Counselling families with an ASD (autism spectrum disorder) child

Counselling families with an autistic child usually involves several key components designed to provide support and guidance to the family. Here’s a sketch of what such a project might look like, as well as detailing some of the project’s components:

1. Assessment of needs and medical history
2. Establishing objectives
3. Psycho-education
4. Family counselling sessions
5. Individualized treatment plan
6. Training of parents

1. Assessment of needs and medical history
The first step is to conduct a comprehensive assessment to understand the specific needs of the family and the challenges they face. This assessment involves gathering information about the child’s diagnosis, the child’s strengths and weaknesses, the family’s goals and difficulties, and current support systems. Aspects such as:

• Medical and developmental history; Family dynamics
• Behavioural, motor, affective, somatic, cognitive peculiarities
• The Portage test can be administered to assess psychomotor and language development and/or the ASRS scale by age (2-5 years or 6-18)
  The techniques used here are from the spectrum of validation, unconditional acceptance, active listening and open questions, observation

2. Establishing objectives
Once the needs assessment is completed, the counsellor works with the family to set clear and realistic goals. These objectives may include:

• improving the child’s communication skills
• managing behavioural challenges
• improving social interaction
• promoting general well-being for both the child and the family.

3. Psycho-education
• The counsellor educates the family about autism spectrum disorder (ASD) and helps them understand its impact on the child’s behaviour, learning, and development. Psycho-education also involves providing information about evidence-based practices, available resources, and strategies that can be implemented at home and in other settings.
• Definition and manifestation: Autism is a developmental disorder of neurobiological origin characterized by difficulties in communication and social interaction, as well as by repetitive behaviours. In autism, three areas of development are affected:
o Social ommunication – difficulties in verbal and non-verbal communication: cannot understand the meaning of some words or expressions, cannot understand certain gestures or tone of voice
o Social imagination – has difficulties in developing social play, carrying out very limited, repetitive imaginative activities and rigid behaviour
o Social relations – difficulties in establishing relations with those around, having a tendency to isolate due to the fact that he fails to communicate and understand those with whom he interacts

What does autism look like? The child with autism:

• shows a strong interest in objects
• they are solitary, detached, having repetitive, often incomprehensible manifestations
• eye contact is limited or absent
• I don’t use gestures to show what I want and I don’t share what I’m doing with others
• facial expression does not betray empathy and often does not change during social interaction
• there are children who may not speak, speak late or have repetitive, bizarre communication. Even if they talk, they may not be able to hold a conversation
• the game is repetitive, there is no imitation, role play, and the child cannot participate in games that involve non-verbal or verbal communication
• needs routine, being resistant to schedule or environmental changes
• there may be rituals, repetitive movements or stereotyped movements
• may present disturbed responses to sensory stimuli
• motor problems can be observed
• sleep and eating disorders
• crises at the relational level with difficulties in understanding
• disruptive behaviours (crying, anger, restlessness, aggression)
• persistent preoccupation with parts of objects
• difficulties in occupying their unstructured free time
• difficulties with abstraction, generalization, conceptualization, understanding sarcasm/humour

Diversity: The term autism includes a wide spectrum of characteristics and each child is unique. It is likely that the same characteristics are not at the same level as other children they have read or will read about. So parents must be helped to understand that:

• what leads to recovery for one child does not hold true for another child with autism
• the pace of recovery is different from one child to another, some may have more severe problems, others less severe problems regarding communication skills or social interaction
• some may be intellectually retarded
• some can operate independently at high altitudes, others at low altitudes
• some children can excel in certain areas
• autism can be comorbid with ADHD, Tourette Syndrome and other emotional pathologies
• this diversity makes it necessary to individualize the intervention for each individual child

4. Counselling Sessions
The counsellor conducts regular counselling sessions with the family to provide emotional support, address their concerns and help them navigate the challenges associated with raising a child with autism. These sessions can focus on managing stress, promoting positive family dynamics, and promoting self-care for parents.
Interaction with parents can often be marked by confusion, dissatisfaction, anger, disappointment. Understanding the stages that parents can go through, follows the stages of grief from shock, mistrust of the diagnosis and the search for other specialists in the hope of invalidating the diagnosis, to denial, anger/desperation/bargaining, fear, blaming others, blaming fate, self-blame, depression, resignation, acceptance, struggle.
In the view of Hardman, Drew & Egan (1996) (apud Laura Elena Nastasa – Counselor for the family at an impasse) the parents of the child or adolescent with disabilities can go through:

