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Treating the Adolescent with ASD: The Quest To Establish Selfhood

In our society, adolescence is thought of as a time of self-discovery and identity formation. It is a time when the individual is not quite a child anymore, but is certainly not an adult; it is the transitionary period between the two. During the span of roughly seven to ten years, or in some cases longer, the child grows up to become a man or woman. The famous developmental psychologist, Erik Erikson, summarized various developmental stages across the lifespan. According to him, the conflict during that stage of life is “identity versus role confusion.” His idea is that the adolescent is trying to navigate his or her place in the world, try and fit in in a unique and personal way, with the ultimate goal of forming a stable sense of self over time. While some of Erikson’s ideas have been challenged more recently, I think the goal of adolescence reflecting the process of identity formation rings true for most, if not all, adolescents to some degree or another. In seeking to establish this unique identity, which can be an ambitious undertaking, the adolescent may reject beliefs or ideas that were previously accepted (Hamman & Henricks, 2005). In addition, he or she may actively challenge parental figures who previously served as role models. Adolescence can be thought of as a potentially stormy time where one’s relationships with parents and caregivers may be quite difficult as the adolescent searches to define and understand him or herself. He or she may find the need to pull away to establish an identity that may be similar to or different from the parents. The storminess of that time period is really a reflection of the adolescent’s need to discover this sense of self.

Individuals with Asperger’s Syndrome typically have average to above-average IQ’s with deficits in social reciprocity, perspective taking, and executive functioning, and they often lack independence in daily living skills. As such the individual with Asperger’s is often living with significant discrepancies between various areas of strength and weakness. For example, an 11 year old with Asperger’s Syndrome may present with verbal abilities that are equivalent to those of a 17-year-old and social skills that are equivalent to a 3-year-old (Volkmar et. al 2000). It can be quite confusing and complicated living with such a large gap, and put the individual with Asperger’s in a difficult situation. It’s very hard to be gifted in certain areas, while challenged in others. As such, the child with Asperger’s typically relies on parents, caregivers, and therapists to help them compensate for various areas of social and emotional weaknesses. In my practice, I often encounter parents (typically mothers) who have spent years serving as their child’s “blackberry” to compensate for their child’s deficits in executive functioning. Children with Asperger’s often rely on their parents out of necessity to help them navigate these complicated, confusing, and even alien social aspects of the world that can feel virtually incomprehensible.

When children with Asperger’s become adolescents this can prove to be quite a difficult time. On the one hand, they may struggle with the developmental pull to “grow up,” to develop a sense of autonomy and self-definition that is age appropriate with their peer group. At the same time, because of their difficulties with socialization, executive functioning, and daily living challenges, they are forced to remain dependent on their parents, at least for a longer time than their neurotypical peers. This conflict creates yet another discrepancy for them, the age-appropriate developmental desire for independence with the reality of the need for continued dependence. This pull can feel irreconcilable and leave the adolescent with Asperger’s and the parents feeling hopeless, depressed, anxious, and guilty.

How do we support these adolescents in their quest for independence while acknowledging the reality of the fact that they do require continued dependence on parents, teachers, and therapists, which may not be the case for their neurotypical peers? Below are some suggestions and guidelines that I have found to be helpful in working with this age group and their parents.

 

Acknowledge the problem – Understanding that the storminess, moodiness, anger, and confusion are actually a normal part of growing up and adolescence. The surge of hormones, the ever-changing physical bodies, confusion about roles, and the challenging quality of the teenager are actually developmentally appropriate responses to a difficult developmental time. Sometimes parents are surprised when they call me up in a “crisis” because their child is acting more challenging and difficult. My response may be reassuring them that they are acting like a developmentally appropriate 15 year old, and it is in fact good news. Sometimes the Asperger’s diagnosis has become the lense through which every behavior is viewed, but the child is also a teenager and tolerating some of the typical adolescent behavior can be quite healthy for the child. The child may also be uncomfortable with the instability of this time so education about puberty and adolescence can be helpful as well.

