Many programs that treat emotional and behavioral disorders will not accept students with high-functioning autism-spectrum disorders like Asperger’s Syndrome, referring those students instead to programs that deal exclusively with neurobiological issues. This effectively segregates young people with autism-spectrum disorders from other populations. “I think that in many cases, this is a mistake; a missed opportunity,” says Utah-based psychotherapist, David Prior, LMFT. “My preference is to judiciously mix different populations in a treatment setting so that patients are challenged to learn new styles of interacting with different kinds of people.This is especially true with spectrum disorders.”
The key, says Prior, is providing a combination of structure, repetitive cuing, customization, and (most importantly) a good deal of nurturance. At Sunrise RTC, the girls’ adolescent treatment program that Prior runs, positive psychology is a staple of staff training. Not only does it define the treatment that the team delivers, it also defines how that team interacts. “Our staff is very close. We take care of each other and have a shared sense of purpose. The result is a sense of safety and community that starts at the staff level and trickles down to the student community. This highly relational approach works best with students who are fundamentally relationally motivated”, says Prior, so his admissions team screens students accordingly.
New Sunrise program participants are partnered with positive older students to inculcate a spirit of safety, community, and nurturance from day one. “Even though spectrum kids often come across as flat, unemotional, and hyper-logical, they’re extremely sensitive. They desperately want to fit in but may be socially anxious from repeated relational failures.” This makes a nurturing treatment approach all the more critical for these often socially skittish spectrum sufferers.
Once this sense of safety is established, Prior’s team of therapists and direct-care staff implements a customized treatment plan for each participant. Their favored approaches for working with students suffering from autism-spectrum disorders include:
Repetitive Cuing: Spectrum students benefit from clear instruction coupled with repetitive visual or verbal cuing to help them routinize new behaviors. In certain situations, this might cause embarrassment, says Prior, unless a positive peer culture is consistently maintained. “That kind peer culture really pays off when, for instance, a girl posts notes in her bathroom to remind her of positive hygiene habits.” Rather than causing ridicule, however, Prior says that his students routinely help each other remember and master even these potentially sensitive new habits. “It’s just part of the culture.”
Consistency: Adolescents suffering from emotional and behavioral disorders can generally benefit from external consistency and structure. But this is all the more true for those struggling with autism-spectrum disorders. Consistency in routine, instruction, social interactions, and culture help create a sense of safety. This consistency also reduces external distractions so that new behaviors and coping skills can be focused on, practiced, and mastered.
Customization: Staff should be trained to distinguish between behaviors that stem from oppositional tendencies and those that stem from neurobiological disorders. Many young people with spectrum disorders have been chronically misunderstood by parents, teachers, and even therapists; in these cases, behaviors resulting from rigid thinking or misinterpretation of visual cues may meet with consequences instead of coaching. Many spectrum students are suffering not only from neurobiological disorders, but also from anxiety, trauma and other co-occurring emotional problems. This means that the therapeutic staff must construct therapies that are flexible, creative, and personalized. This, in turn, requires robust communication. “Customization requires extensive communication in order to maintain a balance of nurturance and structure,” says Prior.
Combination of Talk and Experiential Therapy: Particularly with students suffering from a non-verbal learning disorder (NLD), talk therapy is coupled with experiential approaches. ‘We want to meet these girls where they are and their neurological bias for processing thoughts and emotions is verbal, so we’re careful not to overload them with written or visual therapy assignments. The function of experiential therapies with NLD students is to help them put therapy into action, while the function of verbal processing is to help transform those experiences into sustainable relational habits. We want NLD students in particular to develop a “muscle memory” for newly acquired relational skills. This is done by pairing their verbal strengths with a physical/experiential activity.”