A Pilot Study of DBT Skills Group for Adults with ASD without ID

Background: Comorbid psychiatric conditions, emotional dysregulation, behavior challenges and suicidality are common for adults with autism spectrum disorders (ASD) (Croen et al, 2015; Hirvikoski et al, 2016). While there are evidence-based interventions available to address these challenges, there is a lack of research regarding their feasibility and effectiveness for individuals with ASD. Dialectical Behavioral Therapy (DBT), which targets emotional, cognitive, and behavioral dysregulation, has been used effectively as a transdiagnostic treatment with a number of psychiatric conditions (Ritschel et al, 2015) and may be an effective intervention for individuals with ASD. Standard DBT includes individual therapy and group skills training, although evidence suggests that the skills training component alone may be an effective intervention in some cases. Given the overlap between the comorbid conditions and emotional dysregulation often seen in individuals with ASD and the goals of DBT, it is potentially a beneficial intervention for adults with ASD. The current study was designed to determine the feasibility and appropriateness of DBT as an intervention for adults with ASD without Intellectual Disability (ID).

Objectives: The study aim is twofold: (1) To determine if DBT skills group training is a feasible intervention for adults with ASD without ID; and (2) To determine if modifications to the standard DBT curriculum are warranted to make the treatment more effective or accessible to an ASD population.

Methods: Groups were conducted across four university-affiliated, community-based ASD centers. Training for therapists and ongoing consultation were provided by a DBT expert. Inclusion criteria were chronological age of 18 years or older, diagnosis of ASD, completion of high school regular education, and no co-occurring diagnosis of ID. Groups met weekly for 1.5 hours for 24 weeks using the standard adult DBT handouts and worksheets. DBT modules and durations are illustrated in Figure 1. Feasibility was assessed using a participant satisfaction questionnaire as well as participant attendance and retention rates. Focus groups were conducted with providers to determine appropriateness of materials and curriculum.

Results: Sixteen participants enrolled in the program; 13 (81.25%) completed the full six months of treatment (M_age = 36.62, range: 19-68; 76.92% male). Mean session attendance rate was 87.54% (range 80-96%). Responses on the participant satisfaction scale ranged from 1 (lowest) to 5 (highest) and are reported in Table 1. Overall satisfaction ratings were high (M = 4.45, SD=.82), as was the rating of DBT as an intervention that was likely effective for others with ASD (M = 4.86, SD=.69). Focus group with therapists identified recommended modifications to DBT materials.

Conclusions: The current study provides preliminary evidence of the feasibility of providing DBT skills groups for adults with ASD without ID in community-based clinics and its perceived benefit for this under-served population. Recommended ASD-specific modifications to standard DBT include adding visual strategies to make the teaching of abstract concepts more concrete; simplifying handouts and worksheets to include fewer words and more images; and repeated practice of skills in session.