 

Encourage independence whenever possible – Even though there may be some real difficulties in social skills and independent life skills, I think it is important to challenge adolescents to be independent, at whatever their level. I always tell parents that the goal is to create a gap that is wide enough for the child to stretch to step over, without falling into a chasm. It may be difficult to teach a teenager with Asperger’s to do laundry, help with the dishes, drive a car, take public transportation into the city, or set up a sleepover with a friend or family member, but it will be more worthwhile to expend the effort in teaching him or her how to do these skills independently rather than doing it for the child. Every child is different so what he or she is capable of will vary depending on age and abilities. Praise and reward independence whenever possible. The sense of self-esteem the child feels when being independent can be quite amazing.

 

Accept and support failure as part of life – Individuals with Asperger’s often have poor frustration tolerance and difficulty with cognitive flexibility. As mentioned previously, the chasm between strengths and weaknesses can be enormous. A child may wonder, “how come I am such a reading whiz, but I can’t seem to figure out what to do during recess?” As a result, the child may shut down and resist taking risks. As parents, teachers, and therapists, we are in a unique position to encourage taking risks, and accept that failure is a natural part of life. Adolescence may be a ripe time to explore this issue, by giving the teenager permission and encouragement to fail at things, as they try and figure out who they are, and what they are good at. I often give families homework that as they sit down around the dinner table they all have to share an example of something they failed at during the day. This allows the adolescent with Asperger’s to experience their challenges in a universal way, and learn to persevere despite facing very real challenges.

 

Find an area where the child can shine – Individuals with Asperger’s tend to have an area of stereotyped interest that they can spend hours reading and talking about. Perhaps the child can get involved in a club or activity that reflects that interest where he or she can feel like the star. A child who loves a specific topic may be able to create a blog with help of a parent, and write about whatever interests him or her. A child who loves to sing can join a choir, and a child who likes to act can join a drama or improv group. These experiences can help the child feel good about him or herself.

 

Let the child exercise some autonomy – Many children with Asperger’s are incredibly reliant on parents and caregivers, as they should be. These adults in their lives can literally serve as their lifeline. As they mature, they may be ready to take on some more responsibility with decision making and be ready to exercise more autonomy. The adults in their lives can serve to support that initiative and help them talk through different options, rather than knocking down ideas, or only presenting one option. I know an adolescent boy with Asperger’s who literally could not take himself away from his ipad. It provided him with security that he felt he could not give up. After being threatened by his parents that they would take it away altogether, he created a contract between himself, me, and his parents, that outlined appropriate parameters of the use of his ipad. We talked through the pros and cons of each of the clauses until he, I, and his parents were satisfied with the terms and compromises regarding when he could use the device. Rather than have us tell him what to do, in which case he may feel forced and end up rebelling, we gave him the power to exercise his own initiative in this regard, which he has owned ever since.

 

Adolescents with Asperger’s, like everyone, struggle to develop a sense of identity and feel empowered and successful in their lives. In giving them the space and support to engage in this difficult, yet rewarding journey, we are giving them life skills that will reap benefits across their lifetime.

 

Shuli Sandler, PsyD, is a clinical psychologist licensed in New York and New Jersey. She received her doctorate from Long Island University – C.W. Post Campus in 2007. She works with children, adolescents, and adults in individual, couple, and family sessions, as well as psychological testing. Among her areas of focus in her practice are children and adolescents with Asperger’s Syndrome, as well as those who are experiencing a variety of difficulties in school, and young adults struggling with issues of achieving independence. Dr. Sandler has offices in Spectrum Services, located in midtown Manhattan and Teaneck, New Jersey. She can be reached at shulisandlerpsyd@gmail.com.

References

Hamman, D. & Hendricks, C. (2005). The role of the generations in identity formation: Erikson speaks to teachers of adolescents. The Clearing House; 79: 72-75

 

Volkmar, F.R., Klin, A., Schultz, R.T., Rubin, E., & Bronen, R. (2000). Clinical case conference: Asperger’s disorder. The American Journal of Psychiatry; 157: 262-267.

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