The application of adapted dialectical behaviour therapy concepts and skills in the treatment of adults with autistic spectrum disorder who display challenging or offending behaviours

Purpose

Despite some advances in the assessment and treatment of autism spectrum disorder (ASD), there remains a paucity of intervention and research literature in treating adults with ASD. There is growing evidence supporting a relationship between the core features of ASD and emotion dysregulation. There is an overlap between ASD and borderline personality disorder (BPD) characteristics such as emotional dysregulation, sensory issues and social skills deficits. This paper aims to explore the applications of dialectical behaviour therapy (DBT) concepts and skills in treating ASD individuals who display challenging or offending behaviours. The similarities in characteristics between ASD and BPD and the core issue of emotion dysregulation hold promise in the utility of DBT with ASD.

Design/methodology/approach

This is a conceptual paper that includes a case vignette.

Findings

A DBT-informed treatment approach using the adaptations and reconceptualization, i.e. risky mind–wise mind outlined in this paper, can be considered promising in addressing issues for ASD individuals, particularly those with challenging and/or offending behaviours. DBT incorporates different elements of applied behaviour analysis, cognitive behavioural therapy, mindfulness skills, sensory-based treatments, psychosocial interventions and emotion regulation skills, which makes it a more cohesive and integrated approach to treatment. The authors assert that DBT can be considered a more integrated, strengths-based, habilitative and trauma-informed approach which can be promising in its application to address challenging behaviours or offending in ASD individuals.

Research limitations/implications

It is recommended that research be carried out to evaluate the effectiveness of adapted DBT programs in treating ASD individuals presenting with challenging and/or offending behaviours. Future research can focus on evaluating the effectiveness of the different DBT concepts and skills and the different DBT modules to determine which components of the program are particularly useful for this client group.

Practical implications

Treatment manuals have already been developed for clients with intellectual disability and developmental disabilities who exhibit challenging and/or offending behaviour; hence, it is recommended that modifications be made to make it more applicable and appropriate for ASD individuals. Modifications should address ASD-specific issues (e.g. black and white thinking, cognitive rigidity, sensory issues, impaired theory of mind, emotion dysregulation issues, social skills deficits and anxiety issues). The use of DBT has much wider implications regarding addressing comorbid mental health conditions and personality issues in this client group.

Originality/value

There are limited psychological interventions that prove to be useful for individuals with ASD with complex presentations and challenging or offending behaviours. This paper discusses the application of adapted DBT concepts and skills that appear to be promising in the treatment of this client group.

Third-wave therapies and adults with intellectual disabilities: A systematic review

BACKGROUND

Third-wave therapies appear to produce positive outcomes for people without intellectual disabilities. This systematic review aimed to establish which third-wave therapies have been adapted for adults with intellectual disabilities and whether they produced positive outcomes.

METHOD

Four databases were searched systematically (PsycINFO, Web of Science, MEDLINE and PubMed), yielding 1,395 results. Twenty studies (N = 109) met the present review's inclusion/exclusion criteria.

RESULTS

Included studies used mindfulness-based approaches, dialectical behaviour therapy, compassion focused therapy and acceptance and commitment therapy. Due to considerable heterogeneity in the designs and outcome measures used, a meta-analysis was not possible.

CONCLUSIONS

Evidence indicated that third-wave therapies improved mental health symptoms for some and improved challenging/offending behaviour, smoking and mindfulness/acceptance skills for most. These findings must be interpreted with caution due to the low methodological quality of included studies. Future research should build on the current evidence base, using scientifically rigorous designs and standardized measures.

A Virtual Reality–Based Psychological Treatment in Long-Term Hospitalization: A Case Study

The aim of this article is to provide preliminary efficacy of a psychological intervention for children and young patients to help them to improve resilience, coping strategies for pain, anxiety, and general emotional discomfort in long-term hospitalization using a virtual reality videogame and telepsychology. A case study illustration in an adolescent was 15-year-old Spanish boy hospitalized in the pediatric ward and prescribed dialysis is presented to provide some clinical evidence of the treatment’s strategic feasibility and efficacy for this population. Patient was pre, post, and follow-up assessed anxiety, affective, resilience, and avoidance. Space Academy is a virtual reality–based treatment with positive psychology and third-wave therapy components that consist in understanding the basic aspects of their disease, to promote emotional perception and regulation and promote and develop resilience. Results show good acceptability and feasibility, improved state and trait anxiety, resilience, and emotional competence in controlling behavior. The case illustration shows improvements in anxiety resilience and acceptance. The use of information and communication technologies in psychology is an advance in clinical and health care psychology.