Dealing with Autism as a Family

1. Dealing with Autism as a Family “How family therapy can ease the conflict and improve communication” By Michael Uram Licensed marriage and family therapist, mfc45428

2. About Michael Uram, MA, LMFT • I am a licensed Marriage and Family Therapist in Private Practice in Costa Mesa, CA. I specialize in treating individuals and families that have one person diagnosed on the Autism Spectrum, Asperger’s and ADHD. • I am a Faculty Member at the University of Phoenix. I facilitate courses in their Graduate School as well as the Bachelors Level Courses in the College of Social Sciences. • I counsel abused children, some are diagnosed on the spectrum, through Childhelp Group Homes through the use of Trauma Focused Cognitive Behavioral Therapy.

3. Introduction

4. Family Therapy for Autism/ Asperger’s • The Treatment of Symptoms ofAnxiety, Anger, Family Stress Depression and Conflict. • Anxiety Symptoms – Parents worried when the next meltdown would be, children worry about the unknown, expectations and let downs. • Anger Symptoms – Yelling, Screaming, Hitting, Biting and Crying, sometimes due to frustrations by each member in the family. “Why can’t we have a good dinner?”

5. Family Symptoms • Family Stress – Difficulty managing a days routines and balancing needs of all children and still having time for parents to connect. • Depression – Sadness over symptoms and that life is not what we expected. • Conflict – Frequent Arguments that lead to unresolved anger anxiety and depression. muram@email.phoenix.edu

6. The effectiveness of including the entire family in treatment • Improved Awarenessof Diagnosis and of the impact on the entire family, parents, siblings, grandparents, relatives… • Collaborative Problem Solving leads to everyone in the family having a voice on how to change the dysfunctionalpatterns. • Change beliefs that lead to misunderstanding and increased annoyance or dislike of the child. Separation of the child from Autism. He or she is not autistic, rather, a loving child diagnosed with Autism. Your perceptionis key.

7. The benefit of combining techniques from different theories • Cognitive Behavioral Therapy focuses on changing thoughts and beliefs very well, although it does not address power struggles or what to do when your child does not talk about their thoughts feelings or beliefs. • Collaborative Problem Solving is great for getting everyone to have empathy, detail your concerns and develop a plan.

8. Benefits • Together, they form an effective holistic approach to reaching and changing conflict with a challenging child. • In most cases, elements of object relations theory, humanistic theory and narrative therapy enhance treatment by helping the client develop a stronger sense of themselves, understand the roles that they play in their family and defining themselves outside of the diagnosis.

9. Assessment

10. Assessment of Lagging Skills and Unsolved Problems • from Ross Greene's Collaborative Problem Solving. • “Kids do well if they can.” Clearly Identifies that the child is not the problem. • Develops a clear list of concerns • Sets the stage for choosing one unsolved problem to address in Plan B.

11. Choosing one symptom to focus on and developing a clear plan. • When there are many issues to overcome, it is common practice to attempt to resolve most major complaints all at once, which can be overwhelming. • We choose one major concern to address at a time, which helps the client focus on how to change as well as give the family a clear behavior to measure, increasing your chances of success and building the child’s self esteem. It is very difficult to remain motivated when 1 out of five goals is accomplished. It is much more satisfying to see specific success.

12. Including the siblings in the treatment planning process. • The child’s brothers and sisters are affected by the difficulties that the family has. • Often, these concerns become overlooked or the child is asked to hold it together while their sibling has a rough time. • This leads to resentment of the other child, the sibling missing out on time with their parent and difficulty believing that they are just as important to their parents. • Including them leads to them having a voice, stating their feelings and becoming a part of the positive changes.

13. The benefit of an in home assessment. • At home assessments give me a clear idea of possible triggers that are not always as evident to the family. Sometimes, a description of a situation is not nearly as effective as observing it myself. It could be noticing sensory triggers or observing the child when they are not trying their best to behave in front of the therapist. • Real situation observation is needed in only a few families, When the in home assessment gives the family deeper insight into their difficulties, it can change the family’s health in a significantly positive direction.

14. Treatment

15. Changing emotional triggers • Many children have difficulty accepting that their parents are in control. • When they are at school, they are usually better behaved, although not always. • In assessing and teaching more complex emotions, the child is able to describe their emotions in a changeable way, instead of frequently being angry, sad or stating they do not know. • Once the emotion is defined, The child can redefine the thought that lead to the emotion, giving them the ability to respond appropriately to the trigger instead of an overreaction or an inaccurate reaction.

16. getting unstuck from repeating patterns of behavior • Most arguments or meltdowns have a theme • Power struggles are common • In therapy, I outline the steps that the family makes, since we all make mistakes in having a behavior escalate. • The family then notices each time that the behavior cycle is starting again. – adapted from Asperger’s Syndrome and Difficult Moments

17. Using an automatic thought record • The Thought Record, adapted from the Workbook Mind Over Mood in conjunction with the Plan B guide helps the client and their family identify cognitive distortions and stuck patterns of behavior in a time efficient and documented manner. • The thought record describes the emotions that we have when we have not worked out the concern, discuss all thoughts that support or do not support the thought, then develop a balanced view of the situation, the Plan B template then takes the balanced view and gives the family a method to try to see if they can adapt it to their problem.

18. Developing friendships and social skills • As the client develops a stronger sense of themselves, they are encouraged to practice each skill to connect with other children their age. I develop specific role plays and content to cover when the child is motivated to connect with others. • Having a social connection at school strengthens their support and develops a sense of themselves as a valuable member of the community. • The children sometimes fell that they are hopeless and having a connection with the school can greatly change their day. • My main goal is to have the child “Win the Person, not the argument.”

19. identifying family roles and improving awareness of relationships • Claudia Black’s Family roles often apply to when one Child has difficulty managing their emotions. • Family Hero – Responsible One – Often the sibling • Placater – The People Pleaser – Often the mother • Scapegoat – Acting Out One – The diagnosed child. • Lost Child – Adjuster – Also usually the sibling • Mascot – changes between the members, also a sibling behavior • Identifying how they play these roles is key to changing how they react to each other. If you change the pattern, you change the family.

20. Questions

21. Common Questions • How many sessions does treatment last? Usually 10 – 20, sometimes much longer. • Who should come to the first appointment? Parents and Child. • Is every session with the entire family? It is usually balanced between individual and family, sometimes the parents observe an individual session. • What does this cost? $125 per 50 minute session, sliding scale and some insurances are accepted. • What research is available? The best resource for research is livesinthebalance.org for Collaborative Problem Solving and the Beck Institute for Cognitive Therapy.

22. Resources - Books • Asperger’s Syndrome and Difficult Moments – Brenda Smith Myles and Jack Southwick • Mind Over Mood – Christine Padesky and Dennis Greenberger • The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children - Ross Greene

23. Resources – Groups and Trainings • Debra Ann Afarian – UCP Class: Helping the Behaviorally Challenging Child • ARM – Autism Resource Mom – Debra Smith • OC Asperger’s Group • TACA – Talk About Curing Autism – Local Chapters are in Long Beach and Orange County • Wrongplanet.net – The online resource and community for Autism and Asperger’s

24. Resources - Psychiatrists • I primarily refer to three Psychiatrists that have successfully treated clients diagnosed with Asperger’s. • Dr. Matt Koury – (949) 891-0307 • Dr. Emily Johnson – (949) 753-8800 • Dr. Cat Dang - (949) 270-2902

25. Contact Information • 949-777-6694 2900 Bristol St., Suite G-201Costa Mesa, CA 92626michaeljuram@gmail.comhttp://www.MichaelUram.com