Tag Archives: autism

Gut health and healthy brain function in children with ADHD and ASD

By Michelle Harrell February 8, 2016

With the awareness being brought forward regarding gut health and neurocounseling, the future looks bright for our children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Although all the tools that are available for neurocounseling are excellent for improving cognitive, emotional and social skills, we now have additional research to support the addition of nutritional therapy to our toolboxes as counselors.

Although I am a new counselor, I have spent more than 25 years researching and applying nutritional therapy in my own life after being diagnosed with chronic fatigue syndrome in my early 20s. I have WatermelonTummyseen firsthand the benefits of nutritional therapy and how it affects emotional, mental and physical well-being, especially as I reversed the symptoms of ADHD with both of my two children. As a teacher, I have also witnessed the increase in children with ADHD, ASD, and other mood and anxiety disorders that could be greatly combatted with supportive counseling and nutritional therapy protocols. As I begin my journey as a counselor in the schools and private practice, I can’t imagine not grasping the opportunity to add nutritional therapy for my clients.

Improving gut health can have a dramatic effect upon mood and cognitive functioning because of its healing nature within the immune and nervous systems. The use of nutritional therapy to support gut health in children and adults builds resilience and supports the bottom-up aspect of neurocounseling that understands and recognizes the bidirectional connection between our gut and our brain, as discussed by Allen Ivey and Mary Bradford Ivey.

 

Current statistics

According to the Centers for Disease Control and Prevention (CDC), ADHD currently affects approximately 11 percent of children ages 4-17. ADHD is a chronic mental health and neurological condition that has been increasing at a rate of 5 percent per year since 2006.

ASD is also on the rise. According to the CDC, ASD affects approximately 1 in 68 children in the United States. That rate is expected to increase to an estimated 1 in 25 children by 2025. ASD is currently five times more likely to occur in boys than in girls.

The fact that both of these conditions are on the rise at these current rates in our children should be cause for serious concern. As a parent and a teacher, I have observed the increasing demand that these chronic health conditions are putting on caregivers and professionals. Many counselors are responding by offering neurocounseling and other proven therapies to assist with behavioral issues, emotional regulation and cognitive needs. Neurofeedback, along with cognitive behavior therapy, is also proving to offer improved brain function that is sustained after treatment ends. Because nutritional therapy supports brain function, the two work in synchronicity for a client’s well-being.

Much has been discussed and debated about the issue of diet with children who have ADHD or ASD. Many parents have noted that removing certain foods appears to reduce symptoms of the disorders, and there is general recognition that gluten, sugar and other allergens have had a negative effect on these children. Even though these irritants seem to cause increased symptoms in many children, the underlying gut health situation might be the actual culprit here.

The gut ecosystem is a system that needs to be in balance. The gut is balanced when good bacteria and yeast exist in a healthy ratio within the digestive tract. When this balance is disturbed, food sensitivities and allergies can be noticed. According to Donna Gates (the author of The Body Ecology Diet) and Natasha Campbell-McBride (a medical doctor who wrote Gut and Psychology Syndrome), when gut health is restored, it results in a reduction in food allergens, allowing children to once again consume gluten and other supposed no-nos in a moderate amount.

Children with ADHD and ASD have shown remarkable improvement and overall symptom reversal by using food-healing protocols that increase healthy gut microbes, according to Gates and McBride. This can be a great relief and blessing for families that have been following a strict gluten- and casein-free diet. Imagine the joy of parents who can once again allow their child to attend birthday parties to enjoy cake and ice cream.

 

Basic knowledge

ADHD and ASD are just two of the many mental and developmental disorders that can benefit from the application of nutritional therapy to improve gut health. Gut health is important for brain health and directly affects mood and emotions. A growing number of researchers are interested in the relationship between gut microbes and brain function. According to the California Institute of Technology (Caltech), approximately 90 percent of serotonin is made in the gut. Researchers at Caltech are also studying the benefits of gut flora and its direct contribution to reducing autism symptoms in mice and humans.

According to Lisa E. Goehler, an expert in psychoneuroimmunology and faculty at the University of Virginia School of Nursing, gut microbes are responsible for creating most of our serotonin and numerous other neurotransmitters that are essential for healthy brain function. Serotonin is necessary for the brain to experience a positive mood and be resilient to stress. Microbes in the gut also have the essential task of supporting digestion by synthesizing vitamins, fermenting things we can’t digest and producing hormones that influence our immune, endocrine and nervous systems, according to Goehler.

Not just quantity, but diversity of gut microbes is important for overall health, Goehler says. She states that lean individuals have greater diversity in their gut microbes. But even a heavy person who has a diverse and abundant good microbe count is shown to be in better health than those with limited amounts of microbes, she says. According to Goehler, heavy individuals with a greater diversity of microbes experience fewer problems with metabolic syndrome and cardio and neurovascular disorders. This can even be a factor in the health of children who are overweight.

In general, Goehler reports, when good gut microbes are limited and displaced by toxins and yeast, digestion is impaired, resulting in leaky gut syndrome. In leaky-gut syndrome, yeast begins to take over when good bacteria have been reduced due to antibiotic use and unhealthy food choices. Yeast overgrowth causes leakage in the wall of the small intestine, allowing contaminants and undigested food into the bloodstream that would otherwise not have been able to cross the intestinal wall barrier. Yeast and other pathogens can then travel to the organs and cause additional health issues.

Nutritional therapy to restore balance begins with reintroducing additional healthy gut microbes back into the system. Probiotics and cultured foods seem to be a foundational piece to any effective gut-healing protocol. More of the science that goes with this essential piece of the puzzle is outlined in programs of leading practitioners. The results of restoring healthy flora back into the gut for healing has yielded many positive results for some families with ADHD and ASD.

I was pleased to find the work of two professionals who have been having similar results with the reversal of ADHD and ASD symptoms with a diet based on consuming probiotics and cultured foods. Gates’The Body Ecology Diet and Campbell-McBride’s Gut and Psychology Syndrome were remarkably similar, even though the two developed their works separately on opposite sides of the world. Gates, of California, and Campbell-McBride, of the United Kingdom, collaborated in a video to share the similarities between their results and the importance of balancing the body’s digestive ecosystem. I highly recommend their video as a source of valuable information for anyone seeking to learn more about the advantages of cultured foods (see https://youtu.be/nLP0Ijo2CK4).

Gates and Campbell-McBride both offer straightforward steps for balancing digestion, and they both have documented multiple cases of reversal or, in some cases, complete healing of ADHD and ASD in children when their methods are combined with additional holistic therapies. They both recommend the use of coconut kefir and fermented vegetables as foundational pieces of their plan. They both also mention that, historically, all cultures had some sort of cultured food that supported gut health, but during the latter half of the 20th century, this knowledge seemed to be disregarded for our current modern diet. Introducing these foods back into people’s diets has resulted in tremendous health restorative qualities for many of their clients. Having valuable resources that are in layman’s terms for clients to use can help support clients’ wellness plans.

