1 - (SYM 13) Adapting Dialectical Behavior Therapy (DBT) Skills Groups for Adults with Intellectual Disability, Autism, and Challenging Behaviors

Adults with intellectual disability (ID) and autism spectrum disorder (ASD) are at increased risk for experiencing mental health disorders such as depression, anxiety, and suicidality, as well as for exhibiting challenging behaviors. Although difficulties with emotional regulation are common and often central to clinical presentations, adults with ID/ASD and challenging behaviors face a persistent “double exclusion” from services: standard therapy programs are not designed or resourced to accommodate cognitive

and communicative differences, while ID/ASD services often lack training, infrastructure, and clinical support to deliver evidence-based psychotherapies. This gap contributes to frequent ER visits, loss of housing and services, social isolation, reduced autonomy, and diminished self-esteem.

In response, our adult neurodevelopmental psychiatry team developed an adapted DBT-informed program within the public health system (Québec) for adults with ID/ASD, and challenging behaviors. The program is based on standard DBT and DBT for Adolescents, with substantial modifications to ensure accessibility, comprehension, and skills generalization.

The intervention includes weekly DBT skills groups of 6–8 participants, each accompanied by a significant person from their living environment. Groups consist of twelve 60-minute sessions with a highly predictable, repetitive structure. Skills teaching relies on concrete language, visual supports (image-based slide presentations with keywords, skills cards), and visually structured homework. Participants also receive bi-weekly individual sessions to reinforce learning, complete adapted chain analyses, verify comprehension, and tailor explanations. Training and coaching are provided to family members and support staff to promote generalization across settings.
We describe the various barriers that limit access to DBT for adults with ID/ASD, and demonstrate practical strategies for adapting DBT materials while preserving therapeutic integrity. We will share concrete examples and recommendations to support the development of affirming, equitable, and sustainable CBT-based interventions for neurodivergent populations.