1. Shock: pain, detachment, bewilderment, sadness, but later, if they are supported, they can transform from victims to survivors
2. Emotional disorganization: experiences distrust in one’s own strength, self-blame, in order to then reevaluate the meaning of life and the reasons for current challenges
3. Realization: anxiety about one’s own abilities, self-pity, irritability – to finally understand the needs and constraints that arise with the growth of a disabled child
4. Defensive withdrawal – parents avoid facing the anxiety, some try to solve the problem by looking for specialized institutions and clinics, others withdraw to a safer environment
5. Recognition: parents mobilize to form and create a suitable environment and adopt an individualized treatment plan.

Aspects such as:

• Keeping anxieties under control through cognitive restructuring techniques (CBT)
• Orientation to support groups with the same problems and interests
• Orientation towards one’s own person and towards the family unit (time for oneself, family, hobbies)
• Reformulating the meaning of the child’s problem (the child as a developmental lesson for the parent)
• Formation of a wider core of support (therapeutic team, extended family, friends, community)
• Developing assertiveness (learning to ask for help)
• Formulating small, achievable goals and appreciating the child’s small progress
• Working with the therapist on schemas of shame, rejection, abandonment, insufficiency
• Booking time for the couple as an entity
• Learning techniques for revealing emotions and inner conflicts to your partner

5. Individualized treatment plan

Based on the identified objectives, the counsellor develops an individualized treatment plan, adapted to the unique needs of the child and family circumstances. The plan may include a combination of therapies, interventions, and strategies to address the child’s specific challenges. There are several strategies to address in order to recover the child: ABA therapy, physical therapy, Sensory Synchronization Therapy, Socialization, speech therapy. The success of the therapy depends on 4 factors:

1. the age of the child upon entering the program
2. The degree of family involvement
3. The professionalism of the coordinator and therapists
4. The child’s potential
   The therapeutic team includes: the coordinator, therapists, parents, physiotherapist, speech therapist, educators/teachers.

• a well-organized repetitive program helps the child feel safe at home
• Preparing the child ahead of time supports better any change in the daily routine
• Detecting the child’s sensory sensitivities and trying to take into account his needs. (if certain noises or textures aggravate the child’s manifestations, try to avoid them or protect him from them)
• ASD does not have overnight treatment or quick fixes, however appropriate intervention programs can bring significant progress
• Celebrating the acquisition of new skills, every step, no matter how small, is important for his personal development. Value your child and praise him for each new purchase.
• Identifying things that please the child and offering them as motivating factors to obtain positive behaviours from him.
• Periodic assessment of the child to observe if certain aspects worsen or if new problems appear (speech disorders, socialization difficulties).
• The child does not compare with other children, but with himself, and his interests must be exploited to the maximum in order to gradually introduce new things.
• We work every day with a well-established and structured schedule, by positively stimulating desired behaviours and skills and ignoring or redirecting unwanted behaviours, keeping a positive vision

5. Parent Training:

Parents play a crucial role in supporting their child’s development. The counsellor provides parents with training sessions to improve their understanding of autism, teach effective parenting techniques, and help them acquire skills to meet their child’s unique needs. This training empowers parents to implement strategies and interventions outside of therapy sessions.
Some training ideas shape around behaviour at home, motivation, evaluation, celebration of new skills, individual work at home. Additional information available at Overview of reinforcement techniques in ABA approach (Applied behavior analysis) for children with Autism Spectrum Disorder (ASD) and List of psycho-education brochures

Bibliography:
• Nastasa L.E. & Colab, (2017), Counselling the family at an impasse, Bucharest, Libris Publishing House
• Vermeulen P., (2000), I am special. A Workbook to Help Children, Teens and Adults with Autism Spectrum Disorders to Understand their Diagnosis, Gain Confidence and Thrive, Jessica Kingsley Publishers London and Philadelphia