Tag Archives: asperger

Mental Health Services for ASDs

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Sigmund Freud

Sigmund Freud (Source: Flickr)

Students with Autism Spectrum Disorders (“ASDs”), including Asperger’s Syndrome and Pervasive Developmental Disorder, Not Otherwise Specified (“PDD-NOS”), are often challenged by anxiety, which is an emotional health need. Many school districts contract with county mental health agencies or other providers for forms of individual psychotherapy services that may not be appropriate for some students with ASDs. Further, they may have no other service to offer to address ASD-related anxiety issues.

To add to the confusion, many county mental health agencies have recently re-identified themselves as county behavioral health agencies, yet they do not provide Applied Behavioral Analysis (“ABA”) or any other type of peer-reviewed behavioral intervention. ABA is supported by research to be effective in not only contending with undesired behaviors among persons with ASDs but also in providing explicit instruction to teach the skills these individuals lack.

Explicit instruction in social skills such as greetings, farewells, maintaining a topic of conversation chosen by another person, initiating conversations, and other aspects of human interaction have to taught to many children with ASDs as explicit, scripted procedures. Those procedures can then be generalized into real life by reinforcing them when they occur in natural settings and pointing out to the individual, in vivo, when he/she has engaged in the steps of the procedure so that he/she learns to recognize social contexts in which each script is to be applied.  Eventually, it becomes a learned, rehearsed strategy to deal with specific types of situations.

The degree to which persons with ASDs can master various scripted procedures, or even need this level of support, varies from individual to individual. The same for the degree to which someone with an ASD can generalize knowledge from one context to another, such as from the instructional setting to real life.  It’s called a spectrum disorder for a reason. The range of severity between mild and severe is quite broad and anyone can fall anywhere along it.

Traditional “talk therapy” that promotes developing one’s insight and insight into other people’s perspectives to sort out one’s issues is not necessarily appropriate for some individuals with ASDs. Because there are so many differences among people with ASDs, it’s not fair to say that no one with an ASD can benefit from traditional talk therapy. But, it is safe to say that there are a significant number of students with ASDs who truly cannot benefit from traditional talk therapy but still have emotional health needs that require mental health services as part of their special education programs.

The matter comes down to, “What form of mental health services are appropriate for students in special education who have ASDs and require mental health services in order to benefit from their IEPs?” Well, as with anything in special education, you can’t take a cookie-cutter approach and say one specific type of program will fix everything for everybody. For one thing, no such statement will ever be true; learners with disabilities, even within a population impacted by the same condition, are too diverse for one-size-fits-all programming. Federal law requires individualized programming for this very reason.

That said, there are certain approaches that are generally known to be more effective with students who have ASDs than others. These may work with many students with ASDs, but whether or not they will be effective with an individual student really depends on that student.  The following are possible methods by which effective mental health services can be delivered to some persons challenged by anxiety associated with ASDs.

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Reconciling the Tragedy of Newtown, CT

Connecticut School ShootingThis is one of the most difficult posts I’ve ever had to write, but the challenges it presents to me are nothing compared to what the families of Adam Lanza and his shooting victims continue to suffer, as well as their communities. Maybe I’m feeling a touch of survivor’s guilt. Unlike the dead, I still have the ability to soldier on.

When I initially heard the news, it was over brunch with a colleague and our mutual client. My colleague saw the news on his smart phone and let out an audible, emotional gasp. When he told us what had happened, I didn’t feel anything at all; it was just information and wasn’t real to me, yet.

I was still trying to assimilate everything that had happened in the IEP meeting we’d all been in earlier that morning on the tail of a grueling week that had left me already emotionally exhausted. A mass murder on top of that was evidently more than what my nervous system could handle at the time. Since then, however, I’ve been following the news and the weight of the situation has sunk in quite deeply, now. I can’t read about the victims without tearing up.

An event like this hits me from every side because I have devoted my career to protecting children’s educational and civil rights. Among those is certainly the right to attend a safe learning environment that fosters their development and growth.

On the other hand, the evidence that has been publicized thus far reveals that Adam Lanza was disabled, possibly with a personality disorder, possibly with an autism spectrum disorder. The latter sounds more likely based on the descriptions given of him, though unless someone who has actually diagnosed him is permitted to disclose his confidential patient information, we’ll never really know.

What the reports from those who encountered Adam confirm was that he was socially awkward and withdrawn and that he evidently didn’t process physical pain the ways other people do, which put him at risk of unwittingly hurting himself during high-risk activities, such as soldering electronics. That sounds a lot like a sensory integration problem to me, which is not uncommon among those challenged by autism, along with the social skills deficits he was also reported to suffer.

Regardless of his diagnoses, it was clear to the outside observers who encountered him that he was impaired. And, while none of the lay people interviewed by the media thus far can point to anything that would have tipped them off that this atrocity was going to happen, we are not privy to what any therapists or others who interacted with him on a professional level may have had reason to fear from him.

Even if no one saw this coming, the fact that Adam remained socially impaired into adulthood reflects a lack of adequate intervention when he was younger, particularly given the peer-reviewed research regarding what works with children challenged by autism. The reports from those who encountered him in high school describe a young man who couldn’t relate to other people, would engage in elopement, and experienced meltdowns at school that “required” his mother to come to school and help calm him back down. The Associated Press described these latter experiences as “… crises only a mother could solve …” which reflects an utter failure with respect to school-based behavioral interventions and a gross lack of understanding regarding parental ability versus the mandated duties of the public education system.

I’ve lost count of the number of students I’ve represented whose schools have chosen to call parents away from their jobs in the middle of the day – and parents who have lost their jobs as a result – because it was less costly to the local education agencies to call the parents to come intervene than to staff these students’ programs with expert personnel. Unless the parent has a BCBA, the parent is not the person to call when behavioral problems occur and it is unethical and unlawful for school districts to shift that burden onto parents.

The special education advocate in me finds this outrageous and inexcusable. Just because no one necessarily saw Adam’s potential for murder when he was a public education student with special needs is no excuse for having failed to serve him when the opportunity presented itself to do so. When given the opportunity to prevent this from happening, nothing appropriately effective was done. The burden was shifted to his mother, who ultimately became his first murder victim. Clearly, this was not a crisis that only a non-expert, gun-collecting mother could solve.

While I’ve yet to see evidence that Adam was on an IEP while in public school, based on the descriptions given of him in the media by those who knew him at the time, if he wasn’t on an IEP, it was the world’s biggest child find violation. I have to believe he was on an IEP when he was a public school student.

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