Navigating Adulthood with ASD: A Scoping Review on Modified Cognitive Behavioral Therapy Approaches for Social and Emotional Challenges

Background: Individuals with autism spectrum disorder (ASD) experience a range of social and emotional challenges due to difficulties in communication and interactions with others, sensory issues, and restrictive or repetitive behaviors. ASD severity levels range from level 1, “requiring support”, to level 3, “requiring very substantial support”. An estimated 1 in 45 adults live with ASD. Though many studies in the United States have shown that modified cognitive behavioral therapy (CBT) is effective in treating social and emotional problems in children and adolescents with ASD, very few studies focus on CBT approaches with adults with ASD. Specific challenges in social functioning need to be addressed as limited research and services create barriers to mental health care in this population. This scoping review identifies modified cognitive behavioral therapy approaches effective in addressing social and emotional challenges specifically in adults with ASD.

Method: A literature search was conducted by one reviewer on electronic databases, PubMed and EBSCO Host, using the terms “cognitive behavioral therapy” and “autism spectrum disorder”. Full text articles were reviewed. Included articles examining CBT approaches on adults with ASD aged 18-65, with publication dates between 2015-2024, in English, peer-reviewed, and conducted in the United States. Excluded articles outside of the United States, articles related to medical interventions, articles on participants under the age of 18, and articles that do not include individuals with ASD.

Results: Out of 1,357 articles in the initial search, 12 articles met the inclusion criteria for this review based on age, cognitive behavioral interventions, diagnosis, and studies from the United States. A variety of modified CBT approaches were identified to target social skills, emotional regulation, depression, and anxiety, including mindfulness-based therapy (relaxation techniques), Acceptance Commitment Therapy, psychoeducation, group-based interventions, exposure with response prevention, and Virtual Reality interventions. Some studies show the importance of therapeutic alliance and acceptance from therapists.

Conclusion and Implications: There is some evidence that modified CBT approaches address the social and emotional challenges of adults with ASD. While most of the studies show improvement in social and emotional challenges, mindfulness-based stress reduction is especially effective in emotional regulation, executive function, and reducing anxiety and depression. This review has some limitations due to the small number of studies specifically on adults with ASD, with most studies including age groups under 18 or depression and anxiety comorbid with ASD. Future studies may include more RCTs comparing the effectiveness of different modified CBT interventions for adults with ASD, and longitudinal studies on the effectiveness of interventions at different stages of adulthood.