In conventional Cognitive Behavioral Therapy (CBT) programs, clients are encouraged to self-reflect to improve insight into their thoughts and feelings, promoting a realistic and positive self-image and enhancing the ability to self-talk for greater self-control. However, the concept of self-consciousness is different for children with Asperger’s (AS) and High-Functioning Autism (HFA). There is often a qualitative impairment in the ability to engage in introspection (i.e., self-analysis).
Research evidence, autobiographies, and clinical experience have confirmed that many young people with AS and HFA lack an “inner voice” and think in pictures rather than words. They also have difficulty translating their visual thoughts into words. As one teenager with AS explained in relation to how visualization improves his learning (a picture is worth a thousand words), “I have the picture in my mind, but not the thousand words to describe it.” Some of these “special needs” children have an “inner voice” but have difficulty disengaging mind and mouth, thereby vocalizing their thoughts to the confusion or annoyance of others.
When parents attempt to teach self-reflection skills to their AS or HFA child, certain modifications need to be in place (e.g., a greater use of visual material and resources using drawings, role-play, and metaphor, and less reliance on spoken responses). Many young people on the autism spectrum have a greater ability to develop and explain their thoughts and emotions using other expressive media (e.g., typed communication in the form of e-mail or a diary, music, art, or a pictorial dictionary of feelings).
When talking about themselves, older teens and young adults with AS and HFA do not anchor their self-attributes in social activities and relationships, or use as wide a range of emotions in their descriptions like their “typical” peers do. They are less likely to describe themselves in the context of their relationships and interactions with other people. Thus, the teaching of self-reflection skills may have to be modified to accommodate a concept of self primarily in terms of physical, intellectual, and psychological attributes.
In self-reflection skills training, parents should attempt to adjust their child’s self-image to be an accurate reflection of his abilities and the neurological origins of his disorder. A bit of time needs to be allocated to explaining the nature of AS and HFA and how the characteristics account for his differences. As soon as the youngster has the diagnosis of AS or HFA, the parent needs to carefully and authoritatively explain the nature of the disorder to the family, but the affected youngster also must receive a personal explanation. This is to reduce the likelihood of inappropriate coping strategies to the child’s recognition of being different and concern as to why he has to see psychologists and psychiatrists.
The AS or HFA child also may be concerned as to why she has to take medication and receive “special education” at school. Over the last few years, there have been several publications developed specifically to introduce the youngster or teenager to their diagnosis. The choice of which book to use is the parent’s decision, but it is important that the explanations are accurate and positive. The child will perceive the diagnosis as it is presented. If the approach is pessimistic, the reaction can be to trigger a depression or to reject the diagnosis and treatment. The parent also can recommend the child read some of the autobiographies written by other kids and teens on the autism spectrum. The subsequent discussion is whether and how to tell other people of the diagnosis, especially extended family, neighbors, and friends.
When an accurate perception of self has been achieved, it is possible to explore cognitive mechanisms to accommodate the AS or HFA child’s unusual profile of abilities and vulnerabilities, and to consider the directions for change in self-image. One approach is using the metaphor of a road map with alternative directions and destinations.
Kids and teens on the autism spectrum need the tools to help them hone their self-reflection skills. Here are some examples of prompts that parents can use to start engaging their youngster in reflecting about his or her thinking (brainstorm some additional ones, too):
- During what activities do you become unaware of time passing?
- How did you feel?
- How do other people see you?
- How do you most want to contribute to others?
- If you were brave, what would you do?
- Tell me something that made you happy today (use the other emotion words like frustrated, sad, angry).
- What activities are you good at?
- What are you passionate about?
- What are you thinking right now?
- What are your best gifts?
- What are your dreams?
- What are your goals?
- What could this person be feeling?
- What could this person be thinking?
- What do you do right?
- What do you fear?
- What do you hesitate to admit about yourself?
- What do you like to play with?
- What do you love to do?
- What do you most want to create?
- What do you most want to give?
- What do you value?
- What do you want for your life?
- What has gone well?
- What has not gone well?
- What have you always wanted to try?
- What have you most enjoyed doing in your life?
- What is challenging for you?
- What is the next step?
- What is your best contribution?
- What made you excited today?
- What motivates you?
- What problem do you want to solve?
- What takes energy away from you?
- What was the best part of your day?
- What was the least that you liked about your day?
- When do you feel the most “natural”?
- When is it time to take a break?
- Where are you dissatisfied in your life?
- Where are you meeting resistance right now?
- Where do you get energy from?
- Why do you like it? (best followed by “what makes you say that?”)
As much as these prompts are for the AS or HFA child, they are for parents, too. Parents should find the time to share their thoughts with their youngster and the entire family during family meetings (use some of the self-reflecting questions above as part of the meeting’s agenda).
Parents need to let everyone know what they are thinking and feeling and make it visible. In this way, the AS or HFA youngster realizes that the self-talk that goes on in her head is normal – and sharing it with her family is important. It also gives family members the opportunity to talk about not just what makes them happy, but more importantly, the deep, dark and ugly thoughts that keep them awake at night and in a state of anxiety. Self-reflection is not just about building self-esteem, it is also being able to share negative thoughts. Thus, parents will do well to give their youngster the chance to reflect on his fears – and face them.
Teaching Social Skills and Emotion Management