This document discusses psychotherapeutic approaches for helping adults with intellectual disabilities and autism spectrum conditions. It provides general principles for psychotherapy with this population, such as not expecting narrative awareness, simplifying language, and being aware of potential anxiety that may not be expressed. Challenges like co-occurring medical conditions, sensory issues, information overload, and marginalization are addressed. Identity issues and the search for self are also discussed. Effective psychotherapy is described as not relying on any single modality, addressing misunderstandings, and reconstructing others' perspectives.

1. Psychotherapeutic approaches to
helping adults with intellectual
disability and autism spectrum
conditions
Digby Tantam,
Septimus Ltd.,
Universities of Sheffield, and
Cambridge
22 May RSM
2012

2. Further information

3. Autistic syndrome Restricted repetitiveness
(DSM-5)
Impaired social communication
and social interaction
(DSM-5)
Language impairment
22 May RSM
2012

4. Associated conditions Restricted repetitiveness
(DSM-5)
Impaired social communication
and social interaction
Epilepsy
(DSM-5)
ADHD
Tourette, dyspraxia,
agnosias
Intellectual disability
Language impairment
22 May RSM
2012

5. Consequential conditions Restricted repetitiveness
(DSM-5)
Impaired social communication
and social interaction Epilepsy
(DSM-5)
Sensory issues,
ADHD
Information overload,
melt downs
Anxiety-related disorder
Tourette, dyspraxia,
agnosias
Victimization
Marginalization Intellectual disability
Language impairment
The search for the self
22 May RSM
2012

6. General principles of
psychotherapeutic work in ASD
• Do not expect narrative awareness or
autobiographical memory
• Do not rely on signs of attention
• Simplify language but not ideas
• Look for other communication media
• May be easier to translate and then
respond in action e.g. change carer
behaviour than to communicate
• Role blurring
– Advocate
– Advisor
– Carer
22 May RSM
2012

7. Autistic syndrome Restricted repetitiveness
(DSM-5)
Impaired social communication
and social interaction
(DSM-5)
Enter the other’s world, but
do not expect intersubjectivity
Be aware of the importance of the past and look for
commemorative activities
Provide predictability (may achieve this through
behavioural means e.g. ABC approach)
Be aware that anxiety—and frustration– may not be
expressed
Do not assume that a lack of social interaction is a
Language impairment
lack of interest
Value peer support
22 May RSM
2012

8. Autistic syndrome Restricted repetitiveness
(DSM-5)
Impaired social communication
and social interaction
(DSM-5)
Consider sameness to be a means of achieving comfort through
predictability
An increase in repetition may indicate anxiety
An appropriate balance must be struck about how much comfort is
appropriate
Rituals may be commemorative and acts of iImaginative
reconstruction that are open to involvement and modification by kindly
others
Special interests provide quality of life
OCD and hoarding involve an additional element of folie de doute, or
warding off
Rituals may come to be weapons
Language impairment
22 May RSM
2012

9. Autistic syndrome Restricted repetitiveness
(DSM-5)
Impaired social communication
and social interaction
(DSM-5)
Language, verbal IQ, and intellectual disability are correlated
Alternative means of communication may be useful
People with ID may develop simplifying concepts that can be
effective tools e.g. the open and closed face
Written language may sometimes be more comprehensible
Processing may take longer, but get there in the end
Apparent verbal fluency may be deceptive: it’s understanding not
language that matters
Psychotherapy may be a matter of connecting the dots…
Language impairment
22 May RSM
2012

10. Associated conditions Restricted repetitiveness
(DSM-5)
Impaired social communication
and social interaction
Epilepsy
(DSM-5)
Learning from the EE literature ADHD
Understanding impersistence
Cueing attention Tourette, dyspraxia,
agnosias
Dysexecutive Autistic syndrome
How does Dad handle it?
Intellectual disability
Language impairment
22 May RSM
2012

