HI, my 14 yo high functioning ASD chlid is having some real challenges. Primary school was a breeze, he is smart and never had to study. Secondary... another matter. His social challenges led to his friends from early years - often the result of parental playdates and the like - faded away, he is alone, having hygiene issues, refusing to go to school, sneaking up late at night to get on internet, failing tests. The school is mystified, he was such a good student, and seems to us poorly suited to meet his special learning needs. We live in Jakarta, expats, and my wife travels all the time - which leads to real disruption. We've tried a number of local expat counselors, but none are well suited. We are a bit desperate - thinking about quitting jobs and moving home - but our other kids are doing well, and we don't have really good options on return. So... we were wondering, does anyone know of any CBT specialists who work online - through Skype or some other means. Anyone have experience with that, and is it even a real option? Our boy is quite comfortable online, so we think it might even work better for him than face to face - but we are really new to this. Any guidance or views are appreciated. Cheers, Tom
Welcome to the forum, Tom.
There certainly are on-line counselling services now; I have heard them spoken of on other autism forums, though I don't know any specific examples, nor whether they would be prepared to counsel such a young client. One thing that I would say is that you should try to determine whether the counsellors have any specific experience with autistic clients. Although I have only had face-to-face counselling, I can vouch that this can make a big difference to how successful the counselling will be. I have had counsellors with no autism experience misinterpret my difficulties quite badly, to the point where it was actually counter-productive rather than helpful. On the other hand, a counsellor with good autism experience can make a world of difference; CBT with such a counsellor has helped me enormously in the past.
Another option you might consider is to lurk around some of the other on-line autism forums to see if you can find one that you'd be comfortable for him to use. This site probably wouldn't be so helpful, as there are few autistic teens here; but there are other sites which accommodate a wide range of ages. If he could find other autistic teens in a similar situation to correspond with on-line, it might help him to realise that he is not so alone with his condition, find some useful advice, learn to express his experiences better, and give him an outlet for some of his frustrations. Naturally, you will probably want to monitor this; if so, do be open about the fact that you're doing it; autistic people can be very sensitive to the idea that they are being "spied" on, so it could lead to problems later if you try to monitor him sneakily and he finds out!
Thanks to both Trogluddite and Cassandro for the thoughtful comments. You both have demonstrated the benefit of working with people who understand what we are dealing with. The school our son is with is considered one of the best, and there are great teachers there.... BUT... they have not seen this as a spectrum related issue, rather a troubled boy with discipline issues and need for support. This gets down, then, to assistance with studying, creating the right consequences, and not digging deeper into cause and effect. The counselors we have seen - three - have also been poorly suited. Two thought it just boiled down to family life and the need for better parenting. In that, I can understand the point of people unsuited potentially doing more harm than good. In part by having had us delay years in figuring out we need to look into his issues further. The third - she just recommended he be assessed - which we didn't do - and pretty much gave up.
I met with the school today, and was directed to a counselor I had not before, who really seemed to get it - that we were diagnosing symptoms rather than causes. Our son is really challenging, and that creates challenges in our family. Stress, arguments, disagreements. We need guidance on what to do, steps we need to take - but the counselors have largely said 'get your parenting together, argue less, agree on consequences, be consistent'. All good advice, but hard to do, when we have a very smart, manipulative and unhappy teen on our hands.
I don't know, based on my talk with the school counselor, whether we will find this here in our expat posting. There really are few options - and we have hit the main ones people recommend. We are looking at going home for a week of vacation, and having our son assessed then. But my wife is concerned with 'and then what'? Why have him assessed in the UK or USA, then have recommendations with regard to support that we can't follow. It is with this in mind that I was wondering about online options, whether we could find someone who can work with our son, and us, to come up with strategies, to help our son reframe and better understand his world, and us better understand where he is at, what we can do to help improve his options, life and future.
Again, thanks to both responders and I welcome any other views and suggestions.
Tom said:All good advice, but hard to do, when we have a very smart, manipulative and unhappy teen on our hands.
I can well imagine, I used to be a smart, manipulative and unhappy autistic 14 year old boy many years ago! There are a couple of points there that struck me.
The counsellors seem little interested in his social life at school, yet this is potentially his biggest challenge at the moment. On top of the greater schoolwork expectations, he and his peers are all going through puberty. Changed formal rules at school are relatively easy compared to the new forms of socialising that will be going on around him, and his peers' personalities may be changing faster than he can adapt to them. I found it a very difficult time in my life. I felt like the rug had been pulled from beneath me, as all of the social rules that I'd worked so hard to learn stopped working as my peers grew into young adults. Even his own body may be changing in confusing ways, which may be exaggerated if he has any sensory or motor control issues. That's a hell of a lot to take on while still being expected to do your schoolwork; he has all the other pupils to study too, and a million and one baffling questions zipping round his head, no doubt.
Rather than his home life making him challenging at school, it's more likely the other way around. He'll build up masses of anxiety at school that may be difficult to express, constrained by the formal rules and potential for peer problems that he can't predict. Home is where he is naturally accommodated and understood better, so is his safe environment in which to then express that anxiety. I have seen here and elsewhere how the assumption that behaviours are consistent between school and home can create big problems for getting the right support; the difference in expression of autistic traits can be quite astonishing.
I'd second everything Trogluddite has said. Not sure what the other forums were, though. WrongPlanet.net?
I first saw a school counsellor at age 16, partly about self-discipline, and they were nice and sympathetic and all that, but ultimately didn't help much. As an adult, therapists have almost entirely not understood or recognised autism, so the ideal of 'mentally healthy' that they were looking at didn't apply to me or help concentrate on the actual problems, including around feeling socially inadequate. You seem to have experienced something similar, but at least have the advantage of the diagnosis. Some professionals also claim to understand autism, but do so only through a very narrow perspective of one theory. CBT was difficult for me because I found it very hard to identify troubling emotions, or positive ones for that matter.
So I hope it works with the new counsellor. If it turns out not to after a period of time, I think one of the criteria is to find someone who specialises in autism. Quite possibly such people would be used to offering it online through Skype or other online means in any case, as (a) that's what clients sometimes need; (b) being specialists, they're often further away. These people come recommended: http://www.alongsideautism.co.uk/contact.html Although they may only do adults they may be able to recommend someone else based in the UK. There's also the NAS directory here: https://www.autism.org.uk/directory/browse/cid=15~aid=1.aspx
For me, one of the issues around 'talking treatment' is that I need to know the objectives and the method by which those might be achieved. For example, your son may come to realise and agree that he wants to pursue something online, but stays up so late it affects his mood the next day, because of 'inertia' or 'perseveration'. Therefore the objective is to try to develop better habits. Or maybe to feel he is supported by at least one or two allies at school. CBT tends to be clearer about objectives than many forms of therapy IMHO.
Finally, here's a link about demand avoidance that I've already posted a few times:
Cassandro said:Not sure what the other forums were, though. WrongPlanet.net?
Most likely, yes; that and Aspie Village are the only forums I bother with besides here. Quite possibly the discussion I remember was people seeking such a thing rather than describing experiences of it; it was something I noticed in passing but didn't participate in.
Cassandro said:CBT was difficult for me because I found it very hard to identify troubling emotions
Acknowledging this was the crucial difference in the autism specific CBT that I had. My poor emotional processing was accepted for what it really is. Rather than being seen as a hindrance to the counselling, improving my discrimination of emotions became one of the major goals to aim at. It's ironic that this mistake is made so often, as CBT seems perfectly suited to improving this kind of emotional discrimination.