Be Safe: Intervention Resources for Professionals

Balance structure and flexibility:

Children with autism can benefit from a predictable routine. When possible, keep the timing and general schedule of the session consistent.

Children with autism exhibit great variation in individual needs and learning styles – adapting with flexibility is key.

To increase predictability and structure, consider using a Visual Activity Schedule (VAS) to structure sessions. This is a visual representation that provides an understanding of what to anticipate for a given period of time. Pictures can be used to represent the waiting room, completing weekly assessments, components of treatment (e.g., drawing pictures, practicing coping skills), and portions of treatment that include caregivers.

Expectations for behavior in sessions:

Demonstrate appropriate speaking volumes.

Tell how long sessions will be, giving examples based on time-frames familiar to the child.

Tell the child which items in the room can be touched.

Reduce items in the clinic that are distracting, provide comforting and sensory stimulating items.

Especially when the social aspects or potential benefits of treatment do not motivate children intrinsically, provide frequent reinforcement for the child’s treatment adherence using reinforcers that are relevant to the child.

Children with autism often think concretely. Examples of thoughts, feelings, or behaviors, may not generalize to feelings they experience – Be specific and concrete.

Accommodate the child’s developmental skills in all forms of assessment, by providing both oral and written presentation and simplifying language.

If the child is not able to describe their thoughts, feelings, or behaviors, use other sources of information, such as the child’s caregivers live observation to assess behaviors.

Know that elements of communication such as understanding conversational structure, inferring the intent of the speaker, and responding to non-verbal cues can be challenging for children with autism.

Use visual stimuli frequently throughout different elements of treatment.

Allow children to share in different ways, such as drawing, play with their own toys, and sensory activities. While allowing for expression, don’t make guesses about the meaning of ambiguous self-expression.

Set up a system that the child understands and can use for expressing distress (e.g., a visual cue).

Sensory needs should be taken into account when introducing relaxation and coping skills. Activities such as movement games, sensory tables, blowing bubbles, and listening to calming music can be used.

Teaching about recognizing and understanding emotions is an important part of treatment for children who have experienced sexual abuse. This portion of treatment may be a challenge – it’s okay to move on if you feel that you have reached the limit of the child’s understanding of emotions.

When introducing coping strategies, increased explicit teaching, structure, and repetition may be necessary.

When using role-play, provide concrete directions. Tell the child about the steps for participating or provide a step-by-step visual.

Social stories may be particularly helpful when teaching safety skills and ways to prevent future abuse.

TEACCH Webinars-Free webinar on dual diagnosis and other complex issues in autism identification and treatment.

The National Children’s Advocacy Center offers free trainings (registration required) on a number of topics, including working with children with disabilities.

The Support Center for Child Advocates produced a series of webinars about transition planning for youth with disabilities.

Many people with autism spectrum disorder (ASD) benefit from evidence-based treatments targeting trauma symptoms, such as cognitive behavioral therapy (CBT). However, providers should adapt these treatments to the individual’s needs given communication difficulties, cognitive abilities, or developmental level.

Some individuals may not have the attention span to participate in 50 minutes of traditional “talk therapy.”

• • Maintain their attention by offering regular breaks and incorporating their interests into therapy.
  • Include plans and goals that focus on changing behaviors that are distressing for the patient.
  • If the individual agrees, involve a family member, partner, or caregiver in treatment to support the treatment at home, school, and in the community. Regular practice of concepts learned in therapy is important for progress.
  • Use clear, concise language. Avoid jargon, excessive use of metaphors, or figures of speech. For instance, instead of saying “makes you feel warm inside” say “makes you feel happy.” Make sure that role-plays and social stories are concrete, relatable to the person, and easily understood.

Individuals with autism may need more support to identify thoughts and feelings. It may be helpful to use written and visual information through components such as:

• • Worksheets
  • Fill-in thought bubbles
  • Thermometer image to help visualize strength of feelings/symptoms
  • Prepared images that display key therapeutic concepts
  • Development of visual ‘tool boxes’ that depict skills taught in therapy
  • Make any ‘rules’ or guidelines taught in therapy explicit and explain their context