Effective counseling for resistant teen

[Storygirl]

We did some counseling when DS15 was younger, and we are trying again, after it was suggested that it could be helpful by the psych who did his ASD evaluation last summer. I'm not convinced that we are seeing any progress. I'm also feeling that we are still at the beginning -- we started around the beginning of the school year -- and haven't given it enough time yet. On the other hand, if we aren't making progress, perhaps it's a sign that we should consider looking for a different counselor.

I really don't know how to judge this or make this decision.

What DS15 needs is to be able to change some of his thinking and work on managing his emotions. But he doesn't have a desire to change in these ways. How does a counselor make progress when they first have to convince the person that they have things that they should be working on?

We had a concern about counseling being effective when the person is not on board with the process, so we emphasized with the counselor that we thought the first step was for him to work on bonding with DS, so that DS would not mind going there and would be a willing participant. DS does like his counselor and has not complained about going (except for one comment this morning, when I reminded him that we are going after school), and that alone is a big success. But we are at a point now where having DS be willing to go is no longer a sufficient goal.

There are plenty of things to work on, but the counselor has a hard job. First, DS clams up and doesn't talk, so filling an hour of talk therapy time can be a challenge. The counselor asked DS to write about what is going well or poorly each day in a notebook and bring it with him, so that DS could look at his notes and have something to talk about. Which is a basically good idea, except that DS does not do this on his own and hates writing and thinking and talking about anything in this way, so I have to remind him to do it, and he hates doing things that I ask him to do, so we have not managed to do it consistently. I need to come up with a better system for getting the notebook done. Which is fine. It's just that I feel that makes me responsible for DS's efforts, instead of him taking responsibility and owning it. Which I think is needed for counseling to be effective.

So the counselor has me go in to his office for the first 15 or 20 minutes to talk about how things are going, while DS waits in the waiting room, then we switch, and I wait while DS goes in. Because DS doesn't talk, I can see that this is helpful. But it has created a weird dynamic, I think. I'm not sure that what I talk about is related to what DS and the counselor talk about. They do come out together to the waiting room, so that the counselor can do a 30 second wrap up discussion with me before we leave, and usually what he says has nothing to do with what I talked about at the beginning. So there is a kind of disconnect, where I lay out some problems, I think that maybe they will talk about them, but then the thing that DS is supposed to work on is not related to that.

I could say some more specifics, but I'll leave that for a follow up post and try to keep this OP more general.

The other thing is that DS does not take ownership of his own behavior and how it affects others. A very basic root issue, related in big part to his problems with Theory of Mind / perspective taking. So DS does want changes to happen, but he wants DH and me to change. The counselor, I guess (based on a conversation I finally had with him about this), is trying to get DS to work on negotiating and learning how to compromise. So when DS says that we make him do something he doesn't like (like studying), the counselor's response is for DS to talk to us about doing less studying. DS comes out of the session and will say later, "N says that you guys make me study too much, and I should only have to do 10 minutes of this and not 20" or similar. Which is frustrating, because it undermines what we are trying to do at home (DS has LDs and is a poor student, and we have had a lot of academic issues this year, so we are trying to build up more studying stamina, not reduce it).

I brought that issue up with the counselor, and he said he was trying to help with negotiating skills and was not intending to undermine parental authority. There are other things like this that we discussed -- the studying thing is just one topical example, but there have been other times that DS has said, "N says that you shouldn't be supervising me so much on this," etc.

So it turns out (big surprise) that N is actually telling DS things in counseling about ways that DS should be stepping up his efforts to prove to us that he can be more responsible and needs less oversight. DS just ignores the part that requires any effort from him, and he is taking away as the message that we need to change our parenting, but he is not working on changing any of his own behavior.

In the meantime, in my talks with N, I will talk about how hostile DS can be to us verbally (lots of arguing, demanding, telling us we are idiots, etc), and N coaches me (in a mild way; N is extremely mild mannered) on things like "When DS yells, try not to yell back, but lower your voice instead. Which is really hard to do, but can be effective." Fine! This is good advice.

But the overall take-away message so far is that DH and I need to change some parenting (not debating that we can learn new things, but we are not the root source of the problem), but that DS just gets to sit in the counselor's office for awhile each week and then come home and be the same as always without trying to do better.

Because DS really doesn't care to do better.

I suggested to the counselor that I come in at the end of the meeting instead of the beginning, so that after N and DS talk about for the goals for the week or agree on what DS should work on, I can be in the room to know how that discussion went. So that I can follow up on it with DS on at home better. So that DS knows that I know what N said, instead of having to take DS's word on it. And so that if N proposes something to DS that I disagree with or see that there will be problems executing, that I have a chance to contribute to the discussion.

Two weeks ago, I expressed some of this frustration to N. I had written down some notes ahead of time, as I prepared what to say, and N asked to see my notes, so I had the receptionist make a copy for him. N agreed that DS was focusing only on what N was saying that parents should change, instead of areas where DS should be stepping up. He agreed that it might help for us to have a group discussion at the end of the session to help us all be on the same page each week. N was surprised that DS was claiming that N was saying we needed to back off in parenting. He said that he had been trying to get DS to step up in effort, so that DH and I could step back in supervision, and he seemed really surprised that DS would leave off his part of what he was supposed to do when DS would convey to us what he was being told in counseling.

Last week, I had a headache, so DH went instead, and N didn't call DH in at the end, as we had decided the week before. I will see what happens today when I am there. DH came away from his time at the beginning of the session feeling like the things that N suggests to us as parents is too vanilla and generic. I can see why he feels that way, and I have felt the same. However, I also think that what N has suggested to me so far has lined up with what I would expect a counselor would say, so that his advice to us as parents is not wrong. Maybe it is not recognizing the intensity of our situation, though.

DS seems content to go and absorb a message that he should get to be more independent now and that we should back off. He is not learning, so far, anything about how to modify his own behavior.

And he doesn't want to modify his own behavior. We are the ones who want those things to change. So I am just pondering how counseling can be effective for a teen who doesn't want to change.

We are willing to try new things at home, so that as parents we can better support DS's growth toward independence in tasks. DS has huge EF issues (yes, medicated, and part of what we are doing is working with someone to tweak his meds). So yes, we are open to helpful guidance on things like that. But DS can't come away with a message from counseling that his parents need to be doing all of the changing, and that his thinking and behavior and treatment of other people is just fine.

I don't think that is the message that N intends to be sending, but it is what DS is absorbing. N is super mild mannered. Very Mr. Rogers like in temperament, though a different personality. I think that unthreatening persona has made it easy for DS to feel comfortable having sessions with him (willingness to go and bonding with the counselor were very important first goals). However, at home DS has always responded most to firm instructions. If you just suggest things or try to gently get him on board with things, he just will ignore what you say, or he will argue, and either way, he will stick with his own ideas about things. If there are things we need him to do at home, we have had to be firm and require them. Now, this does cause conflict, and I would prefer for us to be able to have a more amenable way to work with DS, and that is a big goal, that there be less strife and more cooperation.

But I'm trying to think in my mind about whether N is just not the right fit for counseling, because he is not so far been able to spur DS to try to work on anything. I'm sure he hopes that his sessions with DS end up with results at home, but they are not, so far. So should we seek a new counselor? Someone who is more of a straight shooter might be better? DS needs people to be direct and firm with him, but would he react to that by not wanting to go see a counselor?