 

Overcoming barriers

Counselors will come up against a variety of barriers if they choose to integrate food healing into their practice.

First is the issue of counselor training and understanding. Clearly we as counselors did not set out to be certified in nutrition, and many counselors may not want to pursue the additional certification. I have found it worth the time and energy to learn because I can apply it in my own life and experience improved personal health in addition to supporting my clients’ needs. Clients may also feel more inclined to see if food-healing protocols might work for them if their counselor is applying them as well. Regardless of whether you align yourself with another professional who possesses the credentials to offer nutritional therapy or you decide to jump in and educate yourself, your clients will benefit. But the choice is obviously the counselor’s to make.

As a recent counseling program graduate who wants to move forward into practice as a neurocounselor and offer nutritional therapies, it is important to educate myself on current research-based approaches that are demonstrating positive results. Current scientific research shared by Goehler in her workshop titled “Understanding the Gut Brain: Stress Appetite Digestion and Mood” offers one such professional learning opportunity for counselors. Of course, other researchers offer additional workshops. I make it a point to include these types of workshops in my professional development plan.

Although I am knowledgeable about food therapy and plan to constantly improve my skills, I also know my limits and will refer my clients as needed to those who are experienced experts in nutritional therapy. I also know that one size does not fit all. Clients require individualized plans that are suitable for their health needs.

Even if clients begin eating a healthier diet that is right for them, barriers such as cultural resistance at school, work or home can discourage them from continuing a positive habit. Counseling strategies might include encouraging clients to build healthy communication and confrontation skills when responding to those who question their dietary preferences. These skills can especially benefit teenagers who have to address their peers at a time when peer influence is of great importance in their lives.

Barriers of child taste preferences can be a serious problem for parents who have children with ADHD or ASD. Oftentimes, these children resist the foods that will restore their gut health. In his book Conquering Any Disease (2014), Jeff Primack shares the ingenious strategy of introducing delicious fruit smoothies into a child’s diet to restore gut health in children who have health issues. His research and books on food healing and smoothies have resulted in positive outcomes for Foodchildren with ASD and ADHD. These children were soon demanding more healthy smoothies as their tastes slowly changed toward a diet that would support their goal for improved health.

Within private practice, counselors can overcome barriers by educating clients through workshops and seminars. Clients can also benefit from support groups if they feel alone or don’t receive support from their immediate family or community system. Free online forums such as the one that Gates created (see bedrokcommunity.org) can offer testimonials and encouragement for parents who hope to help their children by integrating nutritional therapy along with other holistic protocols and counseling services.

School counselors might experience the most challenging barriers within a system that does not quite understand the role they play as mental health supporters. It would be interesting to see how administrators respond to data indicating that instances of ADHD and ASD are increasing and information about the current solutions available for parents and teachers to offer. The current demand to address the needs of ADHD and ASD students is enormous and requires a significant amount of time and resource planning for all school personnel. School counselors are being called on to assist with the increasing numbers of behavior issues and learning needs related to ADHD and ASD diagnoses. In addition to their current workloads that may include extra administrative duties that keep them from being available for these students’ counseling needs, school counselors are still trying to establish their identities as counselors in schools. This is where advocating for a comprehensive school counseling program as outlined by the American School Counselor Association, a division of the American Counseling Association, can be useful. Comprehensive school counseling programs encourage school counselors to be change agents, which could include mental health efforts that integrate nutritional support for these students.

School counselors can bring this information to light in a variety of ways, including offering a professional development class on mental health for school staff, administrators and school board representatives. As a teacher, I would have appreciated learning more about many of the diagnoses that I was designing 504 plans, individualized education programs and response to intervention frameworks around. Teachers are in the trenches daily dealing with stress and anxiety issues related to ADHD, ASD and other mental health disorders but don’t know the details behind these diagnoses. They will truly need the support of school counselors and administrators in the years ahead given the projected increases for ADHD and ASD.

There are many other creative ways that school counselors could address wellness. Counselors educated on nutritional research could advocate with their school boards and county nutritionists to suggest healthy food options that would be tasty for students. According to Luise Light, the former director of dietary guidance and nutrition education research for the Department of Agriculture, the food pyramid that emerged in the early 1990s was a product of business corporations and not true science. In 2006, Light stated that all of her research was overlooked in favor of corporate interests. In her book What to Eat, she explained how this development has directly affected our society’s health and particularly our most valuable natural resource — our children. Clarifying that the food pyramid is both outdated and not based on the best scientific data could help our society understand nutrition differently.

Another opportunity for counselor advocacy is to work collaboratively with health and science teachers to design lessons that align with current research. I knew of one health teacher who taught children in an impoverished neighborhood the benefits of micronutrients by bringing in a blender and creating fruit smoothies. This exposure to practical solutions that tasted good paid off. The students couldn’t stop talking about their lessons on food and nutrition from this progressive teacher, and I even heard them discussing how they were teaching their parents about healthier food options.

With food therapy and neurocounseling working together, the future looks hopeful for children and families dealing with ADHD and ASD. Obviously, each child is his or her own unique being and will require an individualized protocol that is specific to that child. Professional counselors have been trained to offer amazing tools for improved mental health, and I believe we now have a critical missing link to add to our toolbox. We are at an exciting time in our work, with science and counseling validating the relationship between the mind and body as never before.

 

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Michelle Harrell, an educator working in the Columbia County school system, lives in Evans, Georgia. She earned her bachelor’s degree from Georgia Tech and both a Master of Arts in Teaching MichelleHarrelland a Master of Education (school counseling) degree from Augusta University. She is currently working on her specialist degree in counseling education and supervision. Michelle is also a qigong and meditation teacher in her spare time. Contact her at michelleharrellneurocounseling@gmail.com.

Retaining family focus

By Laurie Meyers September 23, 2015

“Rose” and “Steve” came to American Counseling Association member Laura Marshak for couples counseling because they felt they had been growing further and further apart ever since their son, “Sammy,” who was now in elementary school, had been born with cerebral palsy. Out of necessity, Retaining-family-focusSteve had become the primary breadwinner for the family, while Rose left her job to provide the extensive care that Sammy required.

Over time, Steve buried himself in his work, while Rose handled Sammy’s daily needs. She shuttled Sammy to his appointments for speech therapy, physical therapy and other specialized services and also took on the task of petitioning Sammy’s school for an Individualized Education Program. Rose felt she was doing all the heavy lifting and resented Steve because she thought he wasn’t helping enough with Sammy’s care. Steve, on the other hand, thought Rose didn’t appreciate how hard he was working to secure their financial future. Angry and resentful, they rarely spent time together as a couple, says Marshak, whose specialties include counseling parents of children with special needs as part of a group practice in Pittsburgh.

