Exposure Therapy: Yay or Nay?
What is Exposure Therapy?
Exposure therapy is a well-established psychological technique used to reduce fear and anxiety. It is done by slowly and safely introducing a person to what causes them distress, starting with the least intimidating version and gradually increasing exposure over time. The goal is to help the brain learn that the feared object or situation is not actually dangerous.
For example, if a child is afraid of dogs, exposure therapy might start with looking at pictures of dogs, then watching videos, and eventually being near a calm, friendly dog. Each step is taken at the child’s pace, with lots of support and encouragement.
While this therapy is often used for people with phobias or anxiety disorders, it is also being adapted more and more for children with autism, especially those who struggle with anxiety or rigid routines (Kerns et al., 2016).
How Exposure Therapy Can Help Children with ASD
One of the most significant benefits of exposure therapy for children with ASD is its ability to reduce anxiety over time. Many children on the spectrum experience heightened levels of anxiety, especially in unfamiliar environments or situations. Exposure therapy allows them to face their fears gradually, in a controlled and supportive setting. With repeated exposure, children often become desensitized to the trigger, learning through experience that the situation or object is not as threatening as it once seemed (Wood et al., 2009).
Exposure therapy can also help children with ASD develop greater adaptability when it comes to handling change. Routines are often a source of comfort for ASD children, and even small disruptions can lead to distress. By gently introducing changes in a predictable, step-by-step way, exposure therapy helps children become more tolerant of unpredictability and more resilient when routines shift. This flexibility can improve their ability to function in social situations such as at school and at home. (Storch et al., 2013).
Another benefit is the increased confidence and independence that can result from facing fears successfully. As children work through their fears and begin to master situations they once avoided, they often feel more in control of their environment. This growing sense of mastery can boost self-esteem and allow children to navigate their world with more independence—whether that’s trying out a new sport, participating in classroom activities or completing daily living activities.
In addition to building internal confidence, exposure therapy can support a child’s social development. Many children with ASD are fearful or anxious about interacting with others. Gradual exposure to social settings—such as structured playdates or small group activities—can help children become more comfortable around peers. Over time, this can lead to improved social skills and a greater willingness to engage in shared experiences (Reaven et al., 2012).
Lastly, one of the strengths of exposure therapy is how flexible and individualized it can be. Every child with autism is unique, and their fears are different too. A well thought out plan will tailor the therapy to suit your child’s specific needs, personality, and communication style. Whether your child is verbal or nonverbal, highly sensitive or more stoic, the approach can be adapted to help them succeed at their own pace (Kerns et al., 2016).
Things for Parents to Keep in Mind
While exposure therapy offers promising benefits, it is important to be aware of a few considerations before starting. First and foremost, the pace of the therapy must be slow and sensitive to your child’s emotional responses. If a child is pushed too quickly toward a feared situation, the experience can backfire, causing distress, shutdowns, or even trauma. A well-trained therapist will watch closely for signs of overwhelm and adjust the process to keep it manageable and supportive (Storch et al., 2013).
It is also essential to understand the root cause of your child’s avoidance behaviors. Not every instance of avoidance is due to fear—sometimes it’s related to genuine sensory discomfort. For example, a child might avoid crowded places not because of anxiety, but because the noise, lights or people are overwhelming to their sensory system. In such cases, exposure therapy may need to be combined with sensory supports or accommodations (Robertson & Baron-Cohen, 2017).
Another key factor is finding a therapist who is trained not just in exposure therapy, but also in working with autistic children. A therapist with experience in ASD will understand how to communicate effectively with your child, interpret behaviors accurately, and make the necessary adjustments to the therapy plan. They should also involve the parent in the process, offering guidance, reassurance, and ways you can support progress at home (White et al., 2010).
Finally, patience is crucial. Exposure therapy is not a quick fix. It often takes time and repetition for children to make lasting progress. Some days will go smoothly, and others may feel like setbacks. But each small step forward counts, and celebrating those victories can help build momentum and confidence. A parent’s support, understanding, and belief in their child’s ability to grow can make all the difference!
Written by: Micole
References
American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. https://www.apa.org/ptsd-guideline
Kerns, C. M., Roux, A. M., Connell, J. E., & Shattuck, P. T. (2016). Adapting cognitive behavioral techniques to address anxiety and depression in children and adolescents with autism spectrum disorder. Child and Adolescent Psychiatric Clinics of North America, 25(3), 469–481. https://doi.org/10.1016/j.cbpra.2016.06.002
Reaven, J., Blakeley-Smith, A., Leuthe, E., Moody, E., & Hepburn, S. (2012). Facing your fears in adolescence: Cognitive-behavioral therapy for high-functioning autism spectrum disorders and anxiety. Autism Research and Treatment, 2012, Article 423905. https://doi.org/10.1155/2012/423905
Robertson, C. E., & Baron-Cohen, S. (2017). Sensory perception in autism. Nature Reviews Neuroscience, 18(11), 671–684. https://doi.org/10.1038/nrn.2017.112
Storch, E. A., Arnold, E. B., Lewin, A. B., Nadeau, J. M., Jones, A. M., De Nadai, A. S., Jane Mutch, P., Selles, R. R., Ung, D., & Murphy, T. K. (2013). The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 52(2). https://doi.org/10.1016/j.jaac.2012.11.007
White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2010). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229. https://doi.org/10.1016/j.cpr.2009.01.003
Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224–234. https://doi.org/10.1111/j.1469-7610.2008.01948.x
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