Family Therapy and the Autism Spectrum

Autism Conversations in Narrative Practice

Marilyn J. Monteiro

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317565482
• Edition: 1
• Topic: Psychology
• Subtopic: Autism Spectrum Disorders
• Index: Psychology

The autism spectrum presents a range of communication, social, and sensory differences that are challenging for clinicians to address. Family Therapy and the Autism Spectrum provides a guide to conceptualizing those differences and ways to discuss them with clients and their families. Readers are provided with narrative examples illustrating the application of key concepts introduced in the text. These case examples address issues that range across the life cycle, from families with young children to ones with teens who are emerging as adults. Using the techniques learned in this book, clinicians will be able to guide families towards their positive autism narrative.

This book also features a visual framework to organize the compelling narrative of each person's autism spectrum pattern of developmental differences or brain style. Using this visual framework and the corresponding descriptive language, clinicians and families can work together to create their "autism conversations." The conversations lead to the transformative experiences of developing competencies, resiliency, and advocacy for individuals and their families. The conversations also lead individuals with spectrum differences to use empowering language, supporting their ability to develop self-advocacy and self-determination skills.

Section IIINarrative Development Across the Life Cycle

7 Young Children

DOI: 10.4324/9781315735948-7

Shaping the Family Story

• Providing facts and information about Autism Spectrum Disorder helps parents understand their child’s diagnosis.
• Developing their child’s individualized autism spectrum profile helps parents understand the diagnosis in a meaningful and individualized context.
• Your support helps parents manage the emotional impact of the diagnosis.

Linking Practical Supports to the Emerging Family Story

• Parents gain an understanding of the importance of visual supports when they understand their child’s brain style differences.
• Communication supports, social supports, and sensory supports can be introduced through the entry point of the child’s individualized autism spectrum Brain Style Profile.
• The visual communication, social, and sensory supports gain personal meaning for parents when they are introduced in the individualized context.

Practicing Skills in the Therapy Setting

• Modeling skills with the young child helps parents gain skills.
• Practicing their skills with their child in the therapy context helps parents gain confidence.
• Providing education about autism spectrum differences and resources helps parents reduce their anxiety.

All families with young children experience significant stress as the concept of “parent” collides with the reality of daily life with an infant, toddler, or preschool child. The very nature of parenting young children includes daily contradictions and uncertainties. For parents of children with autism spectrum differences, this ambivalence is magnified.

Parents of young children with autism spectrum differences often describe the experience of realizing that their child is developing with differences as a growing sense of concern. This concern can range from worry that comes and goes, to a strong sense of anxiety about the child’s differences, to a sense of dread about what it might mean if the child does not develop speech, social play, or cope with routine events. Many parents go through a process of watching their child in comparison to other young children, noticing with dismay when their child appears aloof, or plays with objects in the same way over and over, or doesn’t seem to look at people or respond to social smiles. It can be confusing for parents when their child does behave like other children at times. What does it mean if their child cuddles and seeks out hugs sometimes but keeps people at arm’s length at other times? If their child shows an early passion for letters and numbers, and excels at manipulating electronic devices, parents often struggle with whether that should be looked at as a good thing or something to worry about. Sometimes one parent expresses concerns while their partner dismisses those anxieties.

When the diagnosis of Autism Spectrum Disorder enters the family story it can be a stressful and confusing time. What does it mean, exactly, when a pediatrician, psychologist, or other professional uses that term? Many parents report a cascading effect when they hear the formal diagnosis for their child. Questions about practical details come up. Does this diagnosis affect whether or not their child will be able to go to college, drive a car, get married, get a job? In other words, most parents of young children experience a process of feeling enclosed by limitations when they hear the term “autism.”

Clinicians working with parents and their young children with autism spectrum differences provide timely and crucial support when they guide the parents through the process of shaping the singular family story. Parents benefit from gaining a global understanding of the diagnosis. This includes learning factual information about autism spectrum differences, as becoming informed contributes to the shift from powerless to capable. When you share factual information about the autism spectrum with parents of a young child, and pair this with the ability to engage the young child in play with sensory materials, parents gain confidence in your ability to deal effectively with their family story. Your support helps them manage the emotional impact of this sometimes frightening and bewildering diagnostic process. ¹

So what goes into shaping the family story when a young child has received the diagnosis of Autism Spectrum Disorder? Shaping the language the parents use when describing their child, and developing a document that lays out the child’s individualized autism spectrum profile, is a key part of this process. This document helps parents understand their child’s diagnosis in a meaningful and individualized context.