“They said it was too hard to find a qualified baby sitter who could handle their son’s medical complications,” recounts Marshak, who is also a counseling professor at Indiana University of Pennsylvania. “In reality, they did not have much to say to each other anymore and had lost an intimate connection.”

According to Marshak, the author of the recently published book Going Solo While Raising Children With Disabilities, Rose and Steve’s story is not unusual. Instead, it is an all-too-common experience shared by many other couples who have children with special needs.

As loved and wanted as these children may be, the unavoidable extra care they require can take a toll not just on parents but also on siblings and the family as a whole. When a child has special needs — whether physical, medical, intellectual, emotional or educational — parents may find it necessary to alter virtually every facet of family life. For these families, it can sometimes seem as if every resource, from time to money to even patience, are continually at risk of being exhausted. Depending on the severity of the child’s disability or special circumstance, the family may need access to intensive medical, health or other services such as occupational or speech therapy; specialized education and possibly job training; and help with daily tasks that other families may take for granted, from basic hygiene to learning and applying social skills.

Because efforts are understandably focused on navigating the day-to-day and moment-to-moment challenges of addressing their child’s special needs, another very important need can often get pushed to the side: maintaining the overall health and well-being of the individual family members and the family unit as a whole. Parents can struggle to take time for themselves while caring for their children. Marriages and partnerships can be tested or neglected. Siblings might struggle to cope with disparate levels of parental attention, feeling they have been left to face life’s challenges on their own. That’s why counselors can play such an important role in helping these families not just meet the special needs of their children, but also attain a better sense of equilibrium.

Addressing behavioral issues

Charmaine Solomon, a licensed professional counselor (LPC) and sole practitioner in Plano, Texas, says that when families of children with special needs come to see her, they are generally looking for help with the day-to-day issues. One issue that comes up frequently is discipline.

“Families with special needs children struggle to discipline in an appropriate manner,” Solomon says. “Because the child has special needs, they [the families] feel like they can’t hold them accountable.”

Solomon, a member of the Texas Counseling Association, a branch of ACA, has a now-grown son who suffered a traumatic brain injury as a child that left him disabled. This personal experience has informed her counseling practice. One of Solomon’s areas of focus is working with children and adults who have special needs such as autism and intellectual disabilities. She is also one of the founding members of My Possibilities, a continuing education day program for adults with special needs located in Plano.

Considering everything else that the parents may be struggling to manage, a child’s acting-out behaviors may seem like a relatively minor problem, particularly when the child is young, Solomon says. However, as the child gets older, this lack of discipline may become virtually unmanageable or, in some cases, even lead to violence, she notes.

Parents who focus on punishment when their child with special needs is acting out or showing aggression may find themselves locked in an escalating punishment cycle until seemingly the only solution left is to ground the child for life, says Erik Young, an LPC in West Chester, Pennsylvania. He has worked with individuals with special needs and their families for the past 20 years, including in a rehabilitation center, a life-skills training organization, a behavioral health care organization and, for the past four years, as a private practitioner. Young and his wife have also provided foster care for several children with special needs.

When parents come to Young for assistance with their children’s behavioral problems, he helps them develop a behavioral plan, which will vary according to the child’s problem behavior and capabilities. For example, many children with intellectual disabilities possess poor verbal communication skills, and their inability to communicate effectively may be part of the behavior problem, he says. Young frequently works on communication skills with the child and parents, giving the child a book or tablet device with pictures that the child can use to indicate what he or she wants.

Discipline strategies will vary from child to child, says Solomon, but should typically focus on reward and reinforcement rather than exclusively punitive measures. For example, parents should focus on what the child really enjoys, such as spending time on an iPad, and start by setting a time limit on the activity, Solomon explains. If the child displays the desired behavior, the limit will be increased, but problematic behavior will result in decreased time with the pleasurable activity, she says.

When appropriate, Young likes to use cognitive behavior therapy (CBT) to uncover what the trigger or cause of the child’s behavior problem might be. Conversely, it may be that a child’s behavior is not truly problematic but is simply angering or frustrating to the parent for some reason, so he will also use CBT to help the parent understand why. Young will then develop a behavioral plan that may include teaching the child and parents strategies for anger management, emotional regulation and so on.

Robert Jason Grant, an LPC and sole practitioner in Nixa, Missouri, also works with both the child (mainly children who are on the autism spectrum) and the child’s parents to explore factors that contribute to behavioral issues. For instance, he explains, punishment for certain behaviors isn’t successful with children who have autism because these children engage in impulsive behavior.

“[The behavior] is not thought out and may even be a surprise to the child,” says Grant, a member of ACA. “They may not even have time to think about consequences.”

Instead, Grant says, behavioral work should focus on what is causing or contributing to the problem. Because children with autism typically possess little or no ability to regulate emotions or process sensory input, emotional and sensory dysregulation are often the main contributing factors to these children’s discipline problems, he says.

“What tends to create dysregulation, and how do we change that?” Grant asks. “Is it environmental? Do we need to provide sensory breaks? … A sensory break could be something as simple and basic as a private quiet room, let’s say in school, where the child can go to be by [himself or herself], with no other people and no one coming to talk.”

Sometimes, all these children need is to “reset,” Grant says, and that can take as little as 10 minutes.

Grant also works with children and parents to tackle the dysfunction head on. He has designed a specific approach that he calls AutPlay, which is a combination of behavior and play therapy for children who have autism. The play therapy tools he uses include objects such as weighted vests, weighted balls and other sensory toys because children who are on the autism spectrum find these items soothing, he says. Parents can use these toys at home to continue the therapy, and that is important because dysregulation requires constant maintenance, he says.

The benefits of effective discipline go beyond managing specific behavioral issues, Solomon says. When parents discipline a child who has special needs, they are teaching him or her how to tell right from wrong and also how to accept instruction, she asserts. Knowing how to make decisions and how to follow instructions contribute to a child’s sense of independence, adds Solomon, who believes that parents should always be working toward increasing the child’s level of independence.

For instance, some children with special needs may require help feeding or dressing themselves beyond the age that is typical for completing those activities independently, Solomon says. Although it is often easier to continue to dress and feed a child who has difficulties, parents should keep working toward teaching the child to do these things on his or her own, she asserts. Solomon acknowledges that this process can take a little — or a lot — longer, but in many cases, she says, the child will eventually have the capability to do it. The same holds true for many other self-care and independent activities that will ultimately benefit the child, she says.

