Building Connections: ASD and psychotherapy

Transcription

1 Bilding Connections: ASD and psychotherapy Rth M. Strnz Developmental Consellor ASD Learning Specialist (705)

2 Session Overview Rth will present the developmental fondations of atism spectrm disorder (ASD) and explore how ASD affects the parent-child relationship Common parental responses to a diagnosis of ASD; role of Early Recollections in exploring these responses Participants will learn how (and why!) to encorage parents to establish & maintain meaningfl relationships with kids with ASD; to nderstand how their child learns, and how to adapt Adlerian parenting techniqes to make them accessible to families changed by ASD.

3 Agenda 1. Introdctions who s here? 2. Part 1: Understanding *ASD 3. 5-minte break > text, bathroom, chat, caffeinate 4. Part 2: ASD, parenting & therapy 5. Qestions/discssion/feedback * ASD = atism spectrm disorder, levels 1,2 or 3 (DSM-V)

4 Backgrond Theoretical framework: Adler, Montessori, early development & psychology, ecological therapetic approach Experiential backgrond: Teaching, parent consellor, ASD consltant (US & Canada), Developmental Consellor Personal: Sibling, co-parent & parent of people with ASD; adoptive & biological mother

5 ASD in Ontario in :88 children diagnosed with ASD Many ndiagnosed adlts living with ASD; parents & professionals; low social competence/high anxiety Fll range of IQ scores 95% of people with ASD have co-occrring disorders New research & techniqes daily; parents often overwhelmed!

6 Speaking of research.. Brookman et al (2012) - interviewed 100 CMH therapists on serving children with ASD in commnity mental health settings. Findings: therapists perceive serving this poplation as challenging and frstrating de to their limited training. Robledo & Donnellan (2008) interviewed 5 professionals with ASD abot their experience in relationships. Interviewees cited 6 properties of spportive relationships: trst, intimacy, presmption of competence, nderstanding, shared vision of independence & good commnication.

7 Children & Social Interest For Adler > mental health = social interest (Gemeinschaftsgefl) Propose that best practices will: enable child with ASD to reach their developmental potential connect child with ASD with family/commnity in meaningfl, sstainable ways Parent training & encoragement are key!

8 DSM 5 diagnostic criteria for ASD DSM 5 diagnosis: atism spectrm disorder; level 1,2 or 3 (see handot) ASD level 3 = Asperger s Syndrome For yor thoghts > To what extent does diagnosis matter, in yor case conceptalization? To yor ability to spport parents?

9 Case conceptalization Components: a diagnostic formlation, a clinical formlation and a treatment formlation (Sperry, 2005) 1. Diagnostic (what happened?) 2. Clinical (why did it happen?) 3. Treatment (how can it be changed?)

10 Parents carry into the room Frstration (with child or systems) Fatige Fear Denial Shock or srprise Lack of information, or misinformation feeling lost or nqalified Core beliefs abot ability/disability > Early Recollections And more!

11 Case conceptalization reqires developmental perspective! A developmental (not behavioral) disorder characterised by 5 core deficits (Gtstein, 2009) 1. Flexible thinking 2. Commnication 3. Social referencing 4. Self reglation 5. Emotional memory

12 Core deficits of ASD (Gtstein, 2009) 1. Flexible Thinking: identifying mltiple soltions; reflecting on someone else s perspective; managing transition & change 2. Commnication: mlti-channelled commnication; sharing own & others world-views 3. Social referencing: interpreting social ces; social referencing ( eye contact ) 4. Self-reglation: managing emotion; hypo/hyper-reactivity to sensory stimli 5. Emotional memory: remembering & learning from emotions

13 Core deficits of ASD > qality of life Emotional/sensory dysreglation Eating, sleeping/toileting challenges Difficlty making/sstaining friendships Learned helplessness Fight, flight, freeze: responses to transition/ncertainty Sensory isses > personal hygiene; distractibility Underdeveloped/scripted social skills Inflexible adherence to rles/rotines Limited self-awareness & reflective processing

14 What Happens Next? For child with ASD: Difficlty with collaboration, teamwork, commnication, cooperation, self-awareness, cognitive shifting, temporal analysis, contextal information.mltiple obstacles to dynamic development & friendship. For parent: Difficlty establishing co-reglation (Fogel, 1991), trst, reciprocal commnication, redced joy in parenting, difficlty giding, daily strggles mltiple obstacles to relationship bilding.

15 So here we are! Child Difficlties with relationships family, peers Redced self-awareness (insight) Patterns of friendship breakdown Isolation Sensory challenges Anxiety Often a complsive trth-teller Cognitive distortions Commnication barriers > too mch, or not enogh Parent/Caregiver Anger/frstration with child, & with edcational/healthcare systems Loss/grief Fatige/ redced self-care Confsion abot parenting abilities Isolation Marital stress Extended family stress Anxiety > depression

16 Anyone need a 5-minte break for self-care??

17 The For C s Connected, Capable, Conted, Corageos Every child needs to meet these needs; if they can t meet them in healthy ways, they will se maladaptive ways Does the parent believe their child with ASD has these needs? Do they believe the child can meet them? (If not, start here!) Bette-Lo Bettner (1989); Alyson Schafer (2009)

18 The Work Apply this nderstanding of ASD to parent training & therapy: 1) Hear the parent s niqe story. Identify parent s core beliefs re perfection, ability, inclsion etc. 2) Provide a sensory-spportive environment. 3) Explore child s development together be crios abot early milestones ( 4) Get excited abot neroplasticity (Doidge, 2007) 5) Learn abot the child s learning style ~ 90% are visal learners 6) Empower parents to create individalized opportnities to recognize & address the core deficits of ASD!

