As a psychotherapist working with adults on the autism spectrum, I’ve observed how traditional therapeutic approaches sometimes miss the mark in addressing their unique needs. Today I want to share relevant information in this area – modified schema therapy for autism spectrum disorders (ST-MASC), an innovative approach that respects neurodiversity while providing effective mental health support.
Autism spectrum disorders according to ICD11
The International Classification of Diseases ICD-11 makes significant modifications to the approach to diagnosing autism spectrum disorders, compared to the DSM-5 classification. These changes reflect the modern understanding of autism as a complex and multidimensional disorder.
The ICD-11 places particular emphasis on the fact that autism is not a uniform condition, but a continuum of diverse difficulties. This means that symptoms can occur with varying severity and in different combinations. For example, one person may experience significant difficulties in social communication with relatively little stereotypic behavior, while the opposite may be true for another.
In the ICD-11 International Classification of Diseases, autism spectrum disorder (Code: 6A02) is found in the division: neurodevelopmental disorders, subcategory: autism spectrum disorders.
ICD11 Main Diagnostic Criteria
- Deficits in Social Interactions:
- Difficulties in initiating and sustaining social interactions.
- Problems understanding nonverbal signals.
- Challenges in adapting behavior to different social contexts.
- Difficulties in developing and maintaining relationships.
- Patterns of Behavior and Interests:
- Restricted, repetitive patterns of behavior.
- Rigid attachment to routine.
- Specific interests with high intensity.
- Unusual responses to sensory stimuli.
Levels of Severity
The ICD-11 distinguishes three main areas of functioning:
- Intellectual Functioning:
- Without intellectual impairment.
- With intellectual impairment.
- Language Functioning:
- With language disorders.
- Without language impairment.
- Level of Support Required:
- Requiring support.
- Requiring substantial support.
- Requiring very significant support.
Diagnosis vs. therapy for people on the spectrum
This expanded approach allows for a more precise diagnosis and a better understanding of the individual needs of a person with ASD, which translates into the ability to offer more effective therapeutic support.
The new approach in ICD 11 offers greater flexibility in assessing symptoms, taking into account:
- The varied developmental course of individuals on the autism spectrum.
- The different ways in which the same underlying characteristics manifest.
- The possibility of changes in the clinical picture over time.
- Individual adaptive strategies.
Significant changes, in the context of planning the therapeutic process:
- Enable more precise tailoring of support to individual needs.
- They make it easier to recognize ASD in different cultural groups.
- They allow a better understanding of changes in the clinical picture over time.
- They support a more holistic approach to diagnosis and therapy.
Why do we need a different approach in therapy planning?
Many adults with ASD experience co-occurring mental health issues, traditional therapy approaches do not always take into account their unique perspectives and needs. This can be compared to trying to use a GPS system designed for cars to navigate a boat – while some principles may work, the specific needs are quite different.
Co-occurring symptoms and personality disorder
In my practice, I often encounter adults with ASD who have developed specific personality patterns. as adaptive responses to their life experiences. What many people don’t realize is that these patterns, while protective in nature, can sometimes develop into personality disorders that require specialized therapeutic intervention.
Recent studies show that up to 62% of adults with ASD in clinical settings exhibit personality disorder traits. This statistic is not just a number – it represents real people struggling with real challenges that traditional therapeutic approaches sometimes fail to address.
Schema therapy for patients with ASD
Traditional therapeutic approaches often fail to address the unique needs of people with ASD. The effectiveness of Schema Therapy lies in its integrated approach. Schema Therapy (in the form of ST-MASC Schema Therapy Modified for Autism Spectrum Conditions) was developed precisely with these specific requirements in mind.
What makes this approach unique? Schema therapy recognizes two key elements that traditional autism therapy often overlooks:
- Autism-specific needs.
In addition to basic emotional needs, autistic people often need:
- Support in recognizing and regulating emotions.
- Predictable routines and environments.
- Assistance in managing sensory experiences.
- Freedom to pursue special interests.
- Practical guidance for navigating social situations.
2. Various coping strategies.
This approach recognizes that people on the spectrum develop unique ways of coping with their experiences. Some may mask their autistic traits, others may avoid difficult situations, and some may fully accept their natural way of being. None of these strategies is inherently good or bad – what matters is whether they help or hinder overall well-being and functioning
Moving beyond symptom reduction
Instead of trying to “fix” autism traits, schema therapy (in the form of ST-MASC) focuses on understanding each person’s unique needs and helping them develop strategies that work for them. It’s like having a personalized road map, rather than trying to follow someone else’s directions. The goal is not to make someone seem more “typical,” but to help them grow as a person while dealing with the real challenges they face. This may mean finding ways, for example, to cope with sensory overload while participating in valued activities, or developing social strategies that seem authentic rather than forced.
What does this mean for therapy ?
In practice, psychotherapy becomes more flexible and individualized. Instead of following rigid protocols, we work together to understand what works for each person. Therapy for autism spectrum disorders includes:
- Identifying which coping strategies are helpful and which are harmful.
- Finding ways to address both emotional and autism-specific needs.
- Developing ways to deal with difficult situations that are authentic and more compatible with the person with ASD.
- Building on existing strengths rather than just solving challenges.
Schema therapy in the form of ST-MASC. Key elements
- Modifications in session structure:
- Therapy Tempo:
- Increased time to process information.
- More frequent breaks during sessions.
- Adjusting the length of sessions to the patient’s capabilities.
- Session Format:
- Clear structure for each meeting.
- Visual support for the message.
- Written summaries of sessions.
- Therapeutic Strategies:
- Cognitive Techniques:
- Concrete examples instead of abstract concepts.
- Use of special interests in the therapy process.
- Systematic development of social skills.
- Working with Emotions:
- Learning to recognize physiological signals.
- Sensory regulation techniques.
- Gradual building of emotional awareness.
- Specific Interventions:
- Rewriting Schemes:
- Addressing the specificity of sensory processing.
- Adapting visualization techniques.
- Use of specific scenarios.
- Working with Modes:
- Simplified naming of modes.
- Visual representations of different states.
- Practical strategies for switching between modes.
Tips for Therapists
- Session Preparation:
- Structuring the material.
- Preparing visual aids.
- Flexible Time Scheduling.
- Conducting Therapy:
- Checking patient comfort on a regular basis.
- Adjusting the pace as needed.
- Creating a safe environment.
- Evaluating Progress:
- Concrete measures of change.
- Regular collection of feedback.
- Flexible adjustment of goals.
- Devoting a specific amount of time to reinforcement and reminder sessions.
Summary
Schema Therapy in the form of ST-MASC offers a promising solution for adults with ASD and comorbid personality disorders. It combines structure with flexibility, and allows for effective therapeutic support while respecting neurodiversity.
If you are a neurodiverse person and are looking for therapy, find an approach that respects and understands your neurodiversity. The right therapeutic approach should feel like it works with you and not against you.
Bibliography:
Vuijk, R., van Genderen, H., Geurts, H.M., & Arntz, A. (2022). Schema Therapy for adults with autism spectrum disorder and comorbid personality disorder: A case example. In R. Vuijk (Ed.), Adults with autism spectrum disorder: Diagnostic assessment, personality (pathology), and psychotherapy (pp. 115-126).
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