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Evaluation ViewAttendees 11

Clinical Grand Rounds

Autism Spectrum and Developmental Disorders

Clinical Grand Round 2 - Adapting Exposure Therapy with Autistic Clients When They Have High Support Needs: A Live Demonstration

Saturday, November 22, 2025
11:45 AM - 1:15 PM CST
Location: Bolden 2, Level 2
Earn 1.5 Credit
Keywords: Autism Spectrum Disorders, ERP (Exposure and Response Prevention), Underserved Populations
Level of Familiarity: Moderate
Recommended Readings: Vause, T., Jaksic, H., Neil, N., Frijters, J. C., Jackiewicz, G., & Feldman, M. (2020). Functional behavior-based cognitive-behavioral therapy for obsessive compulsive behavior in children with autism spectrum disorder: a randomized controlled trial. Journal of Autism and Developmental Disorders, 50, 2375-2388.,   Blakeley‐Smith, A., Meyer, A. T., Boles, R. E., & Reaven, J. (2021). Group cognitive behavioural treatment for anxiety in autistic adolescents with intellectual disability: A pilot and feasibility study. Journal of applied research in intellectual disabilities, 34(3), 777-788.,   Hersh L, Dwyer P, Kapp SK, Shevchuk-Hill S, Gurba AN, Kilgallon E, Mair APA, Chang DS, Rivera SM, Gillespie-Lynch K. Community Member Views on Autism Intervention: Effects of Closeness to Autistic People with Intellectual Disabilities And Nonspeaking Autistic People. Autism Adulthood. 2024 Sep 16;6(3):253-271. doi: 10.1089/aut.2023.0202. PMID: 39371356; PMCID: PMC11447397.,   ,  
While autistic individuals across the lifespan experience higher rates of anxiety/OCD compared to the general population, they are often unable to access mental healthcare, including Cognitive Behavior Treatment (CBT) for treatment of anxiety/OCD. The reported percentage of autistic individuals classified as Level 3 (requiring very substantial support/high support needs) varies, but estimates suggest that 20-30% of autistic individuals meet criteria. A 2019 CDC report found that about 32% of autistic children had an intellectual disability (ID), often correlated with higher support needs. High support needs can manifest in various ways, and support needs are dynamic—even individuals with Level 1 or 2 autism may have high support needs in specific areas or at certain times. Autistic individuals with high support needs often experience anxiety/OCD symptoms that significantly impact daily living. While many clinicians want to use CBT to address anxiety and OCD in autistic clients, they incorrectly believe that CBT's use with autistic individuals, especially those with high support needs, is inherently different (vs. a modified/tailored approach), and that treating this population is out of their competency. It is well-established that CBT with ERP, when modified and tailored for autistic youth with and without co-occurring ID, is efficacious in treating anxiety and OCD. Exposure has been shown to be the active ingredient in treating these conditions. This interactive presentation will demonstrate how to adapt ERP to support treatment of anxiety/OCD in autistic clients with high support needs. This talk will bridge gaps for CBT practitioners who want to increase their knowledge and confidence in working with autistic clients. Through live role-plays, attendees will observe tailored ERP interventions addressing compulsions related to hygiene, dressing, and food avoidance. Demonstrations will include using ERP to overcome anxiety/OCD and related barriers to Activities of Daily Living (ADLs). Attendees will gain practical skills on how to combine accommodations with ERP principles, create sensory-safe environments, reduce reliance on verbal-only communication, and train caregivers to provide support while not reinforcing anxiety/OCD.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Explain the importance of modifying CBT for autistic clients with high support needs when treating co-occurring mental health conditions.
  2. Differentiate autistic routines/preference for sameness/sensory needs from compulsive behavior/avoidance associated with Anxiety/OCD.
  3. Adapt and apply CBT interventions (eg. exposure, cognitive restructuring) to treat anxiety/OCD in those with Autism with high support needs.
  4. Treatment plan ways to accommodate/teach skills to support adaptive functioning, and address ways anxiety/OCD may hinder adaptive functioning.
  5. Analyze CBT interventions and adaptions and choose treatment priorities to treat anxiety/OCD in those with Autism with high support needs.
  6. Identify “neuro-affirming accommodation” vs. “contraindicated accommodation.”.
  7. Practice creating collaborative treatment goals with autistic clients with high support needs, especially in the domain of communication.