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The podcast discusses the interventions that autistic people do and don't want. It highlights the importance of therapies that support their needs rather than trying to make them neurotypical. The controversial therapy ABA is discussed, which focuses on changing behavior through rewards but can lead to masking and negative mental health effects. Cognitive behavioral therapy (CBT) is explored, but it is found that traditional CBT may not work for autistic people and that adaptive CBT or dialectical behavioral therapy (DBT) may be more effective. The use of medication, such as SSRIs, is also mentioned, but it is noted that it is not a one-size-fits-all solution. Emerging therapies like sensory integration therapy and virtual reality therapy are discussed, but caution is advised to ensure they are ethical and supportive. Autistic individuals express the need for accommodations, understanding from friends, and peer support. Access to therapy and the issue of bias in diagnosis and treatment Imagine waking up every day in a world that wasn't built for you. That's the reality for many autistic people. Welcome to Consciousness in Practice where we explore neurodivergent lives. I'm Speaker 1, your host for today, and joined by me is my lovely co-host Speaker 2, an expert autism by lived experience. Hi everyone, and thank you so much for that introduction. My pleasure. Today we're exploring what kind of interventions autistic people do and don't want. No two autistic people are the same. Autistic people have differences in sensory needs, social communication, and show repetitive behaviours. Therapies should support our needs, not those that are neurotypical. From behavioural therapies like ABA to communication support and even medication, there are so many approaches. But do they actually help? Later we'll be joined by Amy, a speech and language therapist, but first let's talk about what treatment even means in the context of autism. Autism isn't a disease, it's a neurodivergent condition which really just means having a different brain from a neurotypical person. If so, why do we even use the word treatment? Because historically autism was framed as a disorder that needed to be fixed, but today autistic people push for support, not depression. Interesting. And the medical model sees autism as a disorder, assuming reducing autistic traits improves outcomes. But research by Pelicano and colleagues in 2014 suggests that many traditional autism interventions actually lower quality of life because they focus on behaviour change rather than meaningful support. This contrasts with the social model of disability, which argues that barriers in society create disability. So the problem isn't actually autism, but more society not adapting enough to suit all individuals. Likewise, the neurodiversity paradigm, coined by Judy Singer in 1998, reframes autism not as a deficit, but as a natural variation of human cognition. Interventions should mean reducing distress, not making a fact neurotypical. That's exactly why some therapies, like ABA, are so controversial. ABA, Applied Behavioural Analysis. ABA is based on behaviourism and it trains autistic people to look neurotypical through reward. But is changing behaviour actually helpful in the long term? Well, imagine if someone rewarded you every time you made eye contact and not when you didn't. How would that make you feel? Some argue ABA teaches masking, which is when autistic people try and hide parts of themselves to try and appear neurotypical. And research shows autistic masking can lead to long-term anxiety and burnout, not real well-being. I've heard masking is quite an issue when it comes to these things. So yeah, definitely have not looked into it. Clifford and Stein in 2018 found that nearly half of autistic adults who had ABA reported PTSD symptoms. So meanwhile, Betima et al. in 2021 found that ABA prioritises compliance over autonomy, which raised ethical concerns. Wow. So bearing all this in mind, do you think there's any benefits to ABA? So I found research by Anderson in 2023 who asked autistic individuals about their experience with ABA and it found minimal benefits, with some autistic individuals did report learning some non-verbal communication skills, but they also reported more negative mental health effects. So are these minimal benefits really worth the harm? And as an autistic person, I personally don't think so. I totally agree. Despite the risks, ABA is still widely used, but maybe alternatives like cognitive and psychological therapies are worth exploring. One alternative is cognitive behavioural therapy, also known as CBT, commonly recommended for anxiety and depression, which are really common symptoms that people do get when they have autism. But does it actually work for autistic people? So did you actually know that autistic people are twice as likely to have anxiety and four times as likely to experience depression, research suggests? And traditional CBT assumes thoughts influence emotions, so changing thought patterns should