Autism Spectrum Disorder in Children and Adolescents
Common Presentations:
Fixed and/or repetitive interests can include communicating using language acquired from TV shows, videogames, etc. that can lend to the child being “in their own world” (ex. Talking all the time about Thomas the Train, Videogames, and other developmentally relevant fixations)
Hypo-sensory profiles, like difficulty interpreting different temperatures, or textures (ex. Not noticing when the bath-water is too cold, or eating food with the wrapper, etc.)
Hyper-sensory profiles, like sensitivity to sounds, sights, tastes, smells or textures (ex. Cannot go to the movie theater, crying when cloth clothing labels are “rubbing too hard,” etc.)
Preference for routine and structure as well as inflexibility regarding changes in routine resulting in emotional dysregulation, and inability to be soothed
Tendency to always tell the truth, and similarly express distress when others have “broken the rules”
Difficulty initiating social interactions and interpreting social cues (ex. Making eye contact, understanding other people’s perspectives, difficulty engaging in collaborative activities or play)
Executive Functioning: may demonstrate strengths in nonverbal tasks requiring patterns and logic, like math, science, art and computer technology
Emotional Regulation: individuals with ASD may have difficulty with “self soothing” when they become activated, often struggling to identify what will help them to calm down even after the activating event has passed (ex. Staying upset about changes in routine even after the issue has been resolved). Individuals with ASD commonly receive secondary diagnoses of anxiety
Developmental Considerations: as individuals with ASD grow, and gain more awareness of differences from neurotypical peers, social anxieties may become more pronounced. While some children are better able to connect with adults, finding social groups with accepting peers is paramount, especially for adolescents
Considerations:
Unlike many other mental health diagnoses, ASD is far less ambiguous, with a much clearer set of treatment recommendations that often result in significant quality of life improvement
Structure, routine and rule setting are significant strengths and can be incorporated in order to teach flexibility
Sensory regulation is of primary concern in order to help individuals with ASD “have the bandwidth” to learn social skills
Treatment:
Diagnosis: a full neuropsychological evaluation is necessary to make the diagnosis of ASD, and greatly informs treatment considerations, as each individual’s presentation of autism is unique
Interdisciplinary Care: occupational, speech and/or educational therapy may be recommended in conjunction with psychotherapy
Referrals: common referrals include psychiatry, occupational and physical therapy, speech and language, and an array of relevant strengths/movement/arts based extracurricular activities
Psychotherapy: The first goal of treatment involves insight into the individual’s sensory profile, and a range of structural, yoga and mindfulness based interventions are incorporated in this phase of treatment. Following the initial treatment phase, social skills education incorporating developmentally considerate tools (ex. Social Thinking and recreating relevant high school environments) as well as emotional regulation skills are often recommended. It is likely that family will be involved in treatment. Parents must be involved in sessions involving education regarding the diagnosis and treatment as well as collaboration regarding goal-setting. However, individuals with ASD benefit from individual therapeutic relationships, and families are encouraged to offer the client their own space during treatment. There are always exceptions to these recommendations, depending on the needs of the child, adolescent and family.
