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Autism: Child & Adolescent Group Therapy

Emily Coler Hanson LMFT, CGPBarb Stanton PhD, LPCC, LMFT

Objectives 1. Identify unique needs of children/adolescents with autism spectrum

disorders in groups

2. Describe ways to modify the climate of a group for increasing attachment of individuals with an autism spectrum disorder

3. Utilize play therapy techniques in a group setting to increase attachment & build communication skills

4. Incorporate caregiver feedback into future group programming

5. Integrate skills learned into work with individuals with autism spectrum disorders

6. Identify ways to lead groups to benefit participants with different diagnoses

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Characteristics of Autism

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Autism Facts Autism is a neurological disorder, but it is treated within the

mental health system

Asperger’s is not “mild” Autism (DSM IV)

Often see delays development in: Cognitive skills

Flexibility

Frustration tolerance

Problem solving

Social skills

Or the application of these skills when needed

Three core features: Differences in communication

Differences in social interactions

Repetitive, restricted, or stereotyped behaviors (sensory problems)

Over the last 10 years, individuals identified with ASD have gone from 1 in 5,000 to 1 in 64 (CDC, March, 2014)

5:1 males to females

Neurological with brain differences in:

Limbic system and cerebellum (emotions and thoughts)

Amygdala (emotions)

Frontal lobe underdeveloped (impulsivity and executive functioning)

Neuron pathways

Brain stem

Corpus Collosum

90% of adults on the spectrum are under-employed or unemployed

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Mental flexibility (rigid or stuck thinking)

Working memory and recall

Activation, Arousal, and effort

Controlling emotions

Internalizing language

Time management

Metacognition

Adaptive behavior

Executive functioning

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Behavioral Functioning Challenging behaviors happen when the cognitive

demands placed on the individual outweigh the person’s capacity to respond adaptively

Spectrum kiddos are likely to overwhelm easily without being able to verbalize that effectively

Behind every challenging behavior is a lagging skill and a demand for that skill

Neurological disorder than impacts communication.

Behavior is communication.

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Emotional Functioning Transitions are anxiety provoking and exhausting

Can then see Anger dysregulation

Make them more likely targets of bullying

Tearful

Mood lability

Reactive

Disproportionate responses

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Kids do well if they can- Ross Green

Is group therapy right for a child with autism?

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Ever find yourself thinking…? “He won’t sit still.”

“She has bad wiring.”

“She is from a single parent home”

“He is from a bad neighborhood.”

“Her mother is crazy.”

“She just wants attention.”

“She just won’t listen.”

“He is naughty.”

“She has a bad attitude.”

“He wants control all of the time.”

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Refer for Skill Building Occupational therapy for sensory issues

Psychiatry for co-morbid conditions

Speech and language

Learning support when needed

Skills worker for social skill development

Family therapy (implications on the family)

Increases in depression, anxiety, and substance use

Individual therapy

How do I modify a group setting?

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Sensory Space

• 427 youth with autism or intellectual disabilities. Ages 13-21

• From the vantage point of their parents or caregivers • Assessment Scale for Positive Character Traits-

Developmental Disabilities (26 items) and Interview• Median number of strengths was 20• Greatest predictor of strengths was community

involvement and activities (in past year) • Use strength based assessments and individualize them • Speaks to the role caregivers play as well

Strength based is important!

Carter et al. 2015

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• Language skills are incredibly important

– Communicate emotions

– Reporting of events

– Nuances of language

• (ex: literal vs. figurative)

– Be aware of the client’s language skills

• Meet client at their developmental level

• Address sensory needs

• Support affective awareness

• Increase communication skills

• Increase work with caregivers/parents

• Be directive

• Skill building is as important as outcome

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• Don’t rush!

• Be flexible with the client’s pace. Include work outside of therapy sessions

• Relationship with your client is key and time to build this is important

• Incorporate hands on experiences

• Use alternatives to verbal communication when available

• Behavior serves a function- what is the behavior trying to tell you?

• Aggression is a clear message- it’s up to us to translate

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Evidence Based Practice

According to The Center for Neurological and Neurodevelopmental Health:

“Lego therapy has been proven to be an effective way for children with social difficulties associated with Autism, Asperger Syndrome, Anxiety, Depression or Adjustment Disorders to improve their social interaction and communication skills. Improvements in social competence enable children to sustain lasting friendships and reach their highest potential.”