Letting children with special needs do everything they are able to do can also bolster their self-image, says Susan Stuntzner, an assistant professor in the School of Rehabilitation Services and Counseling at the University of Texas, Rio Grande Valley. On the flip side, automatically doing everything for a child who has a disability can send negative messages about his or her capabilities and value and also create a sense of learned helplessness, she says.

Family needs

As children become more self-sufficient, this generally eases the pressure on parents. But parents of children with special needs sometimes come to believe that they are the only ones who can — or should — provide adequate care for their child, Solomon says. Unfortunately, being constantly on call, and with no relief in sight, tends to only cause more problems, she says.

Young says that although families may initially come to counseling for help with a specific problem such as discipline, he also probes for any other stressors with which the family is having difficulty coping, either as a group or individually.

There really is no way to fully prepare for the needs of a child with a disability until you have to do it, he says. Families are suddenly faced with the need to obtain — among other things — health, medical and disability services, Young explains. Further complicating matters is the fact that there is no one central place to obtain services. Disability and educational assistance vary from state to state, and health and medical services are usually secured through insurance plans with varying levels of benefits, Young and Solomon point out.

In addition to coordinating outside services, parents must come up with a plan for meeting the child’s daily needs, Young says. Children with special needs may require additional help with daily activities such as getting dressed or even eating. Children with disabilities may need constant care, meaning someone has to be watching them at all times, Young adds. This means spouses and families may have to engage in tough discussions and make significant compromises. For instance, who stays home to provide care to the child? Who will be on call to take the child to any therapy that he or she might require? To address these needs, one parent will often stop working, which can creates an additional source of stress: money and finances.

Caring for a child with special needs can be a 24-hour job that many families assume they can and should engage in alone, Solomon says. But if all of the family’s time and attention is spent on taking care of the child, who is taking care of the family?

“Oftentimes, families are trying to figure out how to tend to their family member’s needs and concerns to the point that they forget they have their own set of needs,” says Stuntzner, an ACA member who also writes and speaks about living with a disability. “As a result, families … may experience personal or caregiver burnout.” In fact, if parents consistently ignore their own needs, they may eventually grow resentful of how much help their child requires, she warns.

Young works with families who are dealing with a child’s special needs or circumstances to help them recognize that they don’t have to do it alone and that resources are available to them. He points out that he, or any other counselor, can offer the family a neutral source of support — someone to talk to who doesn’t have any kind of emotional attachment or agenda but understands what the family is going through. Because Young also has connections (from his time working in a rehabilitation center and a behavioral health care organization) to state and local agencies that help provide services, he can point these families in the right direction. He even keeps a binder of business cards that he has gathered over time, based on personal or client experience, for tradespeople such as plumbers and handymen who are used to coming to homes with children with special needs and who won’t be disturbed by outbursts or other behaviors that might be regarded as outside the norm.

A system of support

When Grant works with parents of children with autism or other special needs, he always emphasizes the importance of self-care. He teaches parents how to conduct a self-care inventory so they will start actively thinking about caring for themselves.

Encouraging family members to engage in self-care sometimes requires a shift in perspective. For instance, self-care can mean something as small as taking a few moments during the day to indulge in something the individual really enjoys, Young notes. “Instead of a week on the beach — because that’s probably not going to happen — what can they do during the day? [It’s] just little moments that can be refreshing,” he says.

When a child is born with special needs, becomes disabled or is diagnosed with a disorder, Young says, it is common for extended family members and friends to draw back at first, often because they feel like outsiders and aren’t sure what they can do to help. So Young encourages families who have a child with special needs to actively reach out to others, explaining that maintaining a solid social network is crucial for both emotional and practical support.

“I often take my clients through the process of listing all potential resource people — no matter how disconnected — and talk about what they might be able to contribute,” he explains. “Then we go about ‘recruiting’ them so to speak. Find ways to utilize their talents and, thus, spread the stress. People generally want to help when they can. They may just need guidance.”

That’s why Young tells these families to let their networks know what they need specifically. “Take an executive role. You are president,” Young urges his clients. “These people are your Cabinet, your advisers. Make sure you’re getting them to do what you want.”

With a support network, parents can also build a system of respite care. Once a child is used to being with a caregiver, the parents can take breaks, possibly even getting away for a day trip or weekend vacation, Solomon says.

Sometimes families won’t seek any kind of support because they feel ashamed of their struggles, Solomon says. Rather than isolate themselves further, she encourages these clients to seek out others families of children with special needs. She suggests that parents contact local mental health agencies to find support networks.

Young says that lately he has been providing more couples counseling than family counseling because the primary issue for many of his families who are dealing with special needs is actually a problem with the parents’ marriage or partnership. The stress of caring for a child with special needs can take a particular toll on a couple’s relationship, he points out.

Solomon agrees, noting that respite care isn’t just important for parents as individuals but also as a couple. When providing focused care to a child with special needs, it can be particularly challenging to find the time or the energy to just be a couple, she says. Identifying someone who can provide caregiver support can allow couples to take much-needed time for date nights or even a short trip, she adds.

Parenting styles can also drive a wedge between couples who are caring for a child with special needs, says Young, who uses talk therapy with couples. If parents can’t agree on how best to care for or discipline their child, it creates a continual source of conflict, he says. Young helps couples learn to communicate with each other about what they want and need and how best to compromise, if needed.

“I like to use a variety of techniques that hone active listening and clear communication skills and trust,” he says. “One favorite technique I learned at an attachment therapy conference is to have the couple sit in chairs facing each other. One person communicates a brief statement, then the other person has to repeat it back. Then they switch roles. Even this simple exercise can highlight when assumptions are being made and communication is being blocked.”

Young also specifically addresses differing parenting styles with couples, such as when one partner is more authoritarian and the other is more nurturing. He works with these couples to develop a joint parenting style that is balanced — both authoritative and nurturing.

Young also works with the parents in session to practice planning for specific concerns. He asks them to think about how they were raised and how that influences the way they parent today. This exercise helps to spur conversations that can uncover differences in the way they view parenting, he says. Young then helps the couple to negotiate these differences.

Sometimes it’s not parenting style — but substance — that causes the problem. Solomon says disparate distribution of parental responsibility is often a source of tension in families managing special needs. She regularly sees mothers who take all the responsibility for caregiving — either by choice or necessity — which leaves little time for other relationships. Solomon tells her clients that parents need to share responsibility. For example, when possible, fathers should take a turn accompanying the child to therapy. If the mother is the sole caregiver during the day, the father should give her a break by taking on extra duties at night.

Marshak’s couple, Rose and Steve, offered an example of disparate responsibilities — or at least that was how it appeared to Rose. With Marshak’s help, the couple began to discuss the underlying tensions and motivations that had led them to their crisis point.

