Counseling Children, Teens, and Young Adults who are Asperger’s:
I don’t see it as a syndrome
I am Dr. Frank Gaskill, a licensed psychologist and co-founder of Southeast Psych. We are one of the largest group practices in the United States based out of Charlotte, North Carolina. I have been practicing for nearly 20 years.
As a child psychologist, my bread and butter has been helping parents manage defiant kids and improving the parents’ ability to be warm and authoritative. However, the majority of my work falls within the realm of the autism spectrum and more specifically Asperger’s. In a typical week I will see 25 clients (individually or family based) for 45 minute sessions. I will also conduct five or six social skills groups per week with anywhere from 8 to 14 kids per group. During summer and winter breaks, social skills and gaming camps are also offered. At least 75% of my practice is focused upon the Autism spectrum in a variety of modalities including groups, parent support groups, individual/family sessions, camps, and social get-togethers or social outings.
Autism captured my interest in graduate school while at the University of North Carolina - Chapel Hill. In the early 90s, UNC was at the center of the Autism universe. I was exposed to many professors who specialized in early childhood development and who were also involved in mainstreaming autistic kids into regular classrooms. I found the children’s obsessive interest such activities as Legos, Dungeons & Dragons, and trains endearing and somehow familiar.
Upon entering private practice, I consistently ran into preteen kids who were bullied or excluded due to being “different.” Many of these kids had similar characteristics including having a very specialized and specific interest, poorly developed social skills, and above average intelligence. In bringing children together with similar interests who had been excluded from the social mainstream, I found positive outcomes. All of those kids felt different in their regular classrooms, but when they were in group of like-minded kids, their anxiety was reduced and self-worth improved. In group, these kids had found their peers. In experiencing a social connection and losing the sense of loneliness even temporarily, my clients improved across a number of domains including anxiety, depression, and defiance. The one thing all of these clients had in common was Asperger’s.
As Asperger’s was introduced to the DSM-IV in the early 90s, specific clinical training was lacking for clinicians seeking to serve those with this differently wired mind. Most of my training occurred on the job and in reviewing the limited research articles which were available. The most valuable training experience I had in serving this population was my own childhood and my own lineage. To be able to speak the language of Dungeons and Dragons, Star Wars, and Super Mario Brothers helped me beyond measure. I was able to speak their language as the Asperger’s gene runs throughout my family. And because I can speak their language, these Aspie kids trust me, let down their guard, and allow me to teach them the social skills needed for them to thrive in society. However, they also know they can let their “freak flag” fly in my groups with their now dearest friends. My greatest training in serving the spectrum is actually understanding geek culture. I believe that working with an Asperger’s population is more about understanding and embracing their culture so they feel validated and know someone genuinely understands and values them. Their lives have been consumed by being bullied, excluded, or ignored. I have found that providing an environment in which they are celebrated and included is more than 70% of the battle in improving the quality of their lives and inspiring them.
Working with Asperger’s clients is not difficult if you accepting and do your research into their culture. If you cannot appreciate their culture and understand their perspective of being excluded and left out, this population is not for you.
I absolutely love working with my Aspie clients and their families. For me, coming to work is not work at all and time I spend with my clients actually energizes me. My work is more of a mission of spreading the gospel that Asperger’s is awesome and the world would be lost without this differently wired brain. I love the fact that most of my colleagues are unable to understand many of the conversations my Asperger’s kids have with me about the intricacies of Super Smash Brothers Brawl, the need for 20 sided dice, and why Portal 2 is amazing. If these marginal pop-culture references do not interest you, working with Asperger’s clients may not be your niche.
And while I love working with these clients, there is a downside. Most of the time the downside is a father. The autism spectrum is genetic. And many times a dad that is sitting across from me is on the spectrum. Not only does he usually not know that he is on the spectrum, his ability to be open-minded about this issue can be somewhat limited. I have had several dads who are on the spectrum immediately shut down and become unwilling to explore the possibility their son or daughter could be on the spectrum. A parent’s black-and-white thinking can make therapy difficult. A cornerstone of working with an Aspie client is self-awareness and self-acceptance. Without this understanding, very little progress can be made. The most rewarding therapy experience is the dad who says, “Wow, I was a lot like him when I was a kid. Maybe I’m on the spectrum too.” This therapeutic moment is exceptionally rewarding because as a dad is able to recognize his place on the spectrum, it often alleviates years of battles with his son or daughter. They now can related to one another and recognize how they can work together.
One other downside to working with kids who are Asperger’s is dealing with the Diagnostic and Statistical Manual Version 5 (DSM-V). The DSM-V has made my clinical life frustrating and has also added a session to most clients I work with. The most common question I get is, “But I didn’t think Asperger’s exist anymore…” This leads me into an explanation that I have to give to the parents as well as my client (child/teen) about the social engineering and politics behind the creation of Autism Spectrum Disorder (ASD). While the enjoyment of sharing the complex neurodiversity of the spectrum allows me to discuss Einstein, Daryl Hannah, and Andy Warhol, the downside of explaining the politics of autism and all of the misunderstandings about the spectrum can be exceptionally frustrating. In addition, it can be very difficult dealing with professionals as well as parents who buy into the stereotype of the Asperger’s kid who does not want friends and who is introverted. Such kids are no more common than in standard populations. Asperger’s kids typically want to have friends but do not necessarily know how to go about finding and keeping friends. I would say the biggest downside to working with people on the spectrum is advocating for them in a world which does not understand nor appreciate them.
