A Disability-rights approach to autism treatment and support…
My practice approach is based on the idea that autism is not a mental disorder but rather that it is a category that includes within it strengths, challenges, and disabilities.
Because autistic functioning includes some challenges to communication and sensory processing, and because autism is still stigmatized in many areas of our society, behavioral symptoms such as anxiety and depression often co-occur with autism.
I believe that while these challenges may be related to living as an autistic person in our culture, they are not inherent aspects of being autistic. My treatment for autistic clients emphasizes that autism is part of the natural spectrum of human neurodiversity and that autism is a life-long identity rather than a “disorder of childhood.” I am in favor of helping clients develop a positive sense of autistic identity that supports skills such as self-knowledge, self-advocacy, and sense of belonging.
Autism can also include challenges such as managing responses to stimuli and negotiating the organizational demands of daily living. Evidence suggests that autistic brains react differently from neurotypical brains to all sorts of stimuli–both external stimuli, such as sensory information, and internal stimuli, such as thoughts and emotions. For example, autistic brains appear to become aroused more quickly and to take longer to return to baseline.
My therapeutic approach emphasizes self-reliance, self-acceptance, and the social model of disability (recognizing that many aspects of “disability” are created by the environment rather than being located within the person). I find that autistic clients–both children and adults–can benefit from support for developing skills such as awareness of internal states, emotional regulation, distress tolerance, and social interaction scripts. In addition to supportive therapy for emotional experiences, I may focus on pragmatic ways to improve practical functioning. These may include some analysis of unhelpful patterns of behavior as well as behavioral techniques aimed at managing obstacles to effective day-to-day functioning and long term goals.
In younger clients, this may look like engaging in mildly frustrating activities while practicing awareness and labeling of internal states. In older clients, this may include examination of negative experiences to reframe responses from a neurodiversity-positive perspective that reduces shame and allows for greater self-acceptance and regulation in future interactions. I am especially interested in supporting the experiences of teenagers and adults on the spectrum as they explore their autistic identities, especially when newly diagnosed.
Because I operate from a neurodiversity-affirming stance, I do not offer intensive behavioral modification therapies, and I do not believe that encouraging autistic people–children or adults–to “look as normal as possible” is a goal that is appropriate or respectful of autistic difference. For example, I oppose IEP goals such as “improve eye contact” or “quiet hands.” Instead, I recommend accommodations such as “allow student to regulate degree of eye contact during face-to-face interactions” or “support student in using stiming behaviors to improve attentional focus.”
So, what do I believe?
I believe that the route to better quality of life for autistic clients includes support for improving skills and functioning. However, I believe that that support is only meaningful if we mental health professionals use our access and expertise to function as change agents in promoting greater understanding and acceptance of autistic difference as part of the range of neurodiversity.
I believe that autistic functioning varies a great deal day-to-day and according to context, and that terms such as “high-functioning” and “low-functioning” or “verbal” and “non-verbal” are not meaningful or accurate ways to describe autistic people.
I believe that verbal-expression based measures of intelligence do not accurately capture the abilities of many autistic individuals, and that, at the same time, the executive functioning challenges and social needs of many autistic clients are drastically underestimated due to intelligence test scores that suggest high cognitive abilities.
I believe that families and professionals support autistic people best when we include environmental and social factors, as well as individual factors in treatment planning.
I believe that autism cannot be “cured” because autism is not a disease, and that there is no more need to cure autism than there is to cure, say, being female or being gay or being trans. That said, I acknowledge that while autism is part of the spectrum of neurodiversity, it is also a disability that brings many challenges to functioning which can benefit from autistic-centric support and greater autism acceptance in our wider culture.
I believe that research on autistic concerns is most ethical and useful when it is based on the expressed needs of the autistic community—both young and old—and when it privileges the voices of autistic people first and foremost.
I believe that autistic people have a right to speak for themselves and that legislation and research priorities should be determined by those most affected by the outcomes. Because of this, I support the work of The Autistic Self-Advocacy Network. I also recommend following the efforts of the Autism Women’s Network at their website and on the AWN Facebook page, as well as the Thinking Person’s Guide to Autism on Facebook.
Finally, I believe that autistic people of all kinds grow and develop over the life span. Autistic people may develop in their own divergent ways, and may have unique processing and sensory needs life long, but autistic people do learn and change with experience just like everyone else.
I believe autistics can lead fulfilling, enriched lives, but that part of achieving this goal lies in changing the anti-disability bias implicit in so many parts of our culture. For this reason, my work includes not only working clients on the spectrum, but creating training and resources for educators and others who work with autistics in a variety of settings.
Out of respect for requests by autistic self-advocates, I support identity-first language (autistic person rather than person with autism):
“For us, autism is not simply an add-on to our personhood, but is in fact, foundational to our identity.” – Judy Endow, MSW, Author and Speaker