/ DBT-C, English, Therapy / By Sam Steinberg, LCSW-C, from Capital Youth Services in Bethesda, Maryland
Dialectical Behavior Therapy for Children (DBT-C) is an empirically validated treatment that has been developed by Dr. Perepletchikova for children with severe emotional dysregulation and behavioral discontrol. Although empirical research is needed to evaluate its efficacy with children with Autism Spectrum Disorder, clinical observations support its use with autistic, subtly autistic, and sub-autistic neurotype children and their families.
Clinical application of DBT-C to autistic children necessitated further adaptations to the model to better serve specific needs of this population, with the main goals of fostering emotional resilience and family connection. A central part of this work is helping families and clinicians reframe what’s often labeled as “dysregulation.” Many autistic children experience meltdowns and sensory overloads that are frequently misunderstood as behavioral outbursts or poor self-control. However, these are not simply signs of dysregulation—they are often the body’s response to a world that is too loud, too bright, too chaotic, or too fast. In these moments, what may look like bad behavior is actually a form of communication. DBT-C gives us a framework to respond to these moments with skills, adaptive accommodations, and validation.
In traditional DBT-C, we talk about the “double gravity effect”—a term used to describe how emotionally sensitive children are impacted not only by external stressors but also by their heightened internal emotional responses. In working with autistic children, Dr. Perepletchikova introduces the concept of the “triple gravity effect” to describe an even greater impact in autistic children. In this expanded model, children experience the original stressor, their emotional reactivity to it, and the added layer of sensory sensitivity caused by neurologically based processing differences. For some children, even minor changes in routine, unexpected noise, or physical discomfort go beyond overwhelming—to the point of being incredibly impairing. Recognizing this “triple gravity effect” helps us understand why autistic children may need more support—not because they are less capable, but because they are carrying more.
Emerging research now suggests that individuals who present with stereotypical autistic traits only make up a portion of those with the autistic neurotype. This highlights the importance of updating our understanding of autism. The exponential rise in autism diagnoses, rather than suggesting a true increase in the incidence of autism, demonstrates how far we’ve come in being able to identify these traits. Our understanding of concepts such as camouflaging, masking, and internalizing behaviors has allowed us to diagnose autism in subgroups that were previously largely undetected. The rise in diagnoses among biological females demonstrates this shift. Sadly, yet understandably, when families come in after a later diagnosis following a prolonged period of suffering, it’s common to see feelings of confusion, guilt, or self-blame. Part of our work is to hold space for those feelings and to offer clarity, context, and compassion.
Validation is not just a helpful concept, it is foundational! A validating and supportive environment is essential for success, both in therapy and beyond. DBT-C provides a framework for this through core skills like validation, problem-solving, and mindful communication. These skills are adapted for children and families in a way that honors neurodivergent ways of thinking and being. We’re not trying to get children to stop being autistic. Rather, we are trying to help autistic individuals, and their families better understand themselves, reduce suffering, and increase connection.
The adaptations we use in our DBT-C model are grounded in the ongoing work around comprehensive DBT for the autistic neurotype. In particular, the clinical insights and strategies developed by Sami Ascanio, LCSW-C, and Lorie Ritschel, PhD, have been highly influential in shaping our approach. Their work emphasizes neurodivergent-affirming care, assessing for and adding adaptive accommodations, direct teaching of skills in concrete and structured ways, and a strong focus on context and sensory needs. We took these principles and translated them into the DBT-C framework to better serve younger clients and their caregivers.
Adaptations for parents are also an essential part of the model. With a significant biological basis to the neurotype, many caregivers of autistic children are themselves neurodivergent or come to discover aspects of their own neurodivergence through the process of supporting their child. This can be a powerful and emotional journey. For that reason, we ensure that the parenting component of DBT-C is also adapted—offering information in multiple modalities, allowing time and space for reflection, and honoring the unique ways parents process and implement skills. Supporting the caregiver’s learning and self-understanding ultimately strengthens the family system and increases the likelihood of skill use at home.
DBT-C, when informed by neurodivergent-affirming practices and grounded in compassion, has the potential to transform not just behavior, but relationships, self-understanding, and resilience.
