Psychotherapeutic approaches to helping adults with intellectual disability and autism spectrum conditions
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This document discusses psychotherapeutic approaches for helping adults with intellectual disabilities and autism spectrum conditions. It provides general principles for psychotherapy with this population, such as not expecting narrative awareness, simplifying language, and being aware of potential anxiety that may not be expressed. Challenges like co-occurring medical conditions, sensory issues, information overload, and marginalization are addressed. Identity issues and the search for self are also discussed. Effective psychotherapy is described as not relying on any single modality, addressing misunderstandings, and reconstructing others' perspectives.
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Psychotherapeutic approaches to helping adults with intellectual disability and autism spectrum conditions
- 1. Psychotherapeutic approaches to helping adults with intellectual disability and autism spectrum conditions Digby Tantam, Septimus Ltd., Universities of Sheffield, and Cambridge 22 May RSM 2012
- 3. Autistic syndrome Restricted repetitiveness (DSM-5) Impaired social communication and social interaction (DSM-5) Language impairment 22 May RSM 2012
- 4. Associated conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5) ADHD Tourette, dyspraxia, agnosias Intellectual disability Language impairment 22 May RSM 2012
- 5. Consequential conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5) Sensory issues, ADHD Information overload, melt downs Anxiety-related disorder Tourette, dyspraxia, agnosias Victimization Marginalization Intellectual disability Language impairment The search for the self 22 May RSM 2012
- 6. General principles of psychotherapeutic work in ASD • Do not expect narrative awareness or autobiographical memory • Do not rely on signs of attention • Simplify language but not ideas • Look for other communication media • May be easier to translate and then respond in action e.g. change carer behaviour than to communicate • Role blurring – Advocate – Advisor – Carer 22 May RSM 2012
- 7. Autistic syndrome Restricted repetitiveness (DSM-5) Impaired social communication and social interaction (DSM-5) Enter the other’s world, but do not expect intersubjectivity Be aware of the importance of the past and look for commemorative activities Provide predictability (may achieve this through behavioural means e.g. ABC approach) Be aware that anxiety—and frustration– may not be expressed Do not assume that a lack of social interaction is a Language impairment lack of interest Value peer support 22 May RSM 2012
- 8. Autistic syndrome Restricted repetitiveness (DSM-5) Impaired social communication and social interaction (DSM-5) Consider sameness to be a means of achieving comfort through predictability An increase in repetition may indicate anxiety An appropriate balance must be struck about how much comfort is appropriate Rituals may be commemorative and acts of iImaginative reconstruction that are open to involvement and modification by kindly others Special interests provide quality of life OCD and hoarding involve an additional element of folie de doute, or warding off Rituals may come to be weapons Language impairment 22 May RSM 2012
- 9. Autistic syndrome Restricted repetitiveness (DSM-5) Impaired social communication and social interaction (DSM-5) Language, verbal IQ, and intellectual disability are correlated Alternative means of communication may be useful People with ID may develop simplifying concepts that can be effective tools e.g. the open and closed face Written language may sometimes be more comprehensible Processing may take longer, but get there in the end Apparent verbal fluency may be deceptive: it’s understanding not language that matters Psychotherapy may be a matter of connecting the dots… Language impairment 22 May RSM 2012
- 10. Associated conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5) Learning from the EE literature ADHD Understanding impersistence Cueing attention Tourette, dyspraxia, agnosias Dysexecutive Autistic syndrome How does Dad handle it? Intellectual disability Language impairment 22 May RSM 2012
- 11. Consequential conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5) Sensory issues, Meltdowns are catastrophic reactions. ADHD Information overload, melt downs They can only be prevented when tension Is at an early stage but may then be unrecognizable unless individual Anxiety-related disorder prodrome is known Tourette, dyspraxia, Victimization A sensory assessment may be helpful, agnosias Include but should information demands Marginalization Intellectual disability Language impairment The search for the self 22 May RSM 2012
- 12. Consequential conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5) Sensory issues, The risk of a person with an ASD being bullied is ADHD Information overload, 7 times greater relative to the risk of a neurotypical melt downs child of the same age Anxiety-related disorder Tourette, dyspraxia, agnosias Victimization Marginalization Intellectual disability Language impairment The search for the self 22 May RSM 2012
- 13. Consequences of bullying • Passive failure to be included – Reduced use of community resources (social exclusion) – Experience of being unwanted/marginalized • Active rejection , blaming, scapegoating Painted Bird by Edward – Stigma as a means of Gafford, inspired by the keeping threatening novel ‘Painted Bird’ by Jerzy Kosiński, itself Other at a distance based on what has been – Bullying claimed is a fictive war- time experience of the author in Poland
- 14. Consequential conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5) Sensory issues, ADHD Information overload, melt downs Making an impact:uproar, aggression, weaponizing Anxiety-related disorder Containing the risk so that non-reinforcement is Tourette, dyspraxia, possible agnosias Victimization Marginalization Intellectual disability Language impairment The search for the self 22 May RSM 2012
- 15. 22 May RSM 2012
- 16. Consequential conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5) Sensory issues, ADHD Information overload, melt downs Identity borrowings Anxiety-related disorder Providing a healthy identity Tourette, dyspraxia, agnosias Victimization Marginalization Intellectual disability Language impairment The search for the self 22 May RSM 2012
- 17. Coping with a lack of identity • Fads • ‘Obsessive’ relationships • Lack of identity in many people with ASD – Adopting identity wholesale – Joining charismatic groups – Moving places and work • Searching for identity – ‘Transexualism’ – ‘Aspie’ • Identities off the peg – Gangster – Professor – Teddy bear 22 May 2012 RSM
- 18. Consequential conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5) Sensory issues, ADHD Information overload, melt downs Anxiety-related disorder Tourette, dyspraxia, agnosias Victimization Marginalization Intellectual disability Language impairment The search for the self 22 May RSM 2012
- 19. ‘Proper’ psychotherapy • No particular modality is better than another, although person- centered is good • Limited value for CBT (assumes ‘lexithymia’) • Do not expect working through • Social predicaments are relatively less common than in general psychotherapy • Ruminations may be an issue – E.g. issues of injustice • Misunderstandings may be an issue – E.g ‘You’ll be the death of her” • May require the reconstruction of another person’s perspective Practical advice may also be required • 22 May RSM 2012
- 20. The end. Thanks for listening. Slides at www. 22 May RSM 2012
- 21. Consequential conditions Restricted repetitiveness (DSM-5) Impaired social communication and social interaction Epilepsy (DSM-5) Sensory issues, ADHD Information overload, melt downs Tourette, dyspraxia, agnosias Victimization Marginalization Intellectual disability Language impairment The search for the self 22 May RSM 2012