DS does not talk about his feelings, so he doesn't benefit from just having someone to talk to about thing, as sometimes is the case with counseling. I would like for him to benefit from that, but it is not his personality. I would hope that if we had a long-standing relationship with a counselor, that maybe he could get to that point. Maybe. But he is not a talk-about-my-feelings guy, so what we are looking for is for counseling to help him work on changing behaviors that are causing problems with others at home.

If DS is not willing to work on behaviors, then what is the point of the counseling?

[Storygirl]

So how long does one stick with counseling without seeing some changes or results? How do you know if it is an issue of needing more time, because the problems are deep seated and won't be easy to fix, or if the counselor is not being effective and is not a good match?

And again, how can someone benefit from counseling, if they don't want to change?

At the moment, the only thing that I can think of is that we as parents could set up a way to work toward goals with motivation charts, or something, so that there is an external motivation. This can help (some) with habits, such as studying or room cleaning, etc.

But more than habits needs to change. Yes, we want to improve DS's functioning at tasks and willingness to do them. That's a big thing. And we can learn, perhaps, more effective ways to motivate him.

But he's about to turn 16. I'm concerned that he doesn't have internal motivation to work on improvement in the areas of responsibility for tasks, or personal relationships, or his emotional regulation.

He is not bothered by his behavior and emotional outbursts and negative interactions the way that DH and I are. DH and I have a lot of reasons that we want change. DS is content to be the person he is -- he actually likes being gruff and rough and tough and talks about how he wants others to see him that way -- so he doesn't have internal motivation to change.

I don't know if the answer is that DH and I should find a counselor for us, instead, to help us deal with things better, when things are not likely to change. Or if there is a reason to hope that change can happen.

The psych who did his autism evaluation thought that the right counselor could help DS make changes. She really emphasized that she believed it. So does that mean we don't have the right counselor? We are going to a place that specializes in autism, though they work with a lot of other issues, as well.

ETA: He only has angry outburst at home. Not at school or with peers. His angry outbursts are reserved for us parents.

Edited January 22, 2020 by Storygirl

[Storygirl]

If I made for you a list of all of the things that we think he needs to work on, it would be a very long list, so the examples I have included are just examples. I guess I just feel tired of our efforts not working with him, and now I feel like counseling maybe is not making a difference. I don't want to give up, but I don't want to devote our time and money to something that is not proving effective, either.

So how do we judge whether it is worth it or not?

[texasmama]

Resistant teens in counseling is the norm. This therapist has been able to gain rapport with your ds, which is good. However, you are correct that ds needs buy-in to motivate change. 
 

IMO, the therapist should not be surprised that ds is presenting only half of the information. That is typical both of teens and also of ASD. 
 

I think your gut is correct, that this counseling is ineffective. It may be the therapist is a mismatch or this may be the most ds can gain at this stage. I think social skills groups geared toward teens on the spectrum can be a wonderful resource but they are very difficult to find. 

As a therapist, I will say that change comes very painfully slow to ASD clients. As a mom of an ASD 19 son, I will add that just in the past 6 months has my ds begun effective counseling, and it is geared toward anxiety reduction and uses EMDR. He is now self- motivated to change due to discomfort and has the ability to implement change. 
 

 

[texasmama]

6 minutes ago, Storygirl said:

If I made for you a list of all of the things that we think he needs to work on, it would be a very long list, so the examples I have included are just examples. I guess I just feel tired of our efforts not working with him, and now I feel like counseling maybe is not making a difference. I don't want to give up, but I don't want to devote our time and money to something that is not proving effective, either.

So how do we judge whether it is worth it or not?

I think you have answered your own question. It is reasonable to stop counseling at this time and look at it in the future. A year or two with teens makes a world of difference. Helpful to me on my own parenting journey with my ASD kid is realizing that he is on his own time table as far as development and I cannot speEd it up, only support him where he is. My ASD kid has been a big family stressor and a big personal stressor for me so I don’t say that lightly. 

[Storygirl]

Thanks, texasmama. I value your input.

DS hated with a fiery passion going to his last social skills group about two years ago. He hated the idea so much that he didn't even give it a chance, and after one six-week session, I didn't sign him up again. He was extremely belligerent toward me for requiring him to go, so I am a little afraid to try again. But I would like for him to be able to benefit from a group. He does get individual work with an SLP at school.

I did get some information about a group for teens run by the autism center of our local children's hospital. At meetings, parents meet together for support, while teens have their group. I don't have a support group, so this might be a good option for us, even if DH and I just go at first to get connected until DS is ready to participate. I don't know if this particular group allows parents to join without their teens there, but I can ask.

And another thing I can do is ask our counselor to start talking with DS about social skills groups and how it can be helpful to have other teens to talk to. Because DS is more likely to agree to the idea if it doesn't come from me.

It's good to hear that some teens buy in to counseling when they are older. I can't believe DS is about to turn 16.

ETA: I am not afraid of trying, because I am afraid of his previous belligerance in any way. I am just afraid that suggesting trying a group will immediately generate resistance and, therefore, be counterproductive. I don't want to leave an impression that I am afraid of HIM.

Edited January 22, 2020 by Storygirl

[Storygirl]

Even though DS hates the idea of going to a group, there is a big benefit built in, that he is not the only one who expected to do any talking. There is also a drawback, in that he does better learning things 1:1 or in a very small group. Ideally, I think that both a social skills group and individual counseling would be beneficial to him, in combination, if we can get him to buy in.

 

[texasmama]

Good thoughts and ideas. Wishing you the best. This is a long haul marathon, for sure.

A therapeutic (therapist-run) social skills group should be small,  around 4-6 teens. In my experience, learning happens more effectively in a group setting with in-the-moment peer reactions and therapist guidance. Peers are amazing change agents for any age group.

A support group for you would be invaluable. I never found one that worked for my schedule, and I wish I had. 

[kbutton]

17 minutes ago, Storygirl said:

I did get some information about a group for teens run by the autism center of our local children's hospital. At meetings, parents meet together for support, while teens have their group. I don't have a support group, so this might be a good option for us, even if DH and I just go at first to get connected until DS is ready to participate. I don't know if this particular group allows parents to join without their teens there, but I can ask.

Could you promote it to your son as something for you, but that there is fun stuff for him if he goes?  Do they bill the group time as being fun? I wouldn't use the same terms to discuss this group and the previous social skills group even if this one is a social skills group.

Do they want typical peers in the group also? If so, would any of your other children go?

We do a lot of things as a family group, so my kids wouldn't think it odd to have something scheduled to keep them busy while adults meet, and we'd use that to our advantage in a situation like this. I am not sure if you have a way to build off of other things you do to make this seem like any other social event that has activities for multiple age groups at the same time. 

[PeterPan]

It's a hard thing when you realize professionals don't know what they're doing.

2 hours ago, Storygirl said:

DS does not talk about his feelings, so he doesn't benefit from just having someone to talk to about thing, as sometimes is the case with counseling.

That's what we found with ds too. He has a language disability, and putting him on the spot and saying TALK about your feelings doesn't work.

2 hours ago, Storygirl said:

we emphasized with the counselor that we thought the first step was for him to work on bonding with DS

You're asking someone to do something that they are not professionally trained to do, aren't inclined to do, and don't know how to do. The professionals who do this are usually BCBAs/behaviorists, and good luck finding a behaviorist who wants to work with teens. I haven't found an OT banging it out on interoception either, even though that would be another way to have that kind of relationship. (talking about feelings, being more aware, etc.)

2 hours ago, Storygirl said:

But DS can't come away with a message from counseling that his parents need to be doing all of the changing, and that his thinking and behavior and treatment of other people is just fine.

