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Early diagnosis and intervention for individuals with Autism can help establish meaningful treatment goals in therapy and ensure that the needs of the individual are being met. It can also make a significant difference in understanding an individual’s perspective and alleviate the stress and confusion that may come with misdiagnosis. Often an individual with Autism may receive several diagnoses such as ADHD, Oppositional Defiance Disorder, or an anxiety disorder before reaching an accurate diagnosis. While many of these disorders can overlap, an autism diagnosis that may be more appropriate is sometimes overlooked. Misdiagnosis can lead to improper treatment and cause additional stress and frustration for the individuals and families involved. An accurate diagnosis is key in providing individuals with the tools they would benefit the most from and prevents further escalation of symptoms.

What is Autism?

The American Psychiatric Association defines Autism as “a complex developmental condition involving persistent challenges with social communication, restricted interests, and repetitive behavior.” (2023). An individual with Autism has a different way of thinking and processing their world. Autism is not exclusive to only one population or group of people and can present differently from individual to individual. There are several common misconceptions and harmful stereotypes that often result in a delayed Autism diagnosis. Some of these negative assumptions are that to be Autistic you have little to no emotion, lack empathy, or have no social relationships. Individuals with Autism have expressed just how untrue that perception is. The TED Talk by Ethan Lisi “What it’s really like to have Autism” goes into detail in how wrong these misconceptions are and is a must watch for anyone looking to better understand Autism. https://www.youtube.com/watch?v=y4vurv9usYA

How Autism Can Present Differently

Autism is often overlooked as a diagnosis when an individual uses “masking” by camouflaging behaviors or difficulties. Sometimes an individual can get by in these situations and it becomes more apparent there are some concerns once the demand or environment exceeds the skill level or ability of the individual to continue masking. It can make behaviors or concerns seem to “come out of nowhere” when they may have been there all along. The ability to mask does not mean that there are still no concerns or difficulties the individual is experiencing. The presentation of Autism looks different between individuals and even differs between genders. Autism research and guidelines largely focused on boys and can cause girls with autism to be missed. Girls with autism may not exhibit the same degree of repetitive interests or behavior or their fixed interests may be viewed as socially more acceptable than what would usually raise concerns in boys presenting with autism. This can cause girls to be overlooked when considering an autism diagnosis because they don’t fit the stereotypes people have when thinking about autism.

Distinguishing Autism between Other Diagnosis

There are several diagnoses that can present similarly to Autism. It is important when discussing presenting problems and symptoms to try and distinguish the “why” of what is happening. For example, an individual with social anxiety experiences fear in social or performance situations that they think could result in embarrassment or scrutiny. While an individual with autism may have difficulties in social situations because of sensory reasons such as loud sounds, bright lights, or the amount of people that manifest in the similar behaviors. It is important to distinguish what these behaviors are trying to communicate to us and the best method of helping them through these difficult moments. If you have questions about autism and similar diagnoses speak with your therapist or other medical professionals to help determine the best evaluations and next steps.

by: Dawn Ruane

LAC References American Psychiatric Association. (2023). What is Autism Spectrum Disorder? Psychiatry.org – What Is Autism Spectrum Disorder? https://www.psychiatry.org/patients- families/autism/what-is-autism-spectrum-disorder

When looking for mental health support it is important to find a therapist that will see you as an individual while also respecting and understanding your identity. It can be incredibly stressful to find affirming mental health support, but it does not have to be impossible.