improve mental health. However, Petty et al. in 2023 found that autistic distress is often triggered by external factors, such as sensory overload or social rejection, rather than internal thought processes alone. Spanish colleagues in 2017 highlighted that CBT often fails without adaption. In contrast, dialectical behavioural therapy, also known as CBT, may actually be more effective because it focuses on emotional regulation rather than just changing thought patterns. Exactly. For autistic people, don't just need better thinking patterns, what we need is practical strategies to manage sensory and emotional challenges. Adaptive CBT and CBT can help, but only when designed with autistic needs in mind. Another big question is medication. So autism itself isn't something you treat with meds, but anxiety and depression, that's different. SSRIs like Cetraline are commonly described, but do they actually help? So the research is kind of mixed from what I've read. Williams and colleagues in 2021 found that SSRIs can help some autistic people manage anxiety, but they can also cause night and sensory sensitivity and emotional blunting. Wow. So I also read research by Lugo Marvin et al. in 2019, who found that autistic individuals often have different reactions to psychotropic medications, and they suggest that this just needs to be more carefully individualised. That's so true. So medication can be helpful, but it's not a one-size-fits-all solution. Now let's hear from Amy. Now let's take a look at emerging therapies. Speaker one, what's being explored? So I've read quite a bit on this. Sensory integration therapy, also known as SIT, is one area of interest. Schaff and colleagues in 2013 found that structured sensory-based interventions actually help autistic children with emotional regulation, but the evidence kind of seems debated. How about you? Wow, that's so interesting. So I also read that virtual reality, VR therapy, is also gaining attention. Research found that it helps autistic individuals practice social interactions in a low-pressure environment, but some researchers do worry that it encourages masking rather than authentic communication. So like ABA, new therapies must be critically examined for an ethical aim. If they focus on making autistic people fit in rather than supporting them, we risk basically repeating the past mistake. Definitely. So while these new therapies are promising, they need autistic input before widespread use. Exactly. So speaker two, as an autistic individual, I wanted to ask, what sort of interventions would you like? Thank you for asking. So I often just need accommodations in the environment. For example, maybe taxis and self-public transport. Having friends who understand I may need breaks and prefer quieter places is also a matter for me. And something that has helped massively is connecting with other autistic individuals, so I don't feel alone. And research actually supports this in finding peer support for autistic people being so positive. I think peer support should be pushed more. And what about your experiences with therapy? So research previously found that many autistic adults actually struggle to access therapy due to factors such as like long waiting times or lack of trained professionals or financial barriers. Even therapies that are actually designed for autistic needs aren't always available to those who need it the most. Yes, that's a massive issue for me. And even beyond access, there's also the issue of bias. Research found that many clinicians still hold outdated views of autism, which can lead to misdiagnosis or inappropriate treatment recommendations. So I have tried CBT and even social school groups, but often found that therapists don't fully understand girls with autism. What I would love is to be asked about how I view the world rather than have professionals assume they know what is best for me. Yeah, I've read a bit about gender differences when it comes to neurodivergent disorders, which is really interesting. So what I'm hearing is that it's not just about developing better therapies. It's basically about making sure they're accessible and ethical and based on autistic input. Without that, we're just repeating past mistakes in the same way. Exactly. That is so important. So after everything we've covered, what do autistic people actually want from therapy? Not to be fixed, not to be forced into someone else's idea of normal. We want real support, the kind that makes life easier, not harder. Research backs that up. Autistic people need accommodations, a socially friendly environment and alternative communication methods. Not therapies that just suppress who they are. Because if we're truly listening to autistic voices, we need to challenge outdated approaches and push for change. Listening is not enough. It's time for action because inclusion isn't a privilege, it's a right. We've been speaking. Now it's time to be heard. And that's it for today. Thank you to our guest, Amy, and to everyone listening. Keep the conversation going and keep listening to consciousness in practice.