Adapted CBT for Neurodiversity

What is adapted CBT?

Adapted CBT is a form of cognitive behavioural therapy (CBT), a talking therapy that explores the links between thoughts and behaviours, which has been tailored to the ways neurodivergent people may process information, communicate, manage emotions and experience the world.

It can be adapted for people with autism and ADHD, as well as other neurodivergent experiences, so that therapy feels more accessible and relevant to the individual. Adapted CBT can also be helpful if you've tried standard therapy before and felt that it didn't quite fit you and your needs.

Adaptations may include:

Why CBT needs to be adapted for neurodivergent people

Traditional CBT approaches were not specifically designed around the experiences and needs of neurodivergent people. Some of its usual approaches can therefore miss important aspects of how a person with ADHD or autism may process information, communicate or respond to their environment.

For example, some CBT approaches rely heavily on identifying and describing emotions in the moment, discussing thoughts verbally or completing between-session exercises independently. These tasks can prove difficult for some neurodivergent people because of differences in communication and emotional processing.

It is also important to consider whether distress is a response to a genuinely difficult or inaccessible environment. For example, sensory overload or an inaccessible workplace may contribute to distress. Rather than focussing solely on changing a person’s thoughts, adapted CBT can take a more practical approach by exploring environmental challenges and identifying changes that may help.

• Research from a 2023 study by University College London found that autistic adults accessing NHS talking therapies were 25% less likely to experience an improvement in symptoms and 34% more likely to experience a deterioration in symptoms than non-autistic adults.

• Similarly, in adults with ADHD receiving standard CBT, a 2024 mixed-methods study found participants to describe some non-adapted CBT as generic, rigid or too short. It reported that therapy did not always account for difficulties such as working memory, attention, executive functioning and emotional regulation.

These findings highlight why therapy may need to be adapted to the person receiving it, rather than expecting the person to adapt themselves to a fixed therapeutic model.

What does adapted CBT look like in practice?

Adapted CBT can look different from standard CBT in several practical ways. These may include the following:

• Clearer, more structured sessions: Sessions may follow a clear structure, with concrete instructions and specific questions rather than relying on metaphor or ambiguous language

• More written and visual information: Therapy may use checklists, diagrams, worksheets, written summaries and visual prompts to make information easier to understand and remember

• More practical and behavioural strategies: CBT may place greater emphasis on practical strategies, such as breaking tasks into steps, building routines and practising coping techniques

• Flexibility around pace and environment: The pace, session format and environment can be adapted to individual needs, including session length, frequency, online, in-person or telephone therapy, and sensory factors such as lighting and noise

• Connecting therapy to your interests and goals: Therapy can be tailored to your interests, routines, relationships and personal goals, with progress measured against what you want to achieve

Adapted CBT for autism

Adapted CBT for autism takes into account the ways autistic people may experience communication, sensory information, emotions and their surrounding environment.

Adapted CBT for ADHD

Adapted CBT for ADHD takes into account difficulties that can affect attention, working memory, planning, task initiation, organisation and emotional regulation.