Counselling and the Autism Spectrum - Autism Advisory and Intervention Service (AAIS)

Counselling and the
 Autism Spectrum

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Counselling and ASD
Working with a pupil with a diagnosis of Autism Spectrum Disorder (ASD) may present
unique challenges to the school counsellor. Young people on the Autism Spectrum,
many of whom have average to above average intelligence, often exhibit considerable
challenges in social understanding. We need to use tools to help people on the autism
spectrum manage their emotions, anxieties and confusion regarding the social world
(Paxton & Estay, 2007).

What is Autism Spectrum Disorder?
According to the National Autistic Society (2020) Autism Spectrum Disorder (ASD) is a
neurological developmental condition. All individuals with Autism Spectrum Disorder
(ASD) exhibit challenges in characteristic areas, known as the Dyad of Impairments
(American Psychiatric Association, 2013). The characteristic areas of the ‘dyad’ include
challenges in Social Interaction, Social Communication, Flexibility of Thought and
Sensory Sensitivities. Children are referred to as being on the Autism Spectrum to
highlight individual difference. No two young people with ASD are the same and
therefore there is ‘no one size fits all’ approach. The most important point is to get to
know the individual first and foremost.

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Characteristics of Autism Spectrum Disorder

   a) Social Interaction

Young People with ASD may experience challenges: -

   ▪   looking at people when they talk;
   ▪   understanding others and the ‘hidden’ curriculum;
   ▪   understanding social situations;
   ▪   making and keeping friends; and/or
   ▪   preferring own company.

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b) Social Communication

Young People with ASD may experience challenges: -

   ▪   with expressive and receptive language;
   ▪   following lengthy verbal instructions;
   ▪   understanding colloquial sayings;
   ▪   understanding idioms, irony and sarcasm; and/or
   ▪   understanding ‘white lies’ and social use of language.

c) Social Imagination and Flexibility of Thought

Young People with ASD may experience challenges: -

   ▪ listening to the ideas of others;
   ▪ coping with change;
   ▪ compromising;
   ▪ understanding that we all have different opinions and interests
     (Theory of Mind); and/or
   ▪ recognising, understanding and managing emotions.

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d) Sensory challenges

Hyposensitivity and/or hypersensitivity to one or more of the five senses.

          Five Top Tips!

    1. Be prepared
    2. Be clear and concise
    3. Be visual and use
       strengths
    4. Social and Emotional
    5. Be positive!

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e) Strengths may include

   ▪   strong technical ability
   ▪   good rote learning ability
   ▪   being a loyal friend
   ▪   being reliable
   ▪   passion and interest in certain subjects
   ▪   excellent memory.

   ▪ Young People may need a clear explanation of the social expectations and the
     ‘ground rules’ of a counselling relationship They may require reminders and the
     social rules explained on turn- taking and sharing of information;
   ▪ The focus of your meeting should be on concrete issues and solution focussed;
   ▪ young people may require a more structured approach, longer time to process
     new information, shorter sessions and perhaps many more practice sessions.
     written notes may be of benefit; and
   ▪ Young people with ASD may benefit from a Social Story to prepare meeting with
     the counsellor (please see over).

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Social Story
Speaking with a counsellor

We all have difficult times when we need help. Sometimes, it is challenging to get
through a difficult time alone. Problems may build up and you might lose sleep, find it
difficult to concentrate on tasks and your mood may change.

School staff or parents may notice this and suggest that it would be beneficial for you
to speak with a trained school counsellor who knows how to listen and can help you in
a non-judgemental way. The school counsellor provides an opportunity for you to speak
about your worries. With their support, your current problem may be resolved.

You will be given information prior to the appointment such as the name of the
counsellor and a time and location within the school. Some counsellors will try to meet
with you at a time that suits you best. If, however, you need to miss some time out of
class you will be able to catch up afterwards. This can be discussed with staff in school
so it is clear what is happening. We all need help at times. Speaking with the counsellor
is one form of help and support that can often help.

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▪ consider the use of structured visual strategies and the importance of giving the
     client more time to develop a therapeutic relationship;
   ▪ during counselling it is imperative that you ask specific and detailed questions
     when seeking information as individuals may not think of sharing information
     without being specifically asked;
   ▪ be clear, concise and straightforward; and
   ▪ be aware of literal interpretation.

   ▪ effective strategies focus on a structured visual approach;
   ▪ the challenge is to take counselling, which is based mostly on talking, and adapt
     it to a visual model; and
   ▪ try to use a visual approach which capitalises on visual strengths and aptitude.

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Making thoughts visible!
The use of thought bubbles helps people with ASD understand others’ possible thoughts
as well as their own
Comic Strip Conversations (Gray, 1991)

Cartooning someone else’s thoughts and colour coding their emotions can provide the
client with an understanding of the impact of their actions on an intellectual level, rather
than on an emotional level.
Skill Streaming (McGinnis & Goldstein, 1993):-

Breaks down the social skill into a step-by-step sequence of smaller, more achievable
skills.

