Looking for a new therapist for Autistic Teen
April 9, 2021 10:12 PM Subscribe
We are looking for a new therapist for our mid-teenage year old autistic son who also has mental health struggles. His therapist retired recently. Our fantasy is that there is a therapist who has a concentration on autistic teens and young adults that would make a good fit for him for the next 5 to 10 years, but are open minded.
We are looking for a new therapist for our mid-teenage year old autistic son who also has mental health struggles. His therapist retired recently. They had worked together for 5 years. The therapist was a general child therapist, not specializing in autism.
Our fantasy is that there is a therapist who has a concentration on autistic teens and young adults that would make a good fit for him for the next 5 to 10 years. Someone who can help him accept his autism so he can open himself to learning adaptive skills and to do activities of daily living (ADLs). We think with more acceptance of his autism, his ability to work on toileting/hygiene skills and his mental health may also improve (we might be wrong and are open minded to other approaches). We’re interested in the hive minds thoughts for what kind of person (or programs) to look for (credentials, disposition, etc.). We would also be very happy with any leads in Boston area (we are northwest of the city near 95 and 2).
Here’s his profile:
Our son is hyper verbal, social, an excellent writer, veracious reader (especially of history & philosophy), clever at improv comedy, enjoys esoteric films, and passionate about social justice. Therapists (adults in general) tend to enjoy talking to him. He has been in therapy for 12 years and can be quite introspective, but struggles with excepting the fact that he is autistic. He pushes himself to seem neuro-typical rather than embrace his autistic strengths and learn how to adapt for the capabilities he struggles with.
In terms of autism, he has trouble taking people’s perspectives (especially when already in conflict) and has rigid thinking. He has problems with executive function and is working on compensating for that since it doesn’t come naturally to him. Developmentally he struggles with toileting. He has never been fully toilet trained and often has overnight accidents and also poop accidents during the day. He struggles with hygiene related to this. We have worked with Boston Children’s Hospital looking for ideas and ways to resolve developmental delay with little progress over the past decade. He has made some progress in the last year on being dry overnight, but it is still a struggle for him. He does not dis-regulate often, and when he does it is usually due to embarrassment about his toileting issues. Obviously the toileting struggles can have a large social and self-esteem impact.
From a mental health perspective, he often struggles with OCD, anxiety, sometimes with depression, has trouble with sleep schedule (sometimes misses school because of this). He has been a volatile kid during the past half decade as he headed into the teen years with a vengeance.
He struggles with defiance to authority (and internalizing the concept of authority). He resists accepting guidance/teaching from teachers and therapists, although he does love discussing topics in an academic sense. He has tried CBT, but not able to commit to it (which is typical of teens). He attends and does well at a therapeutic public school with special ed teachers, licensed therapists, and speech language pathologist. He has not done ABA and we would not be interested in someone with that training.
We are looking for a new therapist for our mid-teenage year old autistic son who also has mental health struggles. His therapist retired recently. They had worked together for 5 years. The therapist was a general child therapist, not specializing in autism.
Our fantasy is that there is a therapist who has a concentration on autistic teens and young adults that would make a good fit for him for the next 5 to 10 years. Someone who can help him accept his autism so he can open himself to learning adaptive skills and to do activities of daily living (ADLs). We think with more acceptance of his autism, his ability to work on toileting/hygiene skills and his mental health may also improve (we might be wrong and are open minded to other approaches). We’re interested in the hive minds thoughts for what kind of person (or programs) to look for (credentials, disposition, etc.). We would also be very happy with any leads in Boston area (we are northwest of the city near 95 and 2).
Here’s his profile:
Our son is hyper verbal, social, an excellent writer, veracious reader (especially of history & philosophy), clever at improv comedy, enjoys esoteric films, and passionate about social justice. Therapists (adults in general) tend to enjoy talking to him. He has been in therapy for 12 years and can be quite introspective, but struggles with excepting the fact that he is autistic. He pushes himself to seem neuro-typical rather than embrace his autistic strengths and learn how to adapt for the capabilities he struggles with.
In terms of autism, he has trouble taking people’s perspectives (especially when already in conflict) and has rigid thinking. He has problems with executive function and is working on compensating for that since it doesn’t come naturally to him. Developmentally he struggles with toileting. He has never been fully toilet trained and often has overnight accidents and also poop accidents during the day. He struggles with hygiene related to this. We have worked with Boston Children’s Hospital looking for ideas and ways to resolve developmental delay with little progress over the past decade. He has made some progress in the last year on being dry overnight, but it is still a struggle for him. He does not dis-regulate often, and when he does it is usually due to embarrassment about his toileting issues. Obviously the toileting struggles can have a large social and self-esteem impact.
From a mental health perspective, he often struggles with OCD, anxiety, sometimes with depression, has trouble with sleep schedule (sometimes misses school because of this). He has been a volatile kid during the past half decade as he headed into the teen years with a vengeance.
