Besides helping patient and family better understand ASD symptoms, we work with patients on practical breakdowns/needs, social needs, hygiene and prioritization of health and home. In addition to more specific practice on planning their weeks, we will also address needs such as:
- Perception, awareness and insight of how the client presents and participates in the world
- Point of view/mental flexibility
- Optimizing cognitive and executive-functioning skills at home, work, and school
- Learning social norms that others may take for granted, then recalling and applying those in therapy
Those with mild ASD may have no frame of reference for “normal” initiation and follow through (i.e. initiating conversation, clipping fingernails, washing dishes daily, bathing regularly, changing underwear daily, etc.). While working with patients with mild ASD, we face a challenge. How can we build a bridge between the considerable gifts they show in one area and the day-to-day skills that prevent them from excelling with those gifts?
We may be called on to help a young adult who, through the heavy diligence of her parents and the structure of classrooms in grades K-12, did fine in school. But when she gets to the less-structured and more self-directed learning approach of college, fer trouble with planning, organization and self-monitoring may cause her to struggle immensely. Commonly, we may encounter someone who is brilliant at technology and possesses laser-like focus when testing software, but cannot get hired because she doesn’t see the point of regular bathing.
Every individual and situation is different. We find it’s more effective if we learn what motivates each individual and what they most hope to accomplish by working with us. From there, we clearly present cause and effect, specific to personal impacts of needed skills, structure and routine.
We also use modeling, practice, repetition, strategies and visual reminders to help patients exercise social cues, communication skills and appropriate self-care rituals. We often work on communication skills, from personal space and eye contact to appropriate facial expressions, expected and unexpected topics and actions, and vocal quality itself. As the patient does not easily acquire the incidental learning that comes from social interactions, we teach social norms, then recall and apply them repeatedly in direct treatment to use at home, school, work or the community.
Besides outlining pragmatics and rules of conversation, we might cover other areas associated with successful day-to-day coping: recognizing and requesting help when needed and independence and planning at home, work and school. The importance of routine in managing personal hygiene, sleep, meals and medications, problem-solving and mental flexibility, awareness and self-advocacy are addressed. Because a patient's neurodiversity can make self-awareness especially hard, we also rely on honest feedback from loved ones to monitor history, challenges and progress.
It may be necessary to connect with significant authority figures in the patient’s life, such as parents, employers or teachers, so they better understand the individual’s unique cognitive attributes and how to best work with them. As an example, someone with mild ASD can become so fixated on an area of interest that they lose big blocks of time, so it might be helpful for a supervisor to schedule certain tasks within clearly defined time frames. We’ve found that those with mild ASD can often make great progress and live much more rewarding lives, as long as they learn a solid foundation of functional skills and receive compassion and understanding from those with whom they live, learn and work.