A unique and specific intervention can hardly be identified for all the different manifestations of the autistic spectrum. These provide variable levels of complexity and symptoms.
The autistic spectrum It is characterized by a set of conditions and behaviors that can present themselves in a heterogeneous way and correlate to atypical development.
Even if i Autistic spectrum disorders They are diagnosed on the basis of their behavioral expression, it is necessary to intervene on the socio-relational, cognitive and emotional aspects where possible.
In the DSM-5 Asperger’s syndrome It is no longer recognized as a syndrome with its own nosographic autonomy. A single category has been defined where the symptoms are manifested along a dimensional continuum, the Autistic spectrum disorder.
Asperger and high functioning autism
In clinical terms, however, it can be useful to talk about Asperger syndrome or of Autism with high functioning To guide more specific therapeutic interventions.
Some intervention strategies that can be fine for people with “low -function” autism of the educational or rehabilitative type may be not fully suitable for subjects who were considered as more recent times as Asperger.
The therapeutic intervention should therefore be personalized and descended on the functional aspects of the person. Considering resources and critical issues and agreeing it together with the professionals involved, the family and the school context.
The best treatment involves the involvement of a Specialized multidisciplinary group where possible. The initial evaluation must consider cognitive skills and learning skills, language and communication skills, motor development and sensory aspects, the presence of any emotional disorders, physical health, adaptation skills and the presence of problematic and non -adaptive behaviors.
Family members must also be involved and planning parent training interventions to increase awareness and knowledge compared to the way their children perceive and live the surrounding world and help them interact and maintain greater psychological well -being.
The ABA method
Here is only one of the main intervention programs used with children with autism spectrum disorders which is also the one with major efficacy studies. The ABA method (Applied Behaviour Intervention) is made up of a set of behavioral interventions aimed at increasing intellectual skills (Qi), language and behaviors appropriate to the context and a greater level of adaptation.
However it is whatever the intervention, the functional analysis of behavior It allows you to help the person or whoever is close to understanding the function of a certain behavior and modifying it when problematic or dysfunctional.
It allows you to achieve the set objectives by acting on the environment and the quality of life of the person in a structured way. It also provides for the use of psycho-social interventions involving the various life contexts of the person such as the family.
Based on age, specific development characteristics and different needs, it is necessary to expand interventions through the learning of skills aimed at reinforcing autonomy, planning of one’s objectives, emotional self-regulation.
Cognitive behavioral therapy for Asperger
At this juncture it can be useful Cognitive-behavioral therapywhich can be applied where it is useful to increase functional and socially appropriate behaviors, to help adapt to the tasks of daily life and improve communication skills and where the level of development allows it.
People with Autism with high functioning (HFA), or with verbal and cognitive skills and skills in the average or higher than the average, They need to be evaluated at a clinical level adequately and to be able to be followed by adults through targeted and effective interventions.
One of the limits in the current panorama is that many often come to the identification and diagnosis of autism late and find themselves in adulthood to not be able to take advantage of an adequate quality of services and benefit from any treatment.
The problem was born when we discover that many of them will have to deal with the lack of well -structured contexts and “facilitating” services entry and integration into the work and social world and only a minority will not need it.
Effectiveness of psychotherapy
According to the Guidelines of the American Psychiatric Association (APA, 2014) cognitive-behavioral treatment (CBT) It could be effective in cases where a comorbility is presented with anxiety or mood disorders, for the management of anger and in the interventions with family members.
There are few studies that detect the effectiveness of the CBT with these patients, but various authors who recommend their use. There Cognitive-behavioral therapy (CBT) It outlines a series of interventions aimed at dealing with the clinical symptoms more commonly associated with Asperger’s syndrome. For example mood disorders And anxiety disorders And it allows to intervene on cognitive and emotional functioning and on the main deficits.
The problems that these patients often report in therapy are often of social origin or linked to secondary forms of psychopathology. They can be skilled in the school context or in intellectual interests but have compromised socio-relational operation.
For some authors there could be a disorder in the processing of information (Gaus, 2014). The stereotyped and rigid interests often follow in an almost obsessive and not very flexible way and the lack of social understanding, sometimes the scarce problem solving skills, could lead them to isolation and strengthen the feeling of bankruptcy.
This could also have a negative outcome on the professional as well as socio-relational side, lead them to be refused or to be more vulnerable than emotional disorders.
Cognitive-behavioral interventions can be aimed at helping them to identify and recognize their negative automatic thoughts, to develop more appropriate “readings” of social and others’ interactions, to give a sense and more effective regulation of their emotional experiences, to expand self-acceptance and modify any dysfunctional behaviors.
Automoniteraggio, emotional psycho-education, cognitive interventions, stress management and the acquisition and implementation of new face-facing skills and strategies (coping skills) can serve precisely to reduce the possibility of entering painful mental states characterized by anxiety, depression, or anger.
How to help a person with autistic spectrum disorder in the subject’s life contexts
First of all it is necessary to accompany the person himself and family members in acquiring awareness and increasing acceptance of the diagnosis. Based on the knowledge of the subject’s relational and emotional development level, the person’s style of thought must be respected and the peculiar way in which he perceives some stimuli and experiences the sensory aspect.
For some, even small changes can be a source of great stress and break the tendency to rigidly adhere to routines or ritualized behaviors.
If the problem starts from sensory deficits it is important that it can restore a safety condition. If, on the other hand, the fear of change is related to anxiety for an unpredictable world, it is important to help the person to make it more predictable and understandable, this in order to internalize a more functional way of reading what happens to him emotional, to interpret what happens around him and have better faces strategies.
Even if an increased sensory perception is usually more present in childhood and we go to reduce with adolescence, difficulty managing one’s sensory experiences can also be present in adulthood. However, it is essential to help to recognize them and give it a name and understand which environments or circumstances can be activating or too stimulating.
The management of anger
Where crises of anger or aggression are presented, it is important to understand if it is a request for attention or an emotional, cognitive and sensory overload.
In the first case it may be useful to ignore problematic behavior and reinforce alternative adaptive behaviors. In the second it is necessary to contain and secure the subject who is experiencing it and reconstruct the environmental or internal causes that have generated this condition. Then give a name and meaning to painful experience, thus learning to protect yourself.
Interest and adaptation capacity
As for the sometimes restricted interests and towards which they tend to hyper-focaling it is necessary to know that they often constitute a pleasant experience and a useful resource to motivate in the work. It is therefore not recommended to try to remove or discourage them, but develop their functionality, making them more flexible.
It is important to work on ability to adapt to the context and on the ability of self-regulation, skills that can be increased from childhood to adulthood. Furthermore, where possible and the level of development allows it it is useful to intervene on the conditions that could maintain social isolation or the sense of alienation and refusal, above all to avoid worsening in adulthood.
Bibliography
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders – fifth edition. Edited by Biondi M. Raffaello Cortina Editore, Milan 2014.
- Gaus, VL, (2014). The CBT applied to the adult with Asperger syndrome and high -operation autism. Ed.italiana by Antonio D’Ambrosio and Viviana Perfect, Franco Angeli, Milan.
