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Seeing the whole gifted child

By Lindsey Phillips November 30, 2020

Assessing symptoms and determining a treatment plan for clients is never a simple or straightforward task. That can be especially true when it comes to working with gifted and twice-exceptional clients.

Imagine that a second-grader who is highly intelligent comes to your counseling office. The child has some intense interests, which is not uncommon with individuals who are gifted, and they struggle with emotion regulation, which appears to be related to the child’s perfectionism and low frustration tolerance. You might assume that this client’s struggles are just a natural consequence of being gifted.

Emily Kircher-Morris, a licensed professional counselor (LPC) at Unlimited Potential Counseling & Education Center in O’Fallon, Missouri, made this assumption. It wasn’t until her client entered the fourth grade that Kircher-Morris learned that giftedness alone couldn’t “explain away” the student’s emotional struggles. After experiencing a major event, the client’s problems increased to the point that Kircher-Morris referred him to a psychologist for a full differential diagnosis. Upon receiving the results, she was shocked to find out that her client was not only gifted but also autistic.

“I had fallen into the [common] beliefs about giftedness: That the [emotional struggles] were just sensory intensity or perfectionism,” says Kircher-Morris, an American Counseling Association member who specializes in gifted and high-ability individuals. “I missed how intense his meltdowns were and that his intense interests were related to autism, not giftedness.”

It’s true that individuals who are gifted may possess an intense interest, but they can communicate about other topics in addition to that passion, whereas someone with autism spectrum disorder can’t easily talk about other topics, Kircher-Morris explains.

To make an accurate assessment of a gifted client, professional clinical counselors must first know what “giftedness” even means. The problem is that the exact determinants and measurements for giftedness vary from state to state and even school to school. But according to the National Association for Gifted Children (NAGC), individuals deemed to be gifted or talented have the capability to perform at higher levels than their peers, and they require modifications to their educational experience to learn and to realize their potential.

Neither Kircher-Morris nor James Bishop, an LPC at Blank Slate Therapy in Frisco, Texas, distinguish between “gifted” and “high achieving” because they say some individuals need to be cognitively challenged regardless of whether they meet the formal definition of being gifted. And sometimes gifted individuals have learning disabilities or mental health issues that require them to get help — a concept that can be difficult for individuals who are used to having things come easily to them, Kircher-Morris points out.

(Mis)Identifying giftedness

There is also a substantial amount of anecdotal information, as well as misconceptions, about giftedness, and Bishop, executive director of the Passionate Mind Institute, warns that even mental health professionals can fall prey to pseudoscience on the topic. For example, some counselors too easily embrace overexcitability as a common characteristic of gifted individuals even though there isn’t much current research to support the belief, he says.

People may incorrectly assume that someone cannot be gifted if they are not doing well in school or that gifted individuals never need help, Bishop continues. Some also believe that individuals who are gifted are more prone to depression, but research shows they are as well-adjusted, if not more so, than their peers in the general population, he adds.

Such misconceptions, as well as concern about clinical misdiagnoses, led Bishop, a member of ACA, to conduct a study to test the ability of mental health professionals to recognize gifted characteristics in presenting clients using vignettes that illustrated common issues and characteristics related to giftedness. Half of the 330 participants were prompted that giftedness could be a factor, but regardless of that prompting, Bishop found the majority of participants still clung to the diagnosis of a disorder over an assessment of giftedness. (See “The potential of misdiagnosis of high IQ youth by practicing mental health professionals: A mixed methods study” in the journal High Ability Studies.)

Bishop’s study suggests that even mental health professionals, not just educators, have trouble factoring giftedness into their clinical assessments. “Being mindful and educating yourself on the real struggles that gifted [individuals] face can make you a better clinician in terms of assessing a gifted [client] and being able to determine whether their problems are the result of a disorder or are simply part of their gifted nature,” says Bishop, who chairs the NAGC Social and Emotional Development Network.

But finding training in this area can be challenging for counselors. Bishop says he had to get a doctorate in educational psychology to become formally educated in the subject. He isn’t aware of any counseling program that offers a concentration in giftedness.

The lack of adequate training is a problem because, according to Michelle Tolison, a licensed clinical mental health counselor in Charlotte, North Carolina, giftedness should be a specialty just like trauma. In fact, she believes that without being adequately trained, counselors can do extensive damage if they work with clients who are gifted.

Bishop, author of a forthcoming book on anxiety and giftedness for parents, recommends that counselors attend national and state gifted and talented conferences for opportunities “to dive into the subject, meet people in the field and get a sense of how they [as counselors] can play a role.” In addition to the resources provided by Supporting Emotional Needs of the Gifted (sengifted.org) and NAGC (nagc.org), Bishop and Tolison, owner and lead therapist at Dandelion Family Counseling, recommend reading Giftedness 101 (by Linda Kreger Silverman) and Misdiagnosis and Dual Diagnosis of Gifted Children and Adults (by James T. Webb et al.).

The gifted gap

Most gifted children are identified through testing or teacher referrals in elementary schools. The problem is that there is no one standard test used in schools to determine giftedness. On top of that, many school districts don’t test every student. Instead, they rely on teacher referrals, which, as Renae Mayes, an associate professor in the counseling program in the Department of Disability and Psychoeducational Studies at the University of Arizona, points out, introduces bias.

To highlight this potential bias, Mayes, an ACA member whose research focuses on gifted education and special education for students of color in urban environments, poses several insightful questions: How are teachers trained to recognize giftedness? How are they trained to recognize that giftedness exists in many different kinds of bodies? Will teachers see a Black student who can’t sit still in their seat and has lots of energy as someone who is gifted and excited about learning, or will they perceive the child negatively — as someone who has a behavioral problem or wants to disrupt the learning environment?

The sad reality is that the current method of identifying giftedness has led to an underrepresentation of individuals from marginalized backgrounds in gifted programs. Researchers at the Thomas B. Fordham Institute recently found that in schools that feature gifted programs, only three states enroll more than 10% of their Black and Hispanic students in such programs; in 22 states, that figure stands at less than 5%.

Black and Hispanic students are also overrepresented in special education, Mayes points out. When children are put in special education, it often becomes the only lens through which they are perceived, she says, and the likelihood of them also being identified as gifted dramatically decreases. As Mayes notes, these children tend to be viewed through a deficit perspective, which often incorporates stereotypical understandings of culture and disability rather than allowing children to be seen for their gifts and talents.

According to the article “Myths and research regarding the socio-emotional needs of the gifted,” published in the September issue of The Gifted Education Review (of which Bishop serves as co-editor), individuals from different cultures may not be as readily identified as gifted. Among the reasons highlighted in the article are because these individuals’ cultural norms differ from those of the prevalent culture (e.g., what might be viewed as positive assertiveness in one culture might be perceived as too aggressive in another) or because they are gifted in their first language, which differs from the English language programs in their schools.

“There’s a big push in gifted education to modify how we identify students and make it tied to what kids need academically,” says Kircher-Morris, the president and founder of the Gifted Support Network, a nonprofit dedicated to helping the families of gifted and high-ability learners. “And schools are getting better about identifying kids younger, and they’re doing more universal screening,” which helps remove issues of bias that can arise with teacher and parent referrals.

Twice-exceptionality

Gifted individuals may also have a special need or disability. According to NAGC, the term twice-exceptional (also known as “2e”) describes gifted children who have the potential for high achievement but also have one or more disabilities, including learning disabilities, speech and language disorders, emotional/behavioral disorders, physical disabilities, autism spectrum disorder or other impairments such as attention-deficit/hyperactivity disorder (ADHD).

“People don’t often think that individuals who are gifted can also have [a] disability,” Kircher-Morris says. “It’s kind of counterintuitive, so you end up with kids who are exceptionally cognitively able but perhaps they have ADHD or are autistic and they need a 504 plan or perhaps even an individualized education program.”

Kircher-Morris, chair-elect of the NAGC Social and Emotional Development Network, has noticed that sometimes teachers don’t feel as though they have to make accommodations in environments such as advanced placement classes. These teachers just expect that if a student is in such a class, they should be able to do the work. She often reminds educators that not taking a challenging course is not an accommodation. Twice-exceptional students still need to be challenged; they just need some help along the way.

It can be easy for counselors and other mental health professionals to miss a diagnosis of twice-exceptionality, says Kircher-Morris, who hosts the Mind Matters podcast, which focuses on the development of high-ability and twice-exceptional people across the life span. She is also the author of the forthcoming book Teaching Twice-Exceptional Learners in Today’s Classroom.

Kircher-Morris has had several clients get psychological evaluations and come back with a misdiagnosis. She recalls an example in which one of her elementary-age gifted clients was having meltdowns at school, becoming emotionally dysregulated and having trouble understanding nonverbal cues. Kircher-Morris knew the client was gifted, and she strongly suspected he was also autistic. The boy’s parents were reluctant to accept that label because of the stigma surrounding autism. It was easier for them to just say, “He’s quirky because he’s gifted.”

When Kircher-Morris finally convinced the parents to get a psychological assessment for their son, she wrote a letter to the person doing the assessment and told them the child was gifted to ensure that would be factored in. But the person doing the assessment did not specialize in giftedness and ended up diagnosing the child as depressed because sometimes when he had meltdowns, he would say, “I hate myself. I wish I could die.”

Kircher-Morris knew the client wasn’t clinically depressed. Instead, he was having big emotions and wasn’t sure how to talk about them, she says. She adds that one day of testing and questionnaires is not enough to fully understand and diagnosis a person.

Kircher-Morris still works with this student, and now that he is in high school, his autism is more pronounced. When his schedule shifted and he had to start showering in the mornings instead of the evenings, he didn’t handle it well at first. Kircher-Morris worked with him on regulating his emotions around this change. The student also has some issues with friends at school, but other people in his life often view him solely through a lens of giftedness and assume that he shouldn’t have any trouble communicating, Kircher-Morris says. They don’t realize that as a twice-exceptional adolescent, he sometimes does have certain challenges.

Trying to identify a client as twice-exceptional is even more difficult because of the concept of masking. As Tolison notes, gifted individuals with a learning disability can fall into one of three categories:

1) The individual’s advanced intellect compensates for their learning disability.

2) The learning disability or special need overshadows the person’s giftedness.

3) The giftedness and learning disability mask each other to the point that the individual appears to have average intelligence.

Research shows that twice-exceptional children are often diagnosed later than their peers because their struggles aren’t as noticeable initially, Kircher-Morris says. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders states that individuals with autism, for example, may be able to compensate for their comparative lack of social skills until social expectations exceed their abilities, she notes. A gifted child who is also autistic may not have a language delay when they are little, but by the time they get to middle school or high school, their emotional and social struggles and rigid thinking become more problematic.

