Not all teenagers enjoy the "happy-go-lucky" days of adolescence. Unfortunately, there are those who suffer from development disorders such as Asperger’s (AS) and High-Functioning Autism (HFA). When things start to go wrong (e.g., behavioral problems, meltdowns, poor academic performance, etc.), parents often despair of not being able to effectively help their child.
Arguments are waged as to the management of “special needs” teens who act-out aggressively at home or school, commit crimes, or even attempt suicide. Sadly, our society has impoverished resources to address such issues, and while some hospitals are available, all too often the answer is jail. However, research has demonstrated that “troubled” young people on the autism spectrum do not need to be hospitalized or incarcerated to get the help they need. A home-based model of therapy called Multisystemic Therapy (MST) offers treatment services to these teenagers, as well as their parents and siblings.
AS and HFA teens with serious emotional and/or behavioral problems (e.g., substance abuse, severe depression, suicidal thoughts, delinquency, severe anxiety, antisocial behaviors, etc.) have been successfully treated through Multisystemic Therapy. This therapy shows a more hopeful and positive approach and focuses on how to help moms and dads assist their “special needs” teens and how to teach these teens to cope effectively with their schools and communities. In addition, this therapy has been found to be an effective alternative to hospitalization and incarceration.
There is heated debate in our society about the proper roles of psychotherapies and medications for teens “at risk,” as well as teens already suffering. But, what we know for sure is that AS and HFA teens who go untreated: (a) often suffer in silence, (b) can’t learn, (c) tend to act-out their emotions rather than articulate them, (d) have great difficulty forming healthy relationships with friends and family, and (e) tend to isolate themselves from constructive social contacts. Some of these “special needs” teens are placed on a trajectory for jail rather than college at a very early age.
Multisystemic Therapy is a mental health service that focuses on changing how these young people function in their natural settings (i.e., at home, school, in the neighborhood, etc.). It is designed to promote positive social behavior while decreasing problematic behavior (e.g., substance abuse, delinquency, violence, etc.). Therapy involves the following:
- The family sets treatment goals, and the therapist suggests strategies to accomplish them. Specific treatments are used within therapy.
- The interventions are individualized to the family's strengths and weaknesses and address the needs of the AS or HFA youngster, family, peers, school, and neighborhood.
- Treatment teams usually consist of crisis caseworkers, professional counselors, and psychiatrists or psychologists who provide clinical supervision.
- Therapists focus on strengthening the ability of moms and dads to raise “special needs” teens who have complex problems.
- Therapists working in the home have small caseloads and are available 24-hours-a-day, 7-days-a-week.
- Therapists identify strengths in the families and use these strengths to develop natural support systems and to improve parenting skills.
- Therapy is a collaboration between the family and the therapist.
Multisystemic Therapy gets its name because it involves treatment that addresses each of the “systems” that factor into an adolescent’s health and well-being (e.g., his or her social circle, school environment and interactions with teachers, neighborhood environment, family, and home environment).
During therapy, therapists typically meet with the entire family in the home where they focus on such things as assessing and improving parenting skills, as well as the quality of the relationships the adolescent has outside the home (e.g., relationships with peers and the larger community). As a rule, therapists (a) are available to their clients at all times, (b) only work with a small number of families at any given time, and (c) place special emphasis on positive critiques during the therapeutic process. A typical course of therapy lasts for about four months. During this time, therapists typically meet with their families several times a week.
In clinical trials, Multisystemic Therapy has proven effective in reducing long-term rates of criminal offending in serious juvenile offenders – and in reducing their rates of out-of-home placements. Positive long-term effects of Multisystemic Therapy – even 4 years post-treatment – were found. Also, it was found that this therapy reduced long-term rates of re-arrest by 25% to 70% compared with control groups.
- increases family cohesion and school attendance compared with hospitalization
- is an effective alternative to psychiatric hospitalization with “special needs” teens in a psychiatric emergency
- is successful in preventing a significant proportion of teens from being hospitalized
- reduces symptoms of internalizing distress and depression
- significantly decreases behavior problems
In addition, families who received Multisystemic Therapy were significantly more satisfied with their treatment than were families whose teenager was hospitalized.
There is an urgent need for clinically-effective, cost-effective methods to manage antisocial and criminal behavior in “special needs” teens. Oppositional Defiant Disorder, as well as Conduct Disorder, is increasingly prevalent in today’s society and is associated with a range of negative outcomes.
Quantitative reviews carried out for the National Institute for Health and Clinical Excellence have identified Multisystemic Therapy as one of the most promising interventions for (a) reducing antisocial or offending behavior and (b) improving individual and family functioning. If you have an AS or HFA teen who is acting-out in self-destructive ways, consult your family doctor for a referral to a mental health professional.
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