Symposia
Autism Spectrum and Developmental Disorders
Megan R. Ledoux, Ph.D.
San Diego State University
San Diego, California
Tana Holt, PhD
Research Assistant
San Diego State University
Austin, Texas
Lauren Brookman-Frazee, Ph.D.
Professor
University of California, San Diego
San Diego, California
Kelsey S. Dickson, Ph.D.
Assistant Professor
San Diego State University
San Diego, California
Background
Several (70-80%) autistic youth meet criteria for co-occurring psychiatric condition(s); therefore, mental health services play a critical role in caring for these youth1. Executive functioning (EF) difficulties present in both autism and co-occurring psychiatric conditions, often increasing mental health symptoms in autistic youth2-4. EF challenges are a barrier to psychotherapy engagement and effectiveness, with therapists reporting limited EF-specific knowledge and training.5 Further information is needed to improve treatment for autistic youth. The current study examined strategies and supports used to accommodate EF challenges during psychotherapy for autistic youth.
Methods
Data were drawn from the first phase of a multi-phase study aimed to adapt and test Unstuck and On Target for implementation in community mental health services. Caregivers (n = 18; 83% female; 11% male) and providers (n = 43; 83% female; 17% male; 45% Marriage and Family Therapists) of autistic youth participated in qualitative interviews and focus groups, respectively. We examined perspectives on strategies used during psychotherapy to address EF challenges. We conducted in-depth coding to identify themes related to key strategies (e.g., visual supports, increased structure, in-session modeling) for specific EF difficulties. Emergent themes were identified by assessing frequency and salience of codes within and across transcripts.
Results
Across both caregivers and providers, strategies to address or accommodate challenges in flexibility (FrequencyProviders = 10; FrequencyCaregivers=21) and organization FrequencyProviders = 7; FrequencyCaregivers=20) were most common. Across EF domains, visual supports (e.g., visual schedules) and other strategies (e.g., scaffolding therapeutic concepts, extending pacing of the intervention) were most frequent. However, caregivers more frequently reported the use of visual support accommodations whereas providers reported more in-session modeling and other strategies.
Discussion
Among EF challenges (e.g., emotion regulation, organization), flexibility was the most frequently targeted EF challenge. Although the most frequent strategy utilized varied across caregivers and providers differed, visual supports, in-session modeling and other strategies are frequently used to address and accommodate EF challenges. Findings point to the importance of specific strategies to address EF, especially flexibility, within the context of psychotherapy for autism.