Adolescents and Teen Therapy for Asperger's Disorder and Autism Spectrum Disorder

As a Behaviour Interventionist (member of the BC RASP) I am often asked about what services I provide for children and teens with autism spectrum disorder and what was formerly called "Asperger's Disorder."

Of course, many of my patients come for initial assessments of autism spectrum disorder. Additionally, many people see me for significant/severe behavioural issues they are experiencing, that their regular behaviour interventionist can't deal with. This often involves behaviour management consultation, parent training and sometimes working with the schools and classroom teacher to develop specific positive behavioural support programs for an individual student (PBIS). This often involves observations, interviews and sometimes means writing a formal FBA or Functional Behaviour Assessment. Any behaviour plan a school writes should start with a formal FBA. If your child doesn't have an FBA, but is having behavioural problems at school, ask for someone to complete an FBA.

To learn EVERYTHING you need to learn about functional behavioural assessments you could start at the California State webpage: http://www.pent.ca.gov/frm/forms.html

This is by far the most comprehensive site for FBAs available, and I often use these materials exclusively when providing training in behaviour management to school districts.  And it's all FREE!

Often parents of children or teens see me just for psychoeducation. They are trying to implement a behaviour plan, a token or other reinforcement system, and need to know exactly how it's done. This, by the way, is covered under your provincial funding for children with autism.

But one place parents often fall down is keeping a child or teen connected with a behavioural therapist or psychologist over the long term, someone they develop a relationship with, feel free to talk to, and who can teach social learning skills over a long period of time. Often I see children or teens, after an initial emergency is over, for an extended period, but only sporadically. We stay in touch to make sure things are going well, and so that I can continue to monitor school programs and deal with issues before they become major problems again.

Some of this takes ppace within the context of what might be called "play therapy," as we play, and talk about feelings, emotional issues and work through them as we engage in activities that are distracting enough to make the child comfortable with the process.

Usually we try to also follow a structured curriculum such as Michelle Winner's "Superflex" curriculum, or one of her other books that are addressed to older teens and young adults.

While I am familiar with ABA, Floor Time and many other behavioural interventions, high functioning teens and young adults with Asperger's or Autism Spectrum Disorder have a high rate of co-morbid disorders such as depression, anxiety or learning disabilities. And...ADHD. These are issues we address together.

CBT or "Cognitive Behavior Therapy" is one of the many wys we teach skills and address issues successfully. CBT is very similar to therapies and skills children with autism spectrum disorder are exposed to in many school programs, such as The Incredible 5-Point Scale and other emotional regulation programs.

For more information please visit my webpage at www.relatedminds.com or http://www.relatedminds.com/autism/

Feel free to contact me to discuss the services I provide. I am happy to answer any of your questions.

What does research say about treatments for adolescents and young adults with Autism Spectrum Disorder and Aspergers?

A 2012 publication"Interventions for Adolescents and Young Adults with Autism spectrum Disorders" was published by the Agency for Healthcare Research and Quality. It is an excellent report, 374 pages of data, and would be useful to any parent of a young adult, and should be part of the collection of literature in any school district, private practice or mental health program that works with young adolescents (teens) or young adults with Asperger's Disorder/Syndrome.

The full report can be found here: http://www.ncbi.nlm.nih.gov/books/NBK107275/
For instance, many school districts provide "Music Therapy" for student's with Autism Spectrum Disorder or Aspergers. Often this is provided by a "Registered Music Therapist" here in British Columbia.  How does this government report look at music therapy for students with autism?

" 2 poor-quality case studies. Some gains in social skills reported using unvalidated and largely subjective measures. No comparison groups or measures of treatment fidelity; participants not clearly characterized; assessors not masked; differences in concomitant interventions not reported.”

If music therapy is being offered to your child, but no behavioural program, small group social learning group (using materials such as ABA for some or "social learning" programs such as Michelle Winners for others), you need to know that the evidence for using music therapy with autism is weak.
While the report is long it can be downloaded in PDF format and read on your computer or iPad screen. At least those professionals designing, approving and supervising the programs out children use should be familiar with this compendium of research and it's implications as to where to put our effort, money and hearts when dealing with our children, students and clients.

