promising.

Does cognitive behaviour therapy (CBT) help autistic children?

Cognitive behaviour therapy (CBT) might help autistic children and teenagers develop skills to regulate their emotions and manage social situations. Some research has shown that CBT might help with anxiety in some autistic children and teenagers.

Research has shown that some autistic children will benefit more when CBT is modified to meet their needs – for example, to suit their language level.

There’s less research on whether CBT helps with depression and low mood. And there’s even less research on CBT’s effects on other conditions like obsessive compulsive disorder or eating disorders like anorexia.

More high-quality research is needed to understand whether CBT helps autistic children and teenagers with intellectual disability and whether it helps with mental health conditions other than anxiety.

Who practises cognitive behaviour therapy (CBT)?

Psychologists, psychiatrists, some GPs with training in mental health, mental health nurses, some counsellors and other therapists who are trained in cognitive behaviour therapy (CBT) can provide CBT.

Where can you find a practitioner?

You can speak with your GP or one of the other professionals working with your child about a referral to a therapist who’s qualified in cognitive behaviour therapy (CBT). It’s best to look for a therapist who’s also experienced in using CBT with autistic children and teenagers.

You can find psychologists by going to:

You can find psychiatrists at Royal Australian and New Zealand College of Psychiatrists – Find a psychiatrist.

You find counsellors by going to:

You could also talk about CBT with your NDIA planner or local area coordinator, if you have one.

Parent education, training, support and involvement

Generally, the younger children are, the more involved you’ll be. Older teenagers might work with a CBT therapist with little or no involvement from you.

You might attend some or all sessions with your child, or you might attend some separate sessions with the therapist. In these sessions, the therapist will help you identify and think about your child’s emotions and thoughts. The therapist will also help you learn CBT strategies and techniques to use at home with your child in everyday life.

Cost considerations

The cost of cognitive behaviour therapy (CBT) sessions varies depending on the session type (individual or group), the session duration, the professional delivering the therapy and other factors. Generally, costs range from $60-300 per hour or session. Group sessions usually cost much less than individual sessions.

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 CBT 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 might best suit your child.