CT with Aspberger's syndrome in adolescents and young adults

Regarding using CBT for adolescent/young adult patients, with Asperger's Disorder---this is a continuing issue and a very tricky one for our anxiety and mood disorders service. I run cognitive behavioral groups for adolescents (13-17 years) and young adults (18-25 years) with social phobia, along with both individual and group treatment for younger kids with this disorder. The number one clinical confound to effective treatment in our CBT groups is the Asperger's patient. We have to deal with this on many levels. First, it takes lots of work to educate our referral sources (and our own intake staff) that "social skills deficits" is not the equivalent of social phobia. For some reason, even if the Asperger's is the primary (most disabling and interfering condition) the doc's are trying to push these kids through to us as social phobic youth. They want our social groups because we have a social skills component within our exposure sessions, but this is not enough for an Asperger's individual.

Next, inclusion of the Asperger's individual, depending on the severity of the symptoms, can exert a powerful negative effect on the group as a whole. Essentially, the social phobic youth (who are told "you all share this problem of social anxiety; what evidence do you have that others think you look and act wierd; what evidence do you have that you'll be rejected by others because of your social anxiety symptoms?) are confronted with confirmation of their worst fears by seeing what they think is a mirror image of themselves in the Asperger's individual.

For the youth with Asperger's, we find that the cognitive restructuring component is very difficult and instead we have to be much more 'behavioral' in doing repetetive social skills training and use lots of behavioral shaping of their within group behaviors. Maybe because these are kids or young adults and their cognitive developmental skills are affected, I don't know, but the Asperger's patients have great difficulty trying to dispute irrational thoughts. Their thinking is very concrete, perseverative, and focused often on irrelevant issues/ideas that miss the big picture. I have relied on social skills protocols for inpatient schizophrenics (Becker and Heimberg; Bellack) for guiding this work, and now try to send these referrals to our "PDD/Social skills group" with emphasizes adaptive social functioning with managing anxiety as a part of this program (not the main course).

Most troubling is when an Asperger's youth has been referred to us for our social phobia group, and they may be 13 years or older, and the parents have never been told the primary diagnosis is PDD. They are given a build up of CBT's effectiveness for their child's anxiety problem, but upon doing our anxiety workup we see a very different (and sometimes devastating) diagnosis warranting a different treatment.

I'm very interested in the experience of other list members.

Replies:

Re:CT with Aspberger's syndrome in adolescents and young adults, by Tim Williams, 07/06/01 Re:CT with Aspberger's syndrome in adolescents and young adults, by bmmadaus@yahoo.com, 10/02/01

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