Why Does a Child with Why Does a Child with ASD need Individual ASD need Individual

Therapy?Therapy?To address core issuesTo address concomitant issuesTo address issues that might arise in general population, as well (e.g., Adjustment Disorder)

When to use different When to use different modes of therapymodes of therapy

Individual OnlyGroup therapy too difficult for child to manageHome setting too distractingMaturational signpost

Individual and WA and/or Group

Prep, monitoring and reinforcement of grp interventionsWA and indiv gives therapist contact w/ parents, teachers, frds, etc.

It’s the Relationship It’s the Relationship Stupid!Stupid!

Therapy provides a safe place to learn and try new thingsTherapist is a model:– Must display emotional control– Bridge to culture, art, humor and

common forms of communication (pragmatics)

It’s the Relationship It’s the Relationship Stupid! Cont’dStupid! Cont’d

Therapist may be the only friend child has– Therapist is important relationship

outside of child’s family

Therapist mode of interaction is dependent on the individual child

Common Individual Common Individual Therapy Domains Therapy Domains

Dx discussionDepressionFearsAnxietySensory issues

Dating/sexual issuesDrivingAdjustment Disorders

Using Perservations as Using Perservations as InterventionIntervention

Perseveration as Metaphor– Use for social understanding– Emotional understanding– Motivation– Self-esteem and competence– Future career

Discussion of Discussion of DiagnosisDiagnosis

To frame the diagnosis for the child and the familyAddress both strengths and weaknessesDiscuss what “fits” Dx and what doesn’t

DepressionDepression

17-40% rateMay require individual rather than group mode of interventionSuicidal verbiage much more common than plansNegative self-image a prevailing issueBehavioral methods in addition to CBT

AnxietyAnxiety

15% rateMay be related to non-verbal learning disability profile

Anxiety & DepressionAnxiety & Depression

Related to levels of aggressionTend to have poorer relationships with teachers, peers, and family members

(Kim, Szatmari, Bryson, Streiner, & Wilson, 2000)

Systematic Systematic Desensitization Desensitization

Relaxation TrainingRelaxation Training

Relaxation TrainingRelaxation Trainingfor…for…

Anxiety issuesFearsOverstimulation

Relaxation Training Relaxation Training ComponentsComponents

Muscle relaxationsBreathing exercisesImagery

Imagery ExercisesImagery Exercises

Beach (adult)Rocket ship (child)Turtle (child)

Desensitization Desensitization HierarchyHierarchy

Very gradual introduction of the thing producing anxietySpecifying 10+ small steps Working through each giving anxiety a chance to ariseFollow with relaxation activity

Desensitization Desensitization Hierarchy for Fear Hierarchy for Fear

of Thunderof Thunder1. Fake looking graphic of thunder

cloud2. Actual picture of thunder cloud3. Picture of lightening from

thunder cloud4. Picture of thunder cloud near

the child’s home5. Listen to sound recording of

thunder for 1 minute

Desensitization Desensitization Hierarchy for Fear Hierarchy for Fear

of Thunderof Thunder6. Listen to sound recording for

five minutes7. Watch actual video for one

minute8. Watch video for five minutes9. Move 10 steps from window

during storm10.5 steps from window during

storm

Desensitization Desensitization Hierarchy for Fear Hierarchy for Fear

of Thunderof Thunder

11.Next to window during storm12.Stand in open door during storm13.Walk into rain

Last few steps may be hard to do during individual more luck with mobile therapy

DrivingDriving

Helping family decide on viabilityMulti-step plan with reevaluation at each stepSimulator optionsIssues with judgment, coping when others don’t follow the rulesAlternatives to driving

Adjustment DisordersAdjustment Disorders

Problems with changeProblems with transitionsTendency to see things in black-and-white termsProblems recognizing and labeling feelings

Emotional RegulationEmotional Regulation

Emotional Identification (self and others)Understanding Gradations of EmotionsDiscrete Emotions (i.e. frustration v. anger)Enhancement of Empathy

Parent Involvement in Parent Involvement in Individual TherapyIndividual TherapyMaintaining confidentialitySpeaking Separately– Assists in therapist gaining an

accurate picture of what is happening (esp at home)

– Work to generalize intervention techniques

Parent Involvement in Parent Involvement in Individual TherapyIndividual Therapy

Together– Work on parent – child

relationship– Can be helpful to have child

remember and speak about issues

SensorySensorySocial issues may be sensory issues in disguise

Interventions– ‘stim’ toys (i.e., theratube, trampoline)– Ear plugs– Sunglasses– Private stimming (i.e., bathroom)

CommunicationCommunication

Must teach current slangTeach that words can have more than one meaningCorrecting friends usually should be avoidedFigurative language

CommunicationCommunication

Focus on gaining meaning from what another saysAsking questions about conversation partnerListening to ‘boring’ speechProsody

Black and White Black and White ThinkingThinking

Atheism/PriesthoodTie in w/ emotionsMood issuesAcademicSelf-worth

Theory of MindTheory of Mind

‘Reading’ and displaying nonverbal communicationUnderstanding that other’s may already know what you know

Focus on Small StepsFocus on Small StepsSteps obvious to us may not be obvious to the child with ASD– Conversation initiation and maintenance– Organization

• Handing in homework• Notebooks• Room

– Avoiding commenting on facts about another person that may be embarrassing

Focus on Small Steps Focus on Small Steps Cont’dCont’d

‘Reading’ that a peer is upset with themMisreading another’s intent– Stalking– Teasing– Being ‘set-up’

SocializationSocialization

Kids on the spectrum often have a very concrete conception of friendship– i.e. they say ‘hi’ so they’re my friend

Vulnerable to manipulation– Relational aggression should be assessed

Teach what a ‘true’ friend is– Progressive trust building

SocializationSocializationTeach and encourage how to get and use contact information– IM and texting language

Phone calls can be frightening– Use scripts

Break down ‘small talk’– Common conversation topics (i.e., school)