19 #1: Uniqe story & core beliefs Every parent-child relationship is niqe! What is strong in this relationship? What do they admire, appreciate, feel prod of, in their kid? Core beliefs > list losses in childhood; based on these losses: I am People are The world is What happened to yo before age 11, for which yo were not prepared? Who helped yo? How did they do that? What else wold have been helpfl? THIS is how to spport this parent Wingett, 2011

20 The parent-child relationship Hman development happens within relationship (Fogel, 1993) What is the tone of the parent-child relationship? Ask abot previos interventions > What did the parent learn abot their child, from these experiences? Hope, dreams do they KNOW how important they are? Are they spported by this knowledge, or overwhelmed?

21 #2: Sensory-spportive environment Tip: Provide fidgets, wear plain colors & no perfme! Ask abot the child s sensory processing learn what is aversive/acceptable Do window blinds bother their eyes? Do they like dim light? Are they ncomfortable with specific sonds? Smells? Are they hot/cold when others are hot/cold? Do they need to chew gm/fidget/stand p, to pay attention? Do they sally hold a cshion, or love heavy blankets?

22 #3: Developmental milestones Early (social) *developmental milestones: 2 mths > follow movement with eyes; stdy parent s face 4 mths > track moving person with eyes; lagh/smile in respond to parent laghing/smiling 6 mths > respond to own name; look in direction of a new sond 12 mths > look at someone who says their name; take trns making sonds with parent These milestones were missed in infancy by individals with ASD. Parents can learn to help kids meet them later. *SOURCE: Nippissing District Developmental Screen (

23 #4: Neroplasticity > remediation 1. Flexible thinking mltiple soltions; differing perspectives 2. Commnication mltiple channels of commnication; ample processing time; think alod; spport memory with visals 3. Social referencing scaffold for client to discover what can be learned from facial expression/gestral commnication 4. Self reglation explore role of self-reglation in relationships; try ot self-reglatory strategies 5. Emotional memory se photos (visals) of past experiences; inqire how prior experiences felt, how decisions were made

24 #5: Learning style Some children will have had psych-ed testing. If not, what works for the child? How do they learn? Visals (drawn to signs & symbols) Slowed pace of aditory inpt Additional processing time (try 8-10 seconds!) Moving doodling, fidgeting, pacing, standing etc. Encoragement!

25 Thinking process Example: Child experiences anxiety arond decision making Reflect > What experiences will help them gain skills & confidence for decision-making, ths redcing anxiety? Reflect > Which core deficit might affect decisionmaking? Plan > Combine sensory & learning info to create experiences that enables child to make discoveries abot Self!

26 Tools of the trade Collaborative, playfl interactions (board games, ball games) Model management of ncertainty & confsion Clear limits & bondaries Use LESS speech; MORE facial, gestral, postral commnication Provide visal spports write notes, ideas, lists Specific encoragement Patience change and transition feel risky to this child Anticipate obstacles fear, history of trama, discoragement, learned helplessness Use hmor!

27 Mlticltral competency Be patient with yorself & the client Yo re spporting the parent to bild a working alliance between two very different minds, with different life experience, sensory processing, core beliefs abot self. We are ALL a work in process!

28 Keep in toch! Rth Strnz is a Developmental Consellor who specializes in spporting people whose lives have been changed by ASD, in themselves or a lovedone. Rth spports people with ASD of all ages, sing an Adlerianinflenced, ecological model of therapy for individals, parent edcation, and professional consltation. Yo are welcome to contact Rth directly! If yo wish to share the content of this presentation in any format, please reqest permission from rth.strnz@gmail.com.

29 References Bettner, B-L. & Lew, A. (1989). Raising kids who can. Media, PA: Connexions Press. Brookman-Frazee, L., Drahota, A., Stadnick, N & Palinkas, L.A. (2012). Therapist perspectives on commnity mental health services for children with ASD. Administration & Policy in Mental Health & Mental Health Services Research, 39(5). ( ) Doidge, N. (2007). The brain that changes itself. New York, NY: Pengin. Fogel, A. (1991) Developing Throgh Relationships. Chicago, IL: University of Chicago Press. Gtstein, S. (2009) The RDI Book. Hoston, TX: Connections Center. Robledo, J.A. & Donnellan, A. (2008). Properties of spportive relationships from the perspective of academically sccessfl individals with atism. Intellectal and Developmental Disabilities: 46 (4), ( ). Schafer, A. (2009) Honey I wrecked the kids. Mississaga, ON: Wiley & Sons. Sperry, L. (2005). Case conceptalization: a strategy for incorporating individal, cople and family dynamics in the treatment process. American Jornal of Family Therapy, 33, ( ). Wingett, W. (2011). Finding a way: loss, grief & resoltion. Norfolk, NE: Adlerian Conseling & Training.