“And we’ve now lost all of that time to be proactive and to support them and to help them build the skills they need to be successful, confident and happy,” Kircher-Morris adds.

To avoid mislabeling clients, Tolison, a registered play therapist who works with children who are twice-exceptional (particularly those with ADHD), advises counselors to always consider what the client’s behavior is communicating. Are they fidgeting in the classroom because they are understimulated, or is it a symptom of ADHD?

Therapists need to recognize “the blend of symptomology between gifted and diagnosis,” Tolison continues. For example, mental health professionals shouldn’t presume a client is autistic just because the client is smart and struggles to socialize with peers, she says. Instead, she advises digging deeper and considering whether the symptoms decrease or dissipate when the client is in an ideal setting, such as being around others who have interests similar to theirs.

Giftedness and special education are often seen as being opposite ends of the continuum, Mayes says, but she asserts they are separate continuums and can exist simultaneously. “The disability is the how you do something,” she explains. Even though an individual may need to do a task or skill differently or may need help, they can still possess a higher cognitive ability, notes Mayes, who has published several articles on this topic, including “College and career readiness groups for gifted Black high school students with disabilities” in The Journal for Specialists in Group Work.

Mayes recounts a real case example of how these continuums can overlap in a client: A Black student who was in a gifted program in middle school had an accident and suffered a traumatic brain injury. The injury caused the boy to get bad headaches if he sat for long periods of time, and his vision became blurry. But his cognitive ability was unchanged. He just needed some accommodations to help him at school. His teachers didn’t believe he was actually having headaches, however. They assumed he was just trying to get out of doing the work. The boy internalized their disbelief and told his mother the teachers were looking at him as if he were a “lazy Black kid,” a stereotype he knew was prevalent at the school. Soon thereafter, the boy’s grades started to suffer.

His mother became a big advocate for her son and pushed for a special education and gifted label for him. Even so, the school refused. It wasn’t until the boy entered high school and the school counselor joined the mother’s fight that they finally got some accommodations for the student. When the boy translated his talent for STEM (science, technology, engineering and math) into a passion for band, the band director also advocated for him.

This student had to reconfigure his identity as not just a gifted student but as a gifted student with a traumatic brain injury, and he had to learn to self-advocate, Mayes says.

Asynchronous development

Gifted children’s cognitive, emotional and physical development are often asynchronous, meaning that their intellectual development outpaces their maturity or emotional development. Even though their intellectual skills are advanced, their social and emotional skills may lag behind.

“Cognitive giftedness is not necessarily the same as emotional maturity,” Kircher-Morris says. Because gifted children are often highly verbal and speak as if they are mini-adults, people incorrectly assume that their behavioral and emotional regulation skills will also be advanced, she explains. So, counselors should consider clients’ emotional development along with their cognitive development.

According to Tolison, “There can be upward of a 12-year spread between a child’s intellectual age … [and] their social/emotional age.” For example, a twice-exceptional child with ADHD could be 8 biologically, but with the intellectual capabilities of a 12-year-old and the social and emotional development of a 6-year-old. And at times, the child might have emotional outbursts that are on par with a 4-year-old, Tolison adds.

Tolison often helps her clients first understand emotional language. She finds the “anger iceberg” exercise helpful for teaching emotion identification and awareness. Because some clients might be gifted in empathy, this process is less about identifying emotions and more about learning how to express them, she adds. Tolison then helps clients focus on executive functioning skills such as planning ahead, organizing one’s thoughts, flexible thinking and demonstrating self-control — all of which can be challenging for individuals who are twice-exceptional. She may play chess or Othello with clients to help them work on impulse control, for example.

Kircher-Morris engages clients’ higher-level cognitive skills by adjusting her counseling approach. This can be as simple as using a more advanced technique with a younger client (similar to grade skipping in school), or it may involve tailoring a technique to make it more analytical and creative.

The emotion wheel, which describes eight basic emotions and their varying degrees, is a great tool for helping clients identify and name their emotions, Kircher-Morris says. But this tool may not stimulate gifted clients enough to keep them engaged, so she alters it to make it more cognitively challenging. Her emotion wheel is mostly blank. She leaves a few emotion words in different places around the wheel and works with clients to fill in the blank spaces. Sometimes they look up words in the thesaurus or online to find the “just right” word, and then clients evaluate and determine which words should go on the wheel. This activity builds on the higher-level vocabulary that gifted clients often possess, and it provides them with some autonomy in session, she says.

Letting gifted clients direct (but not dictate) sessions

Kircher-Morris finds that gifted children are often unaware that anything is “wrong.” They can be skeptical of counseling at first, especially if their parents are the ones who initiated it. And because these children are gifted, she says, they often want to know the “why” before they completely trust and participate in different counseling approaches.

For that reason, Kircher-Morris encourages these clients to ask questions and takes time to explain the psychology behind the interventions. She also allows clients to explore what works best for them and to develop their own ideas about what would be helpful.

When Kircher-Morris introduces the cognitive triangle exercise (which emphasizes the relationship between one’s thoughts, feelings and behaviors), she moves beyond just drawing the diagram on a dry-erase board. She also poses a hypothetical example to help clients better understand the underlying principle behind the activity.

An example she often uses is a student who has an upcoming math test. She asks, “What uncomfortable emotions might they be experiencing?” After she and the client brainstorm some possible feelings, she asks, “If they’re experiencing those uncomfortable emotions, then what thoughts might they be having?” She draws speech bubbles on the board, and she and the client fill them in together.

Then they discuss how these thoughts might influence the hypothetical student’s behavior, where the student could intervene and how this would change the outcome. Running through this hypothetical allows clients to better understand the way the exercise works before they apply it to their own situations, Kircher-Morris says.

The fact that gifted individuals have higher-level thinking skills also means they are more likely to find fault in others’ logic, Kircher-Morris says. In fact, because these individuals are often brighter than their parents, teachers and others with whom they interact, counselors might find themselves trapped in a logical corner when a gifted client pokes holes in their reasoning. Should this happen, Kircher-Morris advises counselors not to engage in a power struggle.

“Don’t try to assert your intelligence or the information that you have because that’s going to damage the rapport,” Kircher-Morris says. Instead, her approach is to acknowledge the valid point the client has made. For example, she may say, “I hadn’t thought about it that way. I’ve seen this counseling technique work with other clients, but maybe it won’t work with you. Let’s figure out what will work. Do you think any part of that activity might be relevant for you?”

Tolison agrees that gifted clients benefit from being able to have some control over their therapy, but she cautions counselors not to let them dictate the direction of treatment. She says she often has parents who come to her because they previously worked with another therapist who allowed their gifted child to take control to the point that they weren’t making progress. 

Often, gifted clients are excited to engage in a topic they are passionate about, but that can dominate the session. However, as Tolison points out, counselors can turn that passion into a therapeutic intervention. She once had a client who wanted to talk about the dwarf planet Pluto for most of their sessions. She seized on that as an opportunity to teach the client about mindfulness and social awareness.

She used the phrase “I noticed” to stop him from discussing Pluto: “I noticed you’ve talked 20 minutes now on Pluto. I love that you are sharing your passion with me, but can we take a break because I’m a little exhausted from learning that information right now. Let’s talk about something new.” This statement set a limit for the client while also helping them become more mindful of the passage of time and of other people’s feelings, Tolison says.

Tolison also encourages clinicians to be humble when working with gifted clients. “Sometimes the most therapeutic thing you can do for a profoundly gifted kid is be excited about what they can teach you because in that [process], they are also learning,” she says.

Embracing neurodiversity

Kircher-Morris’ goal is to help normalize the fact that different types of brain wiring exist. People with this brain wiring might be divergent from the norm, but that doesn’t mean something is “wrong” with them. Being gifted or twice-exceptional is simply part of the human condition. Normalizing neurodiversity will encourage people to realize that they need help and give them the courage to ask for it, she says.

Counselors are great at understanding the individual needs of clients, she continues, but unless they consider all the factors, including a person’s cognitive ability, then they may misread the situation and the client’s true needs. For example, if a cognitively gifted child is having a hard time making friends, a counselor might focus simply on helping the child build social skills and self-confidence. But then the counselor would be missing the opportunity to consider other possible factors such as bullying, the child’s high stress levels, their feelings of isolation or others’ upward expectations of them — all of which could inhibit the child’s ability to form authentic relationships, Kircher-Morris explains.

So, she advises counselors working with this population to make sure they view their clients’ struggles through a lens of giftedness. How does giftedness or twice-exceptionality influence these clients’ experiences and reality? Clinicians must also figure out how to leverage clients’ strengths with their cognitive abilities to work through any issues they are having, Kircher-Morris says.

Mayes says counselors must be more holistic in understanding clients and see them as more than their struggles or even their giftedness. “We need to take a broader approach in our professional development,” she says, “so we can start understanding more fully individuals’ identities beyond giftedness to include culture, class, gender identity, affectional identities and so much more.”

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Supporting families on their autism journeys

By Lindsey Phillips May 1, 2020

Maria Davis-Pierre, a licensed mental health counselor (LMHC) in Lake Worth, Florida, first suspected her daughter might be on the autism spectrum when she was 6 months old and showed signs of sensory issues. Then at 10 months, her daughter, who had been saying simple words such as “mama,” “dada” and “ball,” suddenly stopped speaking. When Davis-Pierre and her husband tried to get their daughter to mimic them saying the words, she acted as if she had forgotten them. As a therapist, Davis-Pierre understood the importance of early intervention, so she was proactive about getting her daughter a diagnosis. But it wasn’t easy.

Her pediatrician referred her to health professionals who specialized in developmental delays in infants and toddlers. They tested her daughter and thought she had autism spectrum disorder (ASD), but because she was still so young (around 18 months), they didn’t feel comfortable officially diagnosing her. They recommended she see a pediatric neurologist.

After more tests (which cost the family thousands of dollars out of pocket), the pediatric neurologist agreed about the presence of ASD but was also uncomfortable officially diagnosing the child at such a young age. Davis-Pierre told the doctor she was going to sit in his office every day until her daughter got a diagnosis. One week later, that finally happened.

Davis-Pierre thought the next steps would be easy, especially given that both she and her husband are in the health care field. But what she experienced was more frustration.

“At no point — even with the neurologist — was there a check-in with the parent: ‘OK, this is the diagnosis. This is what happens next,’” Davis-Pierre recalls. “It was, ‘OK, here’s your paperwork. This is the diagnosis. Now, go figure it out.’” According to Davis-Pierre, the health care professionals didn’t provide her family with resources or give any consideration to how the family’s culture would factor into their daughter’s treatment.

When Davis-Pierre spoke with other parents of children on the autism spectrum, she found out that this treatment was the norm. And it left her — and the other parents — feeling overwhelmed.