The way I have established my business model is that I actually know very little about insurance and will never be on panels. My philosophy is people will pay a great deal of money to have elective surgery, pay attorney fees, or even make very high payments on a car or home. It has been my assumption that people will pay a reasonable fee to care for their children and family. It is my hope that more and more people will pay attention to the value of psychology in their lives and realize that the money spent in this arena is well spent and changes the quality of their lives. To that end, my current rate is $250 for 45 minutes. I charge $80 per group per child which includes therapy for the parents through a support group at the same time that therapy occurs during the social skills group. My practice bills each individual at the time service or in the case of groups, I charge nine weeks of service at a time. There are times in which I will provide a sliding scale or a payment plan.
For clinicians looking to build a niche practice for those on the spectrum, traditional insight oriented psychotherapy is typically a waste of time for both the clinician and client(s). Being behaviorally and cognitive-behaviorally skilled is typically the best background for a clinician in this area. However, as noted earlier the best research a clinician can do is to get into the world of Asperger’s. This world is easily found on social media such as Twitter but my favorite website is WrongPlanet.net which was founded by Alex Plank.
What books, journal articles, websites, or professional societies might the reader consult in order to learn more about this practice areIn will
Resources I recommend:
NeuroTribes: The Legacy of Autism and the Future of Neurodiversity Hardcover – by Steve Silberman (2015)
The purpose of my social skills groups is to help all of my aspies find friendship. Underlying all of our sessions is the theme of becoming connected beyond special interests and finding lifelong friends. Each session has an educational component and a specific structure. The following gives you a general outline about each of our weeks together.
And as always, please try to set up get-togethers and play dates. Your kids need you to help them organize these get-togethers as such communication does not come naturally to them.
The structure for each session
1) High and low of the week (15-20 minutes)
Problem solve one "low"
2) Group Lesson (20 minutes)
3) Fun activity or deeper conversation time. Session 1: Psychoeducation
Parents get to know each other and exchange contact information
What is Asperger’s
Agenda and discussion of future groups and intro to Dr. Festa as parent facilitator
What are goals and concerns for this group of parents? (specific to group)
Session 2: Fight or Flight night
Introduction to the neurobiology of the fight, flight, or freeze response.
Creation of list of relaxation strategies that work best for each client.
Actual practice at relaxation training and discussion of situations where such strategies could be used best.
Session 3: Bully Night
Introduction to bullying and the reasons behind such behavior.
Consistent themes for this session include understanding power and control as well is how bullies identify their targets. We also discussed safe and unsafe locations in schools.
This session includes an illustrated example of how a lion seeks its prey and determines weakness based upon “difference.”
Role-play is a big component of the session where we practice responding to bullies and understanding when to seek help.
Session 4: Goal Setting
Many kids struggle with their understanding of how to set goals. My clients tend to struggle with knowing what goals are important and what goals are not. This session helps them understand how to target goals in an effective manner.
We tend to get very specific in this session and help them imagine their future selves and the steps needed to achieve that future. The steps often lead back to the basics including: cleaning rooms, finishing homework on time, and doing what they need to do before they do what they want to do.
Session 5: Conversation Skills
By this point in group, my clients are typically having their first play dates. I would like this to occur sooner but this is typically how it works. Tonight session is all about how to get to know another person. I call it becoming “a human detective.”
In this session we role play and practice open ended questions versus closed ended questions. We work specifically on getting one another to talk about themselves as well as engaging in active listening. We tend to learn a great deal about each other during the session.
Session 6: Etiquette Night
Etiquette night, otherwise known as pizza night, is one of my favorite evenings. This is the night in which I challenge kids to address their table manners.
During the week prior we discuss food allergies as well as expectations for pizza night. While I do discuss manners and place settings, my emphasis is on chewing with their mouths closed, not talking with their mouths full, etc.
During the night we play a good manners behavior gain during pizza which makes manners fun. Group accountability is a big component of tonight’s session.
Session 7: Game Night
Game night is exactly what it sounds like. Don’t be afraid but we will be playing video games. The point of tonight is to further our connections, build friendship, and learn to deal with frustration practicing strategies learned throughout our social skills groups.
The cornerstone of tonight’s group is called “controllers down.” My guys will learn to tolerate frustration and set videogame controllers down when told to, without question or complaint.
We discuss the role of video games, frustration tolerance, and how to use gaming for good and friendship rather than an obsessive escape from reality or frustration.
Session 8: Group Choice
During group, themes will often arise. Such themes can include specific bullying issues, family problems, or worries about girls or friends at school. This session allows us to go deeper into one of the specific topics that is tailored to this specific group. We use active listening, open-ended questions, group problem solving, as well as learning to be a human detective and friend. This can be a very powerful group experience.
Session 9: Wrap-up
During our final session, we revisit our topics and provide words of encouragement and affirmation.
We also revisit themes from our sessions together and I emphasize how to maintain connection away from group and how to share our experiences together with family.
As always, the theme of my groups is that our young Aspies are awesome. The key to their success is maintaining friendship and practicing over and over the strategies and ideas that we discussed during group. In addition, the relationships that you build with the other parents during our sessions will further strengthen your children’s chances at success in the future. Social networking is the key for their future and I am grateful to help in this process.