I don't think that is the message that N intends to be sending, but it is what DS is absorbing.

Yes, I think that's a psych/talk counselor thing to focus on personal responsibility, like if they just wanted to take responsibility they would be able to do it, that it's a volition problem rather than a significant skill gap. And when you talk problem solving (which is tested through the TOPS, which you've probably had done), there's spotty intervention on that. Like what, maybe with SLPs? There's sort of a mindset to it. I'm not sure that the way an SLP and a psych/counselor would approach problem solving would be the same. SLP materials for problem solving usually spend more time filling in holes and building mindset. And I agree with you on the danger of the psych/counseling approach. They tried it with my ds and it backfired spectacularly. He didn't have the skills to follow through at all.

2 hours ago, Storygirl said:

DS has said, "N says that you shouldn't be supervising me so much on this," etc.

Ok, so I'm just gonna ask and throw this out there, and I don't mean it like accusatory or personally or anything. Have you talked with the MD or a pdoc to see if maybe some mental health meds would be in order. The irrationality could be the social thinking, but I think maybe be open to the idea of maybe something for mood. Maybe getting that mood/depression/irritability/irrationality piece tidier would let the ds be in a better place to maybe think straight with the counseling he's being given. You cannot rationalize through mood disorder stuff. And I'm not even a fan of terms like that. I'm just saying if it's irrational, maybe rationalizing through it isn't going to get him there, maybe it's chemical, maybe a chemical solution THEN the thinking solution.

Edited January 22, 2020 by PeterPan

[PeterPan]

50 minutes ago, Storygirl said:

Even though DS hates the idea of going to a group, there is a big benefit built in, that he is not the only one who expected to do any talking. There is also a drawback, in that he does better learning things 1:1 or in a very small group. Ideally, I think that both a social skills group and individual counseling would be beneficial to him, in combination, if we can get him to buy in.

 

You already tried a social skills group, right? I think you'll probably find more, but maybe consider a change on the chemistry side (mood, irritability) before doing that again.

[texasmama]

3 minutes ago, PeterPan said:

You're asking someone to do something that they are not professionally trained to do, aren't inclined to do, and don't know how to do. The professionals who do this are usually BCBAs/behaviorists, and good luck finding a behaviorist who wants to work with teens. 

Not accurate regarding counselors. They are trained that gaining rapport is the first step of effective counseling. 

[PeterPan]

1 minute ago, texasmama said:

Not accurate regarding counselors. They are trained that gaining rapport is the first step of effective counseling. 

They're not likely to do what it actually takes. Like come in and play nerf and nintendo for an hour every week for months. Or like jimtaylorknowsautism.comJim Taylor: Knows Autism: Home talks about where he went every week and played chess with the guy. 

And the goal is still TALK and the person with more experience with autism talks LESS.

[texasmama]

I may have misunderstood, but it was my impression that the ds is on psych meds.

Psych meds do have a place in the treatment of mood disorders. I have found that can be a trickier situation to find the right fit for complex kids, and kids on the spectrum are complex, for sure. 

[PeterPan]

She's mentioned he's on meds for the ADHD, but I don't know about more, which is why I brought it up. 

Is there a longterm plan to get him living in some kind of supported living, group living situation? Maybe working on that and working backward, like who they trust there, how they build those relationships, get referrals from them... I would think if he's this stressful you're looking for a place for him to live in a few years. I mean, ds isn't that stressful (except for the problems, lol), and I'm planning on him being OUT. Might not happen, but that's my assumption. As soon as the IEP is over, out.

[Storygirl]

14 minutes ago, PeterPan said:

It's a hard thing when you realize professionals don't know what they're doing.

That's what we found with ds too. He has a language disability, and putting him on the spot and saying TALK about your feelings doesn't work.

You're asking someone to do something that they are not professionally trained to do, aren't inclined to do, and don't know how to do. The professionals who do this are usually BCBAs/behaviorists, and good luck finding a behaviorist who wants to work with teens. I haven't found an OT banging it out on interoception either, even though that would be another way to have that kind of relationship. (talking about feelings, being more aware, etc.)

Yes, I think that's a psych/talk counselor thing to focus on personal responsibility, like if they just wanted to take responsibility they would be able to do it, that it's a volition problem rather than a significant skill gap. And when you talk problem solving (which is tested through the TOPS, which you've probably had done), there's spotty intervention on that. Like what, maybe with SLPs? There's sort of a mindset to it. I'm not sure that the way an SLP and a psych/counselor would approach problem solving would be the same. SLP materials for problem solving usually spend more time filling in holes and building mindset. And I agree with you on the danger of the psych/counseling approach. They tried it with my ds and it backfired spectacularly. He didn't have the skills to follow through at all.

Ok, so I'm just gonna ask and throw this out there, and I don't mean it like accusatory or personally or anything. Have you talked with the MD or a pdoc to see if maybe some mental health meds would be in order. The irrationality could be the social thinking, but I think maybe be open to the idea of maybe something for mood. Maybe getting that mood/depression/irritability/irrationality piece tidier would let the ds be in a better place to maybe think straight with the counseling he's being given. You cannot rationalize through mood disorder stuff. And I'm not even a fan of terms like that. I'm just saying if it's irrational, maybe rationalizing through it isn't going to get him there, maybe it's chemical, maybe a chemical solution THEN the thinking solution.

The counselor agreed that he needed to bond with DS before working on goals with him and said that his personal feeling is that 80% of success in therapy is dependent upon whether the person has a positive relationship with the counselor. The last guy we went to didn't try to connect with DS at all but just jumped into working on communication skills , which were hard for DS, and he hated it (we started working with him for another specific reason and continued with him for some counseling for a bit).

So I was content with a slow and gentle start. I think this counselor got that right, because DS really doesn't mind going and likes N.

But I'm not sure that the counselor has the skills to take that trust that he has been working on and build upon it to help DS work on changes. And it is really hard to do that. DS is not going to be able to follow through with working on goals unless DH and I are in the loop and are working together with him at home. Because 30-45 minutes of talking with someone in a room once a week is not enough. The work in between is what will make the difference, but it's DH and me who have to ensure that happens, because DS has no initiative.

Yes, we are seeing someone about med adjustments, and several ideas are on the table. We are starting with tweaking his current meds first, because we can change around dosages and timing to make sure what we have now is optimized before we add something on. It's going to take a little time to figure it out, because with each change, we will have awhile to watch and determine the effect before trying the next thing. We are adjusting his clonidine this month. We may make another change to the clonidine at our next appointment. If that's not enough, we may add Strattera to our mix. Then we move on from there to other things. We could, I suppose, tell the nurse practitioner (works under a psychiatrist) that we want to jump ahead to the mood stabilizers, and maybe she would agree, but we decided to do it this way.

[Lecka]

Okay — here is my opinion.  Maybe sometime in the next 2-3 years he will have some glimmer of wanting to change his behavior.  Maybe there will be some glimmer from some situation, and if that happens — bam, he’s in with a counselor, ready to take advantage of it.  
 

I also think there is hope with trying medication that it could help make counseling more effectiveness (maybe with less reflexive opposition).  I think it happens sometimes for people.  It would be nice and I think it does happen sometimes.

I think with theory of mind, I have heard accounts where a speech therapist will go over the same ground (like going over a behavior-related incident hoping to help the teen see how they came across or mis-construed or whatnot) and the teen refusing to see another way, insisting things aren’t fair to them or it’s other people starting things and they have no choice, etc, and then after even a year starting to see a glimmer, even after lots of time with no glimmer whatsoever.  This can be that it can be sinking in a little, or it can be some situation comes up where the teen does have some motivation to make the situation work out.  
 