This experience prompted Davis-Pierre, an American Counseling Association member, to start Autism in Black, a private practice that specializes in helping black parents of children with autism get the help they need.

In a blog post on the website GoodTherapy, Janeen Herskovitz, an LMHC in Ponte Vedra Beach, Florida, points out four areas in which counseling can help parents of children with ASD: adjusting to the diagnosis (which is often traumatic for parents), learning parenting skills, staying connected to their partners, and managing stress. Professional counselors can also help families prepare for developmental transitions, learn to effectively communicate with one another and extended family, and navigate cultural barriers.

Working through developmental transitions

ASD “is a neurodevelopmental disability, which means at different developmental stages, our clients are going to run into different developmental barriers, and they’re going to need us as counselors,” says Chris Abildgaard, a licensed professional counselor and director of the Social Learning Center in Cheshire, Connecticut. So, it’s important for counselors to understand where families are on their journeys, he points out. Is the family adjusting to the diagnosis? Are they struggling to communicate with their child? Are they helping a child through puberty? Counselors should also prepare to help families with life milestones such as going to prom, getting a driver’s license or grieving a death, Abildgaard adds.

Some families experience grief when they first learn about the ASD diagnosis, says Michael Hannon, an assistant professor of counseling at Montclair State University in New Jersey. These families will be reconciling a new reality and having to let go of certain elements of the relationship they expected to have with their child. “It’s really about [the family] learning to adjust to the needs, strengths, capacity, and some challenges of the people they love living with autism,” he adds.

Another challenging transition for parents and caregivers is when the child enters adulthood. Parents have likely been involved in every aspect of the child’s life, especially in the school system, so it is a significant adjustment when the child takes over this responsibility, Davis-Pierre says. She helps ease this transition by having parents teach their children to advocate for themselves before they reach adulthood. The more parents involve children with ASD in the day-to-day decisions about their lives and school, the more they realize that their children are capable of advocating for themselves, she says.

Abildgaard, an ACA member who specializes in ASD (and author of the 2013 Counseling Today article “Processing the ‘whole’ with clients on the autism spectrum”), has noticed that families sometimes push their child to do something that the child isn’t ready for or doesn’t want. For example, parents often ask him how they can make their child have a friend. Counselors need to educate parents that relationships take time and that individuals on the spectrum may not fully understand the intricacies of relationships and friendships. They will need support and coaching in this area well into their late teens, early 20s or beyond, he says.

Counselors can also help parents make plans and prepare for certain life events and developmental transitions, Abildgaard says. He finds visuals useful in helping families with a child on the spectrum to process events. Recently, he had a family who was going on a trip to a large city. He brought out his whiteboard and on one side wrote down all the thoughts and feelings the parents were having about the upcoming trip, such as feeling anxious that their child would have a tantrum and run from them. Then, Abildgaard asked the parents to consider their child’s perspective and why he might have a tantrum. On the other side of the whiteboard, he wrote down the child’s thoughts and feelings, such as being overwhelmed by all the lights and sounds.

This activity helped the parents realize the link between their own thoughts, emotions and behaviors and those of their child. It also started a discussion about proactive strategies the parents could take to decrease the likelihood of their child experiencing sensory overload. This, in turn, lowered their anxiety about the trip, Abildgaard says.

Helping families stay connected

Having a child with autism affects the entire family system, Abildgaard says. It affects how parents interact with each other, how parents interact with each of their children, how siblings interact with each other, and how the family interacts with extended family members.

Couples don’t typically preemptively discuss the possibility of a having a child with a disability, Davis-Pierre notes. So, when a child is first diagnosed with autism, parents often have to reassess the roles, expectations, responsibilities and core values of the family, she says.

Counselors may also have to coach families through complicated life events such as divorce. Abildgaard, an adjunct professor in the Department of Special Education at the University of Saint Joseph, reminds counselors that regardless of the situations that families bring to them, it is important to break these situations down into manageable parts for the clients.

When the parents of a client with ASD were going through a divorce, Abildgaard, a nationally certified school psychologist, brainstormed with the parents how best to explain the situation to their son. Abildgaard also learned from the client’s school that the child had been making comments about the divorce there. Abildgaard says his role as a counselor was to help the client process and express his feelings about the divorce. To do this, he said, “Tell me some things your eyes are noticing that are different at home.” He made his language concrete and specific, which allowed the child with ASD to talk about what he had been noticing, such as his parents arguing more. The boy also said he was scared to talk about these things with his parents, so he and Abildgaard worked through his anxiety together.

Then, Abildgaard brought the entire family into his office to discuss these issues. He chose to have them come in during the morning hours when his office would be quiet so the family would be more comfortable and not feel rushed or distracted.

Balancing the parenting of both neurotypical and neurodiverse siblings is another common challenge that Hannon and Davis-Pierre hear about from their clients. They try to help parents learn how to better communicate with their children and to maximize and be intentional about the time they spend with each child.

Hannon, a licensed associate counselor in New Jersey, uses empathizing strategies to help parents understand what their neurotypical child is feeling. For instance, he asks, “What would your neurotypical child say about this experience right now?” and “What would the child say about how you attend to the sibling with autism compared to how you attend to his or her needs?” This exercise allows parent to empathize and reconcile some outstanding issues with their neurotypical children, he explains.

Davis-Pierre’s clients also report struggling to know how to engage with their neurodiverse children. “We’re so used to looking for [the child to verbalize] … the actual feeling that we’re not looking at the behavior of what the child is showing,” she says.

She has parents role-play to gain perspective on what the child might be thinking or feeling and to increase awareness of behavioral patterns. (For example, Davis-Pierre has noticed that her daughter expresses happiness by flapping her arms and spinning in circles.) If appropriate, she has the child role-play with the parent, but if that is not possible, Davis-Pierre does it herself. To increase understanding, parents can also keep a behavioral journal or use the picture exchange communication system, which allows individuals with little or no verbal communication to present a feeling card to communicate their feelings, Davis-Pierre adds.

Children on the spectrum pick up on their parents’ and caregivers’ emotions more often than people think, Abildgaard points out. However, if they do sense these emotions, they often don’t know what to do with them. Children on the spectrum may appear to be ignoring the person or emotion, but in many cases, they just don’t have the language or perspective-taking ability to process the emotion and the “right” response to it, he explains.

So, Abildgaard works with parents to help them process their own emotions and then explain those emotions to their children so they aren’t left to interpret them on their own. In fact, parents can overtly model how to handle certain emotions such as anger or frustration. Abildgaard often suggests that parents (especially those with younger children on the spectrum) put themselves in “time out” to show their children that even adults need breaks.

Cultural implications

According to a 2014 report from the Centers for Disease Control and Prevention, 1 in 59 children in the United States have been identified with ASD. But this number doesn’t take into consideration cultural and racial implications such as delayed diagnosis. According to a 2019 news report on Spectrum, which bills itself as “the leading source of news and opinion on autism research,” black children with autism are often diagnosed later than white children, misdiagnosed more frequently with other conditions such as behavioral problems or intellectual disability, and underrepresented in studies of autism.

Hannon attributes the disparities in diagnosis rates to 1) inequalities in access to health care, 2) mistrust of health care systems among people of color and 3) greater misdiagnosis of symptoms in minority children as behavioral rather than developmental.

Davis-Pierre says the history of racism and discrimination in U.S. health care may persuade some black families not to be completely honest with health care professionals when discussing their children because they fear their children will be taken away. For example, frustration and exhaustion are normal responses for families caring for a child on the autism spectrum, perhaps leading someone to say or think to themselves in a particular moment, “I just can’t do this another day.” But many black families fear serious repercussions should they admit to such passing thoughts with a counselor, Davis-Pierre explains.

Even the treatments families choose for their children are often informed by one’s culture. Applied behavior analysis (ABA) aims to help individuals on the spectrum increase behaviors that are helpful and reduce behaviors that may be harmful to them by positively reinforcing desired behaviors. Debate has swirled, however, over whether ABA is helpful or harmful. According to a 2016 article on Spectrum, some have criticized the therapy for being too harsh in how it corrects maladaptive behaviors and for attempting to make people on the spectrum “normal” instead of advocating for neurodiversity.

But for some families, Davis-Pierre says, ABA makes sense. For example, a black child spinning in circles and banging his head against something in public will often be viewed differently than would a white child who exhibits the same behavior. In this instance, ABA can help protect the black child by helping him learn to replace the maladaptive behavior — one that could put him in danger — with a more socially accepted behavior, Davis-Pierre explains.

The harsh reality is that black people often have to operate differently in public settings because of prejudice and racism, she continues. So, she advises families to consider their child’s behavior and safety when choosing the best treatment for their child’s autism.

Davis-Pierre, author of Self-Care Affirmation Journal and Autism in Black, also finds that clinicians often don’t respect the culture of the home when treating children who are on the spectrum. A client once told Davis-Pierre that she had a therapist come into her home and not remove their shoes despite seeing a place for them by the front door. This act made the parent feel disrespected, and she no longer wanted the therapist in her house working with her child.

Another of Davis-Pierre’s clients was upset by a therapist who had made a decision involving her child without consulting the mother first. While the therapist and child were working together in the family’s home, the child wet himself. The therapist wanted to help the parents by changing the child herself. When the mother discovered that the therapist had gone through her child’s clothes drawers to find clean underwear, she felt as if the therapist had been snooping.

Abildgaard says his role as a counselor is to help clients on the autism spectrum adapt to different social situations and understand social context and social norms for particular settings and cultures. Counselors need to be aware of clients’ cultural and religious norms before instilling certain perceived social skills such as maintaining eye contact, he says. For example, as Abildgaard points out, some Asian cultures make eye contact only with certain people or in certain situations. So, counselors should understand the whole child before prioritizing what social skills or competences are most relevant to focus on in session, he asserts.

Religious beliefs can sometimes pose another barrier to seeking treatment. For instance, Davis-Pierre says, people in the black community are often taught to pray about their problems and not to discuss problems with anyone outside of the family. Counselors may assume that families who aren’t willing or enthusiastic participants in therapy are resistant, but as she points out, they may actually be having an internal struggle between seeking counseling and feeling that they are still maintaining their faith in God.

Davis-Pierre often uses genograms to help clients identify family patterns, such as other family members with a developmental disorder, or cultural values that have been passed along that no longer work for the family. Through genograms, she has noticed that her clients’ families often inherit a pattern of keeping secrets that hurts, rather than helps, the family dynamic. Davis-Pierre acknowledges that even she had a difficult time explaining to her extended family why she and her husband are so vocal about their daughter being on the autism spectrum.

