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Adapting Dialectical Behavior Therapy for an Adolescent with Neurofibromatosis 1: A Case Study

Background: There remains a need for interventions addressing psychopathology in individuals with cognitive and intellectual disability (ID). This case examines the application of Dialectical Behavior Therapy (DBT) in an adolescent with Neurofibromatosis 1 (NF1) and multiple psychiatric diagnoses. Treatment targeted suicidal ideation (SI), non-suicidal self-injury (NSSI) and impulsivity, while addressing cognitive limitations.

Case background: The patient met criteria for Major Depressive Disorder, Borderline Personality Disorder, and Attention-Deficit Hyperactivity Disorder. She had a two-year history of NSSI behavior and two prior psychiatric inpatient hospitalizations. At baseline, she presented with deficits in interpersonal relationships, emotional reactivity and maternal conflict.

Course of treatment: The treatment plan followed the DBT-A protocol, with modifications made to address the patient’s cognitive limitations. Adaptions included greater reliance on behavioral and visual learning strategies, increased maternal involvement, regular collaboration with the multidisciplinary care team, and shortened sessions to fit the patient’s attentional capability.

Treatment outcomes: The patient showed a reduction in NSSI, SI, and did not require further psychiatric hospitalization. Patient and mother evidenced increased skill use. Additional outcomes are discussed.

Conclusions: These adaptations offer a preliminary account of DBT-A for an adolescent with cognitive impairments. Important factors for successful modification included a multidisciplinary treatment approach, adapted and targeted teaching methods, and significant reliance on behavioral principles. This case study suggests that DBT is a promising treatment for individuals with ID and cognitive impairments and should be further tested within this population.


Joslyn Kenowitz1*, Courtney Santucci2, Michelle Lupkin2, Lesley Michael3 and Sandra Pimentel2

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