This whole issue comes up a lot on the Social Thinking website.  They say that knowledge and possibly seeing things when it’s a 3rd party situation and not themselves, comes before applying it to themselves, or motivation.  
 

I think the theory of mind part has a skill element and then sometimes skill has to be there to support the thought processes that would lead to motivation.  
 

When cause and effect are weak it can take so much repetition to build concepts and it gets short-circuited when somebody already says “I already know the answer, the answer is it’s not fair to me.”  But I do think little bits get through the cracks over time.  Hopefully, at least.   
 

The meetings with parents sound good.

Bottom line — I could be wrong, but I don’t think this is something where anybody has any really good answer.  I think the people with the best possible solutions and outcomes are doing “drip drip drip” over a long, long period of time, and doing things like looking at improvement over a 2-3 year time span.  That basically means — pretty small, slow improvement.  But it can also be really meaningful.

And then I think at a certain point there are no guarantees but when it is a sensible recommendation sometimes it is worth doing in case it will turn out good.  I have felt like this numerous times and sometimes it ends up good, sometimes it ends up seeming questionable, but sometimes there is just no way to predict ahead of time so there is nothing for it but to try.  
 

I also think — so right now he willingly goes, and he also speaks?  Going just to sit silently is still getting in the door, but if he goes in and does speak, I think that is worth trying to acknowledge as a higher goal than just going.  I think if you were saying he went but just sat there and didn’t participate at all or speak at all, I would say “it’s time to pull the plug.”  That he does talk and participate — it really is something.  

[kbutton]

9 minutes ago, texasmama said:

Not accurate regarding counselors. They are trained that gaining rapport is the first step of effective counseling. 

Are counselors specifically trained to be able to reach people with language disorders? Our experience challenges that strongly, but I am interested in hearing what counselors are trained to do with people who have a language difficulty.

I don't have time to try to write super diplomatically, and my tone is a frustration with the broader ideas about autism that are out there, not you. I know you are very vested, educated, and have a lot of personal experience with more facets of this issue than I do, so please don't think this is aimed at you.

Most people with autism have some kind of language difficulty, and while it's assumed to be primarily with pragmatic language, I think people are finding that it's much broader than that, and it's not always obvious. BCBAs with their ABA and language background had better luck with my son than most professionals, but most still assumed that when my son was stuck, the problem was intrinsic, motivational, ADHD, or lack of character. None of that turned out to be true, but we would've believed these WRONG professionals if we hadn't seen my son's intrinsic motivation and strong work ethic in other areas of life. 

Finding the right thing to test my son's language skills was super hard. It's almost like 90% of what is wrong with my son's language is stuff that is not testable. We finally did get some materials to help, but wow. It's been hard. But NO ONE understood the extent to which this was a problem in his personal communication because he seems fine. (Part of that is not realizing how much he has going on under the hood--profoundly gifted on top of the autism. but the gifts majorly mask the difficulties.)

Anyway, the person who diagnosed my son is an ed psych that does counseling with a lot of people on the spectrum, including gifted ones, and my son was still a big surprise to her. Our quest to find adequate language testing for him changed the way she tests for things. Even then, we had to find our own therapy materials (which we have since shared with her). He doesn't currently do talk therapy.

Even when we work on my son's IEP, we have to continually fix goals that we think sound fine but in reality expect language that is NOT there at all or isn't there under stress. Simple, simple self-advocacy goals have to be made completely wordless. We now use color-coding. Color-coding for a kid with a Davidson level IQ (his verbal IQ lags behind his nonverbal IQ, but it's still extremely high). 

I really don't think most counselors are trained for that, and if a kid with as many compensatory mechanisms as my son has struggles, kids with greater challenges must really be at a loss.

[Storygirl]

Right now he takes Concerta and Clonidine only, but things might be added to that as we go along. It took us months to get in, so we just had our first psychiatric appointment a couple of weeks ago.

[kbutton]

2 minutes ago, Lecka said:

Bottom line — I could be wrong, but I don’t think this is something where anybody has any really good answer.  I think the people with the best possible solutions and outcomes are doing “drip drip drip” over a long, long period of time, and doing things like looking at improvement over a 2-3 year time span.  That basically means — pretty small, slow improvement.  

Yep.

And then if they can actually see the specific problem with the specific individual and find some materials, it can improve a little better/faster or at least be more effective in the long-term.

[Lecka]

I also think — are you still possibly looking for speech therapy?

There are therapy materials for theory of mind.

I think things where they write out each side on a piece of paper can make it more concrete.  A lot of approaches do something like this where they use a template of some kind and actually write the different perspectives down and then compare them.  (It is also called perspective taking btw.)

I have seen it with cartooning and there is a template in the Mindwings autism manual.  
 

It is supposed to be good to work on it with fiction or a tv show, or a situation that isn’t personally involving the student, first, and not just use it with examples with the student.  But then also people do this after behavior incidents or misunderstandings (but like the next day).  
 

It would be great if the counselor does things like this.  You could ask if he can add it in or use templates.  Or if he has another suggestion or some reasoning.  This is pretty standard autism stuff and he might have some suggestion or something for it.  
 

I address through reading out loud, and there are times when my son can not grasp things even with explanation etc but I do think he has improved with practice.  

[Lecka]

Look, there are so many risks to changing.  
 

First, you have no evidence of the guy not having the ability.  It is just going slow.  Well — that is reality.

Second, changing risks your son feeling he put himself out there and then after a few months he has to change.  That can make — even a better new counselor — not work out as well.  That is just how it can be.  You also risk your son feeling like he can “wait out” counseling, that you guys aren’t really committed to it, so why should he be committed to it.

Third, the counseling thing has to work for your son.  Yes, it should work for you too.  It should.  But it has to work for him first and primarily for him.  You really can’t make it about working for you.  You can’t try to change it to be about accomplishing goals a, b, and c for you.  Because that is just not how buy-in happens.  
 

It’s not a nice situation but I don’t think that changing is going to help unless you have major, major reasons to think a change will truly be better. 
 

And it doesn’t sound that way.  It sounds like patience is warranted and also like — maybe outcomes are pretty unknown, but it seems like it is worth the effort.  
 

I think too, it is so valuable for your son to have someone he talks to every week who likes him and is on his side.  That is so valuable.  He might not really have that anywhere else.  I think a parent role needs to be different than this, but many kids his age get this from friends or teachers etc.  He needs this the same as anyone else his age and probably struggles to get it.  Edit:  I think it can be preventive of worse rebelliousness or acting out, I really do.  What I mean is — it keeps him from getting all his good feedback and recognition being for things like acting stupid or pushing the envelope in some way.  And I don’t think this is a role parents can take, but I think a counselor can.  
 

Also a verbal outlet for complaining is always better than acting out.  It just is.  It would be better to show maturity and problem-solving and emotional regulation — but if those aren’t on the table as much — verbal is always better than acting out, by a thousand.  Edit:  I mean here complaining to the counselor if hopefully it is an outlet...... I don’t mean if he is acting out verbally (like — not a calm discussion of complaints — which I assume is what happens with the counselor).  