Hannon and Davis-Pierre say that counselors have to be brave and willing to talk about clients’ and families’ cultures and about inequalities based on race and ability status. Starting this conversation can be as simple as including a question such as “What cultural traditions should I take into consideration?” on the intake form, Davis-Pierre says. This question shows that the clinician is already thinking about how culture affects treatment, she explains.

Supporting dads

Abildgaard argues that fathers are often overlooked when thinking about an autistic individual’s support network, so mental health professionals must do a better job of incorporating dads into the therapeutic process. He has noticed that mothers with children on the spectrum are often more proactive about independently finding and supporting each other, whereas fathers, even though they are involved in their children’s care, don’t tend to form support groups on their own. Abildgaard suggests that counselors could offer focused support services such as fathers’ groups or “dad’s night out” events to help these men learn from and bond with other fathers in similar situations.

Such support groups matter when it comes to providing care to individuals on the spectrum. Hannon, an ACA member who specializes in the psychosocial aspects of autism on fathers and families, often co-leads a group for fathers who have children with ASD. These men have reported that just being connected with other fathers who share similar experiences can be life-changing. In these groups, dads find others who speak their language and understand their journeys, which makes them feel heard, Hannon says. Groups also help fathers become more aware of their own needs and challenges and discover effective coping and adjustment strategies, he adds.

Fathers also spend a significant amount of time thinking about their children’s prognoses, their children’s futures, and the ways they can prepare their children to live full lives, Hannon says. In his dissertation, he studied the experiences of black American fathers of individuals with autism. At the ACA 2018 Conference & Expo, Hannon presented his findings from a grounded theory study on how diverse fathers orient themselves to their children’s diagnoses. Fathers often want to help their children who are on the spectrum, he continues, but if they have been raised with certain gendered expectations, counselors may need to take a few extra steps to help these dads increase their efficacy with day-to-day activities such as helping with temper tantrums.

Counselors may also need to help fathers retain focus on their emotional journeys because men are often task-oriented in how they solve problems, Hannon points out. Also, because men have often been socialized to engage only with specific emotions such as lust and anger, counselors may have to dig deeper with them to reveal the other underlying emotions. For example, counselors could suggest, “You’re angry, but it sounds like the source of your anger is fear for your child’s safety.”

Generational pushback

Parents sometimes face generational challenges in caring for their children. Hannon describes a common scenario that fathers often share with him: They leave their children in their grandparents’ care, providing suggestions for ways to best communicate with the children and guidance on particular eating preferences. To which the grandparents might respond, “We’re not doing any of that. We’ll do what we want with our grandchildren. They just need a good talking to.”

Such scenarios often leave parents of children on the spectrum feeling frustrated. If the parents and grandparents have a good, healthy relationship, then counselors can help parents learn to communicate openly and honestly with the grandparents. Hannon advises parents to lead with love and acceptance before critiquing the grandparents’ interaction with the children. Parents can first emphasize how the grandparents love their grandchildren before saying that they just want to show them additional, special ways to show love to a grandchild on the spectrum. 

When Abildgaard works with grandparents who need help accepting their grandchild’s diagnosis of ASD, he starts by saying that he could use the grandparents’ help to allow him to better understand their grandchild. Once this barrier is broken down, he finds that grandparents tend to ask more questions and start honest dialogues about grandchildren who are on the spectrum. 

Counselors can also help clients realize that while it is OK to establish boundaries with extended family, they should aim to set realistic boundaries that honor both the child on the spectrum and the family, Davis-Pierre says. For example, if a family depends on grandparents to provide child care, then the family must be particularly careful in setting boundaries. At the same time, the family can still have a respectful conversation with the grandparents about the needs of the child and family.

Adjusting language

Abildgaard’s clients with ASD sometimes complain that their parents always ask the same question after school: “How was your day?” Because, from their perspective, their days are always the same, the children wonder why their parents ask something they already know the answer to. 

Abildgaard advises parents to instead use concrete language such as “Tell me two good things about your day and one thing you would have changed.” This phrasing gets to the heart of what parents actually want to know from their child and makes the conversation more productive, he says. 

Abildgaard is also careful about the language he uses with clients with ASD and their families. Recently, the mother of one of his clients (a boy in sixth grade) told him that her son ran out of his classroom at school. When the boy walked into his office, Abildgaard said, “Tell me two good things about your day and one thing you would have changed.” This prompted the client to tell Abildgaard he had run out of his classroom.

After admitting this, the boy looked at Abildgaard, seemingly waiting to be chastised. Instead, Abildgaard asked the boy, “What do you think I’m thinking right now?”

The boy responded, “You’re thinking you are mad at me.”

Abildgaard drew a thought bubble on a whiteboard and wrote the client’s thought inside the bubble. Then he drew another thought bubble and wrote what he was actually thinking: “I’m wondering what made him run out of the room.”

The boy’s body language instantly relaxed. This exchange took Abildgaard out of the authoritarian role and shifted the conversation from focusing on the problem to focusing on how to solve the problem.

Similarly, Hannon recommends that counselors focus on strengths, and not just deficits and challenges, when working with families who have a child on the spectrum. He makes a point of asking parents about the victories they have had that week or month.

This question prompted one of Hannon’s clients to share how his son had used appropriate language and displayed empathy — a skill the child had previously struggled to demonstrate — that week.

The child’s mother had said, “I’m going to run through the shower.”

The child on the spectrum responded, “No, you can’t do that because you’re going to fall.”

Even though the child hadn’t grasped the true meaning of his mother’s words, he had shown concern for his mother and responded appropriately, which was a huge victory for this family, Hannon says.

Support often makes all the difference. Davis-Pierre and her family’s autism journey may have had a challenging start, but they eventually found health care providers who worked with them as a team. With this support, Davis-Pierre and her husband were able to stop focusing so much on the challenges and instead start enjoying their child for who she is.

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Tools for navigating the world at large

By Laurie Meyers November 22, 2017

By the time children with autism spectrum disorder (ASD) are approaching elementary school age, they are already exhibiting symptoms that typically lead to lifelong social difficulties. Among these symptoms: impaired communication and interaction, an inability to self-regulate and modulate emotions, very narrow and specific interests, and sensory processing difficulties that make it difficult for them to connect with the world at large.

Many counselor practitioners may question whether they are even qualified to work with clients who have ASD. According to the individuals interviewed for this article, however, professional counselors possess a range of skills that can be particularly helpful to this client population.

Stephanie Smigiel, a licensed professional counselor (LPC) who does mobile counseling with ASD clients in the Pittsburgh area as part of the state of Pennsylvania’s behavioral health services, says clients with autism aren’t that different from other populations with which counselors work. She acknowledges that these clients often require a little extra accommodation and counselor ingenuity, but this call to be creative is one of the reasons that she particularly enjoys working with the population.

It is essential, however, that counselors understand clients with ASD and their needs, cautions Smigiel, a member of the American Counseling Association. “Ask yourself, ‘Do I have a bias? Is this a population I can see myself working with?” She notes that people with ASD can have problems controlling their aggression and says it is not uncommon for these clients, sometimes including adults, to pull her hair or scratch her arms.

Neurology tells us that the brains of those with ASD work differently. Those on the spectrum are often labeled as atypical (as opposed to neurotypical). However, those with ASD and many of the people who work with them have begun advocating for a different view: neurodiversity — or the idea that there is no single, correct neurology.

“The neurodiversity movement in the field seeks to apply a culturally competent view of people diagnosed with ASD or other neurological or neurodevelopmental diagnoses,” explains Ali Cunningham, a licensed mental health counselor (LMHC) who specializes in ASD. “As with most cultural groups who are trying to acculturate to the majority group, it is about achieving a balance of honoring individuality and uniqueness while striving to be successful in the majority.”

Cunningham says that many clients with autism struggle with wanting to maintain what makes them unique while still being able to connect with others and navigate the worlds of friendship, romance and work. Culturally sensitive treatment of clients with ASD involves helping them identify how their individuality or uniqueness is a resource while also exploring what new skills or techniques they are willing to integrate into their lives to strike that balance, she says.

“I always try to communicate the message that treatment is not intended to change who you are,” Cunningham says. “Treatment can help highlight the strengths you already have and add to them with skills or techniques that will enhance how you navigate the world and help you meet your goals.”

Boy (and girl) meets world

Because ASD presents early in life, experts in the field emphasize the importance of early intervention. One of the primary ways that professional counselors can help clients with ASD manage the challenges that come with the disorder is by targeting and teaching social skills.

Tami Sullivan, an LMHC and registered play therapist, maintains a private practice in Brockport, New York, that includes ASD as one of its specialties. She uses play therapy to connect with child clients who have autism.

“Children often make sense of their world and the people in it through play,” says Sullivan, a member of ACA. “Play can be used as an intervention [because] it is the native language of childhood. Counselors can understand children, the child’s world and his or her perspectives in the context of play therapy.”

Sullivan notes that children with autism play differently than do their peers without autism. “Children with autism have a low level of engagement in play. Their play is more concrete, private, ritualized … and restrictive,” she says.

She explains that young children with ASD possess limited imaginary or “pretend” play skills. Their tendency to engage exclusively in solo play and difficulty participating in imaginary worlds isolates these children and often precludes them from developing meaningful relationships or friendships with other children.

Sullivan uses a nondirective play therapy approach to engage children who have ASD. This means that rather than using a prescribed set of games or toys, she lets the child take the lead, exploring at his or her own pace.

“In this nondirective approach, the relationship is the key therapeutic medium [that] communicates acceptance of the child,” says Sullivan, an assistant professor in the Counseling and Psychological Services Department at the State University of New York at Oswego. “I aim to make the critical emotional connections that support a reciprocal relationship between us. I … encourage [the child’s] initiative and play with the goal of deepening engagement, lengthening mutual attention and regulating emotion and behavior.”

Once these children feel fully accepted, they begin to communicate and engage in reciprocal social interactions, Sullivan says.

When Sullivan wants to target a specific therapeutic goal, she uses more directive play, choosing activities that help build particular strengths in children with autism. For example, by creating something with the child, Sullivan strengthens the child’s ability to take turns, joint attention (the ability to focus on more than one thing at a time) and social perspective.

Sensory exploration can further increase the connection between Sullivan and the child. Many children with ASD use sensory toys to self-regulate, so in addition to baskets of sensory toys, Sullivan has sand trays, big bean bags and pillows, donut balls, a tunnel and a small ball pit in her office. “I am often invited by them to join in as they self-regulate,” Sullivan says. “This can be a time to connect deeper with the child and build our relationship.”

Sullivan collaborates with her clients’ parents or caregivers using two therapeutic approaches: skills-based/solution-focused therapy and filial therapy.

