Why Does a Child with ASD need Individual Therapy?

2. Why Does a Child with ASD need Individual Therapy? • To address core issues • To address concomitant issues • To address issues that might arise in general population, as well (e.g., Adjustment Disorder)

3. Individual Only Group therapy too difficult for child to manage Home setting too distracting Maturational signpost Individual and WA and/or Group Prep, monitoring and reinforcement of grp interventions WA and indiv gives therapist contact w/ parents, teachers, frds, etc. When to use different modes of therapy

4. It’s the Relationship Stupid! • Therapy provides a safe place to learn and try new things • Therapist is a model: • Must display emotional control • Bridge to culture, art, humor and common forms of communication (pragmatics)

5. It’s the Relationship Stupid! 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

6. Dx discussion Depression Fears Anxiety Sensory issues Dating/sexual issues Driving Adjustment Disorders Common Individual Therapy Domains

7. Using Perservations as Intervention • Perseveration as Metaphor • Use for social understanding • Emotional understanding • Motivation • Self-esteem and competence • Future career

8. Discussion of Diagnosis • To frame the diagnosis for the child and the family • Address both strengths and weaknesses • Discuss what “fits” Dx and what doesn’t

9. Depression • 17-40% rate • May require individual rather than group mode of intervention • Suicidal verbiage much more common than plans • Negative self-image a prevailing issue • Behavioral methods in addition to CBT

10. Anxiety • 15% rate • May be related to non-verbal learning disability profile

11. Anxiety & Depression • Related to levels of aggression • Tend to have poorer relationships with teachers, peers, and family members (Kim, Szatmari, Bryson, Streiner, & Wilson, 2000)

12. Systematic Desensitization Relaxation Training

13. Relaxation Trainingfor… • Anxiety issues • Fears • Overstimulation

14. Relaxation Training Components • Muscle relaxations • Breathing exercises • Imagery

15. Imagery Exercises • Beach (adult) • Rocket ship (child) • Turtle (child)

16. Desensitization Hierarchy • Very gradual introduction of the thing producing anxiety • Specifying 10+ small steps • Working through each giving anxiety a chance to arise • Follow with relaxation activity

17. Desensitization Hierarchy for Fear of Thunder • Fake looking graphic of thunder cloud • Actual picture of thunder cloud • Picture of lightening from thunder cloud • Picture of thunder cloud near the child’s home • Listen to sound recording of thunder for 1 minute

18. Desensitization Hierarchy for Fear of Thunder • Listen to sound recording for five minutes • Watch actual video for one minute • Watch video for five minutes • Move 10 steps from window during storm • 5 steps from window during storm

19. Desensitization Hierarchy for Fear of Thunder • Next to window during storm • Stand in open door during storm • Walk into rain Last few steps may be hard to do during individual more luck with mobile therapy

20. Driving • Helping family decide on viability • Multi-step plan with reevaluation at each step • Simulator options • Issues with judgment, coping when others don’t follow the rules • Alternatives to driving

21. Adjustment Disorders • Problems with change • Problems with transitions • Tendency to see things in black-and-white terms • Problems recognizing and labeling feelings

22. Emotional Regulation • Emotional Identification (self and others) • Understanding Gradations of Emotions • Discrete Emotions (i.e. frustration v. anger) • Enhancement of Empathy

23. Parent Involvement in Individual Therapy • Maintaining confidentiality • Speaking Separately • Assists in therapist gaining an accurate picture of what is happening (esp at home) • Work to generalize intervention techniques

24. Parent Involvement in Individual Therapy • Together • Work on parent – child relationship • Can be helpful to have child remember and speak about issues

25. Sensory • Social issues may be sensory issues in disguise • Interventions • ‘stim’ toys (i.e., theratube, trampoline) • Ear plugs • Sunglasses • Private stimming (i.e., bathroom)

26. Communication • Must teach current slang • Teach that words can have more than one meaning • Correcting friends usually should be avoided • Figurative language

27. Communication • Focus on gaining meaning from what another says • Asking questions about conversation partner • Listening to ‘boring’ speech • Prosody

28. Black and White Thinking • Atheism/Priesthood • Tie in w/ emotions • Mood issues • Academic • Self-worth

29. Theory of Mind • ‘Reading’ and displaying nonverbal communication • Understanding that other’s may already know what you know

30. Focus on Small Steps • Steps 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

31. Focus on Small Steps Cont’d • ‘Reading’ that a peer is upset with them • Misreading another’s intent • Stalking • Teasing • Being ‘set-up’

32. Socialization • 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

33. Socialization • Teach 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)