Edited January 22, 2020 by Lecka

[Storygirl]

As for what we think for his future... we don't know. He participates in vocational rehabilitation, so he will have help getting a job, but we can't predict how his employability will go yet. He may be able to do a steady, regular, low demand job and stick with it. He might hate that and not be able to persist. He comes across as a guy who could do more than he is able, so the school thinks in his transition plan that he can go to vocational school. But I am looking at things without blinders on, and I don't think he can do vocational ed, for various reasons that could be a thread of their own. And he doesn't want to go there (we visited and have talked about it) and is rejecting ideas presented to him.

So he's likely going to live with us or live in an apartment that we pay for. We did just set up a STABLE account, so we are starting to plan for that possibility.

As much as I want all of my kids to find someone to marry and settle down with, I think he would be a very difficult husband.

Not a group home of any sort. He could live in an apartment by himself, eventually, I think, if he needed to and had support. He might not be able to cook much, but he can microwave things. He knows how to clean things but would probably need to have a housekeeper hired. I don't know if he will be able to learn to drive. But he should be able to get himself up and to work (maybe on a bus?) and back home, and he has a hobby that he can pursue for his down time.  But there is still a lot of growth needed before then, so who knows. Definitely not right after high school graduation. He won't be ready.

[kbutton]

Great book: https://www.thriftbooks.com/w/social-skills-activities-for-secondary-students-with-special-needs_darlene-mannix/580403/item/3994364/?mkwid=Ixihvvkm|dc&pcrid=70112885352&product=3994364&plc=&pgrid=21326561472&ptaid=aud-376656234175%3apla-294813787116&utm_source=google_shopping&utm_content=Ixihvvkm|dc|pcrid|70112885352|pkw||pmt||product|3994364|slid||pgrid|21326561472|ptaid|aud-376656234175%3apla-294813787116|&gclid=EAIaIQobChMIhY2jhdOX5wIVR9bACh1-XwOCEAQYASABEgIg8vD_BwE#isbn=0470259361&idiq=3994364

Also the ECLIPSE model stuff and the CAPS stuff. 

Use any professional that will establish a rapport with your son and do stuff that is in these books. Seriously. If the counselor will look at it--great. Our first ABA person did, and it was wonderful. She changed employers, and we lost her to a non-compete agreement. Second ABA person said she would and didn't. About 3 weeks before our last session together (because she was doing something else and not doing it well), she got the book I linked to first, and she started using it with him. It was fantastic for those last three weeks, lol. We still let her go--it was too little too late by then.

Almost everything will need a little tweaking, but these options are a potential place to start. I think starting there with someone that is used to the refusals, theory of mind issues, etc. is a great way to get the job done. 

[kbutton]

3 minutes ago, Lecka said:

Look, there are so many risks to changing.  
 

First, you have no evidence of the guy not having the ability.  It is just going slow.  Well — that is reality.

Second, changing risks your son feeling he put himself out there and then after a few months he has to change.  That can make — even a better new counselor — not work out as well.  That is just how it can be.  You also risk your son feeling like he can “wait out” counseling, that you guys aren’t really committed to it, so why should he be committed to it.

Third, the counseling thing has to work for your son.  Yes, it should work for you too.  It should.  But it has to work for him first and primarily for him.  You really can’t make it about working for you.  You can’t try to change it to be about accomplishing goals a, b, and c for you.  Because that is just not how buy-in happens.  
 

It’s not a nice situation but I don’t think that changing is going to help unless you have major, major reasons to think a change will truly be better. 
 

And it doesn’t sound that way.  It sounds like patience is warranted and also like — maybe outcomes are pretty unknown, but it seems like it is worth the effort.  
 

I think too, it is so valuable for your son to have someone he talks to every week who likes him and is on his side.  That is so valuable.  He might not really have that anywhere else.  I think a parent role needs to be different than this, but many kids his age get this from friends or teachers etc.  He needs this the same as anyone else his age and probably struggles to get it.  Edit:  I think it can be preventive of worse rebelliousness or acting out, I really do.  

What about adding services on the side that tackle some of the ASD stuff therapeutically, and then eventually having the counselor talk to her son about how that's going? 

I agree that the relationship sounds really good for him, but I feel like the counselor is actively undermining parental influence because he's not understanding the dynamic. He's letting Ryan think his parents are a drag at best and actually wrong at worst. 

[Lecka]

I don’t think he is “letting him” think anything.  I think he’s just failing to get through to him.  I think it is extremely hard to get through, not a baseline expectation.  
 

Edit:  what I mean is — yes, he does think these things.  But could somebody else change it?  Is the counselor realistically causing this?  Or is that what he would walk out thinking after anything, because it is what he thinks?  That is what I assume.  

Edited January 22, 2020 by Lecka

[Storygirl]

18 minutes ago, Lecka said:

Okay — here is my opinion.  Maybe sometime in the next 2-3 years he will have some glimmer of wanting to change his behavior.  Maybe there will be some glimmer from some situation, and if that happens — bam, he’s in with a counselor, ready to take advantage of it.  
 

I also think there is hope with trying medication that it could help make counseling more effectiveness (maybe with less reflexive opposition).  I think it happens sometimes for people.  It would be nice and I think it does happen sometimes.

I think with theory of mind, I have heard accounts where a speech therapist will go over the same ground (like going over a behavior-related incident hoping to help the teen see how they came across or mis-construed or whatnot) and the teen refusing to see another way, insisting things aren’t fair to them or it’s other people starting things and they have no choice, etc, and then after even a year starting to see a glimmer, even after lots of time with no glimmer whatsoever.  This can be that it can be sinking in a little, or it can be some situation comes up where the teen does have some motivation to make the situation work out.  
 

This whole issue comes up a lot on the Social Thinking website.  They say that knowledge and possibly seeing things when it’s a 3rd party situation and not themselves, comes before applying it to themselves, or motivation.  
 

I think the theory of mind part has a skill element and then sometimes skill has to be there to support the thought processes that would lead to motivation.  
 

When cause and effect are weak it can take so much repetition to build concepts and it gets short-circuited when somebody already says “I already know the answer, the answer is it’s not fair to me.”  But I do think little bits get through the cracks over time.  Hopefully, at least.   
 

The meetings with parents sound good.

Bottom line — I could be wrong, but I don’t think this is something where anybody has any really good answer.  I think the people with the best possible solutions and outcomes are doing “drip drip drip” over a long, long period of time, and doing things like looking at improvement over a 2-3 year time span.  That basically means — pretty small, slow improvement.  But it can also be really meaningful.

And then I think at a certain point there are no guarantees but when it is a sensible recommendation sometimes it is worth doing in case it will turn out good.  I have felt like this numerous times and sometimes it ends up good, sometimes it ends up seeming questionable, but sometimes there is just no way to predict ahead of time so there is nothing for it but to try.  
 

I also think — so right now he willingly goes, and he also speaks?  Going just to sit silently is still getting in the door, but if he goes in and does speak, I think that is worth trying to acknowledge as a higher goal than just going.  I think if you were saying he went but just sat there and didn’t participate at all or speak at all, I would say “it’s time to pull the plug.”  That he does talk and participate — it really is something.  

The bolded made me laugh in a "haha, you got that right" way. That is just what DS is like.

He does talk to N during the sessions. But I'm not sure how much. DS is an entirely different person at home than he is with teachers at school or with his counselor, so N will not see his true personality. I guess you could say that he will only see the clamming up part of DS's personality. DS won't show him the angry oppositional side or the creative talkative guy who loves a certain kind of teenage boy humor. Around N, DS will say the minimum and only "yes" or "no" if he can get away with it. Or at least until he gets really comfortable.

Partly, I think that until DS gets really comfortable, so that N can see his real personality, that progress will be limited. There may be benefit to sticking it out to let the relationship build, so that eventually he could make a little progress. It could take a long time for a small result.