The study comes to this rather bleak conclusion:

"Few studies have been conducted to assess treatment approaches for adolescents and young adults with ASD, and as such there is very little evidence available for specific treatment approaches in this population; this is especially the case for evidence-based approaches to support the transition of youth with autism to adulthood. Of the small number of studies available, most were of poor quality, which may reflect the relative recency of the field. Five studies, primarily of medical interventions, had fair quality. Behavioral, educational, and adaptive/life skills studies were typically small and short term and suggested some potential improvements in social skills and functional behavior. Small studies suggested that vocational programs may increase employment success for some individuals. Few data are available to support the use of medical or allied health interventions in the adolescent and young adult population. The medical studies that have been conducted focused on the use of medications to address specific challenging behaviors, including irritability and aggression, for which effectiveness in this age group is largely unknown and inferred from studies including mostly younger children."

Another example of  overused interventions are sensory interventions. Some schools are full of these programs, with specialized rooms that children are taken to when they are having behavioural or emotional difficulty. Many times this is the primary intervention on an IEP for a child, in spite of the lack of supportive research for using these techniques. Here is what the American Paediatric Association says:

"Sensory-based therapies using brushes, swings, balls and other equipment are increasingly used by occupational therapists to treat children with developmental and behavioral disorders. However, it’s unclear whether children with sensory-based problems have an actual disorder related to the sensory pathways of the brain, or whether these problems are due to an underlying developmental disorder. In a new policy statement, “Sensory Integration Therapies for Children With Developmental and Behavioral Disorders,” published in the June 2012 Pediatrics (published online May 28), the American Academy of Pediatrics (AAP) recommends that pediatricians not use sensory processing disorder as an independent diagnosis. When sensory problems are present, health care providers should consider other developmental disorders, including autism spectrum disorders, attention deficit/hyperactivity disorder, developmental coordination disorder and anxiety disorder. Occupational therapy with the use of sensory-based therapies may be acceptable as one component of a comprehensive treatment plan. The AAP recommends pediatricians communicate with families about the limited data on the use of sensory-based therapies, and help families design simple ways to monitor the effects of treatment and discuss whether the therapy is working to achieve their goals for their child. Occupational therapy is a limited resource and families should work with pediatricians to prioritize treatments based on problems that affect a child’s ability to perform daily functions. - See more at: http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Recommends-Careful-Approach-to-Using-Sensory-Based-Therapies.aspx#sthash.ORoTzKDN.dpuf

So what is a parent (or spouse) to do? 

First of all, do not rely on the overly optimistic reviews from practitioners. Many school and mental health facilities use the least trained ( meaning cheapest) staff available to work with these students and clients. Start by making sure you have a licensed or registered professional involved. High Functioning Autism and Asperger's Disorder are neurologically based. In many ways they are first and foremost language disorder and disorder of executive function - inability to move from one subject to another, accept changes, "read" other people, demonstrate mental flexibility and control their emotions. These are issues familiar to both behavioural psychologists and speech and language pathologists. (Remember, there is a reason the leader in this field, Michelle Garcia Winner, is a speech and language pathologist!) Start with experts in the behaviours you are most concerned with. Not with a "program."

Next, develop a clear outline of what you want to deal with, what are the problematic symptoms, deficits and concerns.

Then develop a program to address those.

What this study clearly shows is that too much effort is spent on ancillary treatments, that happen to be available, or for which their is a "workbook" that a para-professional can follow. Treatments address deficits and concerns, and whether it be in an IEP meeting (individual educational Plan) or a one to one meeting with your therapist, an appropriate assessment is the best way to find a path to appropriate treatment!

For older teens and young adults these group sessions are not available, and often inappropriate, as higher functioning teens and young adults are more likely than not to be suffering from co-morbid disorders such as anxiety, stress, depression and low self esteem. These, like many of the specific symptoms, can be addressed individually use adaptations of familiar, well researched and evidence based treatments.

While the problem of poor research for treatment of autism and Aspeger's is real, there are still many treatments which we know work, and work well, for most people, and if properly modified by a mental health professional who is familiar with autism spectrum disorder in children, adolescents and adults, the odds start to change.

For more information on diagnostic assessments for autism spectrum disorder (I am an approved provider with Autism Community Training -ACT, and a member of the RASP provider's list) which I provide as a private practitioner, contact my at 778.998-7975. My website is www,relatedminds.com and I have offices in both Burnaby and Vancouver. Most testing is done in Burnaby, as that is where most of the testing materials are. 

My waiting list for autism assessment for children over 6 through adults is fairly short, about 10 days to start the process.

I also provide therapy for adolescents/teens and adults with Asperger's Disorder and Autism Spectrum Disorder.