As young people on the autism spectrum look ahead towards adult life, they and their families often feel anxious as they think about entering unknown territory. It can be reassuring to know that having an autism spectrum diagnosis does mean that a person cannot enjoy a mentally healthy life in adulthood. The people who come to see me in my psychotherapy practice, where I serve adults and older teens on the spectrum, have taught me that a sense of well-being and peace of mind can be realized by many. Granted, living with an autism spectrum disorder can involve some pretty stressful situations and that is what often leads people on the spectrum and their families to seek help from therapists. Fortunately, anyone who is working to meet the needs of these young people and their families can find guidance in the literature on both positive psychology and cognitive-behavior therapy (CBT). While both areas of evidence-based practice have their roots in “mainstream” mental health (where research has focused on human beings in general), people on the spectrum can benefit greatly from these approaches that can help them find relief from their daily stress while also capitalizing on their strengths (Gaus, 2007, 2011a, 2011b).
Positive Psychology: Guidelines for a Healthy Adult Life
The very characteristics that can make people on the spectrum vulnerable to stress and at risk for problems in daily living are the very same characteristics that contribute to their talents and abilities. When therapy goals are being set, it is important to not only address the problems that are causing distress, but also to highlight the assets and coping strategies that the young adult has already developed before coming into treatment. I have marveled at how incredibly resourceful and clever these individuals can be in designing strategies, often without any help, to negotiate their way through a world that is to them very confusing and threatening. A good treatment plan should always include strategies geared toward helping the young person to recognize the things he or she has already done to successfully adapt and to build upon those self-taught skills. This is consistent with the philosophy of positive psychology.
Positive psychology is a growing field that focuses on enhancing the mental and physical health of human beings by highlighting and strengthening assets (e.g., Seligman, 2011). Researchers and clinicians try to understand the characteristics that are associated with happiness as well as resilience and survival through adverse circumstances. While these efforts have been largely geared toward the general population, professionals working with people on the autism spectrum have also found this approach useful (Gaus, 2011b). One important part of this movement has been a focus on defining autism characteristics as differences, not defects. Autism is not seen as a disease but does give a person a unique way of processing information about the world and the people in it. This philosophy has been helpful to me in my practice with my patients because, while this unique way of perceiving the world does indeed cause some of the problems that bring adults into my office, it also gives them strengths and talents. The positive psychology approach allows me and my patients to use some of the autistic characteristics as tools and assets in the therapy.
One of the most relevant concepts that grew out of positive psychology for adults on the spectrum is the definition of intelligence offered by Sternberg (2003). He suggests that people will be most successful if they possess the skills to do the following:
- Define success in one’s own terms, which may or may not correspond to societal or conventional definitions of success
- Adapt to, modify and choose the environments one is in
- Do all of the above by capitalizing on strengths and correcting or compensating for weaknesses
While this definition pertains to all people, it is very useful to young adults on the spectrum in order to help them clarify their goals and identify obstacles.
Cognitive-Behavior Therapy: Creative Problem-Solving for Adults on the Spectrum
CBT refers to a set of strategies for dealing with mental health problems that has existed for over 40 years and has a huge empirical literature supporting its validity as a psychotherapy approach with neuro-typical patients. This large collection of therapeutic approaches all assume cognitive activity affects emotions and behavior and that people can learn to monitor and alter that activity in order to bring about changes in mood and behavior. CBT has been shown to be effective for a wide variety of mental health problems seen in neuro-typical adults, such as major depression and a variety of anxiety disorders (Butler, Chapman, Forman & Beck, 2006). Because people on the spectrum are at best, not immune to the mental health issues that can affect any adult, and may, in fact, be more vulnerable to some (e.g., Attwood, 2006; Gaus, 2007, 2011a; Ghaziuddin, 2005), they should be offered the same evidenced-based therapeutic approaches that might be offered to anyone.