[kbutton]

2 hours ago, texasmama said:

IMO, the therapist should not be surprised that ds is presenting only half of the information. That is typical both of teens and also of ASD. 

I think your gut is correct, that this counseling is ineffective. It may be the therapist is a mismatch or this may be the most ds can gain at this stage. 

As a therapist, I will say that change comes very painfully slow to ASD clients. As a mom of an ASD 19 son, I will add that just in the past 6 months has my ds begun effective counseling, and it is geared toward anxiety reduction and uses EMDR. He is now self- motivated to change due to discomfort and has the ability to implement change. 

 

5 minutes ago, Lecka said:

I don’t think he is “letting him” think anything.  I think he’s just failing to get through to him.  I think it is extremely hard to get through, not a baseline expectation.  

Hmm...do you think that maybe anxiety is at play? Like language difficulties, I think that's another kind of pervasive thing with autism that can seem like the problem is something else, but really, it's just anxiety.

Maybe it's less anxiety producing to think, "My parents are the problem" than it is to think, "I need to change, and it will be hard to learn new skills." And of course, feeling it/reacting to it and thinking it in words are not the same thing--you can just feel it and not really understand that's what's up.

 

[Lecka]

That makes sense that he talks some but isn’t really opening up.  I think it is worth it to see if a time investment goes anywhere.  It’s easy for me to say, ha!  
 

With my relative — I don’t think “oh this ends at a certain age, or level of school.”  There can be glimmers at an older age and after a level of school is completed.  Really there’s not a time to give up or stop trying.  Not to say counseling specifically has to go on.  But there can still be more growth.  
 

I think when there’s a lot of defensiveness it is hard to have that little space where maybe something can get through.  But I think it can happen.  

[Storygirl]

25 minutes ago, Lecka said:

I also think — are you still possibly looking for speech therapy?

There are therapy materials for theory of mind.

I think things where they write out each side on a piece of paper can make it more concrete.  A lot of approaches do something like this where they use a template of some kind and actually write the different perspectives down and then compare them.  (It is also called perspective taking btw.)

I have seen it with cartooning and there is a template in the Mindwings autism manual.  
 

It is supposed to be good to work on it with fiction or a tv show, or a situation that isn’t personally involving the student, first, and not just use it with examples with the student.  But then also people do this after behavior incidents or misunderstandings (but like the next day).  
 

It would be great if the counselor does things like this.  You could ask if he can add it in or use templates.  Or if he has another suggestion or some reasoning.  This is pretty standard autism stuff and he might have some suggestion or something for it.  
 

I address through reading out loud, and there are times when my son can not grasp things even with explanation etc but I do think he has improved with practice.  

Oh, yeah, the speech therapy thing. He gets it at school but not enough. I was researching private providers before the holidays, but then we detoured in our priorities and worked on getting him an OT evaluation for driving first. Now that that's done, I need to go back to the SLP search. I did get a recommendation for someone who works with teens, so I have a name to call. I also picked up a few cards at a conference recently, and I should go back through them to see if anyone might be helpful. Of course, when you stop at a booth at a conference, the response I get is "yes, we have people who do that" but it takes some more effort and research to figure out if they actually offer what he needs.

I think if we can find the right SLP to do language work, that it might have a bigger impact than counseling at this point. Because then if his communication can improve, results from counseling are more likely to improve (I would think).

[Lecka]

I think anxiety is a good idea.  
 

I don’t think it is always the main or mainly contributing thing.  
 

But I think it can be and when it is — it’s the way to go.  Or even if it’s just one factor, it can help a lot.  
 

But I don’t think it’s possible to know specifically or possible to think it’s going to be the key thing in every case.  

Texasmama — that is awesome and I am going to remember that for the future 🙂. 

[Storygirl]

4 minutes ago, kbutton said:

 

Hmm...do you think that maybe anxiety is at play? Like language difficulties, I think that's another kind of pervasive thing with autism that can seem like the problem is something else, but really, it's just anxiety.

Maybe it's less anxiety producing to think, "My parents are the problem" than it is to think, "I need to change, and it will be hard to learn new skills." And of course, feeling it/reacting to it and thinking it in words are not the same thing--you can just feel it and not really understand that's what's up.

 

DS is funny about anxiety. He has a GAD diagnosis. He has had some behaviors related to anxiety, perhaps, though also perhaps with perseverative thinking, which can be related to anxiety. It can be a loop. It's hard to tell what is related to anxiety. He doesn't come across as a worrisome guy. But he doesn't talk about what he is feeling or thinking, and sometimes I think he really doesn't know what he is feeling and thinking, so there could be a lot of anxiety underlying things.

Interestingly, when we told him we were seeing someone new about meds, he asked if there was a medication for anxiety, because he wanted some. But then he can't say why he thinks he needs it.

[Lecka]

Really — I think there can just be thought processes that are causing problems,  just from being fallacies.  I think that can be the underlying thing.  Again — who knows with a specific person, but I do think it can be.  
 

And then there’s always times there are a lot of things going on at the same time!  
 

I do feel like though — I have times I have really relaxed conversations about things that are not “Issues” in any way — just whatever things — and see evidence of thought processes that are contributing to problems.  
 

But I think anxiety is important, too.  I think it can also be really contributing or the main thing.  

[Storygirl]

26 minutes ago, kbutton said:

Great book: https://www.thriftbooks.com/w/social-skills-activities-for-secondary-students-with-special-needs_darlene-mannix/580403/item/3994364/?mkwid=Ixihvvkm|dc&pcrid=70112885352&product=3994364&plc=&pgrid=21326561472&ptaid=aud-376656234175%3apla-294813787116&utm_source=google_shopping&utm_content=Ixihvvkm|dc|pcrid|70112885352|pkw||pmt||product|3994364|slid||pgrid|21326561472|ptaid|aud-376656234175%3apla-294813787116|&gclid=EAIaIQobChMIhY2jhdOX5wIVR9bACh1-XwOCEAQYASABEgIg8vD_BwE#isbn=0470259361&idiq=3994364

Also the ECLIPSE model stuff and the CAPS stuff. 

Use any professional that will establish a rapport with your son and do stuff that is in these books. Seriously. If the counselor will look at it--great. Our first ABA person did, and it was wonderful. She changed employers, and we lost her to a non-compete agreement. Second ABA person said she would and didn't. About 3 weeks before our last session together (because she was doing something else and not doing it well), she got the book I linked to first, and she started using it with him. It was fantastic for those last three weeks, lol. We still let her go--it was too little too late by then.

Almost everything will need a little tweaking, but these options are a potential place to start. I think starting there with someone that is used to the refusals, theory of mind issues, etc. is a great way to get the job done. 

I've looked at links for the above book before -- maybe recommended by you LOL -- and I think put it in a cart. Or I got it from the library? Now I can't remember. But then I wondered if it was more for group work than 1:1. Do you have an opinion about that?

I have the ECLIPSE and CAPS books, but I need to pull them out. Thanks for the reminder.

[kbutton]

2 minutes ago, Storygirl said:

DS is funny about anxiety. He has a GAD diagnosis. He has had some behaviors related to anxiety, perhaps, though also perhaps with perseverative thinking, which can be related to anxiety. It can be a loop. It's hard to tell what is related to anxiety. He doesn't come across as a worrisome guy. But he doesn't talk about what he is feeling or thinking, and sometimes I think he really doesn't know what he is feeling and thinking, so there could be a lot of anxiety underlying things.