Understanding the child’s brain style is important and it provides the entry point to teach parents about practical supports that are a good fit for the child’s autism spectrum brain style differences. The descriptive triangle framework helps parents link practical supports to the emerging family story in a meaningful way. Visual communication supports, social supports, and sensory supports can be readily discussed within the context of the child’s profile in these three key areas. With parents and their young child present in the therapy setting, you are able to incorporate modeling, practice, and education into your sessions. Parents gain competence and confidence and children gain skills and a sense of control and predictability as the family story emerges.

Rusty's Parents Develop Their Story

Rusty, a sturdily built toddler who had just passed his third birthday, filled the room with his exuberant, positive energy. His world was comprehensively and enthusiastically organized around trains. When I met Rusty, he wore a Thomas the Tank Engine shirt and strode into my office hugging a Thomas the Tank Engine backpack to his chest. His mother, Jennifer, had alerted me during our phone conversation that Rusty had just received a diagnosis of Autism Spectrum Disorder, and that he loved trains. This was the first session for Rusty, his mother Jennifer, and his father, Randy.

When Rusty entered the room his gaze fell on a strategically placed pair of blocks. Each block, or cube, displayed a graphic of half of a vehicle. The two blocks fit together to make the sound of the vehicle when placed together. The cube to the left facing Rusty contained a picture of the front half of a train engine while the cube to the right had a picture of the back half.

“Train!” Rusty exclaimed as he walked towards the cubes.

“Train!” I mirrored, as I placed my hands on the sides of the train cube and gently pushed them towards each other. Rusty picked up on my visual cue and took over. He pushed the cubes together and when they connected, the blocks emitted the sound of a train engine blowing smoke.

Rusty erupted in a delightful, spontaneous laugh. I laughed along with him and both of his parents smiled. I exchanged glances and smiles with Jennifer and Randy. Rusty’s gaze, however, remained firmly fixed on the cubes and the cause-and-effect sound created as he pushed the cubes together time and again. I turned one of the cubes to another side and the image of the front half of a helicopter appeared.

“Helicopter!” I said. I tapped the second cube. “Find the helicopter.”

Rusty pleasantly but firmly repositioned the cube so that the front of the train was facing him. “Train!” He continued his routine. After a few more repetitions, Rusty initiated rotating the cube back to the helicopter.

“Helicopter!” He enthusiastically labeled it.

“Helicopter!” I mirrored. “Like Harold!” Harold is the name of the helicopter in the Thomas the Tank Engine world.

Rusty immediately looked at me and took in my presence for the first time when he heard this familiar name. “Harold and Thomas!” Rusty stood in front of me and looked at me, clearly prompting me to pursue this line of conversation.

“Thomas is engine number …,” I said.

“One!” Again Rusty looked at me.

“Thomas is the color …,” I prompted.

“Blue!” Rusty erupted in his contagious laughter once again, turned the blocks back to the train image and pushed them together several more times.

Unfortunately my Thomas the Tank Engine repertoire was nearing its end, as I could not recall the names of any of the other trains. This did not put a damper of Rusty’s enthusiasm for the topic.

“Percy!” he exclaimed.

That was my cue to continue the conversation. “Percy is engine number …”

“Six!”

“Percy is the color …”

“Green!”

Thanks to Rusty’s extensive labeling abilities, we were able to have a spirited conversation about his favorite topic. However, when I showed Rusty interesting toys that were not train-related and when I used language to label anything other than trains, he moved away from me and unzipped his backpack, taking out several trains and hooking them together. He lay on the floor and placed his head in a direct line with his linked trains. He quietly rolled the trains back and forth, closely examining the visual details. His parents and I were silent as we watched Rusty retreat to his nonverbal world of exploring his familiar trains.

