As the incidence of Autism Spectrum Disorders (ASDs) have exploded in the last 15 years, much progress has been made in understanding this complex developmental syndrome. People with ASDS are now recognized as a diverse group with a variety of diagnoses who vary widely in abilities and functioning levels. The defining features of those on “the spectrum” include difficulty with social skills and problems with reciprocal communication. People with ASDs may also engage in excessive rituals, have difficulty regulating their impulses, or display intense and focused interests. Many people with ASDs are either oversensitive or undersensitive to stimuli such as touch or sound. Some have particular talents, or “splinter skills”, and most are good visual learners.
Many treatments have developed in recent years that address the developmental challenges of those with autism, including speech and language therapy, occupational therapy, and social skills training. Certain recreational activities, and perhaps specialized dietary regimes, may also facilitate the development of children with ASDs. Certain psychotropic medications can result in improved behavior and concentration.
A variety of approaches to addressing autism feature family involvement. “Floor play”, which may improve social and emotion-regulation skills, involves intensive parent-child play. Collaborative Problem Solving, which aims to increase the ability of children to manage their impulses and think more flexibly, as well as Functional Behavioral Analysis, which focuses on improving behaviors, both involve parent-child interaction. Beyond specific approaches, research and experience have shown that parents can take a number of steps to enhance their children’s development, including focusing on strengths, maintaining consistent routines, encouraging play dates, and utilizing “social stories” to enhance social functioning.
Many of the aforementioned treatments are effective, and the approaches that involve parents can help them feel supported and empowered. Even so, none of these treatment approaches address the needs of families as a whole; and the needs can be numerous. While the presence of a child with autism in a family can be rewarding, many families face significant time and resource demands. In addition, stress and conflict frequently accompany the challenges of raising a child with developmental delay.
Stress on families can occur at each stage of a child’s life: family members often feel shock and confusion during the toddler years as they first notice delays and scramble to find accurate diagnoses and effective treatments; anxiety and confusion often accompany the struggle to access appropriate services during the school age years; feelings of anguish and disappointment may accompany the teen years, when parents may witness the rejection of their child by peers as well as continued delay; renewed time and resource demands may accompany the scramble to find services during the transition to adulthood; and family members may experience burn-out as they face the ongoing demands of caring for autistic adults.
Each family member and family relationship faces particular challenges throughout these time periods. Struggles to reconcile differences about parenting and treatment approaches can stress the parental relationship. Siblings may struggle with feelings of embarrassment, and are often jealous at the attention and care that parents give to their siblings; as adults, many face the stress of caretaking. Differences often ensue between extended family members and parents over both the causes and the remedies for the challenges of autistic children.
Family stress and strife can exacerbate the challenges of people with autism. Autistic individuals thrive in consistent, calm environments, and need families to serve as effective advocates and caretakers. When family members are anxious or depressed, they may be less able to access effective treatments. Furthermore, strained family environments may lead autistic children to act out more, and limit their ability to make developmental progress. As a result, stress on the family may increase further, creating a negative cycle.
The treatment that is best positioned to break these negative cycles is family therapy. Viewing families in their entirety, family therapists can address unmet needs in individuals and strengthen particular relationships. They can help family members to support one another and communicate more effectively, and assist them in accessing treatments and resources. They frequently work with parents to strengthen their relationship and develop a unified approach to parenting. They may also work to strengthen sibling relationships, and fortify relationships between individual parents and children.
Successful family therapy can generate “positive cycles” that can benefit all family members. Families can develop more cohesive, orderly, and supportive environments, and become better able to access effective treatment. Autistic children become better equipped to develop themselves socially, emotionally, and academically. As the strengths of autistic children begin to shine through, the positive impact on the whole family creates an even more nurturing and positive environment for growth and development.
–Posted by Jonah Green
12/17/09: A variant of this post can be found in Autmont, the online newsletter and forum for parents in Montgomery County who have children with autism.