The other day, a young boy came into the office very upset and dysregulated. His parents apologized for how he was acting, however, it was evident his behavior was stemming from a thought or emotion he was wrestling with. My client is 10 years old, possesses high verbal ability and is extremely knowledgeable in the areas of science and math.
Writing, on the other hand, is much harder for him, and in the past, he has said, “I hate writing because it never matches what’s in my head!”
On this day, the boy came in, went right to the white board and wrote, I hate the phrase YOU NEED TO. He proceeded to circle it, repeatedly. Then, he pulled out a chair, sat at the table, and put his head down.
During this whole-time frame, I uttered one phrase, “Do what you need to do.” I sat on the couch, crossed my legs, and was just present.
He eventually looked up and said, “Why do people say that phrase? Don’t they know what that phrase means to kids like me! Don’t they know the pressure it puts on us! Why don’t they get it?”
The idea of a phrase triggering an emotional response is something I see and hear about every day. Often, people don’t mean to trigger a student and bring on a level of anxiety, but it happens more than we know. Teachers are not the only ones at fault. Parents say things that trigger an emotional response all the time. I get asked, “But isn’t that just their autism? Isn’t that just their difficulty with emotional regulation?” The answer is NO.
There is an abundance of empirical evidence over the past 10 years that suggests a variety of coexisting mental health conditions in autism. One study (Lecavalier, L., McCracken, C. E., Aman, M. G., McDougle, C. J., et. al., 2019) suggested close to 72 percent of children nine and older met criteria for at least one Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) Axis I disorder.
Some of the more common diagnoses include attention deficit hyperactivity disorder (ADHD), social anxiety, generalized anxiety disorder (GAD), oppositional defiant disorder (ODD) and depression. So, what does this all mean? How do we start to address some misperceptions and general understanding of people with an autism spectrum disorder (ASD)?
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First: We, as parents and clinicians, must understand and accept that co-existing mental health conditions are something our children and clients with ASD face. We have to understand what “anxiety” looks like for someone with ASD and what anxiety looks like for someone without the ASD diagnosis. As a parent, acknowledge one’s anxiety or emotional state and provide the support of “What do you need?”
Asking a child, adolescent, or adult “What do you need?” allows for a conversation to start not about the behavior he/she may be displaying, but about his/her emotional state at the time. The child may indicate he/she needs a break, a drink, a hug, or maybe to scream. Your ability to stay calm and present and remind the child you are there will provide this subtle sense of support security.
Don’t worry about the behavior! The behavior can be addressed at another time. Once the child is feeling calm or has moved out of the dysregulated, depressed, or anxious state, he/she will be in a better place to take in verbal language and talk about “fixing” what was just said or broken or done to another person.
Second: We must educate others on how mental health disorders impact the behavioral, social, and at times academic presentation of those with ASD. I have often used the below diagram to highlight the impact mental health needs have on students. We as a community must do a better job in using a strength-based approach to build one’s tools, competences, and positive memories if we are going to decrease the severity of co-existing mental health needs.
This is the cycle many of our children and clients on the autism spectrum go through every day of their lives. By being more proactive in our mental health services and interventions and by thinking about and using one’s strengths, we can intervene at each turn and therefore decrease the chances of greater and more significant mental health illness down the road.
We tend to immediately want to decrease a maladaptive behavior, but often fail to ask where that behavior really comes from. Yes, it can be a function of avoidance or escape or sensory overload, but it can also be rooted in one’s anxiety, depressed state over not feeling good enough in one particular area or defects in one’s executive functioning.
By looking more at those mental health roots, we may be better able to help our children and students feel understood for why they engage in a certain behavior. If we can help them feel more understood, that may help to create more positive memoires and a feeling of “they do get me.”
Lecavalier, L., McCracken, C. E., Aman, M. G., McDougle, C. J., McCracken, J. T., Tierney, E., Smith, T., Johnson, C., King, B., Handen, B., Swiezy, N. B., Arnold, L. E., Bearss, K., Vitiello, B., & Scahill, L. (2019). An exploration of concomitant psychiatric disorders in children with autism spectrum disorder. Comprehensive Psychiatry, 88, 57–64. https://doi-org.flagship.luc.edu/10.1016/j.comppsych.2018.10.012
This article was featured in Issue 102 – Supporting ASD Needs Everyday