I blew some bubbles and they drifted into Rusty’s line of vision. This activated him and he jumped up. “Bubbles!”

I continued to blow bubbles and Rusty approached me, popping bubbles and laughing. When he was back in close proximity to me I handed him a puzzle piece that fit into a square wooden inset board. This puzzle had pieces shaped like fish. Rusty stood and concentrated as he scanned the inset shapes, searching for the match with the seahorse he was holding. I tapped the correct inset and said: “Seahorse.” Rusty placed the piece in the correct place. I handed him an octopus and waited a beat before tapping the octopus spot on the puzzle.

“Octopus!” Rusty correctly named the piece as he placed it in the puzzle.

Just as he had comfortably fallen into a routine with our train conversation, Rusty fell into the routine of receiving a puzzle piece, naming it or hearing the name, and placing the piece into the wooden board. After he placed the last piece I handed Rusty a wooden fishing pole with a magnet attached to the end. Each fish piece contained a metal knob that allowed Rusty to lift the pieces out of the puzzle with the fishing pole. He immediately understood this routine and concentrated on getting the magnet from the end of the fishing pole to connect with a fish piece. I took the plastic zip-up bag that I used to store the puzzle pieces and formed it into a fish-eating bag. I grasped each side of the bag and made the opening open and close repeatedly while using an exaggerated voice to “speak” as the bag.

“Feed me! I’m hungry!”

Rusty alerted by stiffening his entire body as he guided the fish towards the bag. I helped him by having the bag gobble up the fish.

“Delicious! More fish!”

As we were establishing yet another predictable routine, Rusty burst out in his signature laugh and obeyed the bag’s command. I added a language prompt, coaching Rusty to tell the bag: “open wide.” After one prompt he was able to give the bag that command. When Rusty tried to place the fourth piece into the bag I changed the routine, adding an element of unpredictability.

“Uh!” The bag said. “Yucky!” I pushed the fish out of the opening of the bag and it flew in an arc and fell on the floor.

A look of concern covered Rusty’s face with this new development. He hesitated, picked up the fish, and placed it back into the puzzle board. He selected a different piece and resumed the original routine.

As the fish hovered close to the bag’s mouth, I asked Rusty a question. “Do you want the bag to eat it or spit it out?”

Rusty promptly replied in no uncertain terms. “Eat it.”

The bag followed his command. Each time I asked Rusty his preference he asserted that the bag needed to eat the fish. When he placed the last fish into the bag I prompted him to place the fishing pole in as well and to zip up the bag and drop it into the large mesh bag I held in front of him. Rusty released the bag of fish into the container and moved away to resume his solitary play with his trains. We continued this pattern of work (activities directed by me) and play (self-directed activities) while his parents, Jennifer and Randy, watched closely. Each time he completed an activity with me I prompted Rusty to drop the materials into the mesh bag.

After Rusty had completed several inset puzzles with me and had shown anticipation of and follow through with the routine of “start to finish” I handed Rusty a puzzle that required color matching.

“Give this to Mommy,” I said.

Rusty stood for a moment, taking in this new direction. Then he took the puzzle board to his mother. I handed her the bag containing the pieces. “Your turn to play,” I said.

Jennifer took the bag with the pieces and handed Rusty one piece at a time while he leaned over the puzzle board and concentrated on the visual matching. She prompted him to verbally label the colors, modeled the labeling, and used the mesh bag clean up routine.

As Jennifer practiced the routine with Rusty I took out a Velcro ball and two Velcro mitts and held them until they were finished. I looked at Randy. “Now it’s your turn.” I smiled and so did Randy. I handed Randy the two mitts and the attached ball.

Randy held up one of the mitts and held it out towards his son. He helped Rusty hold the strap on the back of the mitt and then showed him how to take the ball off and throw it so it stuck to the mitt. Rusty was immediately intrigued with the process of pulling the ball off the Velcro and smashing it back on the front of his mitt. However, with some excellent prompting by his father, he was able to successfully throw and catch the ball several times. It was clear that he was done with the activity after two exchanges and Randy responded by holding up the mesh bag and dropping his mitt into it. His ...