A look at “Autism-adapted cognitive behavioral therapy for social anxiety in an adolescent with late-identified autism spectrum disorder: a case report” by Hajji Hazem, Kerkeni Ali, Chaabane Maryam, Youzbechi Fatma, Hssen Oumayma, Kerkeni Hajer, Beji Mayssa and Abbes Wafa (2026)
Sometimes autism isn’t noticed until adolescence, when the social world suddenly gets a lot more complicated, masking stops working, and anxiety moves centre stage. This Tunisian case report follows “Maxence”, a 13-year-old whose autism was identified late. It describes how a team adapted CBT to help with his intense social anxiety.
What they describe
Maxence was referred because he was withdrawing socially, freezing completely in situations where he felt judged at school, and relying more and more on screens, which was causing family conflict. Assessment found he was autistic, with prominent social anxiety and alexithymia: difficulty identifying and describing his own emotions.
Standard CBT relies heavily on talking about feelings and thoughts, so the team adapted it significantly.
- A highly predictable structure, so sessions felt safe and familiar.
- Body first, emotions second. Rather than asking “how do you feel?”, they helped him notice physical cues, such as tension and heart rate, before anxiety took over.
- Minimal emotional labelling, keeping emotion words simple rather than demanding detailed descriptions.
- Brief “rescue sentences”: short scripts he could use instead of freezing silently, such as asking for a moment.
- Predictable, repeatable exposure. Gradually facing feared situations in planned, rehearsed steps, while gently reducing safety behaviours.
- Rethinking screens. Rather than simply restricting screen time, they recognised that screens were his fastest way to relieve tension. They worked on building other ways to calm down, so screens weren’t the only escape hatch.
- Family and school involvement to support changes across his whole life.
By the end of treatment and at a three-month follow-up, his anxiety and freezing had reduced, he was engaging more at school and in daily life, and his screen use was better balanced.
A grain of glitter ✨
This is a thoughtful, practical example of making CBT genuinely autism-friendly, and the approach to screen use is particularly wise and compassionate. But it’s a single case, so we can’t know how typical his response would be, or whether improvement was due to therapy, family and school changes, or simply time. The autism assessment didn’t use standard diagnostic tools, which the authors explain reflects limited local access. Outcomes relied mainly on clinical observation and reports from Maxence and his family.
The framing is mostly clinical, focusing on “symptoms” and reducing avoidance, with less said about Maxence’s own goals, strengths or autistic identity.
Why this matters
If you’re the parent of an autistic teenager who freezes in social situations or retreats into screens, it may help to see those behaviours as ways of coping with overwhelm, not defiance or laziness. Therapy that starts with the body, keeps things predictable and offers simple scripts can make the social world feel more manageable. A late diagnosis isn’t too late; it can be the turning point.
When the paddock feels too loud, a quiet stall (or a screen) can be a lifeline. Good support just adds a few more stalls to choose from.