When Sammy was first born, Rose was deeply depressed and wanted to talk about her grief with Steve, explains Marshak, who co-authored the 2007 book Married With Special Needs Children: A Couple’s Guide to Keeping Connected with Fran Prezant, a speech and language pathologist and researcher on disability issues. Steve, however, preferred to avoid discussion and bury himself in his work. Rose thought Steve’s silence meant that he didn’t care about her or Sammy, but focusing on work and providing for his family was actually Steve’s coping mechanism to deal with his grief. As time passed, Rose spent her time learning as much as she could about cerebral palsy and seeking support through a network of other mothers who had children with the disease. Steve worried constantly about how to financially support his family in the present and how to make sure there would be money for his son in the future in case Sammy couldn’t support himself. So Steve worked even harder.

Guided by Marshak, the couple discussed all of these issues in counseling. Rose began to understand that work was Steve’s way of coping with his feelings of grief and worry and that even though he wasn’t sharing his grief verbally, that didn’t mean he wasn’t hurting. Steve learned to become more expressive with his feelings.

Rose and Steve also worked to re-establish their romantic connection by going out as a couple again and trying to view each other as the individuals with whom they had fallen in love — not just as Sammy’s parents, Marshak says. Over time, as they re-established their bond as a couple, they also started to adjust their roles, including sharing more of the responsibilities related to Sammy’s educational and medical needs. Rose even resumed some of the leisure activities she had given up when she felt she was solely responsible for Sammy’s care.

Speaking to siblings

When working with a family who has a child with special needs, it is also important for counselors to take time to focus on the needs of family members who may get overlooked, or at least feel like they are overlooked — siblings.

Grant sometimes works with siblings on their own so they will know they have an outlet for their struggles and frustrations. “One of the biggest challenges [for siblings of a child with special needs] is the feeling of having to take a step back, of giving up things for their sibling,” he says.

Out of necessity, the child with special needs is the family’s biggest area of focus. To the child’s siblings, this circumstance can seem not only unfair but also as if the parents are choosing to favor the child with the disability or special needs, Grant adds.

When Solomon’s son who is disabled was a child, his siblings struggled with feeling forgotten. “I had to teach my [other] sons the difference between ‘have to’ and ‘want to,’” she recalls. Solomon sat down with her sons and explained that it wasn’t a matter of wanting to spend less time with them but rather that their brother needed more of her time.

As the siblings of a child with special needs get older, they may also start to worry about or feel responsible for their brother or sister, Grant says. He regularly teaches siblings games that they can play with their brother or sister who has special needs that will help the child to cultivate specific skills. One such game is called Social Skills Fortune Tellers.

Grant teaches the “neurotypical” sibling — the fortune teller — how to make an origami structure with tented triangles that can be manipulated with the fingers so that different sides or flaps of the triangle show. Each flap holds a social skill to practice. The fortune teller manipulates the origami and reveals a skill, which the siblings then practice, Grant explains. As an alternative, the origami can also be used for emotions, he says. When a particular emotion is revealed, both the neurotypical sibling and the sibling with special needs can share a time when they felt that particular emotion or make a face that demonstrates that feeling.

Grant also uses family play therapy techniques to allow siblings — and all family members — to express how they are feeling or what they are thinking about issues such as how autism is affecting the family or how the parents are parenting. One technique is called “color my feelings.” Each family member uses a white piece of paper with a heart drawn on it. The family members color the hearts with whatever color best represents their feelings, he explains. The family members then share their hearts, allowing everyone an opportunity to talk about the feelings they are having and why they are experiencing those feelings.

Lifelong support

It is painful to contemplate, but there will come a time when the parents are no longer there to help their child with special needs, Solomon says. That is why she is adamant about encouraging her clients to plan for that future now.

Solomon tells parents that they need to consider questions such as: Who will take care of the child? What services will the child need? Where will the child live? Where will the money to pay for the child’s needs come from?

She helps parents learn what guardianship is and urges them to start planning immediately for the lifelong financial needs related to providing for someone with a disability. Solomon also notes that it is important for parents to apply for disability services well ahead of time. Once a child graduates, he or she loses any benefits, such as ongoing speech therapy, that the child’s school provides, she points out. Solomon adds that in Texas, there is currently a 12-year waiting list for state services.

Young also helps families come to grips with the reality of planning for a child’s ongoing support once the parents are gone or are no longer able, for health or other reasons, to continue providing care. Although he acknowledges it is a difficult conversation to have, he sits down with families and helps them develop a long-term plan by investigating options such as sheltered workshops and group homes. Young also emphasizes the wisdom of financial planning with insurance agencies that specialize in estate planning and special needs trusts.

From Solomon’s perspective, this planning process also comes back to encouraging children with special needs to develop as much independence as possible and teaching them skills to help prepare them for the future, just as parents do with any child.

“Just like with another child [without special needs], you ask, ‘Have you done your homework? Practiced your instrument?’ With the child with special needs it’s, ‘Did you practice doing your buttons? Did you take a shower?’” she says. It’s still homework, she adds, but homework of a different sort.

Young says it is important for counselors to empathize with parents about the challenges of raising a child with special needs. At the same time, he encourages parents to let go of the idea of what “could have been” and instead embrace the child that they have because each child with special needs also has his or her own beautiful gifts.

Stuntzner, who is also a member of the American Rehabilitation Counseling Association, agrees. “Coping well does not mean the family has not felt or experienced negatives or difficulties,” she says. “Rather, it is an indication that through the experience of a loved one’s disability, they have found a way to work with the situation so that it brings the family together instead of pulling it apart.”

 

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Additional resources

The American Rehabilitation Counseling Association, a division of the American Counseling Association, is an organization of rehabilitation counseling practitioners, educators and students who are concerned with enhancing the development of people with disabilities throughout their life span and in promoting excellence in the rehabilitation counseling profession’s practice, research, consultation and professional development. To learn more, go to the ARCA website at arcaweb.org.

The International Association of Marriage and Family Counselors, also a division of ACA, is an organization whose members help develop healthy family systems through prevention, education and therapy. For more information, visit iamfconline.org.

Other resources include:

  • “Disability Awareness,” an ACA podcast presented by Robbin Miller. To access the podcast, go to the Knowledge Center section of ACA’s website (counseling.org) and click on “Podcasts.”
  • Yes You Can!: Art-Centered Therapy for People With Disabilities, an ACA DVD presented by Judith A. Rubin. To purchase the DVD, go to the ACA bookstore (counseling.org/publications/bookstore).
  • “Autism Spectrum Disorder,” an ACA Practice Brief written by Carl J. Sheperis, Darrel Mohr and Rachael Ammons. To access this brief, go to the Knowledge Center section of ACA’s website (counseling.org), click on the “Center for Counseling Practice, Policy and Research” and then “Practice Briefs.”