CBT teaches people to monitor their own thoughts and perceptions with the hopes that they will become more aware of their interpretive errors, but not to change the individual’s entire personality. As with any neuro-typical patient in CBT for a mental health problem, the therapist’s job is to teach the adult with Asperger’s Syndrome/High Functioning Autism (AS/HFA) to identify and modify the cognitive activity that is causing problems in living. For people with AS/HFA, this means to:
- Teach new cognitive and behavioral skills that were never learned
- Teach compensatory strategies for deficits that cannot be changed
- Facilitate self-acceptance
- Teach strategies to decrease or prevent symptoms of co-morbid mental health problems, such as anxiety disorders and depression
Of the many CBT techniques that are useful for people on the spectrum, problem-solving is one of the most versatile sets of tools for a young person to take on the journey into adulthood. Growing out of traditional CBT (D’Zurilla & Goldfried, 1971), problem-solving skills can help people cope with a multitude of stressful events and pitfalls that come at any point across the lifespan. Armed with this step-by-step formula for thinking objectively about dilemmas and conflicts, a young person can manage more independently the complex and often overwhelming world of adult life. There are many versions of the problem-solving steps in the CBT literature, but the following 8-step approach was tailored to meet the needs of adults on the spectrum. When facing an overwhelming situation that, at least initially, seems insurmountable and/or leads to a surge of intense emotions (e.g., “meltdown”), a person who is working on problem-solving skills will be asked to go through the following steps in order to address the issue:
- Identify and define your problem. Ask, “What is bothering me in this situation?”
- Define your goal. Ask, “How do I wish it could be different?”
- Identify the obstacles in the way of your achieving your goal. Ask, “What is getting in my way?” and identify ASD thinking, social, emotional, and sensory/movement differences that might be involved.
- List several possible solutions to address the obstacle(s). Ask, “What are the possible solutions for the obstacle(s)?” List as many as you can think of, no matter how silly some may seem (some psychologists call this step brainstorming).
- Consider the consequences of each solution. Ask, “What are the pros and cons of each solution?” and weigh the best against the least feasible.
- Choose the best solution(s) to try out first. (Please note that reference to psycho-educational and self-help materials on autism characteristics is often needed for a person to independently consider specific thinking, social, and emotional management strategies.)
- Implement the solution and track your progress. Put the solutions in place and come up with an objective way to measure your progress. Remember to measure the goal you set in step 2.
- Evaluate the solution to see if it met the goal you defined in step 2. Ask, “Did the solution meet my goal, or do I need to try a different solution?” Rate how close you got to your goal (stated in step 2) on a scale of 0–100 percent. Celebrate if you met your goal or came close, modify the plan if needed, or go back to step 3 if you have had no progress.
Using this formula to solve problems effectively takes practice. Like any skill, most people need guidance or coaching through many rounds of examples before it will become “second nature.” Therapists, teachers or patient family members may be a good source of this support. Combined with the philosophy of positive psychology, problem-solving skills help young people on the spectrum become active participants in planning their future. Through the approaches described here, these individuals can define their own goals, become more knowledgeable about their own strengths and weaknesses and then use that information to increase life satisfaction.
Dr. Gaus is a licensed psychologist in private practice with offices in Huntington, NY and at Spectrum Services in Manhattan. She is the author of two books on the subject of adult Asperger syndrome: “Living Well on the Spectrum: How to Use Your Strengths to Meet the Challenges of Asperger Syndrome/High-Functioning Autism” and “Cognitive-Behavioral Therapy for Adult Asperger Syndrome.” For more information, you can contact her through her website at www.drvaleriegaus.com.
Attwood, T. (2006). The Complete Guide to Asperger’s Syndrome. London: Jessica Kingsley Publishers.
Butler, A.C., Chapman, J.E., Forman, E.M., & Beck, A.T. (2006). The Empirical Status of Cognitive-Behavior Therapy: A Review of Meta-Analyses. Psychology Review, 26(1), 17-31.
D’Zurilla, T. & Goldfried, M. (1971). Problem Solving and Behavior Modification. Journal of Abnormal Psychology, 78, 107-126.
Gaus, V.L. (2007). Cognitive-Behavioral Therapy for Adult Asperger Syndrome. New York: Guilford Press.
Gaus, V.L. (2011a). Adult Asperger Syndrome and the Utility of Cognitive-Behavioral Therapy. Journal of Contemporary Psychotherapy, 41(1), 47-56.
Gaus, V.L. (2011b). Living Well on the Spectrum: How to Use Your Strengths to Meet the Challenges of Asperger Syndrome/High-Functioning Autism. New York: Guilford Press.
Ghaziuddin, M. (2005). Mental Health Aspects of Autism and Asperger’s Syndrome. London: Jessica Kingsley Publishers.
Seligman, M.E.P. (2011). Flourish: A Visionary New Understanding of Happiness and Well-Being. New York: Free Press.
Sternberg, R.J. (2003). Driven to Despair: Why We Need to Redefine the Concept and Measurement of Intelligence. In L.G. Aspinwall & U.M. Staudinger (Eds.), A psychology of human strengths: Fundamental questions and future directions for a positive psychology (pp. 319-329). Washington DC: American Psychological Association.