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Social Skills Picture Stories (Gray, 1993; Baker 2006):-

Each story is made up of a series of digital photos of the child re-enacting a particular
social situation. Thought bubbles are made visually explicit to help the child
understand another’s perspective (“Theory of Mind”).

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Examples of visual strategies

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Research indicates that individuals with impairment in “Theory of Mind” may find
great difficulty in ‘seeing things’ from any other perspective than their own and
consequently have particular difficulties determining the intentions of others and with
tasks regarding understanding another person’s beliefs (Baron-Cohen, Leslie & Frith,
1985);

Young people with ASD may: -
   ▪ exhibit social skills and social awareness, more akin to that of a younger child
     (Attwood, 2003). Dealing with teasing, friendships and relationships may be
     challenging for the young person with ASD;
   ▪ have difficulty understanding complex cause and effect relationships
   ▪ exhibit literal understanding and think in a polarised manner resulting in mistaken
     underlying assumptions.
   ▪ become stuck in one way thinking without being able to see there are alternative
     possibilities. Cartooning can facilitate reframing. For example, the young person
     draws out his interpretation of the situation and the counsellor draws the
     reframed situation.
   ▪ use extreme emotional phrases to describe how they are feeling. For example,
     the young person with ASD may exhibit “all or nothing” catastrophic thinking.
   ▪ benefit from the use of a visual scale to illustrate that all emotions are on a
     continuum.

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Emotional Toolbox (Attwood)
   ▪   physical (quick release of emotional energy)
   ▪   social (constructive release of emotional energy)
   ▪   relaxation (slow release of emotional energy)
   ▪   sensory
   ▪   solitude

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Young people with ASD may: -

   ❖   require explicit support in seeing possible solutions and alternative possibilities
   ❖   benefit from visual prompts to illustrate multiple choice scenarios
   ❖   benefit from reminders when s/he previously overcame a similar problem
   ❖   benefit from keeping a ‘Daily Positive Diary’ or ‘Gratitude Journal’ which
       requires recording something positive each day (please see below)

Example of Daily Positive Diary

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Feedback from our Young People
People with ASD may find it difficult to use eye contact with the counsellor, especially
when talking about feelings. Please respect this and know we are still listening to you
and value your support. Fearghal, 16 years old.

People with Autism may need more time to get to know the counsellor. It took me
eight visits before I felt comfortable enough to tell the counsellor my worries. Once we
develop a trusting relationship with you, we will trust you and be able to speak to you
but please give us more time and be patient with us, especially in the first few
sessions. Jemma, 17 years old.

It helped me when the counsellor drew out a situation using stick men and thought
bubbles. This helped me understand how someone else may have been feeling in the
situation. Sarah, 14 years old.

People with Autism may need to speak to the counsellor as it can be difficult to have
that one friend you feel you can trust and confide in. I trusted a friend once but when
she told others my business I was worried about opening up to her again. Jemma, 17
years old.

It helps if the counsellor asks straightforward open ended questions. Sean, 16 years
old.

Counselling has really helped me. Without the school counsellor, I wouldn’t be in sixth
form and I wouldn’t be doing as well as I am. Thank you. Laura, 17 years old.

This booklet for school counsellors is full of useful information which I know would
help me in a counselling situation. I would recommend all school counsellors take time
to read this booklet. Nathan, 17 years old.

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Useful Reading
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th
     ed.) Washington, DC: Author

(2003). Asperger Syndrome: A guide for parents and professionals. London: Jessica Kingsley
      Publishers.

Attwood, T. (2003). Asperger Syndrome: A guide for parents and professionals. London: Jessica
     Kingsley Publishers.

Attwood, T. (2001). Exploring feelings. Cognitive Behaviour Therapy to manage Anxiety. Texas:
     Future Horizons.
Baker, J.E. (2006). The Social Skills Picture Book for high school and beyond. Arlington: Future
     Horizons.

Baron- Cohen, S., Leslie, A.M., & Frith, U. (1985). Does the Autism child have a theory of mind?
     Cognition, 21, 37-46.

Dunn Buron, K., & Curtis, M. (2004). The Incredible 5- Point Scale: - Assisting students with Autism
     Spectrum Disorders in understanding social interactions and controlling their emotional
     responses”. Kansas: Autism Asperger Publishing Company.

Kelly, A.,& Sains, B. (2009). Talkabout for teenagers. Speechmark Publishing.

McGinnis, E., & Goldstein, A. (1997). Skillstreaming the elementary school child: New strategies and
     perspectives for teaching prosocial skills. Champaign, IL: Research Press.

Paxton, K., & Estay, I. A. (1997). Counselling people on the Autism Spectrum. A practical manual.
     London: Jessica Kingsley Publishing Company.

Stallard, P. (2019). Thinking good- Feeling better. A cognitive behaviour therapy workbook for
       children and young people. Chichester: John Wiley & sons Ltd.

Wing, L., & Gould, J. (1979). Severe Impairments of Social Interaction and Associated abnormalities in
      children: Epidemiology and Classification. Journal of Autism and Developmental Disorders, Vol
      9 (1).

© Autism Advisory and Intervention Service (AAIS)

© Autism Advisory and Intervention Service (AAIS)