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To contact the individuals interviewed for this article, email:

 

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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

Critical social skills to incorporate in a 21st-century social skills group

By Aaron McGinley September 16, 2014

If you provide counseling services to clients who have autism, or any of several other mental health conditions, at some point you will inevitably work with them on social skills. And if you are like many of the practitioners I know, you have a sizeable collection of the various resources and materials available to support work on social skills. Why shouldn’t you? The works of Jed Baker, Michelle Garcia Winner and Carol Gray, among others, are full of insightful and engaging techniques to help polish interpersonal skills.

The challenge for many clinicians is how to fit these various curriculums into a world filled with Instagram, Facebook and the dreaded Snapchat. To update an old saying, this isn’t your father’s selfiesocial world.

The bulk of most social skills curriculums are appropriately focused on “in-person” social skills. Issues such as personal space, body language, conversational cues and job interview skills still offer overwhelming challenges for some individuals with special needs. But the social norms found in everyday interactions are further complicated by rapidly evolving technologies and social media platforms. Effective social skills instruction needs to reflect this reality and the changing norms that accompany these rules. If we are going to teach social skills effectively, our curriculums must reflect the unwritten rules of the 21st century.

Anecdotally, I have found that clients benefit from the same instructional strategies that are used with more traditional social skills training programs. Visual supports, direct instruction, role-plays, social cognition exercises and other strategies can still work to address Facebook faux pas, Snapchat social rules and email etiquette. However, such difficulties cannot just be added in on the fly. Because smartphones and tablets are fully integrated into today’s world, they also need to be fully integrated into any robust social skills curriculum.

 

The art of the ‘selfie’

Although “selfies” are a popular part of youth culture, and a tempting means for socially awkward youth to engage with their social world, the wrong type of selfie can sabotage a youth’s reputation, or worse, compromise his or her safety.

A social skills instructor might help a client recognize some of the unwritten social rules of selfies:

  • Don’t post more than one selfie in a day
  • Try to post selfies only at exciting new events
  • When possible, try to include other people in your selfie

 

Social media savvy

The time is gone when social skills instructors could easily redirect residents away from computers and toward the day-to-day challenges of social interactions. Social media use is now a regular part of most cultures, and the socially awkward youth cannot easily avoid the world of social media. At the same time, social media can be a source of challenges such as cyberbullying, Internet safety issues and other difficulties that are beyond the scope of this article.

With that said, there are some ways that social media savvy can be combined with common social skills lessons:

  • When doing a lesson plan on hygiene/fashion and reputation, have students show or draw their Facebook profiles for feedback from the group.
  • When discussing conversational skills such as active listening, discuss how these rules apply to online conversations.
  • When discussing boundaries, bring up such issues as what sorts of comments should go on a public wall, how often to “like” someone else’s pictures and similar issues related to conversational boundaries.

 

Email etiquette

Politeness, self-advocacy, follow-through, conciseness and other important social skills do not stop at the Internet’s door. When working with students on social skills, it might be helpful to support them by offering email etiquette lessons.

  • When running a lesson on “think before you speak,” suggest that students find a point person to run sensitive emails by before sending them.
  • When facilitating a discussion about self-advocacy, discuss how to practice self-advocacy in an email.
  • When discussing conversational skills such as manners, touch on how to incorporate these skills in email communications.

 

Let’s talk texting

At some point, many socially awkward young people get involved in tricky texting situations. Some do not recognize the challenges that can come along with “sexting.” For others, the challenges of dealing with unrequited love via text can be too much. A social skills instructor can:

  • Discuss texting styles
  • Help students understand what types of conversations should happen via text
  • Discuss the frequency of texting as it applies to different types of relationships, such as friends, teachers and other social roles

 

Between the time this article was written and posted, online social norms might have evolved dozens of times. But this only underscores the importance of being intentional about incorporating technology etiquette into social skills work. So sit down, pull out your social skills curriculum and ask yourself …“Is my social skills curriculum ready for the 21st century?”

 

 

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Aaron McGinley is student member of the American Counseling Association living in Asheville, North Carolina. In addition to serving as a social skills consultant at Beacon Transitions, an independent living program for young adults, he works as a clinical intern at Caring Alternative as he completes his work toward a clinical mental health counseling degree at Montreat College. Contact him at aaronmcginley001@gmail.com.

 

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Update: Aaron McGinley gave a TED Talk on this topic in September 2016. See the video at https://youtu.be/26EJ5D5Zf0A

 

 

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Focusing on ability, not disability

By Amy L. Cook, Laura A. Hayden and Felicia L. Wilczenski April 29, 2014

My junior high school teacher once told me to reach for the stars in life and said I could accomplish anything I put my mind to. Now, I really do believe this!” — Courtney Vinson’s story from Think College, a project of the Institute for Community Inclusion at the University of Massachusetts Boston

learning-Small

This excerpt from Courtney Vinson’s story describes her pathway to college and the workplace despite being diagnosed with an intellectual disability (ID) and told by educators that she had limited future options.

According to the American Association on Intellectual and Developmental Disabilities (AAIDD), ID is characterized by significant impairment of intellectual functioning (IQ of 70-75 or lower) and significant impairment of adaptive behavior, with onset occurring before age 18. During Courtney’s senior year in high school, she applied and was accepted to the Pathway program at UCLA. Pathway is a two-year certificate program for students with intellectual and other developmental disabilities that offers a combination of educational, job-related and social experiences.

Pathway is just one of more than 250 college campus-based programs that are offered to students with ID. Some of these programs feature inclusive postsecondary educational options, meaning that students with ID are integrated into mainstream college classes and campus activities rather than being separated from the campus community. Courtney is now employed full time at a resort hotel and feeling proud of her achievements.

The prevalence of ID has burgeoned due to the diagnosis of autism spectrum disorder having increased by almost 300 percent during the past decade. Given the high incidence rate, school counselors need to be in position to assist students with ID in making successful postsecondary transitions. While many educators may have focused on these students’ disabilities, school counselors can recognize their strengths and encourage positive pursuit of postsecondary options.

Federal legislation, including the Individuals with Disabilities Education Act (IDEA) and No Child Left Behind, mandates educators to present students with disabilities with appropriate postsecondary transition opportunities, including “further education, employment and independent living” (IDEA). However, according to findings from the National Longitudinal Transition Study-2, conducted by SRI International (formally Stanford Research Institute), students with ID are less likely to graduate high school and achieve competitive employment than their peers without a disability.

In an attempt to close these gaps, educational institutions have increased postsecondary educational options for individuals with ID, including offering greater access to higher education through concurrent enrollment between high schools and universities. Such programs provide students with ID the opportunity to attend college and enroll in college classes, participate in college-based activities (for example, clubs, intramural sports and extracurricular activities) and, in some cases, reside on campus. Additionally, in 2008, Congress passed the Higher Education Opportunity Act with the goal of increasing accessibility to higher education for students with ID. This federal legislation has resulted in the development and implementation of inclusive college education options nationwide. The goal of these postsecondary education programs is to prepare these students for gainful employment and enhance their independent living skills.

