Exploring Autism Therapy: Resources, Insights, and Support

Dialectical behavior therapy (DBT) is a structured, skills-based therapeutic approach originally developed to support individuals with borderline personality disorder (BPD). Over time, it’s been adapted to help people manage anxiety, depression, emotional dysregulation and more. 

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DBT focuses on four key skill areas: emotional regulation, distress tolerance, interpersonal effectiveness and mindfulness. These tools offer practical strategies to manage emotions, reduce stress and foster healthier relationships.

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For autistic adults, DBT is especially helpful for managing sensory overload, intense emotions, difficulty with self-advocacy and challenges in social communication. One of DBT’s strengths is its use of practical step-by-step tools that break complex experiences into manageable parts.

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This article focuses on one of DBT’s core skills: DEAR MAN––a technique that supports assertive communication and self-advocacy. DEAR MAN can help autistic adults express their needs clearly, reduce anxiety in difficult conversations and build healthier personal and professional relationships.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects the development of a person’s brain and nervous system. ASD is part of the natural diversity in human brains, traits and behaviors, also called neurodiversity. Autism occurs along a spectrum, and each autistic person may have a very different combination and intensity of autistic characteristics and support needs. In general, when compared to neurotypical peers, autistic individuals typically experience differences in sensory and cognitive processing, social approaches, communication and their relationship to routine and repetition.

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ASD has long been stigmatized and misunderstood, even within the medical community. Often, autism is associated with early childhood, but in reality, it’s a lifelong diagnosis. The CDC estimates that nearly five and a half million US adults are autistic, yet the scarcity of resources for autistic adults is staggering. A 2019 study found that 84% of US counties have no diagnostic resources for autistic individuals of any age, and accessing high-quality mental health services as an autistic adult is notoriously difficult.

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For many autistic adults, this gap in resources can make getting help daunting—but all the more important. Autistic adults are more likely to be diagnosed with a mental illness––between 40 and 50% of autistic individuals have or have had anxiety, and as many as 40% have or have had depression, compared to 18.2% and 21.4% of all US adults, respectively. Even more worrying, 66% of late-diagnosed autistic adults reported experiencing suicidal ideation at some point in their lives. Stigma and a broad social failure to accommodate autistic needs are likely drivers of poorer mental health outcomes among autistic adults.

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Autistic adults can thrive despite adversity, but many of us confront similar challenges and could benefit from support. These can include, but are certainly not limited to:

• Masking and unmasking
• Autistic burnout
• Sensory sensitivity and sensory overload
• Disclosure and accessing support
• For late-diagnosed autistic adults, processing a new diagnosis

When I was growing up in the 90s and early 2000s, autism spectrum disorder was heavily stigmatized and misunderstood. Since I did exceptionally well in school, no one in my family even considered I might be autistic. Throughout my life, I struggled a lot with focus, sensory sensitivities and interacting with other people. When I was diagnosed with Ehlers-Danlos Syndrome (EDS)  in 2019, I learned how common it is to have ASD or ADHD with EDS. I was diagnosed with ADHD in 2021, but it still felt like I was missing a piece of the picture.

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Until recently, most adults were not diagnosed with autism in their youth. There are likely several reasons for this, including a variety of issues within the diagnostic process. People of color, nonbinary people, transgender individuals and women have been historically underdiagnosed. This is due to discrimination, stigma or misconceptions. The diagnostic process started to improve in the early 2000s, with new diagnostic criteria that more accurately represents how autism shows up in the world.

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For those of us who weren’t diagnosed earlier in life, though, getting an accurate diagnosis can be hard. Some of us have learned how to mask or camouflage so efficiently that we blend into a neurotypical world really well, making it difficult to find a provider who will take our request for an autism assessment seriously.

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This is one of the many reasons why working with a neurodivergent-affirming clinician is critical when seeking a formal diagnosis. Regardless of the outcome, the diagnostic assessment process can play a helpful role in better understanding yourself.