Family Stress and Establishing Intervention Priorities for Kids on the Autism Spectrum

When prioritizing interventions for the child with High-Functioning Autism (HFA), parents should decide which factors contribute to an adverse family environment.

A common mistake made by doctors and therapists who work with families affected by autism spectrum disorders is to treat the HFA symptoms, when in fact it’s the parent's depression or anxiety that is a major contribution to family strain. (Note: Sibling-conflict may also be a factor contributing to family strain.)

Often, high levels of parental stress lead therapists to prescribe for the “special needs” youngster rather than educate parents and recommend that they obtain therapy. This is not to say that parents and siblings must be infinitely adaptable to the HFA child’s problematic symptoms, or that family problems are always the result of parental issues. The point is that family distress has many sources. 

Using medication in certain cases may reduce the HFA child’s inflexibility, instability, and anxiety, and therefore improve life at home for everyone. However, if the persistent anxiety of raising a youngster on the autism spectrum has fueled depression or anxiety in his or her parent, or has inflamed conflict in the marriage, usually treating only the “special needs” youngster is not enough. To treat issues in the parent(s), or the tension between partners/spouses, it is most likely that specific treatment is needed.

The quantity, scale, and range of difficulties experienced by children with HFA can be confusing. Everyone involved, the child, parents, and even teachers, can be swept up in this difficulty. The first challenge is to create the hierarchy of symptoms - and the problems they create. Often, problems fall into a cluster of symptoms. The primary task of the parent is to determine which symptoms should be targeted first. Creating a hierarchy of specific symptoms lends itself to methods for behavioral modification.

Questions and “order of consideration” when approaching this dilemma include symptoms that (a) threaten the safety of the child, family members, or others; (b) create anxiety for the child; (c) are sources of adversity in the family's life; and (d) jeopardize sustained educational progress.

Safety is the most persuasive reason that kids on the autism spectrum are referred for therapy. Aggression and violent outbursts are common in many on these young people, and they may engage in other types of risky behaviors (e.g., throwing or destroying objects). In addition, there are traits of the disorder that make aggression and self-injury harder to control. 

Additional factors that may contribute to problematic behavior in the HFA child include the tendency to engage in repetitive and stereotyped behaviors, rigid adherence to patterns or behaviors, lack of empathy for others, deficits in generalizing from one circumstance to another, and deficits in abilities to soothe and comfort themselves. As a result, the safety to kids on the spectrum - and those around them - are the highest priority.

The child’s emotional distress takes center stage once safety is not a primary worry. Kids on the autism spectrum who are sad, anxious, or continually irritable have great difficulty learning, monitoring themselves, and “reading” their environment. Their emotions override their abilities to recognize events and think through the solutions to everyday problems.

Also, in many cases they can’t respond with the necessary flexibility to the rapidly changing demands of the social world. As a result, emotional distress often destroys opportunities to learn information, increase social relating, and gain new social skills. A child who is constantly upset will not be able to demonstrate his or her actual abilities.

The effects of an HFA youngster's symptoms on a family are diverse, and some symptoms can be extremely challenging. Adverse effects on a family can be difficult to isolate - and harder still to quantify. Sometimes, the symptoms exhibited by kids on the autism spectrum exceed what parents can manage.

The way parents adapt to the “special needs” youngster grows out of a complex interplay of his or her social skills, deficits, temperament, and the limitations and demands of other family members that must be met. 

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