The word autism generally seems to cause a great deal of anxiety when mentioned.  I find this to be particularly true of counselors who have not had the opportunity (or pleasure, in my opinion) to work with children on the autism spectrum.   The latest and fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has recently developed new criteria for evaluating autism.  Regardless of the changes, I’ve found certain consistencies to be beneficial in the counseling process when working with this population.

1.      Simplify the environment

An important aspect of counseling that is sometimes overlooked is the environment.  Is the therapy room noisy or overcrowded?  Counselors usually fill their office with children’s artwork and pop-culture references.  While this decor can make the atmosphere more welcoming, such things can also serve as distractions that overload the senses (typically known as sensory overload). 

In my practice, I’ve found that simplifying the setting, by using less décor and limiting extraneous noise, is effective when counseling children with autism.  Limiting distractions is further beneficial if the child also exhibits ADHD, a disorder that oftentimes occurs concurrently with autism.  I recall one session in which a client chatted about Hannah Montana for nearly 40 minutes after seeing a poster of the singer on the wall.  While it was an enjoyable conversation, it was quite a challenge to steer our discussion back on track.  Simply put, fewer distractions may lead to a more focused session.  Counselors, if you decide to leave certain things in the room, opt for items that the child will most likely not perseverate on.  A short conversation with the parents about their child’s interests can help you navigate around this.

2.     Use fewer metaphors

Taking time to learn about clients’ interests beforehand can be advantageous to the therapeutic process in several ways.  One particular tip that comes to mind here is the use of metaphors.  Children with autism may have difficulty understanding figurative language.  Counselors may find it helpful to be straightforward during talk therapy, or otherwise to create unique metaphors that reflect the child’s specific interests.  After all, therapy can be powerfully effective when the right parallels are drawn between an individual and an intangible concept.

3.      Role play instead of pretend play

Children with autism sometimes have difficulty using imagination, and may actually learn better through the imitation of appropriate behaviors.  There are a number of ways to implement this, whether that be through social stories, role-playing with the counselor, or by having the child join a social-skills groups with same-age peers.

Have you ever worked with a child with autism? If so, what have your experiences been like?
________________________________________________________________________Sadaf Siddiqi is a certified counselor with an interest in mental health research and it’s application to children and families. Please share your thoughts with her at ssiddi12@jhu.edu.