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December 11, 2017
Articles
"When the parent learns to talk to the strengths of the child, the child is better able to view him/herself as capable and of value..."
-- Charlyne Gelt, Ph.D., (PSY22909), M.F.T.


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Facing the Challenges of a Child on the Autism Spectrum

by Charlyne Gelt, Ph.D., (PSY22909), M.F.T.

We face an explosive rate in the nation's autistic population. As therapists we need to understand how a child on the autism/Asperger's spectrum really sees the world. Parents need to know how to cope with all their behaviors, how to define "normal" or "typical" from "autistic," and how to best meet these needs within the family. Therapists can assist parents in learning to cope with the grief and loss of the hoped-for "normal" child, and can help them understand their child's behaviors and develop proactive rather than reactive responses. But first, we need to know what we are dealing with.

Autism is a severe developmental disorder in which children are isolated from the world around them. It affects the individual's ability to convey thoughts and interact with others. Although there is a broad spectrum of symptoms, it is marked by poor language skills and an inability to handle social relations. Early intervention is the key because a large part of the skyrocketing costs can be reduced with early diagnosis and intensive intervention.

Which Treatment Approach?

Disease Model
With the disease model, treatment is focused on identifying and removing autism, the idea being that once this inner state is removed, then the autistic behavior may remediate. The behaviors are considered symptomatic, and therefore are not considered the prime targets for intervention.

Psychological Model
This model is based on Theory of Mind and systems framework. Children with autism are merged with the mind, thoughts, and actions of the parent. They have yet to develop the ability to attribute mental states to others or take into account the fact that different people have different thoughts (Baron-Cohen, Tager-Flushberg, & Cohen, 1993, 2000). Inadequate empathic attunement and/or insufficient mirroring, and deficits within the parent-child family dynamic, are seen as contributing to the child's inability to know his/her own mind. Children with autism have not yet found their "rhythm of safety," meaning a "being who is felt to guarantee the child's own sense of being." (F. Tustin). The work, then, is focused on attachment, engagement, and emotional development and uses the relationship to help the child build up a sense of self.

Applied Behavior Analysis (ABA) is the intervention of choice if one believes that the etiology is genetic, biological, or environmental. It is based on continuous reinforcement. It is the primary method being used today with autistic children. The behavioral model breaks autism down into small conceptual units (self-destruction, imitation, vocalizations, units of grammar, labeling, etc.). Contrary to the psychological model, it suggests that there are no developmental crises or intra-psychic conflicts to resolve, no opposing forces, no rage, and no terror of abandonment because the child never knew any other state. (Lovaas & Smith 1989). It is the most researched, and thus has the most documented successes. It is predicated on behavioral interventions that shape behavior by quick and immediate rewards, waiting for the desired behavior and very quickly rewarding that behavior, most often with food. The problem is satiation and lack of ability to generalize learning to external environments.

Family Issues

One priority is to develop awareness of the family dynamics and assess how they may play out in the educational realm and in seeking services. Frequently, the family is overwhelmed or unwilling to address the marital and family issues. Blame, anger, and pain of unmet marital and/or family needs are often projected onto the school system. Another priority in parenting is to address inclusion needs within the family system, not just at the educational level. When parents view the autistic child as fragile, weak, handicapped, or disabled, the child learns to view him/herself in the same way. If everyone in the family -- except the special needs child -- has duties and responsibilities (such as taking out the trash, setting the dinner table, or helping in the yard), then the child learns to see themselves as less-than or dependent. Doing tasks for the child that the child can do for themselves only promotes a defeatist, victim attitude within the child, and creates resentments in the siblings whose own developmental needs may not be getting met. Often parents of special needs children talk for their child or about their child as though the child wasn't even in the room.

However, when the parent learns to talk to the strengths of the child, the child is better able to view him/herself as capable and of value. In my work with special needs children, I always encourage families to address the issue of full inclusion within the family system - right from the start. For the child, it is the capacity to do for oneself that translates into greater social acceptance by peers and gives them a much greater opportunity for success in the world.