The first approach involves identifying goals and solutions for the child’s behavior and challenges that are causing stress on the family system. Sullivan then works with the parents to identify ways in which they can support and encourage the child as he or she develops new skills and abilities.

For example, children with autism often express anxiety through their behavior. Sullivan teaches parents how to identify this and how to help children recognize what they are feeling. The parents can then prompt their children to use coping skills they have learned with Sullivan, such as relaxing their bodies, distracting themselves or trying to change the way they feel about a situation.

With filial therapy, Sullivan says the work centers around strengthening the parent-child relationship in the counseling process. This is done in part by teaching parents play therapy relationship-building techniques such as reflecting the child’s feelings, empathic listening, imaginary play skills and limit setting.

Finding friends

During the elementary, middle school and high school years, social skills become even more critical, Sullivan says, particularly as they relate to the making and keeping of friends. “These children [her clients with ASD] desperately want to have friends, but they don’t know how,” she says.

Sullivan uses group therapy to help children with autism cultivate stronger social and relationship skills. She holds one group for children of elementary school age and another for clients of middle and young high school age.

When designing the groups, Sullivan decided the training for the elementary school-age children would be more effective if it featured an element of play. She chose to incorporate Lego-based therapy, a method pioneered by neuropsychologist Daniel LeGoff after he noticed that when children with ASD worked together to build things, they were more naturally inclined to socialize with each other. Sullivan pairs the Lego therapy with a structured lesson. She says the underlying play therapy lessens the children’s anxiety about the group while the building exercises aid in teaching social and friendship skills.

The group meets for 90 minutes once a week for 10 weeks. It is run by a professional counselor (either Sullivan or her colleague) and a relational coach who demonstrates social skills by engaging in role-play with the counselor.

Each session starts with a sensory warmup in which group members can play with sensory toys. After the warmup, the leaders and participants decide, as a group, what kind of Lego structure they want to build that day. The building process is collaborative and uses defined roles such as builder, supplier and engineer. From session to session, the children take turns playing each role. Once roles are assigned, the group must work together to decide how to go about building the structure.

As the group is building, the leaders introduce that session’s topic, such as learning how to have a conversation. The counselor talks about what the skill involves — in this case, trading information — and demonstrates it through role-play with the relational coach. This often consists of “good” role-play and “bad” role-play. For example, you don’t start a conversation by going up and introducing yourself, but you do hang back and wait until a topic comes up that interests you and then join the conversation.

Sessions end in free play, during which the children, over time, begin to interact with each other on their own, Sullivan says. The children’s parents or other family members receive a sheet after each session that outlines the skills the group worked on that week. As homework, parents are encouraged to help their children practice the skills they learned in group.

If possible, Sullivan also provides packets for the children’s teachers. She says that in some cases, teachers call her to collaborate, whereas in others, the parents work with the teachers. Many of the children in Sullivan’s groups are in mainstream classrooms. So, she recommends that their teachers identify peers to serve as social mentors and then provide time for the students with ASD to practice their skills at school.

The group also explores appropriate humor, a topic for which bad role-play is particularly suited, Sullivan says. The relational coach will display inappropriate humor — for instance, using potty language or imitating one kid making fun of another kid — and the counselor will react. Afterward, the coach and counselor ask the group members what they saw: “Did you notice that Tami didn’t laugh and that she actually looked kind of sad?” Then the coach demonstrates appropriate humor by telling a joke, and in response, Sullivan or her colleague will laugh. Sullivan also gives the children (and their parents) a list of appropriate topics to joke about and recommends joke books.

The group also discusses how to be a good sport. “We talk about a lot of things that you don’t do when you want to play a game with someone,” Sullivan says. For instance, “You don’t want to be a policeman or a referee — you don’t want to remind everyone what the rules are all the time.” The lesson teaches children to focus on what their role is in the game and how to participate in a sharing way. The topic also offers an excellent opportunity to talk with group members about additional skills such as dealing with frustration by walking away, taking a break or engaging in deep breathing, she says.

In later weeks, the group experience involves more discussion, such as talking about how to choose an appropriate friend. The children compile lists of qualities that are appealing to them in a friend and what makes a person a bad friend, Sullivan says. She also works with parents to help them brainstorm places, such as school clubs, where children can make positive connections.

Sullivan says the group leaders routinely look for opportunities to point out when children are demonstrating some of the skills they have learned in the group. Recently, during freestyle play, one boy, inspired by the monster structures they had been building, talked about wanting to have a Halloween party. His fellow group members then asked one another about their Halloween costumes and activities.

Teenage training

Sullivan’s group for clients of middle school and younger high school age runs for 14 weeks. It also focuses on conversational skills but covers additional topics such as how to handle rejection, how to handle rumors and gossip and how to be a good host. This group doesn’t incorporate Lego therapy. Instead of starting sessions with sensory play like the younger group, participants in the older group talk about their experiences trying to implement the skills they are learning. They also receive more homework to reinforce those skills.

Sullivan says the group spends a significant amount of time talking about bullying, rumors and gossip. “We teach a lot about how to reinvent yourself,” she says.

For instance, the group leaders emphasize that it is counterproductive to handle rumors or gossip by addressing them directly or denying them because those actions merely create more rumors and gossip, Sullivan says. Instead, they teach participants to redirect by using a sense of humor, walk away if someone is getting in their face and establish support figures in school and at home. They also talk about what to do about a damaged reputation, how to not take rumors and gossip personally, how to find other groups to hang out with and how to identify and connect with supporters within the school.

Sullivan says participants practice skills together during the group sessions, but group leaders also encourage them to set up short get-togethers with friends outside of group. In doing so, the leaders emphasize the need for the group members to practice sharing and exchanging ideas with others during these get-togethers. What group leaders don’t want is for group participants simply to get together for parallel play, such as two people playing video games separately, side by side, Sullivan says.

Group leaders review the process of getting together in great depth, even covering actions as simple as answering the door. “You don’t just open it,” Sullivan tells group members. “Invite the friend in and ask what they want to do.”

Next, the host should present the friend with two possible activities to choose from and let the friend decide which sounds more fun. Once they complete that activity, the host should talk with the friend about what else they could do, Sullivan coaches.

The sessions for Sullivan’s group incorporate ideas from the Program for the Education and Enrichment of Relational Skills (PEERS) for Adolescents model, an evidence-based social skills intervention developed by UCLA’s Semel Institute for Neuroscience and Human Behavior. PEERS focuses on the following topics:

  • How to use appropriate conversational skills
  • How to choose appropriate friends
  • How to appropriately use electronic forms of communication 
  • How to appropriately use humor and assess humor feedback
  • How to start, enter and exit conversations between peers
  • How to organize successful get-togethers with friends
  • How to be a good sport when playing games or sports with friends
  • How to handle arguments and disagreements with friends and in relationships
  • How to handle rejection, teasing, bullying, rumors/gossip and cyberbullying
  • How to change a bad reputation

Conversation starters

Cunningham, who practices at the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida, also uses the PEERS for Adolescents program with middle school- and high school-age youth. The groups last 16 weeks, and participants must be accompanied by a parent or someone else who functions as a social coach, she says. The “coach” requirement is in place so that the youth will have support not only for practicing their skills but also for finding opportunities for social engagement, Cunningham says. The clients with ASD meet in one group, while the parents/social coaches meet in a separate group to learn about the skills the youth are acquiring.

Cunningham, an assistant professor of counseling at Lynn University in Boca Raton, says that sessions start with role-play. Facilitators model some common errors related to that week’s skill lessons so that group members can learn what not to do. The facilitators then use role-play to demonstrate scenarios for using the skills effectively. The group participants then rehearse the skills and are given homework requiring them to go out and practice their skills in the outside world.

The group spends a substantial amount of time on conversational skills, beginning with how to start one, Cunningham says. Most people might say that the way to start a conversation is by introducing yourself, but few people actually do that, she notes, because it makes it seem like you’re selling something. Instead, group members learn how to find something that they have in common with the person and then make a comment or ask a question to continue the conversation, she explains.

People with ASD often have very particular, idiosyncratic interests, Cunningham says, so group participants learn about things that most people like to talk about, such as books, TV shows, movies, music or video games. She also tries to help clients understand steps they can take to expand their own interests or to make connections between their interests and the interests of others. For example, one of Cunningham’s clients with autism listens to a niche kind of electronic music. She has explained to him that he might not be able to find other people who listen to that exact music, but he can seek out people who like music that is similar.

After learning to start a conversation, the group moves on to how to maintain one, focusing on elements such as listening and having an equal exchange of information rather than doing all the talking or asking question after question. Participants also learn how to use humor in a conversation, how to pay attention to feedback and how to join a group conversation, Cunningham says.

Bullying is another important topic, but the focus isn’t so much on how to cope with it as how to prevent it from happening in the future, Cunningham says. One thing that group members learn is how to distinguish between actual bullying and straightforward feedback that they may get from someone who is annoyed by their behavior.

Cunningham also runs a PEERS group for adults with autism that includes four weeks focused on dating. (Cunningham doesn’t include the topic of dating in her younger groups but not because she thinks participants aren’t interested. Rather, it’s because parents of children with ASD often aren’t comfortable with their kids exploring romantic relationships, particularly when they still aren’t savvy about friendships.) The dating portion of the program focuses on topics such as appropriate ways to engage in flirting and assessing whether another person is interested.

It isn’t uncommon for men with ASD to be perceived as creepy, Cunningham notes, because they don’t typically understand how to read other people’s cues and might continue pursuing someone who is not interested in them romantically. Meanwhile, there are others with ASD who, despite their desire for a romantic relationship, won’t engage with anyone because they can’t tell if the other person is interested, she says.

Other topics the group discusses include how to handle peer pressure and sexual pressure.

Job hunting

Many people with ASD have trouble finding and keeping a job due to several factors, including a lack of social skills, difficulty understanding workplace culture and sensory difficulties that can cause them to become overwhelmed more easily. However, Smigiel believes that the most significant factor keeping those with ASD from career success is a lack of support.

In essence, Smigiel says, career counseling for those with ASD is similar in spirit to providing career counseling to any other client — it is a matter of finding out the client’s strengths and weaknesses. Smigiel did her internship at a vocational services agency that provided job counseling for those with ASD and intellectual disabilities. The agency helped clients practice their interviewing skills and assigned them a job coach who would try to connect them with positions that matched their skill levels.

Smigiel has worked with people on the high end of the autism spectrum who have found their niche in computer work, but at the vocational agency, they tried to match all clients, including those on the lower end of the autism spectrum, with jobs. “I’m a firm believer that anyone can have meaningful activity,” she says.

The key is to play on the focused nature of those with ASD. “What are they obsessed with?” Smigiel asks. “What can I do with that?”

