For therapists who work with children on the autism spectrum, the family interview or assessment can be quite difficult. It can be hard to determine how much information to obtain and how much information to omit. And for many of us, getting a parent or family to remain focused during the assessment and provide structured answers is a challenge. Parents often end up going on a tangent — out of anxiety, out of fear, or out of relief that they are finally getting help.
That’s why Linda Kelly and Janice Plunkett D’Avignon wrote the very practical Charting the Course for Treating Children with Autism: A Beginner’s Guide for Therapists. The guide can help practitioners not only start the process of working with a family — providing assessments and gathering pertinent information for treatment — but also develop their own clinical forms to use before treatment begins. And perhaps most important, it can help us make families feel at ease.
Therapists sometimes struggle with asking the right questions and follow-up questions that can help reveal a client’s most troublesome symptoms. Often, there is so much to gather in so little time that information often goes unreported, underreported, or even over-reported by families. And again, it is important to remember that parents and guardians may be intimidated. That means the clinician must gather what they need to carry out appropriate treatment while still making families feel comfortable enough to share pertinent details.
According to Kelly and D’Avignon, “probing too deeply too soon may interfere with building the therapeutic trust needed to develop the client-therapist relationship.” As they explain, guardians of children on the spectrum “have often learned through experience that others are judging them. They have been viewed as being too overprotective, too controlling, or lacking in parenting skills. They report often regretting disclosure” — and that makes new relationships “not easily formed or trusted.”
The authors do a good job guiding the reader on how to outline the beginning stages of treatment. They also do a good job reminding us to be mindful of interviewer bias — preconceived notions on the part of the therapist as interviewer — and of problems that can cause a family to underreport information and become guarded or defensive.
The book both highlights the therapist’s job of acquiring necessary information for treatment and emphasizes the emotional and psychological barriers for families in the mental health system.
Kelly and D’Avignon discuss how to conduct a comprehensive interview. It should, they write, include a family profile form, to gather general family-based information; a referral form, to gather information about why the referral was made and what the need is; diagnostic information, including what testing has already been done; background information on parents; medical history of the family and child as well as developmental history; information on social/communicative/behavioral development; and the use of a support-systems form, to look at friend or family support. All of these forms and guidelines are extremely useful.
One thing the authors do not mention is how much a parent or family might benefit from and appreciate the structure provided in the book. Two questions I had while reading: How does this enhance the assessment process? Why is this any different from a typical assessment?
The other very practical thing readers may want to know is how they might reproduce the worksheets in the book without violating copyright laws. Luckily, the usefulness of the material in the book outweighs these minor questions. With a little research or some outreach to the authors, one should be able to find out the copyright situation.
When a therapist gets lost in the details of a family interview, everyone begins to feel overwhelmed, maybe even confused. Having a book that outlines necessary steps is a saving grace. If you are a therapist who needs help with interviewing the family, conducting a sound assessment, developing a treatment plan, interviewing the child, and setting boundaries, objectives, and future goals, this book is for you. Working with children on the spectrum takes a lot of patience and experience, and Kelly and Plunkett D’Avignon can help you prepare.
Charting the Course for Treating Children with Autism: A Beginner’s Guide for Therapists
W. W. Norton & Company, March 2014
Hardcover, 288 pages