He struggles with defiance to authority (and internalizing the concept of authority). He resists accepting guidance/teaching from teachers and therapists, although he does love discussing topics in an academic sense. He has tried CBT, but not able to commit to it (which is typical of teens). He attends and does well at a therapeutic public school with special ed teachers, licensed therapists, and speech language pathologist. He has not done ABA and we would not be interested in someone with that training.
Are you sure it's developmental delay and not urinary/bowel dysfunction? Getting checked out for a physical issue might be best in this case.
posted by kingdead at 3:09 PM on April 10, 2021
posted by kingdead at 3:09 PM on April 10, 2021
It looks like you live in the Boston area? We do, too, and my son (23 years old) sounds similar in some ways to your son. We've been having a very hard (and so far unsuccessful) time finding a therapist for him. But I want to recommend AANE if you don't already know about it. They provide many many services for children, teens, and adults on the spectrum and their families, parents, partners, etc. One of the services is referrals to care providers. You may very well have better luck than we have. Good luck!
posted by primate moon at 11:13 AM on April 12, 2021 [1 favorite]
posted by primate moon at 11:13 AM on April 12, 2021 [1 favorite]
This thread is closed to new comments.
— Listening to Actually Autistic and ADHD voices. This has been huge for self-acceptance! I'm more appreciative of my gifts now that I know my struggles are shared. I've also gotten a lot of ideas for handling pesky day to day issues. Learning about the double empathy problem is life-changing. It's been a big confidence boost seeing how easy it is to make friends when there are no neural barriers between us. Turns out I'm great at connecting with other ND people, it's just NTs that give me grief! I signed up for Facebook and Discord groups, watched YouTube and TikTok videos, and read books & blog posts for us, by us.
— Realizing my Dad, uncle, cousin and grandfather are autistic. Do you have other ND family members? I've read that our traits are highly heritable. Women/AFABs often mask which makes it harder to pick up (I discovered in my 30s). I feel much less alone now, knowing.
— IFS (Internal Family Systems) therapy. It's been a wonderful tool for self-growth and embodiment, it's really helping me deal with the accumulated trauma of being an autistic person in the world. I also feel it has enhanced my perspective-taking skills and first-person memory consolidation. DBT and CBT were useful in a surface-level way, as frameworks for identifying red flags in cognition and behavior, but IFS teaches me to honor all my feelings and negotiate with my full self, rather than suppressing or redirecting what upsets me. I haven't found an issue yet that IFS is not equipped to handle. I set the pace; I control the action; I choose what I want to address each week. It's present and future-focused, informed by the past but never wallowing in it. I like that my therapist feels like an equal, a trusted advisor instead of an authority figure. The storytelling aspects appeal to my verbal brain, and the emphasis on deep metaphor harnesses what I feel are the best (and least appreciated) qualities of my autistic cognitive style.
If you can, I would highly recommend getting a therapist who is themselves neurodivergent. But the most important thing is finding someone competent he trusts. I actually prefer zoom therapy to in-person, as I feel I'm able to emote more when I'm in control of my home sensory environment. You might reach out to Natalie Engelbrecht of Embrace ASD or the coaches of Hendrickx Associates. Unsure if they work with teens.
— Daily movement. Walks, bike rides and yoga are vital to my well-being. I'm a heavy masker and I have alexithymia and mild dyspraxia, it's been hard for me to realize/accept how intense my somatic issues truly are. Going on a sensory diet and setting aside dedicated alone time for stimming has helped. I've heard that somatic therapy works wonders in addressing sensory integration, poor muscle tone and coordination problems, but I haven't tried it yet.
— Accepting agency in dealing with executive dysfunction. This has been at tricky one for me, as I struggle with many issues like short-term memory, task switching, task prioritization, and forming habits. I took some tests to identify which aspects affect me the most, and I'm looking for a neurodivergent coach to help me select strategies. I've stopped shaming myself for relying on lists, alarms, planners and calendars to do things others achieve easily on the fly. It's a slow accretion of behavioral changes here. This is a limitation I have really mourned; the amount of unconscious grief your son is experiencing may be tremendous. I have had to release or modify many of my hopes and dreams based on what I now know about myself. The important thing is to realize that goals are still achievable, you just have to approach them in a different way than NTs.
— Sleep: I wind down about two hours before bed, popping 150 mcg melatonin and dimming the lights progressively until only a small red light remains. (The melatonin is slightly more effective if I take it earlier in the day, about 9ish hours after I wake up, but that's hard for me to commit to. Order online, the dosage you find in stores is way too high!) I keep the room cool by shuttering the vent, opening the window a bit and using a cool mist humidifier. A DIY pillow nest makes for a nice weighted blanket scenario. I wear a sleep mask and earplugs, and I sleep nude or dress in a lightweight silk sleep "uniform" to cut down on sensory issues. Reading books and listening to an instrumental album on loop helps me chill out.
Okay, hope the info dump helps! Feel free to DM for commiseration and/or more specific resources :)
posted by lloquat at 2:16 PM on April 10, 2021 [7 favorites]