Mental Health in Autism
As most readers who know anything about me already know, in addition to my role as President of US Autism, I have also owned my own private practice working in the field of mental health and special education for almost 30 years. But what I haven’t shared widely is that in addition to doctoral-level degrees in both School Psychology and Special Education, I also have what I consider to be a “hobby degree,” with an additional 90 graduate hours of training in the field of naturopathy. When I share this, people often ask me why I have three separate, and even seemingly unrelated degrees. In response, and in line with last week’s featured video Ron Sandison: An Autistic Man’s Journey with Mental Health, I have found that until we bridge an individual’s mental health needs with their school and/or workplace success and address their physical, mind-body wellness, no amount of mental health counseling or psychiatric intervention really solves the mental health challenges. So, for this week’s US Autism Blog Post, I want to share some priorities that I address when conducting a new client intake and when working with the clients in my mental health practice. These also align closely with the video I posted just this morning featuring Dr. Rebecca Knowles on the topic of using bottom-up therapies to treat meltdowns and neuro-crashes in autism.
In my clinical intake, like most mental health practitioners, I do a thorough intake before I take on a new client. But within my intake I ask some kind of unusual questions. For example, in addition to the typical “what brings you here and how are you feeling” questions, I ask about sleep, breath awareness, digestion and elimination, skin health, sensory sensitivities, movement and exercise, and for adults, their level of emotional and spiritual connection to others as well as the world beyond themselves. I also dig deep into how things are going at work or school. Last, I have several questions that quickly tell me about an individual’s learning and thinking style, their system of sequencing and executive functioning, and the individual’s potential range of intelligence. For me, all of these are necessary pieces to understand a client’s mental health. Through the years, I have found that many clients referred to me for mental health counseling really need medical treatment to address a problem with their physical health or they need major changes in workplace or school to receive proper accommodation and support for day-to-day success.
Once I have begun treating a client. unless they are experiencing an active mental health crisis, I still find that addressing underlying mind-body wellness can be the best place to initiate mental health treatment. This means that for some client’s, I refer them to an Integrative Physician that can work on wellness in conjunction with the mental health assessment or counseling services I am providing. If sleep is a problem, I also refer clients for a sleep study to rule out sleep disorders. I have found that a large number of individuals who present with ADHD have sleep disorders. Then, once a client finally enters my practice, they usually get a healthy dose of breath control and sensory awareness training within the first couple of sessions. From there, I build a very individualized program of intervention that includes both traditional mental health practices as well as educational or vocational intervention and support. In some cases, this leads to a comprehensive evaluation to better understand underlying learning or mental health markers. Last, while I do not officially work as a naturopath, I certainly draw from the basic principles of naturopathy to inform some of my recommendations for wellness in mind and body. For more information about what that entails, I have authored the book Naturopathic Wisdom: A Common Sense Mind-Body Approach for Struggling Children and Teens.
Through the years of my practice, I’ve come to believe that the way we train professionals for specialization and the compartmentalization in which most of us are forced work within our particular fields of study, while necessary for depth of understanding, can be highly counterproductive to the breadth of understanding that is needed to treat a whole person. As one example, most psychologists who assess and write psycho-educational recommendations for teachers have never sat on and Individualized Educational Planning Team within a school. Similarly, most physicians do not have the time to really explore the possibility of physical illnesses or mental health conditions outside of their area of specialization, nor can they fully consider the effects of an inappropriate educational or vocational situation on physical health. We all work in our own bubbles. This leads me to a call for increased awareness and training for all professionals serving those with autism to work, whenever possible, within true multi-disciplinary teams. It is only here that we learn about the areas of expertise that we lack. In coming weeks, I will be sharing US Autism Panel discussions to highlight how bringing extremely different professionals together can build success for those across the autism spectrum.