Intervention Planning for the Family of the Autistic Child: A Multilevel Assessment of the Family System*

Abstract

The clinician working with the family of an autistic child may need to assess the family at several levels. The first level requires an assessment of the behavioral deficits and excesses of the child. The next level examines the family in terms of their behavioral skills and the impediments that occur when they implement behavior change programs. The third level involves assessing the family unit to identify obstacles to change. While many well‐functioning families may be stressed by the crises that arise in raising an autistic child, other families are predisposed to dysfunction regardless of the presence of the child.

Trajectory of development in adolescents and adults with autism

“…Chief concerns of families during adolescence include challenging behaviors, social and communication skills, restrictions in family activities due to caregiving demands, management of school and related services, and worries about the future independence of their son or daughter with autism [Fong et al, 1993]. There is some evidence indicating that psychological distress increases during adolescence among parents of children with autism [Bristol and Schopler, 1983;Harris, 1984;Marcus, 1984;Koegel et al, 1992]. This increase may be due in part due to the larger size of the son or daughter in adolescence and adulthood, which may make behaviors that were tolerable at earlier ages extremely stressful and problematic.…”

“…What accounts for the extra level of strain that appears to accompany parenting an adult with autism? Several studies have pointed toward the extensive accommodations families make in the course of establishing caregiving routines, the high levels of challenging behaviors, the difficulty maintaining positive family interactions, and the social isolation that can accompany caring for an adolescent or adult with autism [Harris and Powers, 1983;Harris, 1984;Norton and Drew 1994]. In a study of caregiving tasks, parents of adults with autism were significantly more likely than parents of adults with Down syndrome to report being stressed by challenging behaviors and to perceive that caregiving demands were increasing with age [Holmes and Carr, 1991].…”

The Teacch Approach to Autism Spectrum Disorders

“…For example, Harris (1984aHarris ( , 1984b has long advocated that clinicians attend both to the behavior management skills and to the emotional health of individual family members and the family system, in order to develop effective individualized intervention programs. Konstantareas (1990) has summarized a comprehensive psychoeducational approach to work with family members that both addresses their grief and psychological needs, and provides practical recommendations about developmental stimulation and child management.…”

What Family Therapists Might Learn From Child Psychiatry

“…Because the etiology and the treatment of autism, diabetes and anorexia nervosa have been of interest, comprehensive reviews of these conditions have been reported recently. Currently, it appears increasingly evident that autism has a biological etiology, although it has profound effects on the family (Harris, 1984). In a like vein, Johnson (1981) concludes there is no evidence for a familial etiology of diabetes, but that the effects of a serious disease on both children and parents has been insufficiently studied.…”