The school counselor’s role

According to the U.S. Department of Education, the number of students with disabilities receiving federally funded special education services in public schools has increased from 8.3 percent to 13.1 percent during the past three decades. More than 463,000 children with ID are now receiving such services. Given the burgeoning population of students with disabilities and federal legislation that mandates improved higher education accessibility for these students, school counselors will increasingly be called on to share their expertise in college and career preparation and to assist in developing appropriate transition plans for students with ID.

The American School Counselor Association (ASCA) position statement on students with disabilities says that the professional school counselor’s role includes “providing assistance with developing academic and transition plans for students in the IEP,” or individualized education program. Staying aligned with the ASCA National Model, school counselors can support students with ID in achieving postsecondary educational and vocational goals in a variety of ways, including through individual and small group counseling, consultation to teachers and parents, and advocacy for children with ID.

Cognitive behavioral interventions can be used to help students with ID modify their thinking, feeling and behavior. Specifically, these interventions can be applied to help these students reduce their anxiety and increase positive characteristics that contribute to success, including development of an internal locus of control. When engaging in individual and group counseling, school counselors can use cognitive behavioral interventions to help students with ID recognize their strengths and rephrase negative thinking into positive thinking and subsequent positive self-talk. In small groups, students can help each other recognize strengths and reinforce rephrasing of negative thinking into positive thinking and self-talk. School counselors can serve as group facilitators by praising rational and positive self-talk when it is displayed, while providing a safe and calm environment for these students to share their concerns and feelings about postsecondary transition. For example, school counselors can help students with ID to identify negative feelings or self-talk (for example, “I don’t think I can succeed in college”) and turn it into positive feelings or self-talk (“I know I can succeed in college because I have sought help when I’ve needed it in high school”). In addition, school counselors can provide these students with tangible steps for reframing negative comments (for example, “Identify one way you have been successful in school in the past”).

School counselors can provide consultation to teachers and parents concerning the current needs of students with ID. This might include offering guidance on how to identify those needs (understanding the defining characteristics present in children with ID), and preparing and sharing material that identifies learning strategies that are helpful for students with ID. It might also include facilitating and delivering workshops with guest speakers who can share strategies to help support adolescents with ID with their postsecondary educational and vocational goals.

As students with ID are preparing to graduate from high school, school counselors can also emphasize to teachers the importance of providing these students with emotional encouragement and strength-based feedback that communicates a belief in their ability to succeed. The more information school counselors can share with teachers and parents, the higher the likelihood that students with ID will be properly prepared to face the challenges of the final year of high school, make appropriate postsecondary plans and feel supported throughout the transition.

Counselors can also promote awareness of the unique needs of this population by advocating on their behalf with current teachers, university admissions committees and future employers. When writing letters of recommendation, counselors can highlight the strategies these students have used to succeed academically — strategies that will further benefit them as they pursue their postsecondary educational goals.

Postsecondary educational options

A variety of postsecondary educational opportunities are available for students with ID. School counselors can collaborate with special educators, parents and school psychologists to ascertain students’ needs and ensure an appropriate fit when exploring postsecondary options. Options range from separate programs held on college campus grounds wherein students with ID take courses separately from their mainstream peers, to inclusive programs that permit students with ID to enroll in or audit regular college classes, participate in college activities/clubs and intramural sports and, in some cases, reside on campus. For students residing nearby a higher education institution that supports students with ID, opportunities may also exist for concurrent high school and college enrollment. Currently, eight higher education institutions across Massachusetts have formed partnerships with roughly 40 high schools in which students with ID are offered the opportunity to attend college while completing their high school education. Through these partnerships, students acquire a deeper understanding of interest areas related to their career goals, develop self-sufficiency in negotiating the complexities of the university and broaden their social contacts and use of free time.

For example, the Inclusive Concurrent Enrollment (ICE) Partnership Program at the University of Massachusetts Boston (UMB) aims to improve opportunities for postsecondary education for students with ID. This initiative involves inclusive concurrent enrollment for high school students ages 18-22 who are receiving special education in high school. Educational coaches from the high school facilitate the transition to the postsecondary setting. The students with ID are enrolled in college courses, which they either audit or take for credit. Their career development is fostered through job shadowing, paid and unpaid internships, and integrated competitive employment.

UMB staff collaborated with educational coaches from Boston Public Schools (BPS) to implement this program through a grant from the Massachusetts Department of Elementary and Secondary Education. During the fall 2012 semester, seven BPS students participated by auditing classes based on their interests — for example, creative writing, art history, sociology and so on. Five of these students completed the courses. During the spring 2013 semester, seven additional students from a nearby city enrolled in courses of their choosing. Additionally, a mentoring program pairing students in the ICE program with matriculated undergraduate students was initiated during that semester. Moreover, in an attempt to ensure best practices, a professional development workshop concerning universal design for learning was conducted for UMB faculty with the assistance of UMB’s Institute for Community Inclusion. In addition, an interagency advisory council was formed to provide guidance and feedback.

Initial results suggested that these students learned to advocate for themselves by arranging course accommodations through the UMB disabilities services center. The students also engaged in activities outside of the classroom (for example, pool, gym and track), and three of the students used their identification cards to visit the library housed on UMB’s campus. All of these students had the same access to the academic and social support services as UMB’s general student population. Postsecondary education for students with ID serves as a transition to adult roles and responsibilities.

Conclusion

As is evident from Courtney’s story of postsecondary success and entrance into the workforce, we cannot afford to marginalize any person. Everyone needs to contribute, and school counselors can share their expertise when supporting students with ID in exploring postsecondary options.

Some educators may think that students with ID are being set up to fail if they are encouraged to pursue postsecondary education — particularly inclusive postsecondary options. School counselors, on the other hand, are in position to recognize and celebrate these students’ interests and motivation to obtain postsecondary education just like their peers without disabilities. School counselors understand developmental changes and appreciate that students with ID pass through the same adolescent-to-adulthood transitions as students without disabilities. Consequently, these students need the same stimulation and support.

Through effective postsecondary opportunities, students with ID gain soft skills such as self-advocacy, self-confidence and self-determination that are critical for future employment. Postsecondary options, and particularly inclusive postsecondary educational programs, have resulted in improved outcomes such as better employment opportunities for individuals with ID. School counselors can play an important role in preparing students with ID to be independent adults and ready for college. The role of school counselors needs to be broadened beyond serving just the general student population to one that is inclusive and fulfills the needs of students with ID throughout the postsecondary transition planning process. For more information, refer to the AAIDD website at aaidd.org and the Think College website at thinkcollege.net.

