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A Systemic Approach to Working With People with Autism Spectrum Disorders and Their Families

A Systemic Approach to Working With People with Autism Spectrum Disorders and Their Families

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Autism Spectrum Disorders Autism Spectrum Disorders Presentation Transcript

  • A Systemic Approach to the Treatment of the Autism Spectrum Disorders Greater Washington Society for Clinical Social Work Jonah Green, MSW January 18, 2009 Schedule:  10-10:15-Introduction/Overview  10:15-11:00-Part I  11:00-11:15—Break  11:15-11:45—Video of individual with ASD  11:45-12:30—Part II/Video  12:30-12:45—Break  12: 45-1:30—Part III  1:30-:45--Discussion  1:45-2:00-Evaluations 1
  • Introduction ___________________ Part I ___________________ Defining Autism, ___________________ Symptoms, Etiology, ___________________ Screening/Diagnostic ___________________ Process, Differential ___________________ Diagnosis, Co-Morbidity, ___________________ Effects on Functioning, ___________________ Epidemiology, Non- ___________________ Systemic Approaches to ___________________ Treatment ___________________ ___________________ 2
  • Part II ___________________ ___________________  The Systemic Context— ___________________ Effects on Overall Family ___________________ System/Interactions ___________________ Outside of the Family, ___________________ Effects at Particular Life ___________________ Stages, Effects on ___________________ Specific Family ___________________ Relationships ___________________ ___________________ ___________________ 3 View slide
  • Part III ________________________ ________________________ Systemic Approaches to ________________________ Treatment ________________________  Support and Problem- ________________________ Solving: the “Family Focus” ________________________ Approach ________________________  Generating a Stronger ________________________ Family Structure:The ________________________ Contemporary Structural ________________________ Framework ________________________  Couples therapy when one ________________________ partner has Asperger’s 4 View slide
  • Part I: Understanding Autism and Non- Systemic Approaches to Treatment ___________________________ ___________________________  Definition of Autism and the Autism ___________________________ Spectrum ___________________________  “The Triad” of symptoms: impaired ___________________________ relationships, difficulty with ___________________________ communication, restricted ___________________________ interests/behaviors ___________________________  The 5 discrete diagnoses: Autistic D/O, ___________________________ Asperger’s, PDD-NOS, Rett’s, ___________________________ Disintegrative D/O ___________________________  The three primary diagnoses and their ___________________________ different symptoms; Asperger’s lacks ___________________________ delay in verbal IQ, PDD-NOS lacks full ___________________________ symptomatology ___________________________  Additional symptoms/challenges for people on the spectrum: sensory ___________________________ processing, sleep, gi issues,  Effects on Functioning throughout the Life Span  The drive for comfort and stimulation  Common Strengths for people with ASDs:visual abilities, memory, splinter skills 5
  •  The Question of Etiology  Medical Screening: Modified Checklist for Autism ________________________ ________________________  Making the Diagnosis: Team of psychologist, OT SPLP, ________________________ educator, social worker ________________________  The Various Rating Scales: ________________________ Gilliam, Autism Rating Scale ________________________  Resources for making the ________________________ Diagnosis: DDA/School ________________________ System/Private providers ________________________  Differential Diagnosis: OCD, ________________________ ADHD, Social Anxiety  Co-Morbidity: OCD, ADHD, mood issues  Epidemiology: 1 in 150 6
  •  Common Non-Systemic Approaches to Treatment _________________________________ _________________________________ _________________________________  Characteristics of Successful _________________________________ Approaches: begins early, intensive, _________________________________ involves family, structured, utilizes _________________________________ behavioral principles _________________________________  “Normalization”, or helping kids to “feel _________________________________ normal” vs. “Treatment” _________________________________  Applied Behavioral Analysis; intense, _________________________________ specific skill-building _________________________________ _________________________________  TEACHH:visual structure and _________________________________ organization _________________________________  LEAP: educational inclusion _________________________________  Picture-Exchange Communication _________________________________ Systems: communicating with pictures _________________________________  Greenspan/Denver/DIR Model: play _________________________________ which develops reciprocity _________________________________ _________________________________  Social Skills Groups: teaching specific _________________________________ skills  Educational Supports (504s, IEPs, accommodations/special programs, FastForward, Cogmed, Kurzweil) 7
  •  Language-Communication Therapy: _________________________________ intense teaching of pragmatic language _________________________________  Functional Behavioral Analysis; _________________________________ addressing the function of behaviors _________________________________ _________________________________  Medication: anti-depressants, stimulants, _________________________________ anti-psychotics _________________________________  Collaborative-Problem Solving: relating _________________________________ more flexibly _________________________________  Relationship Development Intervention _________________________________ (RDI): making use of ‘productive _________________________________ uncertainty’ _________________________________  Sensory Integration Therapy: modulating _________________________________ sensitivities and increasing awareness _________________________________ _________________________________  Dietary Interventions: reducing gluten and _________________________________ casein, adding Omega-3s _________________________________  Emphasizing Strengths; memory, visual _________________________________ abilities, etc. _________________________________  Individualized sports: karate, tennis, etc. _________________________________  Mentor programs _________________________________  Play Dates/Controlled social events  Social Stories: improving behavior and teaching skills  The battle against screen time 8
