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Family Stress and Establishing Intervention Priorities for Kids on the Autism Spectrum

When prioritizing interventions for the child with High-Functioning Autism (HFA), parents should decide which factors contribute to an adverse family environment.

A common mistake made by doctors and therapists who work with families affected by autism spectrum disorders is to treat the HFA symptoms, when in fact it’s the parent's depression or anxiety that is a major contribution to family strain. (Note: Sibling-conflict may also be a factor contributing to family strain.)

Often, high levels of parental stress lead therapists to prescribe for the “special needs” youngster rather than educate parents and recommend that they obtain therapy. This is not to say that parents and siblings must be infinitely adaptable to the HFA child’s problematic symptoms, or that family problems are always the result of parental issues. The point is that family distress has many sources. 
 

Using medication in certain cases may reduce the HFA child’s inflexibility, instability, and anxiety, and therefore improve life at home for everyone. However, if the persistent anxiety of raising a youngster on the autism spectrum has fueled depression or anxiety in his or her parent, or has inflamed conflict in the marriage, usually treating only the “special needs” youngster is not enough. To treat issues in the parent(s), or the tension between partners/spouses, it is most likely that specific treatment is needed.

The quantity, scale, and range of difficulties experienced by children with HFA can be confusing. Everyone involved, the child, parents, and even teachers, can be swept up in this difficulty. The first challenge is to create the hierarchy of symptoms - and the problems they create. Often, problems fall into a cluster of symptoms. The primary task of the parent is to determine which symptoms should be targeted first. Creating a hierarchy of specific symptoms lends itself to methods for behavioral modification.

Questions and “order of consideration” when approaching this dilemma include symptoms that (a) threaten the safety of the child, family members, or others; (b) create anxiety for the child; (c) are sources of adversity in the family's life; and (d) jeopardize sustained educational progress.

Safety is the most persuasive reason that kids on the autism spectrum are referred for therapy. Aggression and violent outbursts are common in many on these young people, and they may engage in other types of risky behaviors (e.g., throwing or destroying objects). In addition, there are traits of the disorder that make aggression and self-injury harder to control. 
 

Additional factors that may contribute to problematic behavior in the HFA child include the tendency to engage in repetitive and stereotyped behaviors, rigid adherence to patterns or behaviors, lack of empathy for others, deficits in generalizing from one circumstance to another, and deficits in abilities to soothe and comfort themselves. As a result, the safety to kids on the spectrum - and those around them - are the highest priority.

The child’s emotional distress takes center stage once safety is not a primary worry. Kids on the autism spectrum who are sad, anxious, or continually irritable have great difficulty learning, monitoring themselves, and “reading” their environment. Their emotions override their abilities to recognize events and think through the solutions to everyday problems.

Also, in many cases they can’t respond with the necessary flexibility to the rapidly changing demands of the social world. As a result, emotional distress often destroys opportunities to learn information, increase social relating, and gain new social skills. A child who is constantly upset will not be able to demonstrate his or her actual abilities.

The effects of an HFA youngster's symptoms on a family are diverse, and some symptoms can be extremely challenging. Adverse effects on a family can be difficult to isolate - and harder still to quantify. Sometimes, the symptoms exhibited by kids on the autism spectrum exceed what parents can manage.

The way parents adapt to the “special needs” youngster grows out of a complex interplay of his or her social skills, deficits, temperament, and the limitations and demands of other family members that must be met. 


Resources for parents of children and teens on the autism spectrum:
 
 
 
More articles for parents of children and teens on the autism spectrum:
 
Social rejection has devastating effects in many areas of functioning. Because the ASD child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

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Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

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Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

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Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with ASD face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

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Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

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Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

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High-Functioning Autism and Asperger’s: A Normal Variant of Personality?



All the traits that describe High-Functioning Autism (HFA) and Asperger’s (AS) can be found in varying degrees in the normal population. For example:

  • People differ in their levels of skill in their ability to read nonverbal social cues.
  • The capacity to withdraw into an inner world of one's own special interests is available in a greater or lesser measure to everyone. In fact, this ability has to be present in those who are creative artists, scientists, mathematicians, musicians, etc.
  • A lot of people have outstandingly rote memories - and even retain vivid imagery into adult life.
  • Collecting objects (e.g., stamps, old glass bottles, or railway engine numbers) are socially accepted hobbies. 
  • Many who are capable and independent as grown-ups have special interests that they pursue with marked enthusiasm. 
  • People differ in their levels of skill in social interaction.
  • There is an equally wide distribution in motor skills.
  • Pedantic speech and a tendency to take things literally can also be found in many people.

In one documented case, a man whose visual memories of objects and events were so vivid and so permanent that they interfered with his comprehension of their significance, appeared to behave like someone with Asperger’s. However, he did not meet enough of the criteria to actually receive the diagnosis of the disorder.

The difference between someone with HFA or AS and the “neurotypical” (i.e., non-autistic person) who has a complex inner world is that the neurotypical does take part appropriately in two-way social interaction most of the time, whereas the HFA or AS person does not.

Also, the neurotypical, however elaborate his or her inner world, is influenced by social experiences, whereas the person on the autism spectrum seems cut off from the effects of outside contacts.

People are usually diagnosed with HFA or AS because they are at the extreme end of the normal continuum on all these characteristics. In a few of these individuals, one particular aspect may be so marked that it affects the whole of their functioning. 

Even though HFA and AS do appear to merge into the normal continuum, there are many cases in whom the problems are so marked that the suggestion of a distinct “disorder” seems a more likely explanation than a “variant of normality.”


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The Top 5 Social Skills to Teach Children on the Autism Spectrum

Difficulty with social skills is not isolated to kids with High-Functioning Autism (HFA) and Asperger’s. Many of these young people exhibit difficulties with a variety of social skills for numerous reasons.