For instance, Smigiel says the agency had many clients with ASD who loved to clean, so the vocational center helped them set up a car detailing program. The clients’ attention to detail produced “the cleanest cars you ever saw,” Smigiel says.

Counselors working with people with ASD have to think creatively and find that person’s niche, says Smigiel, who believes that everyone on the spectrum possesses strengths. For instance, some clients might be obsessed with organizing, which might make them a good fit for working in a clothing store and keeping all the displays in order.

Clients with ASD also often need help retaining their jobs because they don’t necessarily understand the social skills involved in working with others. As a result, they might ask too many questions, not understand what is and isn’t appropriate to say to a boss or have trouble interacting with co-workers, Smigiel says. In more severe cases, people with ASD might have poor personal hygiene, neglecting to brush their teeth or take a shower either because they don’t see it as a need or because it creates a disturbing sensory sensation for them.

At the vocational center, staff members would provide lessons on the importance of brushing teeth and taking showers, Smigiel says. When teaching these kinds of lessons, counselors should be aware that people with ASD are forthright and won’t want to do something “just because,” Smigiel says. Instead, the staff would say, “You need to take a shower because, otherwise, you’ll smell,” and, “You need to brush your teeth because, otherwise, you’ll get cavities.”

Emotional regulation

Clients with ASD also need help acquiring the self-regulation skills to cope with stress and frustration on the job, says Jamie Kulzer. An LPC in the Pittsburgh area, Kulzer helps clients with ASD and other cognitive disabilities as part of a multiweek vocational training program that teaches cognitive, self-management and vocational skills. The program includes internships with local businesses.

“We have found that emotional regulation is really important because if you’re escalated, [you] can’t access the other resources that you have to deal with problems.”

The program has participants envision an emotional thermometer, with green representing a calm, rational state and red representing a state of extreme sadness, anger or excitement. When individuals are in the red, they are unable to make good decisions, so Kulzer teaches clients to monitor their thoughts and behaviors and to be vigilant to when they are in the “yellow.” She also teaches clients to practice techniques such as deep breathing, visualization or standing up and stretching to help themselves avoid going from yellow to red.

Once clients have returned to a green state, they can approach a problem by asking for help or by using a divide-and-conquer strategy that breaks problems down into smaller, more manageable pieces. They can also express their problem by using “I” statements, such as “I need” or “I don’t understand,” explains Kulzer, an ACA member and assistant professor in the clinical rehabilitation and mental health counseling program at the University of Pittsburgh.

Program participants also learn about the physical and emotional gas tank, which is a measure of mental and emotional fatigue, Kulzer says. A full tank enables the client to be fully alert, present and ready to take in new information. An empty tank makes the client susceptible to aimless daydreaming, flooding emotions, racing thoughts and frustration.

Clients are taught that they can help keep their gas tanks full through self-care measures such as healthy eating, drinking water regularly and getting enough sleep. Kulzer also teaches program participants to approach their work or other projects by breaking them down and doing the easiest parts first and making sure to take frequent breaks.

It is critical for clients with ASD to monitor their physical and emotional gas tanks and to take action when they feel themselves getting to half full, Kulzer says. This means stopping and asking themselves, what’s draining the tank? For one person, it might be staying up too late to play video games, which requires better self-management. For another, it might be the result of being in an overly stimulating environment and needing to take a break by briefly leaving the area, Kulzer says.

In anticipation of the second half of the program, participants work on their vocational skills, which includes an emphasis on general communication. For instance, clients are taught to use “I” statements to talk about their feelings and encouraged to repeat back any request made to them to ensure that they are hearing it correctly and are aware of the nonverbal messages they are sending, Kulzer says.

People with ASD often have difficulty looking others in the eye, which can mistakenly give others the impression of disinterest. Kulzer’s program teaches these clients to say things like, “Eye contact is difficult for me, but I am listening.” Clients are also encouraged to indicate their attention and willingness to work by sitting up straight and taking out their earphones, Kulzer says.

The group also talks about social interaction. Subjects include what is appropriate to discuss in the office and how office friendships can have pros and cons. For instance, although it may be great to have someone you like and get along with, if you favor that person and don’t treat everyone equally while working, it can result in hurt feelings and misunderstandings.

Kulzer also talks with group members about issues such as scheduling and making decisions independently without telling a supervisor. She uses the example of someone with ASD who takes a bus that gets them to work 15 minutes early and then assumes this means that they can also leave 15 minutes early. Kulzer explains to group members that they can’t change their schedules (or make other similar decisions) without first discussing possible options with their boss.

The group participants receive feedback from Kulzer and other instructors as they work in their internships. Together, they tackle problems that come up in the workplace and implement suggestions for improvement. Kulzer says that many of the group’s members go on to pursue associate degrees or certificates in their internship field.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Practice briefs (counseling.org/knowledge-center/practice-briefs)

  • “Autism Spectrum Disorder” by Carl J. Sheperis, Darrel Mohr and Rachael Ammons

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Achieving a better understanding of adult autism

By Kenneth J. Smith September 11, 2017

Autism, Asperger’s and “nerd” personality features (to use a concept from Temple Grandin, a prominent author and speaker on both autism and animal behavior) seem to have something of an air of mystery and intimidation for many mental health professionals. Let’s face it, clients with autism/Asperger’s have very different ways of perceiving and thinking than most counselors do. For instance, talking about feelings in an unstructured way à la Carl Rogers is unlikely to be nearly as productive with these types of clients as with other clients. Barring extreme examples, I prefer to think of individuals with autism, Asperger’s or nerd characteristics as having a set of co-occurring personality features rather than a mental disorder. To that end, I refer to these kinds of clients as PFAANs (personality features of autism, Asperger’s and nerds). I refer to non-PFAANs (sometimes called neurotypical) as NONs.

When I became a licensed professional counselor, I had a decade of experience running pigs through mazes (animal behavior/animal welfare research) for my Master of Science and working as a humane handling consultant/reviewer in more than 350 slaughterhouses (basically, I did work similar to what Grandin does in slaughterhouses). During that time, I read all kinds of books by Grandin and others to see how autism might help me understand animal and human behavior and cognition to further my work and career. Coming from this background, I was rather surprised to learn that I was expert in counseling adults with PFAAN, and now a large part of my practice rotates around this. I provide a therapy group for developing social skills in adults with PFAAN, and I help NONs better understand and engage with spouses or loved ones with PFAAN. At least in my region, there are very few mental health colleagues I can refer to who have much expertise in adult PFAAN approaches and needs.

The lack of services for adults with PFAAN (and their loved ones) is striking. Many resources are available for childhood/adolescent autism, but these approaches do not seem well-suited for adults, and there is almost nothing for people over age 21. Although I have no hard statistics to back this up, I suspect that individuals with PFAAN make up at least 20 percent of the U.S. population. To quote Hans Asperger, “Once one has learned to pay attention to the characteristic manifestations of autism, one realizes that they are not at all rare.”

To illustrate how many clients you might be seeing without realizing that they have PFAAN, consider whether you could apply the ways of thinking presented in this article to many of your clients who work in science, technology, engineering and math careers. You will see clients with PFAAN in your practice, so it is important to have a way of understanding their thinking patterns.

A central issue for clients with PFAAN is their lack of ability to naturally recognize emotions and empathize with others. If you’re confused by how to help, it may be useful to conceptualize the different ways that emotions seem to work in these clients compared with most other clients. A common tool used in mental health therapy is the Feeling Wheel developed by Gloria Willcox. It is the one tool I have found that both PFAANs and NONs seem to comprehend, so it has served as a valuable tool in bridging the understanding gap between these two groups.

The Feeling Wheel is an excellent way of visually conceptualizing how emotions work differently for clients with PFAAN and NONs. Grandin has suggested that a good method for teaching cognitive flexibility to individuals with PFAAN is to describe people and their actions as a mixture of colors.

The Feeling Wheel (see above) is also in line with another of Grandin’s concepts in which she describes a difference between PFAANs and NONs. She says that many individuals with PFAAN tend to think in specific pictures, whereas NONs seem to think in words/emotions. How this pictures versus word concept works can be quite complicated, but the visual concepts in the Feeling Wheel simplify how to explain this difference. I have developed a list of concepts using the Feeling Wheel and its colors to help counselors and clients empathize with one another and to get to the clients’ goals and skill development.

Concepts

Concept A: People with PFAAN will intuitively get/understand only the innermost (core) feelings. If most people in the world had PFAAN, the Feeling Wheel would probably contain just an inner core (see image below).

The recognition of the detailed emotions (represented in the outer rings of the Feeling Wheel above) seem to develop naturally in NONs but not in individuals with PFAAN. The outer rings of the Feeling Wheel can be taught to clients with PFAAN, but this must be done in an inductive way, similar to the way that most NONs learn math. NONs start with 1+1=2; people with PFAAN need to draw a picture of what the more subjective feeling looks like in NONs so that they can relate the outer rings back to the inner core that they more readily understand. I’ll share more about this later.

Concept B: Emotional processing changes how the world is seen and experienced. NONs can have all kinds of emotions at the same time. For example, if a NON sees a cow, he or she might have several different emotions at different intensity levels about that cow at the same time:

a) Peaceful: “That cow chewing cud is so Zen.”

b) Anxious: “That cow might come and attack me.”

c) Sad: “That cow will be killed to be eaten.”

d) Angry: “I get angry about the ways cow are treated in bullfights.”

The NON’s emotions will also tend to make the picture of the cow less distinct when the person turns the cow into words and emotions. (I think this is somewhat similar in idea to Carl Jung’s archetypes. For example, you don’t remember one cow; you shove the individual cow you see into the archetype cow in your mind.) So, often, this will happen in NONs:

Individuals with PFAAN tend to have only one or a few emotions at a time. They seem prone to black-and-white thinking, rigidity to change and litigiousness (for example, they may ask what the hard rules are for social interaction). So, when a person with PFAAN sees a cow, and if he or she finds cows peaceful, conceptually, the emotional experience he or she will likely have is the picture of that cow overlaid with the emotion (see below).

The way that emotions work in people with PFAAN seems to more closely model the way that emotions work in social animals. For example, a dog either likes a person or is scared of a person, but the dog rarely seems to have both emotions at the same time.

Concept C1: Individuals with PFAAN tend to have one emotion at a time (AND versus OR emotions). NONs can often experience several emotions together. I refer to this as AND emotions (see below).

 

Clients with PFAAN may also have different emotions about something, but they can process only one at a time. I refer to this as OR emotions (see below).

Concept C2: NONs mix emotional colors to get completely novel feeling colors, whereas PFAANs flip between colors. Related to Concept C1, NONs use AND emotions to make new emotional colors (think of mixing paint). A NON might feel strongly peaceful yet a little afraid when seeing a cow (mix dark blue and light orange to get a teal emotional archetype cow).