  •  Individual therapy: ________________________  Make concepts concrete: ________________________ play-dough, rubber bands, ________________________  Offer specific guidance: ask ________________________ when, where, with whom, use ________________________ cartoons and role plays  developing the ‘theory of ________________________ mind’ using speech bubbles ________________________  Using sociograms or ________________________ “closeness circles” to identify ________________________ and improve relationships ________________________  using the relationshipL “I ________________________ wonder if you do this when?”  Use active empathy but avoid intrusiveness  The need for patience  Meeting with counselors and friends  Decision-making analysis  The Reality Principle; getting 9 these guys to look beyond typical women
  •  Part II: The Systemic Context of Autism _______________________  Common Family Dynamics: time/resource demands, stigma,isolation, _______________________ behavior issues, guilt/blame, parental _______________________ strife, problems with other siblings  The Stages of Grief Model: shock, denial, _______________________ anger, bargaining,acceptance. Family _______________________ members can be at different stages, need to grieve again at each developmental _______________________ stage _______________________  Common Ways of Coping: Normalization (addressing autism within the context of _______________________ other needs), Crusadership (illness as an _______________________ occupation), Altruism (can neglect own needs), Resignation (can lead to _____________ depression)  Positive Effects of Having An Autistic Member of the Family: increased cohesion, empathy among siblings, personal growth 10
  • Challenges for Families At Particular Developmental ___________________ Stages  Infant and Toddler Stage: the stress ___________________ of diagnosis, difficulty bonding, ___________________ negotiating different family ___________________ reactions, finding supports  School-Age: Need for advocacy, ___________________ arranging treatments/child care, ___________________ managing behaviors  Adolescence: coping with chronicity, ___________________ isolation/peer rejection, need to ___________________ build functional living skills, facing dangerous tantrums ___________________  The Transition to Adulthood: ___________________ coordinating services ___________________  Adulthood (Autism vs. Asperger’s): maximizing independence and ___________ supports/ongoing demands 11
  • Typical Challenges for Particular Family Relationships (in middle- class America) _______________________  Mother-Father: enmeshment vs. _______________________ disengagement _______________________  Mother (typically)-Autistic Child: “doing for” autistic child, depression/guilt in _______________________ Mother _______________________  Father (typically)-Autistic Child: Father can be rejecting/withdrawing, focused on _______________________ behavior and achievement, Father’s self- _______________________ esteem effected  Mother or Father—non-autistic child: may _______________________ neglect needs of child, pressure child to _______________________ care for or ‘make up’ for autistic child  Autistic child-non-autistic child: jealousy, _______________________ “survivor’s guilt”, embarrassment _______________________  Grandparents-parents: can be critical and non-supportive _______________________  Caveats: these responses are typical of dominant social group, all families and relationships are different, and the presence of the autistic child can also 12 have positive effects
  • Part III: Systemic Approaches to Addressing ___________________ the Challenge of Autism ___________________  Goals: Maximizing functioning for all family ___________________ members, increasing ___________________ normalization, increasing ___________________ support, knowledge, and ___________________ capacities of family to ___________________ manage stress, advocate, and manage the treatment ___________________  The Need for support as well ___________________ as re-structuring ___________________  The need to address ___________________ systems issues beyond the ___________ family 13
  • Initial Systemic Approaches for Families with Young _______________________ Children _______________________  Initial Engagement: _______________________ Normalizing, reframing, and the _______________________ drawing out of individual _______________________ narratives _______________________  Considerations for segmenting _______________________ sessions _______________________  Assisting in Generating Order, _______________________ Obtaining Resources, and _______________________ trouble-Shooting _______________________  Empowering the “Treatment _______________________ Managers: Offering Information and Support  Facilitating Positive Ways of Coping: Advising them to look at needs of family, individual needs, and other relationships 14
  • Systemic Approaches in Working With Older Adolescents and _______________________________ Adults _______________________________ _______________________________ _______________________________  Navigating systems: Obtaining vocational _______________________________ assistance, education, getting benefits, housing, _______________________________ finding respite care, transportation, peer groups _______________________________  Addressing isolation, overuse of t.v., _______________________________ pornography _______________________________  engaging staff and family: meet both with adults _______________________________ with autism and without, and coordinate with agencies _______________________________ _______________________________ _______________________________ Strengthening the Family Structure (for _______________________________ Families who Have Autistic _______________________________ Children at Home) _______________________________ _______________________________  Continuing with Normalization, Reframing, and _______________________________ Supportive Interventions, and developing a _______________________________ systemic worldview via relational questions _______________________________  Applying a Contemporary Structural Approach: _______________________________ What it is and why it works with these families _______________________________ (see handout) _______________________________ _____________ 15
