Towards a comprehensive approach to mentalization-based treatment for children with autism: integrating attachment, neurosciences, and mentalizing

Abstract

Autism spectrum disorder (ASD) is diagnosed based on socio-communicative difficulties, which are believed to result from deficits in mentalizing, mainly evidenced by alterations in recognizing and responding to the mental states of others. In recent years, efforts have been made to develop mentalization-based treatment (MBT) models for this population. These models focus on enhancing individuals’ ability to understand and reflect on their own mental states, as well as those of others. However, MBT approaches for people with ASD are limited by their existing theoretical background, which lacks a strong foundation grounded in neuroscience-based evidence properly integrated with attachment, and mentalizing. These are crucial aspects for understanding psychological processes in autism, and as such, they play a pivotal role in shaping the development of tailored and effective therapeutic strategies for this specific population. In this paper we review evidence related to the neurobiological, interpersonal, and psychological dimensions of autism and their implications for mentalizing processes. We also review previous mentalization-based frameworks on the psychosis continuum to provide a comprehensive understanding of attachment, neurobiology, and mentalization domains in therapeutic approaches for autism. After presenting a synthesis of the literature, we offer a set of clinical strategies for the work with children with autism. Finally, we provide recommendations to advance the field towards more robust models that can serve as a basis for evidence-based therapeutic strategies.

Applied human neuroscience: Fostering and designing inclusive environments with the 3E‐Cognition perspective

“…Specifically, in the case of autism spectrum disorder (ASD), these efforts to 'cover' certain autistic features involve a significant cognitive effort, which can lead to heightened stress responses and diminished mental well-being (Cook et al, 2021). In addition, it can negatively impact self-identity development (Costa-Cordella et al, 2023;Hull et al, 2019Hull et al, , 2017. This evidence reveals that a limited perspective to consider individuals in terms of exclusive and hierarchical categories (abilities and disabilities, typical and atypical) is not capable of responding with equity to neurodiversity (Sarrionandia, 2017).…”

Applied Human Neuroscience: Fostering and Designing Inclusive Environments with the 3E-Cognition Perspective

“…Specifically, in the case of Autism Spectrum Disorder (ASD), these efforts to 'cover' certain autistic features involve a significant cognitive effort, which can lead to heightened stress responses and diminished mental well-being (Cook et al, 2021). In addition, it can negatively impact self-identity development (Costa-Cordella et al, 2023;Hull et al, 2017Hull et al, , 2019. This evidence reveals that a limited perspective to consider individuals in terms of exclusive and hierarchical categories (abilities and disabilities, typical and atypical) is not capable of responding with equity to neurodiversity (Sarrionandia, 2017).…”

Depression in autism: Unmasking the mediating role of mentalization, attachment, perceived social support, and psychological flexibility

“…The core symptoms of ASD include social dysfunction, which is thought to affect caregiver relationships, and may be further complicated by the fact that relatives may show subclinical symptoms. However, despite these barriers, attempts are being made with encouraging results (Costa-Cordella et al, 2023;Krämer et al, 2021;Thevenet et al, 2018). In the long term, a mentalization-based approach is promising, but autism-specific adaptation in method development will presumably be essential.…”