HELP FOR PARENTS OF CHILDREN WITH ASPERGER'S & HIGH-FUNCTIONING AUTISM

Education and Counseling for Individuals Affected by Autism Spectrum Disorders

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Affective Education for Children and Teens on the Autism Spectrum


A major part of emotional development in “typical” (i.e., non-autistic) kids and teens is how they recognize, label, and control the expression of their feelings in ways that generally are consistent with social norms (i.e., emotional control). Self-regulation of feelings includes recognition and description of feelings. Once a youngster can articulate an emotion, the articulation already has a somewhat regulatory effect. Typical kids are able to use various strategies to self-regulate as they develop and mature. They begin learning at a young age to control certain negative feelings when in the presence of grown-ups, but not to control them as much around friends. By about age 4, they begin to learn how to alter how they express feelings to suit what they feel others expect them to express.

By about age 7 to 11 years, “typical” kids are better able to regulate their feelings and to use a variety of self-regulation skills. They have likely developed expectations concerning the outcome that expressing a particular feeling to others may produce – and have developed a set of behavioral skills to control how they express their feelings. By the teenage years, they adapt these skills to specific social relationships (e.g., they may express negative feelings more often to their mom than to their dad because they assume their dad will react negatively to displays of emotion). “Typical” teens also have heightened sensitivity to how others evaluate them.

Unfortunately, young people on the autism spectrum do not develop emotionally along the same lines and time-frame as “typical” children do. Children with Asperger’s (AS) and High-Functioning Autism (HFA), after all, have a “developmental disorder” – their emotional age is younger than their chronological age. Thus, they must be taught emotion management and social skills. Affective education (i.e., teaching children about emotions) is an effective way to accomplish this goal.

Affective education is a crucial stage in a course of Cognitive Behavioral Therapy (CBT) and an essential component for children and teens with AS and HFA. The main goal is to learn why one has emotions, their use and misuse, and the identification of different levels of expression.

A basic principle is to explore one emotion at a time as a theme for a project. The choice of which emotion to start with is decided by the Cognitive Behavioral therapist, but a useful starting point is happiness or pleasure. A scrapbook can be created that illustrates the emotion. For younger kids, this can include pictures of people expressing the different degrees of happiness or pleasure, but can be extended to pictures of objects and situations that have a personal association with the feeling, (e.g., a photograph of a rare rock for a child with a special interest in rock collecting).

For older teens, the scrapbook can illustrate the pleasures in their life. The content also can include the sensations that may elicit the feeling (e.g., aromas, tastes, textures). The scrapbook can be used as a diary to include compliments, and records of achievement (e.g., certificates and memorabilia). At a later stage in therapy, the scrapbook can be used to change a particular mood, but it also can be used to illustrate different perceptions of a situation.

If therapy is conducted in a group, the scrapbooks can be compared and contrasted. Talking about dinosaurs may be an enjoyable experience for one group member, but perceived as terribly boring for another. Part of affective education is to explain that, although this topic may create a feeling of well-being in the one participant, his attempt to cheer up another person by talking about dinosaurs may not be a successful strategy (perhaps producing a response that he did not expect).

One of the interesting aspects noticed is that group members with AS and HFA tend to achieve enjoyment primarily from knowledge, interests, and solitary pursuits, and less from social experiences, in comparison with “typical” group members. They are often at their happiest when alone.

Affective education includes the clinician describing – and the AS or HFA child discovering – the prominent cues that indicate a particular level of emotional expression in facial expression, tone of voice, body language, and context. The face is described as an information center for emotions. The typical errors that young people on the autism spectrum make include not identifying which cues are relevant or redundant, and misinterpreting cues. The clinician uses a range of games and resources to “spot the message” and explain the multiple meanings (e.g., a furrowed brow can mean anger or bewilderment, or may be a sign of aging skin; a loud voice does not automatically mean that a person is angry).

Once the key elements that indicate a particular emotion have been identified, it is important to use an “instrument” to measure the degree of intensity. The clinician can construct a model “thermometer,” “gauge,” or volume control, and can use a range of activities to define the level of expression. For instance, the clinician can use a selection of pictures of happy faces and place each picture at the appropriate point on the instrument.