  • _______________________________ Goals of Family Therapy And _______________________________ _______________________________ Interventions to Achieve Them: _______________________________ _______________________________  The Strengthening of the _______________________________ Hierarchy _______________________________ _______________________________  Putting parents in charge of _______________________________ discipline _______________________________  Encouraging parents to position _______________________________ _______________________________ themselves as a unit _______________________________  Assisting parents with collaborative _______________________________ problem-solving, limit-setting _______________________________ _______________________________  Applying the “guard rail” technique _______________________________  Cautions/considerations: especially _______________________________ watch for “unbalancing” against the _______________________________ “enmeshed Mom” _______________________________ _______________________________ _______________________________ _______________________________ _____________ 16
  •  The Development of Caretakers’ Nurturing and Understanding _______________________________________ _______________________________________  Encourage both parents to position _______________________________________ themselves to offer nurturance _______________________________________  Ask children’s opinions of parents’ _______________________________________ _______________________________________ remarks _______________________________________  Maintaining a connection with parents _______________________________________  Scripting parents in “practical empathy” _______________________________________ _______________________________________ (wanting as opposed to feeling) _______________________________________  The Development of “Skill-Building _______________________________________ Skills” by parents _______________________________________ _______________________________________  Showing them how to build a theory of _______________________________________ mind in their children: getting them to ask _______________________________________ kids what others may want or think _______________________________________  Showing parents how to coach kids in _______________________________________ _______________________________________ emotion regulation: getting kids, to slow _______________________________________ down, separate, ask “So what?” _______________________________________  Role-playing (including puppets and _______________________________________ figures) to develop problem-solving skills _______________________________________ _______________________________________  Games such as “Stop, Relax, and Think” _______________________________________ 17
  •  The Development of _______________________________________ Emotional Bonds Between _______________________________________ Particular Parents and _______________________________________ _______________________________________ Children _______________________________________ _______________________________________  Hold sessions with the “less _______________________________________ close” parent and child(ren) _______________________________________ _______________________________________  Filial Play Therapy, encouraging _______________________________________ _______________________________________ reflection and empathy _______________________________________  Encourage enjoyable activities, _______________________________________ _______________________________________ physical closeness _______________________________________ _______________________________________  Breaking Down Dysfunctional _______________________________________ Coalitions _______________________________________ _______________________________________  Supporting the “less competent” _______________________________________ _______________________________________ parent _______________________________________ _______________________________________  Blocking (and supporting) the _______________________________________ enmeshed parent _______________________________________  Blocking inappropriate cross- generational alliances 18
  • _______________________________________________ _______________________________________________  Minimizing Scapegoating _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________  Allying with the scapegoat (sitting _______________________________________________ _______________________________________________ next to) _______________________________________________ _______________________________________________  Checking in with the scapegoat _______________________________________________ _______________________________________________  The Alter Ego Technique (“speaking _______________________________________________ _______________________________________________ for”) _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________  Strengthening the parental _______________________________________________ relationship _______________________________________________ ___________________________________  “Turning towards”/time for themselves  Improving communication  Making a safe space for emotions  Generating more equity/more flexible roles 19
  •  Supporting the non-autistic child ____________________________________________  Position them close to you and parents ____________________________________________ ____________________________________________  Offer individual sessions and filial ____________________________________________ sessions ____________________________________________ ____________________________________________  Strengthening the sibling relationship ____________________________________________ ____________________________________________  Sibling sessions—foster fun and problem- ____________________________________________ solving ____________________________________________ ____________________________________________  Developing Family Unity ____________________________________________ ____________________________________________  Games and exercises—Family Sandtray, ____________________________________________ Life Stories game, play with puppets and ____________________________________________ characters ____________________________________________ ____________________________________________  Improving the relationship with ____________________________________________ ____________________________________________ grandparents/other family members ____________________________________________ Encourage their support and block ____________________________________________ ____________________________________________ criticism/intrusion ____________________________________________ ____________________________________________ ____________________________________________ The vision: An adaptable and functional family ____________________________________________ ____________________________________________ that is supported and supported, supports ____________________________________________ each member’s needs, attends to each ____________________________________________ relationship, and supports and empowers the person with autism  Addendum: Couples Work when one 20 partner has Asperger’s Disorder