Transcript Craig House: - The Watson Institute

Why Does a Child with ASD
need Individual Therapy?
To address core issues
To address concomitant issues
To address issues that might arise in
general population, as well (e.g.,
Adjustment Disorder)
When to use different
modes of therapy
Individual Only
Group therapy too
difficult for child to
manage
Home setting too
distracting
Maturational
signpost
Individual and WA
and/or Group
Prep, monitoring
and reinforcement
of grp
interventions
WA and indiv gives
therapist contact
w/ parents,
teachers, frds, etc.
It’s the Relationship
Stupid!
Therapy provides a safe place to
learn and try new things
Therapist is a model:
– Must display emotional control
– Bridge to culture, art, humor and
common forms of communication
(pragmatics)
It’s the Relationship Stupid!
Cont’d
Therapist may be the only friend child
has
– Therapist is important relationship
outside of child’s family
Therapist mode of interaction is
dependent on the individual child
Common Individual Therapy
Domains
Dx discussion
Depression
Fears
Anxiety
Sensory issues
Dating/sexual
issues
Driving
Adjustment
Disorders
Using Perservations as
Intervention
Perseveration as Metaphor
– Use for social understanding
– Emotional understanding
– Motivation
– Self-esteem and competence
– Future career
Discussion of Diagnosis
To frame the diagnosis for the child
and the family
Address both strengths and
weaknesses
Discuss what “fits” Dx and what
doesn’t
Depression
17-40% rate
May require individual rather than group
mode of intervention
Suicidal verbiage much more common
than plans
Negative self-image a prevailing issue
Behavioral methods in addition to CBT
Anxiety
15% rate
May be related to non-verbal learning
disability profile
Anxiety & Depression
Related to levels of aggression
Tend to have poorer relationships
with teachers, peers, and family
members
(Kim, Szatmari, Bryson, Streiner, & Wilson, 2000)
Systematic
Desensitization
Relaxation Training
Relaxation Training
for…
Anxiety issues
Fears
Overstimulation
Relaxation Training
Components
Muscle relaxations
Breathing exercises
Imagery
Imagery Exercises
Beach (adult)
Rocket ship (child)
Turtle (child)
Desensitization Hierarchy
Very gradual introduction of the
thing producing anxiety
Specifying 10+ small steps
Working through each giving
anxiety a chance to arise
Follow with relaxation activity
Desensitization
Hierarchy for Fear of
Thunder
1. Fake looking graphic of thunder cloud
2. Actual picture of thunder cloud
3. Picture of lightening from thunder
cloud
4. Picture of thunder cloud near the
child’s home
5. Listen to sound recording of thunder
for 1 minute
Desensitization
Hierarchy for Fear of
Thunder
6. Listen to sound recording for five
minutes
7. Watch actual video for one minute
8. Watch video for five minutes
9. Move 10 steps from window
during storm
10. 5 steps from window during
storm
Desensitization
Hierarchy for Fear of
Thunder
11. Next to window during storm
12. Stand in open door during storm
13. Walk into rain
Last few steps may be hard to do
during individual more luck with
mobile therapy
Driving
Helping family decide on viability
Multi-step plan with reevaluation at
each step
Simulator options
Issues with judgment, coping when
others don’t follow the rules
Alternatives to driving
Adjustment Disorders
Problems with change
Problems with transitions
Tendency to see things in black-andwhite terms
Problems recognizing and labeling
feelings
Emotional Regulation
Emotional Identification (self and
others)
Understanding Gradations of
Emotions
Discrete Emotions (i.e. frustration v.
anger)
Enhancement of Empathy
Parent Involvement in
Individual Therapy
Maintaining confidentiality
Speaking Separately
– Assists in therapist gaining an accurate
picture of what is happening (esp at
home)
– Work to generalize intervention
techniques
Parent Involvement in
Individual Therapy
Together
– Work on parent – child relationship
– Can be helpful to have child remember
and speak about issues
Sensory
Social issues may be sensory issues
in disguise
Interventions
– ‘stim’ toys (i.e., theratube, trampoline)
– Ear plugs
– Sunglasses
– Private stimming (i.e., bathroom)
Communication
Must teach current slang
Teach that words can have more than one
meaning
Correcting friends usually should be
avoided
Figurative language
Communication
Focus on gaining meaning from what
another says
Asking questions about conversation
partner
Listening to ‘boring’ speech
Prosody
Black and White Thinking
Atheism/Priesthood
Tie in w/ emotions
Mood issues
Academic
Self-worth
Theory of Mind
‘Reading’ and displaying nonverbal
communication
Understanding that other’s may
already know what you know
Focus on Small Steps
Steps obvious to us may not be
obvious to the child with ASD
– Conversation initiation and maintenance
– Organization
• Handing in homework
• Notebooks
• Room
– Avoiding commenting on facts about
another person that may be
embarrassing
Focus on Small Steps
Cont’d
‘Reading’ that a peer is upset with
them
Misreading another’s intent
– Stalking
– Teasing
– Being ‘set-up’
Socialization
Kids on the spectrum often have a
very concrete conception of
friendship
– i.e. they say ‘hi’ so they’re my friend
Vulnerable to manipulation
– Relational aggression should be
assessed
Teach what a ‘true’ friend is
– Progressive trust building
Socialization
Teach and encourage how to get and
use contact information
– IM and texting language
Phone calls can be frightening
– Use scripts
Break down ‘small talk’
– Common conversation topics (i.e.,
school)