Conceptualizing Pathways to Depression and Anxiety in Autistic Youth Using the Cognitive and Behavioral Model of Low Self-Esteem

Autistic youth are more likely to experience both anxiety and depression than their nonautistic peers, yet treatment options are extremely limited. Clinicians working with this population lack a robust evidence base of psychological models within which to formulate and treat these enduring internalizing disorders in autistic youth. Negative self-esteem is a robust risk factor-and treatment target-for internalizing disorders in nonautistic youth that remains largely understudied in autistic youth. The Cognitive and Behavioral Model of Low Self-Esteem (Fennell, 1997) was conceived to guide the development of cognitive-behavioral interventions targeting this construct in the general population. The model highlights how low-self-esteem develops from the interacting effects of temperament and negative experiences, leading to the formation of dysfunctional assumptions, and the subsequent development and maintenance of anxiety and depression. Autistic individuals are known to have specific vulnerabilities across the core elements of this model, making it potentially pertinent for this population. In this paper, we describe a theoretical extension of the model for autistic youth. We then use a blended case example to inform case conceptualization using the model to understand how low self-esteem may develop in an autistic youth and act to maintain anxiety and depression. Future directions for research into the use of the Low Self-Esteem Model in autistic youth are also discussed.