We’ll continue our series on how we treat particular behavioral health conditions. In my last article, I provided an overview of how we treat child and adolescent depression and anxiety. In today’s post, I’ll tackle how we treat autism.
What is Autism?
Autism is a developmental disorder, which is a condition that impacts a child’s ability to achieve and demonstrate developmental milestones and expectations. The cause is unknown but, in this writer’s estimation, it likely has genetic underpinnings.
Autism impacts a child’s ability to effectively communicate and socialize. These children may speak in short phrases, not understand the rules governing conversations, and struggle with receptive language. They tend to be aloof or are socially awkward. They also engage in repetitive behaviors such as flapping their hands (especially when excited), lining up their toys rather than playing with them, pacing or walking in circles, or obsessing on topics, fears, or concerns. Children with autism also tend to struggle with sensory issues; they cover their ears in response to mundane sounds, are very finicky during mealtime, and can find it difficult to find clothes with which they feel comfortable.
The Biggest Complication in Treating Autism:
The challenge with treating autism is that its symptoms are so diverse. I can show you a hundred children or youths with autism, and while each may have the core symptoms, they may present very differently. In comparison, a child with depression invariably has depressing thoughts and accompanying behavior; so, we treat the thoughts and behavior and we’re well on our way to the child’s recovery. However, it’s far more complicated to treat a condition that shows up in different ways; one child with autism may be nonverbal and socially aloof, another fully communicative and friendly but obsessive, and another speaking in truncations, wants to play with peers but is socially awkward, and has severe sensory challenges. Each child would require a completely different treatment plan.
How We Can Conceptualize Autism’s Differing Severity-Levels
Practitioners formerly used several diagnoses to reflect the varying severity levels of autism, which included ‘Autistic Disorder’ and ‘Asperger’s Disorder’. The former denoted a more severe form of autism, while the latter reflected milder symptoms. However, with the DSM-V, practitioners have but one diagnosis that encompasses the entire spectrum: Autism Spectrum Disorder (ASD). However, there are specifiers and different ‘levels’ of autism: 1, 2, and 3, to denote the level of severity. In that respect, a child may be diagnosed with or without intellectual impairment, and with or without language impairment. Moreover, the three levels are described below:
Level 1: Requires Support
Level 1 ASD is the mildest, or the most "high-functioning," form of autism and reflects what formerly was known as Asperger’s Disorder. Children with level 1 ASD have a hard time communicating appropriately with others in that they may not say the right thing at the right time or be able to read social cues and body language. A person with ASD level 1 usually is able to speak in full sentences and communicate but they may obsess on topics or present as overly bossy. They may try to make friends, but not be very successful. They may also have trouble moving from one activity to another or trying new things. Additionally, they may have problems with organization and planning, which may prevent them from being as independent as other people their age.
These children tend to be quite emotional and reactive because they have a difficult time understanding social nuances and expectations, which can then prove to be quite frustrating. However, it’s notable that children with autism, at all levels, tend to be more emotionally reactive.
Level 2: Requires Substantial Support
Children with ASD level 2 will have more obvious problems with verbal and social communication than those diagnosed with Level 1. Likewise, they will find it harder to change focus or move from one activity to the next. Children with level 2 tend to have very narrow interests and engage in repetitive behaviors such as hand-flapping, scripting from videos, or getting stuck on certain topics that can make it difficult to function in certain situations. These children may pace back and forth or ask the same question over and over. A person diagnosed with ASD level 2 tends to speak in simple sentences and also struggles with nonverbal forms of communication.
Level 3: Requires Very Substantial Support
Level 3 is the most severe form of autism. Children in this category will have many of the same behaviors as those with levels 1 and 2 but to a more extreme degree. Problems expressing themselves both verbally and nonverbally can make it very hard to function, interact socially, and deal with a change in focus or location. Engaging in intense repetitive behaviors is another symptom of level 3 ASD. A person with ASD level 3 will have a very limited ability to speak clearly and will rarely initiate interactions with others. When they do, they will do so awkwardly and are often intrusive. They may accept their peers approaching them, but again, will ‘not know what to do’ as the interaction proceeds.
How Do We Treat Autism?