11. Consequential conditions Restricted repetitiveness
(DSM-5)
Impaired social communication
and social interaction Epilepsy
(DSM-5)
Sensory issues, Meltdowns are catastrophic reactions.
ADHD
Information overload,
melt downs They can only be prevented when tension Is at an early
stage but may then be unrecognizable unless individual
Anxiety-related disorder prodrome is known
Tourette, dyspraxia,
Victimization A sensory assessment may be helpful, agnosias Include
but should
information demands
Marginalization Intellectual disability
Language impairment
The search for the self
22 May RSM
2012

12. Consequential conditions Restricted repetitiveness
(DSM-5)
Impaired social communication
and social interaction Epilepsy
(DSM-5)
Sensory issues, The risk of a person with an ASD being bullied is
ADHD
Information overload, 7 times greater relative to the risk of a neurotypical
melt downs child of the same age
Anxiety-related disorder
Tourette, dyspraxia,
agnosias
Victimization
Marginalization Intellectual disability
Language impairment
The search for the self
22 May RSM
2012

13. Consequences of bullying
• Passive failure to be
included
– Reduced use of
community resources
(social exclusion)
– Experience of being
unwanted/marginalized
• Active rejection ,
blaming, scapegoating
Painted Bird by Edward
– Stigma as a means of Gafford, inspired by the
keeping threatening novel ‘Painted Bird’ by
Jerzy Kosiński, itself
Other at a distance
based on what has been
– Bullying claimed is a fictive war-
time experience of the
author in Poland

14. Consequential conditions Restricted repetitiveness
(DSM-5)
Impaired social communication
and social interaction Epilepsy
(DSM-5)
Sensory issues,
ADHD
Information overload,
melt downs Making an impact:uproar, aggression,
weaponizing
Anxiety-related disorder
Containing the risk so that non-reinforcement is
Tourette, dyspraxia,
possible agnosias
Victimization
Marginalization Intellectual disability
Language impairment
The search for the self
22 May RSM
2012

15. 22 May RSM
2012

16. Consequential conditions Restricted repetitiveness
(DSM-5)
Impaired social communication
and social interaction Epilepsy
(DSM-5)
Sensory issues,
ADHD
Information overload,
melt downs Identity borrowings
Anxiety-related disorder Providing a healthy identity
Tourette, dyspraxia,
agnosias
Victimization
Marginalization Intellectual disability
Language impairment
The search for the self
22 May RSM
2012

17. Coping with a lack of identity
• Fads
• ‘Obsessive’ relationships
• Lack of identity in many people with ASD
– Adopting identity wholesale
– Joining charismatic groups
– Moving places and work
• Searching for identity
– ‘Transexualism’
– ‘Aspie’
• Identities off the peg
– Gangster
– Professor
– Teddy bear
22 May 2012 RSM

18. Consequential conditions Restricted repetitiveness
(DSM-5)
Impaired social communication
and social interaction Epilepsy
(DSM-5)
Sensory issues,
ADHD
Information overload,
melt downs
Anxiety-related disorder
Tourette, dyspraxia,
agnosias
Victimization
Marginalization Intellectual disability
Language impairment
The search for the self
22 May RSM
2012

19. ‘Proper’ psychotherapy
• No particular modality is better than another, although person-
centered is good
• Limited value for CBT (assumes ‘lexithymia’)
• Do not expect working through
• Social predicaments are relatively less common than in general
psychotherapy
• Ruminations may be an issue
– E.g. issues of injustice
• Misunderstandings may be an issue
– E.g ‘You’ll be the death of her”
• May require the reconstruction of another person’s perspective
Practical advice may also be required
• 22 May RSM
2012

20. The end.
Thanks for listening.
Slides at www.
22 May RSM
2012

21. Consequential conditions Restricted repetitiveness
(DSM-5)
Impaired social communication
and social interaction Epilepsy
(DSM-5)
Sensory issues,
ADHD
Information overload,
melt downs
Tourette, dyspraxia,
agnosias
Victimization
Marginalization Intellectual disability
Language impairment
The search for the self
22 May RSM
2012