 

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Amy L. Cook is an assistant professor in the Department of Counseling and School Psychology, College of Education and Human Development, at the University of Massachusetts Boston. Contact her at amy.cook@umb.edu.

 

Laura A. Hayden is an assistant professor and school counseling program director in the Department of Counseling and School Psychology, College of Education and Human Development, at the University of Massachusetts Boston. Contact her at laura.hayden@umb.edu.

 

Felicia L. Wilczenski is a professor and interim dean of the College of Education and Human Development at the University of Massachusetts Boston. Contact her at felicia.wilczenski@umb.edu.

 

Letters to the editor: ct@counseling.org

Processing the ‘whole’ with clients on the autism spectrum

By Chris Abildgaard December 23, 2013

Puzzle_smallFor clinicians working with individuals who have an autism spectrum disorder (ASD), a key component to any therapy (group or individual) is helping these clients see the “big picture” when it comes to social situations, academic assignments, the need to do daily chores at home, reacting to the size of a problem and so on. Piecemeal representations, or focusing only on certain parts, do not allow one to see or understand the global context of a situation.

Many of our clients on the autism spectrum get stuck on these “parts” due to deficits in their executive functioning and their inability to see the big picture (Gestalt processing deficit). From a cognitive behavioral perspective, one may associate this with rigid thinking, which leads to an emotion of frustration and sometimes anger as a “negative automatic thought.” These negative automatic thoughts eat away at these clients, and they become so inflexible that they cannot move past the thought and get to the point where they can process the whole event.

On tasks that require holistic processing, such as reading a social situation, individuals with an ASD or other social learning challenge often don’t fare very well. They are poor social observers who get stuck in their negative automatic thoughts. Many times, past negative results have an impact on their overall cognitive sets about being social (“I have failed at being social in the past. Why will this be different?”). Both social and academic successes are reliant on a person’s ability to integrate separate “social pieces” into a cohesive understanding of a larger
task or social situation (the big picture).
The person must be in a mental state to allow flexibility in his or her processing of the event.

Think of it as a jigsaw puzzle. Kids with an ASD can see only one or two puzzle pieces at a time and get frustrated because they can’t see how the pieces they have — and see as the most important — will fit into the larger puzzle. These core deficits affect the therapeutic process and the time it will take in therapy to process and restructure one’s thinking about a particular situation.

Have you faced the following situation as a clinician? A parent comes into the session and wants to talk about a specific incident in which “Ben” (the client) had a huge reaction to something that occurred over the course of the week. Now you are asked to process this situation with Ben several days later, but Ben will get stuck on parts or details of the situation that really have nothing to do with the bigger picture. To Ben, those parts he is stuck on are critical aspects that others (in this case, his mother) have failed to see. This is not an issue of reality versus fantasy. Rather, it goes to the heart of Ben’s social processing abilities and how he interprets the importance of events that are all relative to his core deficits in executive functioning, Gestalt processing and theory of mind (being able to take the perspective of another person).

So, how can we help? What follows is a simple yet effective strategy that counselors can use to improve social processing. The goal would be to help clients who have social learning challenges to make their own social plans and understand the social context they are in.

Investigating the big picture

What we know about individuals on the autism spectrum is that many (but not all) are visual learners. Using visuals is key to helping these clients understand the social expectations of situations. Initiate what we call a “social task analysis” on a piece of paper, white board or napkin (if nothing else) by drawing or writing out the following “parts” to the whole situation your client is processing with you. This process is not meant to be hard or upsetting for children or clients. It should be done when they are in a state of relative calmness and open to processing what they are thinking about or something that occurred in the recent past.

Remember, social problem-solving interventions should not be used only to process something negative. These strategies can be used to process something the person is thinking about, something that may be causing the person stress or even when something positive has happened. In fact, initiating a social task analysis following a positive event may help these clients to recall that positive outcome the next time they are faced with similar situations.

The social task analysis should include the following steps:

a) Identify the context. This includes not only the place and time of the situation but also sets the social and behavioral expectations for that situation.

b) Write down the names of the individuals involved. This brings meaning to the people in the situation.

c) Identify the “tipping point” in the situation. This might be a social roadblock, problem or glitch faced by the people or it can be a positive turn of events. It merely signals that something has happened to affect the thoughts, feelings and actions of people in a given space.

d) Identify the thoughts, verbal expressions and feelings of those involved.

e) Draw out a “plan” for the situation if there is a roadblock the person needs to overcome. The fact of the matter is that there may not always be a solution right then and there. It is more important that clients learn how to create a plan or a sequence of steps to attempt as a means of overcoming roadblocks rather than knowing there is always a “right” or “wrong” outcome. Counselors might find it beneficial to make a plan A and a plan B with clients as a means of teaching cognitive and behavioral flexibility. 

f) End by teaching clients to implement a reflection piece. Teaching clients (and their families) how to reflect back on a given situation is critical to developing positive episodic memories. This reflection time should be a learning opportunity that will help them the next time they face a similar roadblock.

When possible, and especially in school settings, leave some time for “behavioral rehearsal” of the possible scenarios that were discussed. I don’t think the students we are trying to teach social cognitive concepts to have enough opportunity to see themselves “be social,” so anytime a role-play can be performed, it will help them with their working memory of the situation as well as the motor planning aspect of all the social sequences. Research in this area of role-playing and video modeling certainly supports its use.

During your behavioral rehearsal, introduce some perspective-taking concepts by explaining the thoughts and feelings of people involved (and please start using the word “maybe”). For example, you may have the child or client verbally rehearse the following scenario: “Next time I see Joey, I will remember that he likes the Red Sox and maybe he will ask me about the Yankees. I will feel good because I asked him about something I know he likes. If he doesn’t ask me about the Yankees, that is OK too.”

This concept of “maybe” is important for our more rigid thinkers to understand. The use of the word “maybe” aims to create flexibility and is proactive because it does not allow these clients to create just one picture in their heads related to how things are “supposed to go.”

Helping clients on the autism spectrum to see the bigger picture will take time, patience and a variety of tools in the clinician’s toolbox. Setting small goals that enable improvements to be seen in this area is important because it will allow the counselor, the client and, in the case of children, the client’s parents to know that things are progressing in the right direction.

 

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Chris Abildgaard is the director of the Social Learning Center in Wallingford, Conn. He is a nationally certified counselor, a nationally certified school psychologist and a licensed professional counselor with a specialization in autism spectrum disorders and social cognitive interventions. Through his clinical practice and professional interests, he has been exploring methods for integrating cognitive behavior therapy with other tools to improve executive functioning. Contact him at chris@sociallearningcenter.org.