I’ll present some more specifics in this current post, delineating the treatment options based on the severity level.
To provide effective treatment, at each level, as with any condition, we first have to answer a number of questions to ascertain what behaviors are most problematic, the trigger for the behaviors, how often the behavior occurs, under what conditions, and what tends to help improve the outcome. These questions are highlighted in my following post – here’s the link: The Behavioral Therapist Detective
Once we have those questions answered for each problematic behavior, we can move into the treatment phase.
At level 1, the interventions are largely in the form of:
- Practicing social skills via role-playing, rehearsal, and practicing of social skills in-the-home with parents, and during play-dates
- Utilizing social skill groups, with other kids who also have autism, to practice skills and help make friends. Here at Community Psychiatric Centers, we offer such social skill groups and you can email me at DrCarosso@aol.com to see if your child is a good fit.
- Anticipating problematic situations and finding different ways to intervene to avoid the same reactions.
- Utilizing occupational therapy to address sensory sensitivities
- Broadening interests and limiting access to those items on which the child is obsessing.
- Speech/Language therapy may be used to enhance pragmatic language skills or general communication skills.
- Utilizing counseling or in-home services (IBHS) to help the child or youth manage mundane situations the child finds to be frustrating and, in that respect, working toward reducing emotional outbursts.
- At level 2, we use the same interventions cited above, but just with increased intensity given the symptoms are more severe.
- There may be more focus on language skills, via S/L therapy, with a focus on both speech (articulation) and pragmatic language abilities.
The focus in level 3 entails the aspects described above but primarily includes being able to respond to prompts and simple directions, pay attention, complete simple tasks, identify objects, model others’ behavior, and master similar simple behaviors. There is no better way to accomplish these goals than the utilization of Discrete Trial Teaching (DTT). I’ve written at length about DTT; here are some links to those posts:
It’s notable that Applied Behavioral Analysis (ABA) has become synonymous with the treatment of autism. However, ABA is, in reality, a very broad set of interventions that can be used for every and any behavioral health condition. ABA is often confused with DTT; in that respect, DTT is based on ABA in that DTT utilizes the principles of ABA but DTT does not represent the totality of what ABA encompasses. To clarify these aspects of ABA, here is the link to my eBook on Applied Behavioral Analysis (ABA) and the use of DTT with accompanying teaching videos:
Many children respond very favorably to the aforementioned intensive, repetitive, but child-friendly in-home or in-school services (IBHS Services) that can be provided numerous days per week. IBHS services are offered here at Community Psychiatric Centers, as well as weekly outpatient counseling at our clinic, as-is medication management.
Medication can be invaluable to treat some of the symptoms of autism including anxiety, repetitive behaviors, and emotional reactions. If your child is receiving services through Community Psychiatric Centers, you can make an appointment for a medication consultation.
Take Care of Yourself and Your Relationships
You will face many demands and challenges as you raise your child with autism. You’ll be tempted to blame yourself but try to accept that your child’s condition has nothing to do with your parenting. However, you now have the challenge of learning how to better manage your child’s tendencies. As you learn more, you’ll feel better-equipped, more confident, and less frustrated. Many parents benefit from a support group; we offer such a support group at Community Psychiatric Centers; if you wish to participate, feel free to email me at DrCarosso@aol.com.
Also, it can be invaluable to utilize family support to help with the care of your child, but also to give you somebody with whom to share your thoughts, feelings, and frustrations, and to have people to lean on. It can also be helpful, calming, and reassuring to maintain a spiritual connection. In that respect, your relationship with God during difficult times can be literally a God-send as you rely on your relationship with God and use scripture to provide reassurance, such as “I can do all things through Christ Who Strengthens me” or “Do not fear or be dismayed… The eternal God is your refuge… When the righteous cry for help, the Lord hears…” A daily devotional, with meditation on scripture and prayer, can be a wonderful way to start the day.
Don’t forget to exercise and eat a balanced diet. You need to maintain your fitness to be fully available to help your child. Also, set aside scheduled and special alone time with your spouse or partner – you two need each other, so nurture that relationship!
That’s A Wrap
I hope that helps to clarify some of the interventions used to treat autism, based on the level of severity. If you have questions, reach out at DrCarosso@aol.com