World Autism Awareness Day

For Autism Awareness week, we spoke with Adele O’Hanlon Senior Child Psychotherapist and Sue Reid, Child and Adolescent Psychotherapist, who share their experiences of  how child psychotherapists can work with children with autism and their families, with comments on the current lockdown situation for these families.

Adele shares her experiences of working in Camden MOSAIC an integrated service for children with disabilities, which includes the Child Development Team and Social Communication Assessment Service. While Sue has also written widely on Autism and Psychotherapy - shares how child psychotherapists can work with children with Autism and their families, and comments on the current lockdown situation for these families.

Have Child and Adolescent Psychotherapists always worked with Children with Autism?

Sue Reid begins "As child psychotherapists we’ve had a long interest in therapeutic interventions with children with Autistic Spectrum Disorders. I saw my first child with autism in 1970, and then set up the Autism Team and Research Workshop at the Tavistock Centre in London. I was determined to involve parents from the very beginning, and this led to a support group for parents and the active involvement of those parents in setting up a series of conferences for other parents, people with autism, professionals, and stakeholders."

How does a Child Psychotherapist work with children with autism?

"The child psychotherapist is interested in understanding the uniqueness of each family and of each child with autism. In the course of psychotherapy, we seek to understand what lies beneath the child’s difficult behaviour so that we can intervene in a helpful way. My primary therapeutic aim is to get communication going within the family and in a new way. This is helped by our training in observation. All psychoanalytic psychotherapists are trained in observation; The observational state of mind is a friendly, curious state of mind, non-judgemental, in which the therapist is interested only in ‘getting to know’ the family. If the therapist can see the world through the child’s mind, experience the world as s/he experiences it, it should become possible to use this understanding to help the child’s development. "

What would you say to families of children with autism in the current COVID-19 crisis?

"The current situation of lockdown is likely to be stressful for all families, but for the family of a child with autism, the stress will be increased exponentially. I want to emphasise here that we nowadays use the term ASD, and I want to underline Spectrum, parents are more likely to be able to provide some of what their child needs if they can connect with the reality that we all experience anxiety, that we all dislike unexpected change, and that we all need some structure in our lives.. It can also help to remember that we all get angry when we’re frightened. Children with autism are very quick to pick up atmospheres, and this will be particularly challenging at this point in time, and I would therefore suggest that parents wherever possible, try to meet their own needs as well. Creating a realistic timetable for you and the child with autism may provide some containment for their anxieties."

Further resources for parents of children with autism, as well as adults with autism can be found on National Autistic Society website.

Child psychotherapy at MOSAIC CAMHS and Child Development Team

Camden MOSAIC aims to enable families to help their children to participate in all aspects of family and community life. It is a joint service provided by CNWL NHS trust and the London Borough of Camden.

The service provides assessment, diagnosis and therapeutic intervention with a range of professionals from health and social care. The MOSAIC team includes: Child and Adolescent Mental Health professionals such as Psychiatrists, Clinical Psychologists and Child Psychotherapists and Speech and language therapists, Occupational Therapists and Physiotherapists, Health visitors, Paediatricians, Family Support Workers and Social Workers.

What do Child Psychotherapists add to the team?

Child psychotherapists at MOSAIC work within the Child Development Team (CDT) for under 5s. We are members of the multi-disciplinary assessment teams that see children with social and communication difficulties. The majority of the referrals to this team have been for assessment of Social communication difficulties or Autism.

Child psychotherapists in the Child Development Team undertake a number of clinical tasks, including initial appointments with families, usually with a colleague from another discipline, and then planning for an assessment or intervention.  Child psychotherapists in this team are trained in two standardised tests for Autism; the ADOS (Autism Diagnostic Observation Schedule) and the ADI (Autism Diagnostic Interview). We undertake these tests with our colleagues from other disciplines. Child psychotherapists are also involved in the diagnosis or assessment feedback to the family. However, this only takes place once the team has discussed the assessment, as it is important to have views from different professionals. If the child does not get a diagnosis, we explain why, and think with the family about what other support may be helpful.

As child psychotherapists, we also offer an extended assessment with younger children who are referred for an Autistic Spectrum Disorder assessment; we see some families for up to five sessions if the team feel that further understanding of the child is needed, or support with relationships within the family is needed.

For children that we feel would benefit from individual child psychotherapy or parent child work, we can refer the child to MOSAIC and continue the longer term work in that capacity.

What does a Child and Adolescent Psychotherapist bring to the work at MOSAIC?

Child psychotherapy helps the team to keep thinking about the emotional life of the child and relationships between the child and parents or carers during the assessment process.

As MOSAIC is a service for children with disabilities, feelings of loss and guilt are very common. Child psychotherapists are very well placed to support colleagues and families around these fundamental issues.

The child psychotherapy work at MOSAIC with children on the autistic spectrum is often around developing a stronger sense of agency in the child and helping parents to see the whole child and the meaning behind their behaviour. Child psychotherapy is led by what the child brings. Children who are developing in a less neuro-typical way often bring such rich, quirky and imaginative play and communication into sessions.  I think the child psychotherapist’s capacity to be interested in and try to understand the child’s experience of the world is deeply valuable, particularly with children and families at MOSAIC who can be relatively isolated.