During the therapy, it is important to ensure that the AS or HFA child shares the same definition or interpretation of words and gestures and to clarify any semantic confusion. Clinical experience has indicated that some young people on the spectrum can use extreme statements (e.g., “I am going to kill myself”) to express a level of emotion that would be more moderately expressed by a “typical” child or teen. During a program of affective education, the clinician often has to increase the AS or HFA child's vocabulary of emotional expression to ensure precision and accuracy.

The education program includes activities to detect specific degrees of emotion in others – but also in oneself – using internal physiologic cues, cognitive cues, and behavior. Technology can be used to identify internal cues in the form of biofeedback instruments (e.g., auditory EMG and GSR machines). The AS or HFA child – and those who know him well – can create a list of physiologic, cognitive, and behavioral cues that indicate an increase in emotional arousal. The degree of expression can be measured using one of the special instruments used in the program (e.g., the emotion thermometer). One of the aspects of the therapy is to help the child perceive his “early warning signals” that indicate emotional arousal that may need cognitive control.

When a particular emotion and the levels of expression are understood, the next component of affective education is to use the same procedures for a contrasting emotion. For example, after exploring happiness, the next topic explored could be sadness; feeling relaxed could be explored before a project on feeling anxious. The child is encouraged to understand that certain thoughts or emotions are “antidotes” to other feelings (e.g., some activities associated with feeling happy may be used to counteract feeling sad).

Some young people with AS and HFA can have considerable difficulty translating their feelings into conversational words. There can be a greater eloquence, insight, and accuracy using other forms of expression. The clinician can use prose in the form of a “conversation” by typing questions and answers on a computer screen, or by using certain techniques (e.g., comic strip conversations that use figures with speech and thought bubbles). When designing activities to consolidate the new knowledge on emotions, one can use a diary, e-mail, art, or music as a means of emotional expression that provides a greater degree of insight for both the child and clinician.

Other activities to be considered in affective education are the creation of a photograph album that includes pictures of the child and family members expressing particular emotions, or video recordings of the child expressing her feelings in real-life situations. This can be particularly valuable to demonstrate her behavior when expressing anger.

Another activity entitled “Guess the message” can include the presentation of specific cues (e.g., a cough as a warning sign, a raised eyebrow to indicate doubt, etc.). It is also important to incorporate the AS or HFA child's special interest into the program (e.g., a child whose special interest is the weather can express his emotions as a weather report).

Emotional Flooding—

The opposite of emotional control is emotional flooding, which is characterized as overwhelming and intense feelings that can't be controlled. During an episode of emotional flooding, the autistic child's rational mind is disconnected, his nervous system is saturated, and his prefrontal cortex ceases to exercise its controlling function. Flooding may turn into panic and fear, fight or flight. It takes a long time to come down from this heightened state, and afterward, the "special needs" youngster is often completely drained to the point of exhaustion.

Here is a 7-step plan that parents can use to deal with emotional flooding in their AS or HFA child:

1. Create signals your AS or HFA youngster can use to let you know he is about to have an episode of emotional flooding. Signals can give these kids a tool to put some space in between the reaction and their response. One 11-year-old boy with AS came up with the word “burning” to use when he felt himself getting ready to spin out-of-control. He would shout “burning, burning, burning.” His sister knew this was the signal to back off, and his mom knew this was the signal to intervene. It worked for him by giving him a few seconds before his emotions took over.

2. When your child is flooding, don’t leave him alone – but don’t try to take away his uncomfortable emotions either. If you have an AS or HFA adolescent, give him some distance until he is ready to talk.  With a younger kid, wait and listen for a shift in the intensity, and then step-in to help soothe. Sometimes you can directly ask if your child needs help to feel better (e.g., “I notice you are really upset. Do you need some help to calm down?”). If your child is not ready, he will let you know. But if he is ready, you will get a nod yes, at which point you can make some moves to soothe. When an AS or HFA youngster is out-of-control emotionally, she needs your help to get her equilibrium back. You can’t problem solve until this has been accomplished. This is true even if the emotional flooding has occurred as a result of some disciplinary measure.

