Schema Therapy applied to autism spectrum disorders

By Cristiano Antonino On Mar 4, 2023

Autism spectrum disorders: Schema Therapy (Young, 1990; Young et al., 2003) constitutes an integrated therapeutic approach, which bases its foundation on the concept of the person’s emotional needs

These needs press to be met in the course of our primary relationships

When basic needs are not adequately and consistently met during childhood, so-called ‘early maladaptive schemas’ (SMP) are formed, i.e. schemas containing memories, emotions, physical sensations that are automatically reactivated in adulthood, influencing behaviour.

Once early maladaptive schemas have started to develop, individuals learn to mitigate feelings of distress by developing coping responses: surrender, overcompensation, avoidance.

These three coping responses are maladaptive because their function is to alleviate discomfort rather than allow corrective experiences to ‘refresh’ schemas and satisfy basic emotional needs.

Schema Therapy aims to modify these ingrained schemas and provide corrective emotional experiences to reduce early schema activation while satisfying basic emotional needs that were frustrated during childhood.

The Schema Therapy model adapted to autism spectrum conditions (ST-MASC)

In persons with autism, maladaptive schemas may originate, at least in part, as a result of the perceived discrepancy between the person and the environment, since the latter is largely modelled to meet the needs of neurotypical individuals.

The most common early maladaptive patterns in the population with autism include:

the defectiveness schema, experienced as a sense of being fundamentally flawed, broken, different or unlovable;
the social isolation schema, experienced as a pervasive sense of not belonging to any group or community;
the pattern of distrust, experienced as an expectation of being hurt, humiliated, targeted or abused by others.

The ST-MASC model suggests two modifications to the original model: the first concerns the specific needs of autism, the second concerns the coping responses adopted by people on the spectrum.

The first modification pays close attention to the needs associated with the functioning of persons on the autism spectrum: i.e. that of attunement and co-regulation throughout life (the need for support in recognising and responding to one’s internal world, including emotional and physiological states), the need for routine, predictability and consistency (i.e. the need for a stable and reliable base from which the individual can feel safe to explore and modify their behaviours), sensory input analysis (i.e. the recognition that adults on the autism spectrum often have sensory processing differences that can impact on central nervous system arousal) freedom to focus on interests (i.e. the need to honour the depth and focus of the autistic mind and facilitate well-being), the need for social and practical guidance (i.e. the understanding that people with autism may need guidance to navigate a predominantly neurotypical world, particularly in the areas of social and practical functioning).

The second modification sees people with autism develop a combination of coping responses of surrender, overcompensation and avoidance with respect to the characteristics of their functioning in order to manage their lives in a neurotypical world.

Overcompensation refers to the behavioural response that is in opposition to the internal impulse.

It has to do with the concept of camouflage that people with autism develop in order to disguise their peculiar characteristics of functioning, with a significant discrepancy between what is the external presentation of the behaviour and the internal experience.

Avoidant coping responses include strategies implemented by people with autism to avoid being in contact with certain stimuli or unpleasant situations, or particularly neurotypical aspects of the world.

These avoidance behaviours often occur in potential comorbidity with conditions of agoraphobia, social phobia, substance abuse or avoidant personality symptoms.

In summary, the ST-MASC model aims to reduce the early activation of the maladaptive pattern and modify maladaptive coping responses into adaptive coping responses, while accepting the nuclear functioning characteristics, i.e., the needs related to functioning on the autism spectrum.

Therefore, a continuous assessment of the origin and function of problem presentation is essential to differentiate schema-driven behavioural patterns from behavioural patterns related to autism functioning.

Schema Therapy and autism, in conclusion

Schema Therapy adapted to the population of persons on the autism spectrum (ST-MASC) pays particular attention to the specific needs specific to autism, designed in conjunction with, and not instead of, the basic emotional needs described by Young and colleagues (2003).

These needs must be analysed in order to determine which coping behaviours are adaptive and which are maladaptive.

Indeed, without an understanding of the basic needs of persons with autism, one runs the risk of attempting to reduce the recurrence of certain behaviours and increasing those that, while appearing more adaptive in relation to the environment, do not help the person on the spectrum in the direction of personal well-being.

Bibliographic references

Bulluss, E.K. (2019). Modified schema therapy as a needs based treatment for complex comorbidities in adults with autism spectrum conditions. Australian Clinical Psychologist, 1, 1-7.

Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, Mandy W. “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. J Autism Dev Disord. 2017 Aug;47(8):2519-2534. doi: 10.1007/s10803-017-3166-5. PMID: 28527095; PMCID: PMC5509825.