Individuals with PFAAN won’t readily mix colors, although they might flip between emotions rapidly. The flipping is where they are analyzing what to do (“Should I cry or run away?”) if more than one emotion is present (for example, strong peaceful feelings and a little fear of a specific cow). Usually, the emotion expressed in the client with PFAAN is the most “vivid” color emotion.

Concept D: Individuals with PFAAN take more time to process and switch between emotions. OR emotions and emotional flipping appear to lengthen the time it takes to process the emotions. This lack of speed in emotional processing is often interpreted by NONs as not caring, being cold or being anti-social. The speed of emotional processing seems very important to most people, and many of my clients with PFAAN develop deep shame for their inability to rapidly process emotions. (See No. 5 under the “Counseling approach ideas” section below for more illustrations of this concept.)

Concept E: Individuals with PFAAN are prone to emotional and sensory overload, which may lead to a new emotional color that equals shutdown. What do you often get if you mix all the colors of the feelings together in individuals with PFAAN? Black. This is a good conceptualization of what happens in many people with PFAAN when they are confused or overloaded: shutdown.

Shutdown also happens in NONs (think about the shutdown of emotional controls in the animated movie Inside Out, where everything became gray and the emotions no longer worked). However, it usually takes much more time and intensity (think posttraumatic stress disorder) for NONs to get to black.

To extrapolate from the work of John Gottman in couples therapy, men are generally more prone to sensory/emotional shutdown than are women (see Gottman’s concepts of stonewalling and flooding for more information and illustrations). Based on my work with clients with PFAAN, I strongly suspect that men naturally have more features of PFAAN than women do. The Centers for Disease Control and Prevention reported that autism is 4.5 times more likely to be diagnosed in males. This means that many more men than women would have mild features of PFAAN. Grandin suggests that among girls, PFAAN is often labeled as being a “tomboy,” which doesn’t seem to receive the same level of focus or concern as the presence of autism in males. New research also suggests that females with PFAAN may generally be better than males are at social masking of these features. Or to quote Asperger, “The autistic personality is an extreme variant of male intelligence.”

An example from my experience is that giving too many food choices to a client with PFAAN can lead to shutdown. A large menu may be too hard for these individuals to process in a given amount of time because what they “feel” like having can often take much more time to figure out than it would for other individuals.

Concept F: The default emotion of most individuals with PFAAN is anxiety (if not shutdown). Anxiety appears to increase in those with PFAAN from adolescence on. I believe that increased anxiety proneness is a strong feature of being a person with PFAAN, although such a view is controversial. Novelty — good, bad or indifferent — almost always causes more fear in those with PFAAN than it does in NONs. Hence, rigidity in behavior, speech, routine or time management may often be an attempt to control fear.

Individuals with PFAAN and animals share the experience of novelty and sensory overstimulation producing anxiety and fear. An example from livestock science is the observation of flight zones in animals. The flight zone is how far an animal stays away from a person or experience. The less anxiety the animal feels, the smaller the flight zone. Novelty and sensory overload in animals produce fear or anxiety and lead to avoidance behavior. Thus, if this is the animal’s experience, the flight zone increases. Flight zones are reduced through exposure and positive (or at least neutral) experience. Being around strangers often produces great anxiety in animals and in clients with PFAAN. Thus, both will often avoid strangers whenever possible.

Counseling approach ideas

It is important to realize that counselors will likely need to be much more directive and teacherlike with clients who have PFAAN than with their other clients. Unconditional positive regard, reflection and talk therapy probably won’t be particularly useful because these clients are unlikely to get what these Rogerian-based interventions are working on or doing. What is most likely to be helpful to these clients is to remain focused on the skills that they need and then teaching them those skills. What follows are some approaches I have discovered that seem to help clients with PFAAN in the context of therapy.

1) Teach/discuss the Feeling Wheel concepts. I have found that simply teaching the Feeling Wheel concepts discussed in this article provides many clients who have PFAAN with the tools to move toward their goals and something constructive to do in the counseling context. These clients tend to be analytical and often like testing ideas. Interestingly, many clients with PFAAN are shocked when they find out that most people experience more than one emotion at a time. PFAANs and NONs speak a very different emotional language, so it is important to have a “Rosetta stone” to help facilitate emotional communication.

2) Teach the general behaviors that the emotions cause or are related to. For me, these are the main behaviors that go with the Feeling Wheel, and teaching these behaviors gives clients with PFAAN clues of what to look for in others. Behaviors are often easier to measure than are other ways of interpreting emotion. I relate the core emotions to the following broad behaviors (although there are many others):

Emotion Behavior

Powerful Having a choice/creating

Joyful Attraction/pursuit

Scared Avoidance/flight/urgency

Mad Aggression/flight

Sad Slowing down/reflecting

Peaceful Calm/unhurried/content

In my experience, the best emotional states in which to be empathic/thoughtful are sad, peaceful and powerful. Mad, scared and joyful appear to be more action oriented. Make sure that the client with PFAAN is in or near one of the thoughtful emotional states when practicing empathy training.

3a) Teach these clients to label the emotion they see in others so they can relate it back to the core emotions and choose an emotionally appropriate response. Practice what the emotions on the Feeling Wheel’s outer ring look like. For example, ask what the visual and auditory signs are of a person who is discouraged. The person may look down, exhibit less body movement, speak about being discouraged and so on. Once that emotion is labeled, trace it back to the core emotion (discouraged is a kind of “scared”) to help the client understand it better and have empathy.

3b) Teach clients with PFAAN phrases and actions that can be used once they empathize with the person’s emotion. Just because clients with PFAAN learn to empathize does not mean that they know how to respond appropriately. For example, a client with PFAAN might feel great anxiety at a funeral. To break the silence and sense of mourning that is causing his anxiety, he may start talking loudly to those around him about a new model airplane he is working on. This incorrect social response can have serious repercussions.

It can be helpful for these clients if counselors assign them a set response (at least in the beginning) for each core emotion. For example, you might instruct the client, “If you determine that a person is sad, a good response is to tell that person, ‘I am sorry that X happened’ in a calm voice.”

4) Teach one concept from the Feeling Wheel at a time. Remember, the emotional parts of the Feeling Wheel should be taught to clients with PFAAN in much the same way that you would teach children math: Start with the basics and work up. Clients may have no idea what scared looks like in themselves or others, so provide clear, visual, colored examples to illustrate the emotion. For instance, if the emotion is isolation, you might provide the visual of a person trapped in a purple box (because purple is the color for sad on the Feeling Wheel). A mirror might also be useful to show these clients what their facial expressions seem to be communicating to the counselor at any given time.

5) Teach clients to say “whoa.” Emotional processing takes longer in people with PFAAN, so it becomes very important for these clients to be able to communicate this to others. This is especially important in intimate relationships. I have noticed that many individuals with PFAAN are married to or have intimate relationships with NONs who are very emotional. To adapt a Catholic marriage concept, I think there might be great complementary benefit to such matches. He (usually) balances out her (usually) emotionality, whereas she provides him with an emotional vocabulary and a feeling of being needed. Sometimes this arrangement works well for many years, but then the more emotional partner begins to believe that the emotional avoidance and lack of emotionality/spontaneity on the other partner’s part indicate that he no longer loves her. Very often, this is not the case.

To offer a case example, if a wife asks a husband how he feels about her, she usually wants an answer that is specific and immediate. If the husband has PFAAN, it may take him some time to work out exactly what feelings he needs to communicate, no matter how much he loves her. This delay is often interpreted as the husband not caring, which can cause serious relationship issues. Either the client with PFAAN or the counselor needs to explain to the wife that it is hard for the husband to rapidly communicate his feelings but that, given time, he will tell her exactly how he feels.

You might also help clients with PFAAN “schedule” spontaneity into their relationships to improve them. I had a friend who decided that his wife liked being surprised with flowers, but he was not at all given to being spontaneous. So, he sat down, budgeted how many times he could afford to give his wife flowers (yes, he had a flower budget), and then randomly assigned different dates on his schedule for presenting the flowers. As a result, she got spontaneous (thus emotional) demonstrations of affection, and he still got to operate via a schedule and a budget. It worked great for them.

In a work example, a colleague wants to know everyone’s gut feelings about a new project. It may be important to teach the client with PFAAN how to tell this colleague that it will take time to understand what he or she feels about the project. If forced to communicate too quickly, deep anxiety or shutdown may occur. Clients with PFAAN typically have difficulty with “gut” feelings.

6) Use superhero/comic/sci-fi character modeling. Most of my clients with PFAAN like superheroes, fantasy and science fiction. Anime, a kind of film animation that originated in Japan, also seems very popular with these clients. I have noticed that almost every time an anime character has an emotion, the emotion is accompanied by an exaggerated facial expression or sound cue. You almost always know how an anime character feels, which may explain why anime is so popular among individuals with PFAAN. Many researchers seem to suggest that Asian cultures include more PFAAN by nature (e.g., saving face, defaulting to authority) than many other cultures do, which may explain why anime has these features.

I always ask my clients with PFAAN about their favorite superheroes or other favorite characters. This gives me insight into the clients and often provides a good picture that I can use to help them develop the emotional attributes exhibited by the characters they admire. I use this superhero therapy in a variety of ways, but one good technique that uses the Feeling Wheel is to make a color feelings diagram based on the client’s favorite superhero so that the client has some visual concept to reference.

For example, a client with PFAAN may really like and want to emulate Spider-Man. Spider-Man is a mix of powerful (he fights evil and has superpowers), joyful (optimism and hope) and scared (social anxiety caused by nerdiness) emotions. Aiming the client toward getting the emotions he or she needs to be more like the superhero provides structure for change. “I have plenty of scared. To be more like Spider-Man, I need to practice being more powerful.”

One warning: Make sure that clients choose characters who will move them toward healthy and effective goals. If a hero (or anti-hero) whom a client has chosen would be unhealthy to emulate emotionally or morally, don’t be afraid to speak up. I say this from personal experience. I had one client who really liked the character Deadpool, but under no account should this character be an emotional or moral model.

Conclusion

The concepts I have illustrated connected to the Feeling Wheel have been a revelation in helping my clients understand the difference between PFAANs and NONs and how to approach skill building and therapeutic effectiveness. It is the only tool I know of that explains and demystifies emotional responses in PFAANs and NONs (the group that most counselors fall into). These concepts and approaches have made a huge impact on my ability to help clients with PFAAN and their loved ones.

Adults with PFAAN will find their way into your practice. It is important to know how their emotions work and what may be effective and rewarding in therapy, both for them and for you.