However, a social skills program developed to address general social impairments doesn’t adequately address the social skills deficits specific to HFA and Asperger’s.

When selecting social goals for intervention, it’s crucial that parents prioritize and address the skill deficits that are most relevant to their child (e.g., eye contact may be a greater priority than negotiation skills, given its significance in social interaction, such as monitoring other’s reactions to indicate interest or engagement).

In addition, it’s important that all instructional activities have an underlying social purpose. Make clear to your child how and why the goals selected are relevant for him or her.

The five broad skills that are particularly relevant to HFA and Asperger’s are: social problem-solving skills, play and friendship skills, emotion-processing skills, conversational skills, and basic interactional skills.

Specific social skills to teach should include the following:

•  Conversation skills need to cover basic elements of how to start, maintain, and end a conversation. The subtler aspects of conversations should be included as well (e.g., asking questions of others, choosing appropriate topics, joining a conversation already underway, making comments, taking turns in conversation, and using nonverbal indicators to express interest).

•  It’s crucial to teach basic friendship and relationship skills. The concept of friendship and the important qualities of being a good friend should be discussed, listed, and practiced (e.g., compromising, following group rules, greeting others, responding to greetings, sharing and taking turns, and joining groups).

•  It’s also important for parents to teach the nonverbal behaviors that are important to social interaction (e.g., appropriate eye contact, social distance, voice volume, facial expression, etc.).

•  Parents should also help their child to understand thoughts and feelings of self and others. You can begin by increasing emotion recognition and vocabulary skills, because most kids on the autism spectrum are not familiar with emotional terms beyond the basics.

•  Perspective-taking and empathy training are two other great skills to teach. Here, you want your child to act out situations in which different people think different things or have different underlying motives.

•  Social problem-solving should be taught (e.g., what to do when your youngster is teased, feels left out, or is told “no”). The focus here is on the development of practical solutions, coping mechanisms, and self-control for difficult interpersonal situations.

•  Make use Social Stories to introduce new social skills. Social Stories are “written illustrations” that present social information. Although they provide some specific guidance about what to do or say in a social situation, they also highlight social cues, the motives or expectations of others, and other information that the child may not have appreciated.

Your youngster should be aware of his or her personal target goal and should be “reinforced” for meeting it throughout the social skills training you implement (e.g., reinforcement charts posted on the wall, goal or point cards, cups in which the goal is affixed and tokens are placed, etc.).

For new or emerging skills, the child can be reinforced the moment the skill is displayed spontaneously. 

For more information on teaching social skills to children with HFA and Asperger's, click on the link below:

==> https://www.social-skills-emotion-management.com
 
 
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
 
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Making the Abstract Concrete: Teaching Social Competence to Kids on the Autism Spectrum

Many children on the autism spectrum don’t understand abstract concepts. They have trouble reading between the lines. If a person says, “I’m so angry I could spit,” they may wait and watch for the person to spit. Social competence requires an ability to think abstractly.

If the child has difficulty in this area, he or she may fail to understand facial expressions, have difficulty keeping emotions in check, have problems taking turns, interrupt others while they are speaking, prefer talking to adults rather than other kids, share information in inappropriate ways, talk too much about their favorite topic, or withdraw from conversations with peers entirely.

Similar to teaching many academic skills, teaching social competence involves abstract skills and concepts. Because kids with High-Functioning Autism (HFA) and Asperger’s tend to be concrete and literal, the abstract nature of these interpersonal skills (e.g., kindness, reciprocity, friendships, thoughts, and feelings) makes them especially difficult to master.

A first crucial step is to define the abstract social skill or problem in clear and concrete terms (e.g., knowing when your friend is joking versus being mean). The behavior must be clearly put into action and the youngster taught to identify it and differentiate it from other behaviors (e.g., Is this a friend or not a friend? Is this a quiet or a loud voice? Was I being teased or not? Am I following directions or not?).

Examples of making the abstract concrete include:
  • “If-then” rules can be taught when the social behaviors involved are predictable and consistent (e.g., “If someone says ‘thank you,’ then you say ‘you're welcome’.”).
  • Kids on the autism spectrum who are learning eye contact may respond better to the more concrete “point your eyes” than to “make eye contact” or “look at me.” 
  • Personal space can be defined concretely as “an arm away” or “a ruler away” instead of “too close.”

Short menus of behavior options can be presented for particular social situations for these young people to choose among (e.g., three things you can do to deal with teasing).

Visually-based instruction is another great way to make the abstract concrete. Many kids with HFA and Asperger’s – even those who have considerable verbal skill – demonstrate a visual preference oand learn best with visually-cued instruction. Incorporating visual cues, prompts, and props to augment verbal instruction can make abstract social skills more tangible and easily understood.

Other visually-based instruction may include:
  • A large “Z” made of cardboard can be used to depict the back-and-forth flow of a conversation.
  • Examples of intermediate and finished products can be used to demonstrate steps in activities or projects. 
  • Kids on the spectrum can be taught to look at the eyes of others using a cardboard arrow. They can be instructed to hold the arrow on the side of their face next to their right eye, and point it at the eyes of the person to whom they are speaking. This aligns their face and eyes in the correct direction. Once this skill has been practiced using this concrete visual cue, use of the arrow can be faded out.
  • Pictures can be used to define concepts or clarify definitions.
  • Voice volume or affect intensity can be depicted visually in a thermometer-like format.
  • Written lists can be used to summarize discussion topics.

Such visual prompts can be faded out eventually, and the skill can be practiced in more natural contexts.

For more information on teaching social competence to kids on the autism spectrum, click on the link below:
 
 
 
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
 
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