Evidence Based Practice

• To be a better Lego builder

– Children need to learn from each other

– Solve disputes

– Cooperate

– Follow rules

– Be helpful to others

* Children have generalized these skills to other arenas (home, school)

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What is a Lego Social Skills Group?

• Geared towards children who struggles with peer interactions

• Designed to assist children with initiating and engaging in social interactions

• A link between therapy sessions and real life situations

• Agenda: Group rules, structured 3 person build, snack, free build. Photos as needed.

LEGO Group Rules

1. If you break it, please fix it

2. Put Lego pieces back where you found them

3. No climbing on furniture

4. Do not take pieces from other teams

5. Use quiet voices

6. No throwing Legos

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Lego Social SkillsEngineer: In charge of the building plans. Requests parts from the supplier and gives instruction to the builder of how the parts fit together.

Supplier: In charge of the parts for the project. Selects needed parts based on the engineer’s description and provides them to the builder.

Builder :In charge of the construction of the project. Receives parts from the supplier. With instruction from the engineer, adds the correct parts to the project.

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• I saw my son

• Interacting successfully with other kids

• Able to give instructions to other kids on how to build

•Had to listen to peers on how to build

•Working together to achieve a main goal

•Witness a meltdown for the first time that wasn’t him doing it. He had a lot of questions for me on the ride home about it

•My son never once told me that he didn’t want to go to the Lego’s group.

•He told me he felt comfortable and his anxiety level was low – that rarely happens

•We saw another group member last weekend out in the community and my son said “Hi” to him and had a conversation that wasn’t one-sided. It only lasted a few minutes, but it was really great to see the two of them interact together.

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• “I got my little professor back”

• Child asked his school to respond to him like we did in Lego group

• Teachers asked for input from facilitators regarding interventions

What we learned: DON’T CHANGE ANYTHING!!!

The importance of consistency of group leaders, routines, layout of sessions, rules

The need for multiple facilitators

How to handle meltdowns

Group room selection, due to the volume of group and kids coming in and out of the room

The importance of a caregivers presence

To go with the flow

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What we saw: Connections made with group members Lots of smiles, eye contact, encouragement and

compliments No judgments Reciprocal conversations Sharing Laughter Anxieties decrease Improvements in school Confidence Teamwork Patience Pride

Engineer: In charge of the building plans. Requests parts from the supplier and gives instruction to the builder of how the parts fit together.

Supplier: In charge of the parts for the project. Selects needed parts based on the engineer’s description and provides them to the builder.

Builder :In charge of the construction of the project. Receives parts from the supplier. With instruction from the engineer, adds the correct parts to the project.

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Resources Attwood, T. (2008). The Complete Guide to Asperger’s Syndrome. Philadelphia, PA: Jessica Kingsley

Publishers.

Carter, E.W., Boehm, T.L., Biggs, E.E., Annandale, N.H., Taylor, C.E., Loock, A.K., & Liu R.Y. (2015). Known for My strengths: Positive Trait of transition age youth with Autism. Research & Practice for Persons with Severe Disabilities, 40(2), 101-119.

Fortuna, R. (2014). The social and emotional functioning of students with an autism spectrum disorder. Support For Learning, 29(2), 177-191.

Hume, K., Sreckovic, M., Snyder, K., & Carnahan, C.R. (2014). Smooth Transitions: helping Students with ASD Navigate the school day. Teaching Exceptional Children, 47(1), 35-45

LeGoff, D.B. (2004). Use of LEGO as a therapeutic medium for improving social competence. Journal of Autism and Developmental Disorders, 34(5), 557-571.

LeGoff D.B., Sherman M (2006). Long-term outcome of social skills intervention based on interactive LEGO play. Autism,(10), 1-31.

Marshall, N., & Tragni, P. (2015). Successful Transitions into Mainstreamed High Schools for Students on the Autism Spectrum. Relational Child & Youth Care Practice, 28(1), 53-61

Owens, G., Granader, Y., Humphrey, A., & Baron-Cohen, S. (2008). LEGO therapy and the social use of language programme: an evaluation of two social skills interventions for children with high functioning autism and asperger syndrome. Journal of Autism and Developmental Disorders, 38(10), 1944-1957.

Pierce, J.M., Spriggs, A.D., Gast, D.L., & L, D. (2013). Effects of visual activity schedules on independent classroom transitions for students with autism. International Journal of Disability, Development and Education, 60(3), 253-269.

Red River Valley Asperger-Autism Network