Interestingly, when we told him we were seeing someone new about meds, he asked if there was a medication for anxiety, because he wanted some. But then he can't say why he thinks he needs it.

That is potentially huge. 

In other conversations, he comes across as anxious to me. With what texasmama said about her son, I think it could really be the crux of things for you guys. 

[kbutton]

3 minutes ago, Storygirl said:

I've looked at links for the above book before -- maybe recommended by you LOL -- and I think put it in a cart. Or I got it from the library? Now I can't remember. But then I wondered if it was more for group work than 1:1. Do you have an opinion about that?

I have the ECLIPSE and CAPS books, but I need to pull them out. Thanks for the reminder.

I don't know if it's for individual or group work because the BCBA used it with him, and she adapted it--like, he needed some of the same concepts, but he needed it at a different level than the book was designed for. She bridged that gap but used the book to have kind of a checklist and general sense of where to take things. 

ETA: I don't even own the book, lol! But the BCBA loved it when she realized how she could use it with him. It was just that she did everything except this for a long time, even though we asked her to do this kind of thing from day 1 because it was so effective with the first ABA person. Sigh. But she found his language issues (while also not realizing how bad they were and blaming him when her "very fine intervention, thank you" wasn't deep enough to fix the problem), so it wasn't a total loss.

Edited January 22, 2020 by kbutton
Additional information

[Lecka]

What *I* have seen contributing to that “it’s not my fault, I had no choice,” is 

1) feeling like people always say “what you are feeling is wrong, what you think is wrong.”  That is a situation someone can have when they are just always told they are wrong and don’t understand.  My relative’s mom had a sigh she would do, and by the time he was a teen my relative would just get his back up when he heard that sigh, and think “I am always wrong, but I don’t feel like I am always wrong, so why should I care how I am wrong again.”

2)  just not seeing the same things in interactions that others see, and this leading to a misunderstanding.

And maybe not the personality to feel anxious about “always being wrong,” as much as just “whatever — I guess I will be belligerent, since nothing else gets me anywhere, and people always say I am doing things wrong anyway.”  Which — maybe that is also anxiety?  But I don’t know if it is or not.  
 

I think it helps this relative to be accepted on his own terms.  But there are still difficulties as he can still BE rude even if it is not intentional.  But it is better than trying to police him when he just experienced it as criticism and can’t see where people are coming from too much.  
 

But my relative does see a counselor and I think it is positive for him, even though he’s not “better” — but he has changes and can gain more insight.  Sometimes over things we have all thought he would never get and then we realize “oh, he’s actually better about this thing,” but it’s so gradual it’s hard to see it or notice it.  

[kbutton]

So, things that I've seen happen with anxiety that don't seem like anxiety: defiance, rigidity, lack of perspective taking even when skills are present for that situation, meltdowns, AVOIDANCE, TASK REFUSAL, silliness, controlling behavior, grouchiness, snippy attitude, turning the blame back on someone else, defensiveness.

That's without a GAD diagnosis--that's with what is considered situational anxiety.

Add in the inability to specify what the problem is (i.e. I don't understand how the directions apply to this task, I don't know how to fix what I'm doing to match what is expected, I don't have x skill that this task requires, and so on), and it's ugly. Just in our case, the language crops up and causes the anxiety, or ADHD crops us and causes the anxiety. It's ALL there, but the quantities and the way it's tossed together differ, like the difference between pancakes and biscuits, lol!

 

 

[kbutton]

Oh, and explosiveness can be anxiety. We had that until more skills were learned. Then it turned into going mute to avoid exploding. Better but still not a "fix."

[Lecka]

You are getting good feedback for anxiety!!!!!!  I hope it is promising.

I have seen a long Eclipse video.

They start by teaching skills individually or in a small group.  Then they have things as a class or large group.  So it is both individual and group.

A skill level will determine their readiness for individual or small group or large group.  That is what I remember at least.  
 

It is one that talks about attribution which sounds like it would be helpful!

The power point and video I saw for it are very good.  I ended up not buying the book.  I will see if I can find that again if you might rather watch a video.  

[Storygirl]

He really just can't see things from another point of view. It's a big stumbling block. Here is a simplified version of a conversation that we have daily.

DS: Why do I have to eat breakfast? I'm not hungry. It's dumb.

DH or me: Because you don't eat lunch after you have taken your meds, so you need to eat now. You need energy for the school day, so that you can learn.

DS: That's dumb. I'm not hungry. I hate school and don't want to learn. You guys are mean on purpose. Idiots.

Interspersed with yelling and stomping, etc, and generally poor and hostile interactions with us.

We've been working on the breakfast things for years and have tried a bunch of ideas, and my point of posting is not really to talk about breakfast. But just to show that he can't take in an idea that is not his own, even when the idea is logical, and even when the idea has been repeated daily for years and years and years.

And even when he has asked the question!! He won't listen to the answer, because he doesn't like it.

N's thought was to let him skip breakfast and feel the natural consequences of being hungry. But DS won't feel hungry, so that means being at school for the whole day with no nutrition, so I'm not okay with it, given his trouble with academics as it is.

My goal would be for DS to work through somehow to accepting that he needs to eat, even when he doesn't feel hungry, to think of food as necessary fuel. DS is a really really long way from having this view, but working toward it would be good, not only so that he can eat breakfast, but so that he can understand how to switch his thinking and listen to other points of view.

I would rather that N help DS work through his thinking on problems like this, but instead he seems to be always on DS's side. "Okay, how can we help your parents understand that you don't want to eat?"

And it's not about "sides" but about helping DS be able to accept our point of view sometimes. Because not being able to accept a point of view other than your own is a big big problem, much greater than the example of not wanting to eat breakfast.

And being able to interact with people that you disagree with without being rude. What I typed out up there does not include the angry inflection and yelling and hostility involved.

And then sometimes I think that well, at least he does not interact in that way with anyone other than DH and me. So perhaps the ultimate solution is for him to grow up and not have to live with us, and that we just have to endure it, because we haven't been able to effect change.

But then I think about him having a girlfriend or a wife and kids, and it just worries me so much that I hope he does not. And then I feel badly, because I don't want him to be lonely, And then I say that even if we don't improve our relationship with him, that it's worth it for him to work on skills that he can use with other people.

And N's advice is for us to let him skip breakfast and to work hard not to raise our own voices when he raises his.

Which is not horrible advice, but is just kind of advice lite, if you know what I mean.

I know it can take time to dig down to the issues, and I do value that DS likes N and hope that the relationship can grow, and I do think that if we try to switch counselors, there is no guarantee that someone else might be someone that DS likes as well or who will help him make further progress.

And maybe this kind of stuff is more the realm of a language focused SLP, if we can find one that DS likes. He likes his SLP at school, and she understands his issues, but there just is not enough time with her, and she and her employer do not do private therapy.

 

Edited January 22, 2020 by Storygirl

[Lecka]

This is the power point for Eclipse Model:  http://www.kansasasd.com/webinar_attach/_KansasJan11.pdf

I think this is the webinar.  My internet is slow.  
http://www.kansasasd.com/webinararchive.php?aid=15

I listened to it a few times while doing laundry or whatever, but it has been a few months ago now.  

[Lecka]

Is there any chance of embedding perspective taking into his reading instruction?  Just throwing it out there.  Characters in books have perspectives, they can have different perspectives, etc, it can go along with talking about characters or historical figures (Mindwings does this, and it’s something I think teachers can just add in if they know it is a need for their students).  

