why does a child with asd need individual therapy? to address core issues to address concomitant...
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Why Does a Child with Why Does a Child with ASD need Individual ASD need Individual
Therapy?Therapy?To address core issuesTo address concomitant issuesTo address issues that might arise in general population, as well (e.g., Adjustment Disorder)
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When to use different When to use different modes of therapymodes of therapy
Individual OnlyGroup therapy too difficult for child to manageHome setting too distractingMaturational signpost
Individual and WA and/or Group
Prep, monitoring and reinforcement of grp interventionsWA and indiv gives therapist contact w/ parents, teachers, frds, etc.
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It’s the Relationship It’s the Relationship Stupid!Stupid!
Therapy provides a safe place to learn and try new thingsTherapist is a model:– Must display emotional control– Bridge to culture, art, humor and
common forms of communication (pragmatics)
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It’s the Relationship It’s the Relationship Stupid! Cont’dStupid! 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
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Common Individual Common Individual Therapy Domains Therapy Domains
Dx discussionDepressionFearsAnxietySensory issues
Dating/sexual issuesDrivingAdjustment Disorders
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Using Perservations as Using Perservations as InterventionIntervention
Perseveration as Metaphor– Use for social understanding– Emotional understanding– Motivation– Self-esteem and competence– Future career
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Discussion of Discussion of DiagnosisDiagnosis
To frame the diagnosis for the child and the familyAddress both strengths and weaknessesDiscuss what “fits” Dx and what doesn’t
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DepressionDepression
17-40% rateMay require individual rather than group mode of interventionSuicidal verbiage much more common than plansNegative self-image a prevailing issueBehavioral methods in addition to CBT
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AnxietyAnxiety
15% rateMay be related to non-verbal learning disability profile
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Anxiety & DepressionAnxiety & Depression
Related to levels of aggressionTend to have poorer relationships with teachers, peers, and family members
(Kim, Szatmari, Bryson, Streiner, & Wilson, 2000)
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Systematic Systematic Desensitization Desensitization
Relaxation TrainingRelaxation Training
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Relaxation TrainingRelaxation Trainingfor…for…
Anxiety issuesFearsOverstimulation
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Relaxation Training Relaxation Training ComponentsComponents
Muscle relaxationsBreathing exercisesImagery
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Imagery ExercisesImagery Exercises
Beach (adult)Rocket ship (child)Turtle (child)
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Desensitization Desensitization HierarchyHierarchy
Very gradual introduction of the thing producing anxietySpecifying 10+ small steps Working through each giving anxiety a chance to ariseFollow with relaxation activity
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Desensitization Desensitization Hierarchy for Fear Hierarchy for Fear
of Thunderof Thunder1. Fake looking graphic of thunder
cloud2. Actual picture of thunder cloud3. Picture of lightening from
thunder cloud4. Picture of thunder cloud near
the child’s home5. Listen to sound recording of
thunder for 1 minute
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Desensitization Desensitization Hierarchy for Fear Hierarchy for Fear
of Thunderof Thunder6. Listen to sound recording for
five minutes7. Watch actual video for one
minute8. Watch video for five minutes9. Move 10 steps from window
during storm10.5 steps from window during
storm
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Desensitization Desensitization Hierarchy for Fear Hierarchy for Fear
of Thunderof Thunder
11.Next to window during storm12.Stand in open door during storm13.Walk into rain
Last few steps may be hard to do during individual more luck with mobile therapy
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DrivingDriving
Helping family decide on viabilityMulti-step plan with reevaluation at each stepSimulator optionsIssues with judgment, coping when others don’t follow the rulesAlternatives to driving
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Adjustment DisordersAdjustment Disorders
Problems with changeProblems with transitionsTendency to see things in black-and-white termsProblems recognizing and labeling feelings
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Emotional RegulationEmotional Regulation
Emotional Identification (self and others)Understanding Gradations of EmotionsDiscrete Emotions (i.e. frustration v. anger)Enhancement of Empathy
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Parent Involvement in Parent Involvement in Individual TherapyIndividual TherapyMaintaining confidentialitySpeaking Separately– Assists in therapist gaining an
accurate picture of what is happening (esp at home)
– Work to generalize intervention techniques
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Parent Involvement in Parent Involvement in Individual TherapyIndividual Therapy
Together– Work on parent – child
relationship– Can be helpful to have child
remember and speak about issues
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SensorySensorySocial issues may be sensory issues in disguise
Interventions– ‘stim’ toys (i.e., theratube, trampoline)– Ear plugs– Sunglasses– Private stimming (i.e., bathroom)
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CommunicationCommunication
Must teach current slangTeach that words can have more than one meaningCorrecting friends usually should be avoidedFigurative language
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CommunicationCommunication
Focus on gaining meaning from what another saysAsking questions about conversation partnerListening to ‘boring’ speechProsody
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Black and White Black and White ThinkingThinking
Atheism/PriesthoodTie in w/ emotionsMood issuesAcademicSelf-worth
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Theory of MindTheory of Mind
‘Reading’ and displaying nonverbal communicationUnderstanding that other’s may already know what you know
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Focus on Small StepsFocus on Small StepsSteps 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
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Focus on Small Steps Focus on Small Steps Cont’dCont’d
‘Reading’ that a peer is upset with themMisreading another’s intent– Stalking– Teasing– Being ‘set-up’
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SocializationSocialization
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
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SocializationSocializationTeach 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)