Autism


Brief Introduction

This document is provided as a guide for choosing a psychologist for the treatment of Autistic Spectrum Disorders.  It is not meant to be a guide for treatment.  The information here is not meant to replace an evaluation by a qualified practitioner.  For information on Autistic Spectrum Disorders, visit the National Institute of Mental Health or the Yale Child Study websites.  For the purposes of this document, autism refers to all of the disorders in the autistic spectrum, including Asperger’s Disorder.

Therapist Qualifications

Working with an autistic patient requires specialization on the part of the psychologist.  Many of the approaches that work with non-autistic patients do not work when applied to patients with autism.  In fact, many “standard” approaches can become the source of behaviors when applied to these patients.  As such, a competent psychologist who is not accustomed to working with this specific population may not anticipate the specialized approaches that are required.  While many techniques are currently being developed specifically for treating autism, some clinicians are more informed than others.  As always, you must rely on your intuition to judge the effectiveness a practitioner.

What to Expect from Testing

There are specific tests that address autism.  Psychologists use a battery of tests to assess abilities in many areas including verbal, social, physical, and math skills as well as physical coordination and emotional functioning.  Since many of the symptoms of autism may suggest other disorders, psychologists may use tests to rule out other diagnoses.  The clinician will use a battery of tests to create a complete picture of the patient.  One important factor to note:  A neuropsychological battery will take hours of face-to-face testing by a clinician, followed by report writing.  Although the tests themselves include instructions that indicate the administration time for one of the tests used will be one and a half hours, that test may take six hours for one person and two hours for another, if done properly.  Experienced clinicians often will 'test the limits' and will provide breaks as needed.  This adds time to the testing.  A typical neuropsychological test battery will include several tests of varying lengths.  The true time it will take to complete an assessment and a more-than-adequate report will surpass the actual time approved by insurance companies.   After testing is completed, the psychologist/neuropsychologist will present the results to the patient so that the results are fully reviewed and understood in lay terms.  Typically, the patient is responsible for passing on copies and information to the general practitioner, pediatrician, neurologist, school, lawyer, or other involved parties.

Therapeutic Focus and Interventions

One of the keys to treating autism is that each and every patient requires carefully individualized treatment programs.  The psychologist must continually mold and evolve the treatment according to the patient’s needs.  A therapist might need to utilize a number of different approaches before finding the right one for a particular patient.  The therapist must be willing to be flexible and creative and must be able to think horizontally.  That being said, some of the behaviors you may expect a psychologist to address are:

  • Problem solving skills.
    • Responding to difficult situations.
    • Fallback plans.
  • Cause-effect skills.
    • Making the connections between one person’s actions and another person’s responses.
    • Chronological event sequencing.
  • Communications skills.
    • Increase understanding of social interaction.
    • Understand the rules of everyday communications
    • Improve verbal and nonverbal communication.
    • Decrease body posturing.
    • Improve ability to play interactively.
  • Organization skills.
    • Learning to prioritize.
  • Desensitization to sensory stimuli.
  • Reducing black-and-white thinking and improve the ability to think in terms of a continuum.
    • Ethical or legal violations (e.g., jay-walking is not as serious a crime as bank robbery).
    • Physiological stimulation (e.g., a paper cut is not as serious as a broken leg).
    • Understanding the degree of reaction that is appropriate with a given situation.  For example, all jokes don’t require hysterical laughter.
  • Reduce focus on restricted patterns of interest (also known as the ”special interest”).
  • Improve motivation.
  • Nutrition, sleep hygiene, and exercise goals.

What to Expect From Sessions

Therapeutic goals are made expressly for the particular patient.  The goals must be individualized and focus on particular behaviors and specific interventions.  Again, all therapists are not equal in their abilities to focus on behaviors and to devise interventions.  For this population, it is important to think horizontally and creatively in forming interventions.  It is also important to not let one’s ego impede progress.  That is, if a therapist becomes stuck on an intervention that does not work, they must be willing to re-think the situation and reformulate their behavioral program.  Be choosy in picking a therapist.  Once you have chosen a therapist, you should re-evaluate whether the therapist is working for you after about one month.  Be particularly aware that traditional behavioral methods do not work with autism.  Creative variations to traditional behavioral techniques should be the norm.

*Important Things to Watch For In Therapy*

Many commonly used approaches have pitfalls when used incorrectly.  Here are some of them and things to watch for when used in treatment of autistic patients.

  • Over-reliance on the use of the “special interest” to assist in learning of other areas – At times, using the “special interest” to facilitate development of specific skills is helpful.  However, when a goal is reached, it is important to find a new method to approach future learning in order to avoid reinforcing the fascination with the “special interest”.
  • Rigid use of behavioral methods (such as the Magic-1-2-3 method) – These techniques offer a short term solution to managing specific behaviors.  However, when used rigidly or even regularly, they may become reinforcing in and of themselves!
  • Use of food rewards to train – Unfortunately, food has been used across a board as a reward for a wide range of goals.  This can be harmful on many different levels.  Most importantly:
    • It places the focus on the food rather than the actual goal. 
    • It can lead to an increase in negative behaviors for the sole purpose of obtaining the desired food item.
    • It places a focus on particular non-healthful food items, which can cause dietary problems.
  • Use of de-stimulation (quiet time) as a reward or punishment – This may lead to a pattern of behavior in which an autistic person will engage in negative behavior in order to be put in for quiet time rather than directly communicating this desire.
  • Desire to concentrate only on the patient’s talents – There is some pressure to leave an autistic person alone to develop along the lines of their special interest or talent.  While this may seem practical or even romantic, it might restrict the patient’s development.  People are multifaceted beings.  By allowing autistic patients to develop in their areas of weakness, they are given the ability to achieve on a broader level even if they do choose to stay within their area of interest.

Medication

There are many medications right now that have heavy backing from psychiatrists as well as psychologists.  While it may be comforting to be able to provide a patient with an approved medicine, medication can never be more than a partial solution.  No matter what, behaviors must trained and skills must be learned.  It is easy to think of this the way we think of dieting.  In the same way that diet pills are not a long-term solution to weight loss, medications are not a long-term solution to autism.  There is a temptation to simply medicate and call it a day.  In doing so, the patient does not learn the necessary life skills such as maintaining motivation, learning how to learn, or learning how to communicate with and fully relate to others.  Some medications may be useful and perhaps necessary for some patients.  However, it is most beneficial to utilize behavioral and practical interventions before seeking medication.  (Please note:  Some physical concomitants, such as seizures, will require anticonvulsant medication and the direct care of a neurologist.)