[Lecka]

I am sorry he is so difficult about breakfast, and other things.  

Edited January 22, 2020 by Lecka

[texasmama]

41 minutes ago, kbutton said:

So, things that I've seen happen with anxiety that don't seem like anxiety: defiance, rigidity, lack of perspective taking even when skills are present for that situation, meltdowns, AVOIDANCE, TASK REFUSAL, silliness, controlling behavior, grouchiness, snippy attitude, turning the blame back on someone else, defensiveness.

That's without a GAD diagnosis--that's with what is considered situational anxiety.

Add in the inability to specify what the problem is (i.e. I don't understand how the directions apply to this task, I don't know how to fix what I'm doing to match what is expected, I don't have x skill that this task requires, and so on), and it's ugly. Just in our case, the language crops up and causes the anxiety, or ADHD crops us and causes the anxiety. It's ALL there, but the quantities and the way it's tossed together differ, like the difference between pancakes and biscuits, lol!

 

 

Yep. Anxiety drives a lot of behaviors and in my ds’s case, the exhaustion produced by constant anxiety caused significant depression. The past couple of years has been a train wreck of mood disorders. I think the transition from late teen to adult is particularly challenging for this population and lasts much longer than typical. Still not sure if my ds will be ready to go away to a small college next fall, which is his plan. One step at a time. 

[texasmama]

2 hours ago, PeterPan said:

They're not likely to do what it actually takes. Like come in and play nerf and nintendo for an hour every week for months. Or like jimtaylorknowsautism.comJim Taylor: Knows Autism: Home talks about where he went every week and played chess with the guy. 

And the goal is still TALK and the person with more experience with autism talks LESS.

I’ve done plenty of low talk therapies with kids and teens using play, games, art, movement, active play (ball games), etc. A good therapist will meet a client where he is. Not all therapists are trained in or practice play-based therapies, and this one may not be. 
 

Finding a good fit in a therapist can be difficult. 
 

As a therapist who also has the experience of raising a kid on the spectrum to adulthood, I will say that my parenting experience enriched my skills as a therapist with the ASD population (and their parents) a thousand times over. My personal experience trumps any training or professional experience I’ve had. 
 

These kids/teens are complex and need individualized treatment plans. I think the best results are gained from utilizing a variety of different professional disciplines intervening over many years combined with parental interventions on a daily basis.  The results are not often obvious or immediate. It is indeed a slow drip.

[texasmama]

1 hour ago, kbutton said:

Are counselors specifically trained to be able to reach people with language disorders? Our experience challenges that strongly, but I am interested in hearing what counselors are trained to do with people who have a language difficulty.

I don't have time to try to write super diplomatically, and my tone is a frustration with the broader ideas about autism that are out there, not you. I know you are very vested, educated, and have a lot of personal experience with more facets of this issue than I do, so please don't think this is aimed at you.

Most people with autism have some kind of language difficulty, and while it's assumed to be primarily with pragmatic language, I think people are finding that it's much broader than that, and it's not always obvious. BCBAs with their ABA and language background had better luck with my son than most professionals, but most still assumed that when my son was stuck, the problem was intrinsic, motivational, ADHD, or lack of character. None of that turned out to be true, but we would've believed these WRONG professionals if we hadn't seen my son's intrinsic motivation and strong work ethic in other areas of life. 

Finding the right thing to test my son's language skills was super hard. It's almost like 90% of what is wrong with my son's language is stuff that is not testable. We finally did get some materials to help, but wow. It's been hard. But NO ONE understood the extent to which this was a problem in his personal communication because he seems fine. (Part of that is not realizing how much he has going on under the hood--profoundly gifted on top of the autism. but the gifts majorly mask the difficulties.)

Anyway, the person who diagnosed my son is an ed psych that does counseling with a lot of people on the spectrum, including gifted ones, and my son was still a big surprise to her. Our quest to find adequate language testing for him changed the way she tests for things. Even then, we had to find our own therapy materials (which we have since shared with her). He doesn't currently do talk therapy.

Even when we work on my son's IEP, we have to continually fix goals that we think sound fine but in reality expect language that is NOT there at all or isn't there under stress. Simple, simple self-advocacy goals have to be made completely wordless. We now use color-coding. Color-coding for a kid with a Davidson level IQ (his verbal IQ lags behind his nonverbal IQ, but it's still extremely high). 

I really don't think most counselors are trained for that, and if a kid with as many compensatory mechanisms as my son has struggles, kids with greater challenges must really be at a loss.

You’re good. Lol  No, counselors are not specifically trained to work with clients with language disorders. That would be specialized training in addition to the typical track  

Testing is an entirely different area, and this also requires a lot of skill and ability to follow rabbit trails. 
 

SLPs also own a corner of the ASD treatment market for good reason. They are an invaluable part of a treatment team. 

What I found, both professionally and personally, is that treatment is as much an art as a science. What works for one person does not work for another. What worked last year does not work this year, even for the same kid. And, in truth, none of our kids get all of what they need all the time. There’s not enough time, money, or other resources to see to that. We all have to pick and choose based on our personal resources looking at the kid in front of us at the time. In spite of the research and leaps of knowledge in this field, so much is still spitballing. The most helpful professional in 19 years for my son has been the OT he had from age 3-12. His current therapist (counselor) is very effective with him but in large part due to EMDR, which is not an intervention I would have expected to use with him. It is more typically used for trauma treatment. But it is how it worked out for us, by chance or with God or whatever you ascribe it to.

Edited January 22, 2020 by texasmama

[Terabith]

My ASD kid is not oppositional.  But while she talks (a lot), she hasn't talked EFFECTIVELY with any counselors.  She made major progress with a counselor who did sand tray work, but in that case, even the therapist had no idea what she was working out, but we all agreed she was clearly working out something.  And she got much better, and we stopped.  A few years later, we tried again with a more traditional talk therapist, but it was pretty pointless.  Honestly, the adult who seems to "get her" the best has been her Wilson tutor.  I felt that that relationship was so valuable that after we finished Wilson, we've kept her on as a general "tutor," but mostly just so she continues to have an adult in her life who gets her and who can advocate for her and who can tell us if she sees red flags.  And incidentally helps her with math.  

[kbutton]

15 minutes ago, texasmama said:

His current therapist (counselor) is very effective with him but in large part due to EMDR, which is not an intervention I would have expected to use with him. It is more typically used for trauma treatment.

I am not surprised it works. I wonder if something that disrupts responses to trauma can disrupt less than ideal ingrained responses to things that are not trauma and/or "everything" is somewhat traumatic as a relative thing when you're different from the norm. 

[kbutton]

17 minutes ago, texasmama said:

You’re good. Lol 

Thank you for your gracious explanation! I've missed seeing you around, and I didn't want my vehemence to bump you out of the thread. You always have good things to say. 

40 minutes ago, texasmama said:

I think the transition from late teen to adult is particularly challenging for this population and lasts much longer than typical. Still not sure if my ds will be ready to go away to a small college next fall, which is his plan. One step at a time. 

We're a little behind this (10th grade), but as my son is going to do vocational training next year, I am worried about anxiety cropping up unexpectedly with the pressure of performing and learning skills that involve lots of following directions and being scrutinized as you do them. He does have some anxiety about being "ready" to be finished high school and for what is next, which he has been able to verbalize (yay for new skills!). Anyway, we keep trying to let him know this stage is rather open-ended and not something that has a timeline. This is both reassuring and terrifying for him (open-ended stuff--agh!), but the reassuring part is winning out so far.