Episode 57: Supporting Families with Children Living on the Spectrum

In this episode of The Family Couch, we talk with Dr. Cindy Graham about how to help children on the autism spectrum manage their autism in a healthy way.

We jump in by defining “Autism Spectrum Disorder.”  This term is more recent to the general population because Autism was previously broken into five other disorders. Asperger’s Disorder, Autistic Disorder, Childhood Disintegrative Disorder, Rhett’s Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified.  In the last revision of the diagnostic manual, these all changed to being Autism Spectrum Disorder (ASD). There is a range of presentations from “low functioning,” where individuals can be non-verbal and usually have a lower IQ, up to higher functioning, where individuals are highly verbal and just struggle with certain social aspects of life.

We talk about how this change to ASD has affected families who previously had a diagnosis of one of the original five separate disorders.  Graham provides that families may have a feeling of loss or being cheated because there was a distinction previously between the five. With Asperger’s taken away, people often feel the need to qualify with that information, so they will say, “My child has Autistic Disorder but previously was diagnosed as having Asperger’s.”

Graham discusses the three main things to look for when diagnosing a child.  The first is looking at a child’s obsessions. If they are particularly obsessed with anything, rigid adherence to rules, obsessions with parts of objects, collecting certain types of things, etc.  The other major symptom is presence of social issues. On the higher functioning end, a person may not have a hard time making friends but they do not understand things like sarcasm or subtle language cues.  If you say, “Get lost!” this person may wonder why you want them to lose their way. On the lower end of the spectrum, they have little interaction with others and make little eye contact. Some may be okay with certain types of touch and others are very resistant to touch.  The third criteria is difficulty with communication.

Because the symptoms are so broad, it is difficult for parents to see sometimes that their child may need to be tested.  Graham discusses that it is often difficult when children are higher functioning. Parents will say that their child is quirky or different.  Often if children have an Autism Spectrum Diagnosis, they will play with kids younger than their age due to the developmental delays. Graham provides that ASD is diagnosed 4x more frequently in males.  Even in her own practice, it is predominantly boys. This can lead to difficulty in diagnosis in African American boys because behavior problems will be diagnosed differently. Graham notes that in girls, the presentation is often more severe.  She discusses that there are certain genes that are implicated for this disorder. People used to think that some kids become autistic because their moms didn’t show them enough attention. Graham explains that there is still a lot of parent-blaming that happens.

Graham discusses that in the late 90’s and early 2000’s there was lots of discussion about vaccines causing autism.  This is still a hot-button issue today, but the researcher and studies that were conducted were retracted by the journals.  The research that was conducted was found to be very flawed and not believable. There is no known cause for autism. It is neurologically based and genetics and environment play a role.  There is not one thing that can be pinpointed to say “this causes autism.” Graham discusses that in the 40’s there were two doctors looking at similar groups of children in two places in the world studying their behaviors.  In the 90’s and early 2000’s much more focus was placed on this area of disorders. When we have more awareness of something, the diagnostic rate goes up. Graham does feel that this is overdiagnosed, but it is important to catch this as early as possible so they can get the help they need.  Accurate diagnosis is important but it is difficult, especially when a child is higher functioning.

We talk about what Graham helps families to understand about their diagnosis and how to manage it.  She provides that the first worry is almost always, “Will they be okay…will they be able to enjoy their life…will they get married?”, etc.  Graham discusses the importance of catching ASD early. There are lots of options for families, like day camps, group homes available for adults with similar diagnoses, and companies that specialize in finding jobs for adults with ASD.  The second worry is usually related to behavioral problems. This has to be taken piece by piece to deal with. Graham says that parents are always getting looks and advice from others about how to handle their children. This is very discouraging and shameful for parents who have children with ASD.  They often hesitate to take their children out in public, and Graham feels that it just should not be this way. We briefly discuss social media posting of tantrums, which Graham strongly disagrees with–both from the perspective of a person posting to shame someone else as well as taking videos of your own children.  Aside from doing this to show a medical professional what happens, Graham disagrees with this as it gives the child attention.

We discuss who Graham helps parents when they are dealing with their own self-doubt related to their child’s diagnosis.  Graham provides that for most parents she is helping them remove their doubt. Parents often doubt themselves because of criticism they receive from others.  She wants to help them challenge their doubtful thoughts. There is always a story behind their confidence issues in raising their children. She likes to start off with the more positive sides of parenting and focus on things like catching their children being good and praising them for it.  Parents of kids with special needs are at higher risk for depression, anxiety and caregiver fatigue. She praises their children as they do things, and parents will often say that they didn’t realize they should do that. Graham also has parents work on ignoring the inappropriate behaviors. She has them limit their reactions.  If a child is climbing the bookshelf, you just pull them down and redirect them to an appropriate activity instead of making a huge deal of them being on the bookshelf. A child with ASD may see their parent react and decide to do it again for the reaction. If you pair the calm response to behavioral issues with praise for good behaviors, the child learns that when they are following directions their mom and dad are excited, and when they misbehave, they don’t react.



Cindy Graham is a Licensed Psychologist who specializes in Autism Spectrum Disorders, intellectual disabilities and behavioral problems.  She is also a wife and a mom of two young boys and lives in Maryland. Graham recently founded her own practice, The Brighter Hope Wellness Center.



WEBSITE: https://www.brighterhopewellness.com/

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WEBSITE: https://cindytgrahamphd.com/

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