 

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Kenneth J. Smith practices at Spirit of Peace Clinical Counseling in Ohio. He enjoys working with clients with PFAAN and clients with existential challenges, teaching and speaking. He holds a bachelor’s degree in animal science, a bachelor’s in history, a master’s degree focused on animal welfare/behavioral psychology and a master’s in clinical mental health counseling focused on the treatment of shame and guilt. Contact him at info@kentherapy.com or through his personal professional website at kentherapy.com.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The Social Adventures and Experiments of  Tommy Joe Peterson

By Brandon S. Ballantyne February 7, 2017

The idea of this therapeutic short story is to creatively illustrate the various dilemmas that occur from the perspective of a socially awkward young man, Tommy Joe Peterson. Through the story, the reader is able to gain perspective on the thought process and problem-solving skills of this uniquely talented 11-year-old boy.

Whether this fictional story is read by a child or read to a child by a teacher or counselor, the discussion questions included at the end are aimed at facilitating reflection and interpersonal growth. I believe that discussing the responses to the discussion questions will allow for improved awareness and insight into real-life dilemmas and help children to improve their problem-solving skills in a creative, narrative manner.

The target population for my therapeutic short story consists of teachers, parents, therapists and children of elementary through middle school age, particularly those with a mental health diagnosis similar to or consistent with autism spectrum disorder or social anxiety.

Friendship

Hello, my name is Tommy Joe. I am 11 years old. And in my mind, I am not just a boy. I am the world’s most coolest teenage superhero in my school. Well, at least I pretend to be.

Let me tell you about the time I almost saved my friend William from a flying plate of steaming hot lasagna in the cafeteria. Oh, and just so you know, William is only a few months younger than me. This is what happened …

The day started out just like any other day. I woke up at 6:37 a.m. I always wake up at that time to ensure that I get as many cartoons in as I can before I leave for school at exactly 8:02 a.m. I like the superhero cartoons. Batman is obviously the best, and I think I am like him in some ways. Although most adults say I am socially awkward, whatever that means. Clearly, they do not understand my abilities.

Anyway, after my cartoon time, my mother prompted me to participate in what she calls “activities of daily living.” She is a nurse, and I hear those types of phrases all the time. I have gotten used to it. This is the part of my morning routine during which I brush my teeth and comb through my brown wavy hair. I usually place some deodorant under each armpit, but not a lot. I typically do not like the texture, but I tolerate it enough to get at least a little bit of scent on me. Every good superhero needs a scent — at least that is what my mother tells me.

It was almost time to leave for school, so I slipped on my Velcro shoes and placed my bright red turtleneck on so it fit nice and snug, just the way I like it. I refuse to wear anything else but that red turtleneck. I feel most like a superhero in that shirt. Some people tease me for this. They clearly do not understand my abilities.

The bus ride to school is short. I live only four blocks from the school. And as a fifth-grader, riding the bus is the cool thing to do. On that day, the older kids were making fun of the way I was dressed. They always do. They also make fun of the way I only spray certain sections of my hair. You see, only some sections of my hair get messy, so there is no need to hairspray it all down. Only certain sections need a touch-up.

I do not think that the other kids understand my perspective. I don’t mind though. Life can be hard for a superhero like me. Clearly the other kids on the bus do not understand my abilities. And anything is better than riding to school with your parents, although my mother does listen to good music. But that is beside the point, and I do not want to ramble on, so let’s get back to the story of how I almost saved my friend William from an extremely steaming hot plate of lasagna.

I meet my friend William at the same spot every day before going into school. Every superhero needs a sidekick, and William is mine. William is shorter than me, and he refuses to be called Billy. He thinks that William is more formal, and he likes that. He has red curly hair and orange glasses. I do not really know where he got those glasses, but I like them. His glasses usually slip down to the end of his nose, and he has to spend most of the day adjusting and readjusting them. We have every class together. Every superhero needs a sidekick, and at least William understands my abilities.

The day was pretty boring until art class. It is like that every day. William and I count down the minutes leading up to our fourth-period art class. For us, it is more than just art class. It is a time for us to create new supercool superhero ideas. And on this day, the topic of class was “favorite transportation.” This was a perfect topic for superheroes like us.

William and I decided to create a spaceship. This was no ordinary spaceship. This was a supercool spaceship that William and I had imagined ourselves using to explore the outermost limits of our galaxy — beyond the black holes, red dwarfs, supernovas and solar flares.

By the way, space is my other supercool area of interest. William is mostly indifferent to the idea of space travel, but every superhero needs a sidekick, and because of that, I think he would come with me anyway. I guess the only problem would be if William gets motion sickness. I wonder if he gets sick in the car? To tell you the truth, I do not really know how William gets to school each day. I have never been in a car with him. Quite frankly, I only see him at school. Oh well, I do not want to ramble. Let’s get back to the story of how I almost saved William from an extremely overwhelming, steaming hot plate of lasagna in the school cafeteria.

Before describing the scene that would be about to take place in the cafeteria, it is important for me to be able to tell you how our art project turned out. William and I made a spaceship using cardboard, paint and a whole lot of glue. The spaceship was red, just like my turtleneck.

William is exceptionally good at folding cardboard, so I gave him the job of working on the wings. William attached long, narrow wings that seemed as if they would touch the ceiling. We carefully added glue to all the areas that needed to be held together, and then we added more glue, and then more glue, and then one last coating of glue to ensure that this spaceship could tolerate the astronomical elements that space travel would bring to the table. Every good astronaut needs a sidekick.

Our hands were sticky from the glue. It was hard for us to pull our fingers apart. But our spaceship was complete. William and I carefully placed the spaceship in our art closet to dry.

The bell rang for lunch. We hurried out of the classroom without cleaning up the rest of our materials. This was necessary because we need to get to lunch early so that we can sit at the table in the left corner — the one by the ice cream cooler. I like ice cream sandwiches, and it is important to be next to the cooler so that I can get two of them before they sell out. Every superhero needs his energy, and I just happen to get mine from ice cream sandwiches.

William prefers pizza, but they do not always have that. I once had the idea of putting my ice cream sandwiches on my pizza, but I have not been able to convince William to try it with me. And as a superhero, you need your sidekick to be on board before trying anything new. But that is for another story. Let’s get back to this one. I don’t want to ramble.

William and I entered the cafeteria and at a casual but fast pace assumed positions at our table by the ice cream cooler. The cafeteria was loud and chaotic as various students attempted to jockey for position in the lunch line. The teacher on duty was obviously struggling to keep order. I could tell by the look on her face. I did not have this teacher for class, but any good superhero can tell when another person is in obvious distress. I wish I could have helped her, but I needed to remain in position at my table.

This was partly due to the fact that the ice cream cooler is positioned just outside the kitchen, and as kids pass through the lunch line, they typically select their favorite ice cream product to complete their tray. William and I do it backward — we wait for a break in the line, and then we purchase our desserts first. Most kids do not think of going to the ice cream cooler first because it is positioned at the end of the line. Being the most supercool superhero that I am, I had developed this approach early last year. William agreed with me, although he typically does. William is a great sidekick.

The time was right. William and I stood up to go make our selection. I always purchase two ice cream sandwiches. William typically purchases the Italian ice. At least I think he does. Anyway, it was at that moment when we stood up that I began to notice an increase in chaos in the far right-hand side of the cafeteria. I quickly glanced over, and before picking out my ice cream, I noticed a food fight taking place. It was on the other side of the cafeteria, but it appeared as though it was escalating rapidly.

I needed to get my ice cream. I reached down and realized that I could not pull my fingers apart to grab it. Oh no, it was my worst nightmare. My fingers had been glued together from working on our spaceship in art class. It seemed that the harder I tried to pull them apart, the more they seemed to be glued together.

I had one dilemma with not being able to literally pick up my ice cream sandwich, and another dilemma with the rapidly growing food fight that was moving across the cafeteria like a tidal wave. I had to make a decision. I either needed to take cover and sacrifice my ice cream sandwich, or I needed to take the chance of being hit by food and attempt to grab my ice cream with my glued-together fingers. I had to think quickly.

At that moment, I noticed a red substance flying through the air toward William. I saw it out of the corner of my eye, so it was hard for me to tell what it was. But as it flew through the air, I realized that it was a piece of lasagna. It was hot. I could see the steam coming off of it as it whizzed past the heads of various students.

At this point, even the teachers were taking cover. Mr. Jones was under the table, and Ms. Sprockett was hiding behind the soda machine. The flying lasagna was coming our way, and based on my superhero calculations, it was heading directly toward William.

Everything was moving in slow motion. William was frozen in fear. He needed me. I quickly lunged in his direction and raised my hands in an attempt to take most of the blow from the flying lasagna. Every good superhero occasionally makes sacrifices for his sidekick — at least Batman did.

The only problem was that my fingers were still glued together. The lasagna not only hit my arms, covering me in sauce, but it also smothered William. He had sauce and cheese all over him. And the worst part of it was, I didn’t even get my ice cream sandwiches. The last thing I remember was William tasting the lasagna that was dripping off of his cheeks. William is always good at embracing chaos.

I guess even the best superheroes sometimes have trouble rescuing others. But William and I are still friends. He has forgiven me, and there are no hard feelings between us. I guess what I have learned from this situation is that every superhero needs a sidekick. I do not know what I would do without William. He is my best friend. But maybe next time, I won’t use so much glue.

 

Therapeutic discussion questions 

  • According to Tommy Joe, every superhero needs a sidekick. Who is the sidekick in your life? Who do you feel supported by? Who listens to you when you talk?
  • What makes someone a friend? What makes you a friend? What types of things do friends do for one another?
  • Discuss a difficult situation that a friend helped you with. What did they do to support you?
  • Discuss a difficult situation that you helped a friend with. What did you do to support them?
  • The glue on Tommy Joe’s fingers makes it difficult for him to rescue William and pick up his ice cream sandwiches. What should Tommy Joe have done prior to going into the cafeteria that would have made it easier for him to help William?
  • What is a goal you have in your life? What is an obstacle you face in your life? How can you plan ahead to make accomplishing your goal easier?
  • What can your sidekick do to help you reach your goal?
  • If you were Tommy Joe, what would you have done differently in the story? How would making different decisions have affected the outcome of the story?
  • Is there another way the story could have ended? If so, I would love to hear your version.

 

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Brandon S. Ballantyne, a licensed professional counselor and national certified counselor, has been practicing clinical counseling since 2007. He currently practices at Reading Health System in Reading, Pennsylvania, and Advanced Counseling and Research Services in Lancaster. He has experience working with both adolescent and adult clients struggling with moderate to severe depression and anxiety. He has facilitated many unique interventions and group modalities in the area of addressing relationship conflict and negative thought patterns. Contact him at ballantynebrandon@yahoo.com.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having your article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.