3. Understand the difference between emotional flooding and a child’s drama-driven display that is created to get something. If you have a youngster that you really feel uses emotional flooding strategically to get a particular response out of you, then back off until the intensity dies down, and then offer some assistance (but don’t give in to an unreasonable demand). If your youngster is using flooding manipulatively, and she is not successful in getting the results she is after, she will eventually stop. The goal here is to help your youngster learn to self soothe and problem solve.

4. Help your youngster move from (a) acting out intense emotions to (b) labeling and describing them verbally. Words help to diffuse and give a youngster some tools to begin regulating emotions. The better able your youngster is at describing in detail her emotional state or reactions, the better she can regulate them.

5. Never attempt to suppress negative emotions. No child can help the feelings he has. He can only learn how to best manage them. Getting rid of negative emotions prematurely just sends them underground, where they can gain intensity and explode later during an unrelated event.

6. Try to figure out what the trigger is for your child’s emotional flooding. Sometimes triggers are obvious (e.g., reactions to change of routine). But, sometimes out-of-control behavior is a reaction to something that isn’t so obvious in the current situation.  For example, an AS or HFA youngster who has been repeatedly rejected and/or teased by peers may be overly-sensitive to even the slightest hint of criticism from parents.

7. When emotional flooding has run its course and the child is calm, parents can attempt to address the problem in question. Encourage your child to talk, and then reflect back to him what you heard (i.e., provide feedback). In this stage of the game, it’s more important that your child feels understood than for you to correct his way of thinking. Let him play out the scenario, and then show you understand his point of view. After you have accomplished this, you can start helping him to come up with a solution to the problem that caused him to “flood” in the first place.

Teaching Social Skills and Emotion Management


COMMENTS:

•    Anonymous said… I needed this today. My so. Had an "emotional flooding" moment and let me know that kids walk away from him or ignore him completely when he tries to talk to them. How do i get services for social and cognitive behavior help at age 14?
•    Anonymous said… I wish we could have found people that actually knew how to do this. My daughter is now 22 and things have not gotten any easier. We put her in 3 different places when she was younger and none of them helped at least not long term.
•    Anonymous said… I would like to know if anyone here has a HFA adult age now that cusses them out constantly and nothing at all is ever their fault.
•    Anonymous said… My daughter is 18 and heading to college in the fall. I've always wanted her to be able to get this kind of help. I've tried in my own way, but it's hard. So nervous to let her go. Don't give up smile emoticon
•    Anonymous said… Once my son got to high school...he became more discerning of people's motives. After a while he could care less what anyone said or thought about him (negatively ). He had a few friends in Anime Club and pretty much ignored the bullies.
•    Anonymous said… So very true!! It breaks my heart every time our son THINKS a kid is either making fun of him, when he or she is not and it's just "typical kid banter". Or like recently, when a boy at his middle school was taking GREAT advantage of him because he knew how desperately our son wanted friends. He just didn't see the insincere behavior and thought it was what friendship is supposed to be. Just killed me when he figured it out after we talked to him about the "bad thing" that happened. frown emoticon But there is a bright spot to this. It can be taught and learned, understanding certain social cues and how to watch for them. He's getting there. It's just that, for so many others, this sort of thing is instinctive. For our kiddos, we have to help them, point things out, role play, help them learn it. Merry Christmas everyone!!!
•    Anonymous said… That's is all we all can do with a child with Aspergers is try in our own way. What worked yesterday may not work today so we just keep trying. smile emoticon
•    Anonymous said… This is exactly my son too
•    Anonymous said… You are not alone, my son is 11. Place after place he went and all they would do is CBT. Now we live where there is an Autism center and he's too old, their age cut off is 8.
•    Anonymous said…. It's hard when you just want to make everything ok. Milan is not on the spectrum but he struggles socially and it's so hard to watch or answer why his five year old brother has so many friends and party invites

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