Resources
The Trevor Project
The Trevor Project provides public education, research and resources that can be accessed 24/7 through their website focusing on crisis intervention services and suicide prevention for members of the LGBTQI+ community under the age of 25. They have trained and licensed crisis counselors who are available through calls, texts, or chats who provide confidential and secure services.

https://www.thetrevorproject.org/
Call: 1-866-488-7386
Text: ‘Start’ to 678-678

Mental Health America
Mental Health America partnered with the Human Rights Campaign to develop a screening tool that can be helpful for individuals looking for affirming mental health care and providers. This tool was created to support Queer and Trans Black, Indigenous, People of Color (QTBIPOC) find culturally responsive and affirming mental health care. It has questions centered around discovering what experience and training a therapist has in topics of inclusion, responsiveness, and intersectionality.

https://screening.mhanational.org/content/questions-help-qtbipoc-find-affirming-mental-health-providers/?layout=actions_f

The Therapeutic Relationship
As a client you have the right to quality therapeutic services that are professional, ethical, and maintain healthy boundaries. While it is important to find a therapist who uses certain styles of therapy and treatments that you are looking for, studies show that the therapeutic relationship is significantly more impactful than the methods a counselor uses in sessions. If you do not trust or feel supported by your therapist, it is unlikely that you will benefit from their services. A good therapist will be open to discussing concerns that a client has about the therapeutic process and relationship and respond to those concerns appropriately. Clients also have the right to terminate services if they feel that a
therapist is not the right fit for them and their goals. Additionally, it is important to remember that even if a therapist describes themselves as LGBT-affirming, they still may not be the right choice for you. Most practices provide background information and biographies for their therapists. This can give you insight on their counseling style, experiences, certification, and specialties and help you determine if they may be the right fit.

Clients Rights

It can be overwhelming when looking for a therapist or when determining if a therapist is the right fit for you. Sometimes a client may feel that they need to discontinue services with a therapist or look for a second opinion. Listed below are a few key takeaways for clients to remember.
 Clients have the right to terminate services with a therapist at any time.
 It is not the client’s responsibility to educate a therapist on their identity.
 Clients can report concerns about unethical behaviors to the appropriate licensing board or professional organization that the provider would belong to.
 If your therapist is under licensing supervision as an associate therapist, you may also discuss concerns with their supervisor.

written by: Dawn Ruane LAC

What is a Coping Skill?

Coping skills are essential tools that can help an individual deal with stressful situations or difficult
emotions in healthy and productive ways. They can be unique and personalized to meet the needs of an
individual and can be both short- and long-term strategies. While there are many different types of
healthy coping strategies the most recognizable skills are usually problem solving or emotion focused
such as asking for support, time management, meditation, and journaling. Most people find benefits
from using a combination of both. So, why do so many people feel that coping skills are ineffective for
them?

Misconceptions about Coping Skills

“Coping Skills don’t work for me because I’m still overwhelmed.”

Often people will think that coping skills are unhelpful because they will still feel stressed out,
overwhelmed, or anxious even after using a coping strategy. It is important to remember that coping
skills can be effective in helping someone build resiliency and minimize the impact of anxiety or difficult
emotions. However, no strategy can eliminate your stressors or feelings of stress & anxiety entirely.

“I can’t stop my thoughts, so meditation or mindfulness won’t work for me.”

When using strategies such as mindfulness it is important to remember that the goal is not to suppress
emotions or stress but rather to develop an awareness of our thoughts, emotions and how our body
may be reacting. For coping strategies to feel effective we often must be comfortable with being
uncomfortable. This is accomplished by focusing on the present and how we are thinking, feeling, and
our surroundings without judgement. By avoiding feelings of discomfort or anxiety when trying new
coping strategies, we find short term relief that gradually builds into more intensified feelings of anxiety
over time when faced with the same anxious thought or situation. Avoidance does not teach us the
skills to navigate these difficult moments but can give more power to our anxious thoughts causing us to
feel “stuck”.

“I don’t have the time.”

In today’s busy world it can seem daunting when thinking about another “task” to add to our to-do lists
and schedules. A misconception people have when thinking about coping strategies is that they require
a lot of time, money, or resources. One or two effective strategies can still make a difference and do not
require extensive planning. We can also utilize coping skills proactively before a stressor happens or
reactively after a stressor occurs. By thinking ahead, we can develop tools and skills that will help us feel
better equipped to navigate unplanned stressors.

What does this all mean?

There is no one size fits all approach to coping skills and strategies. While many coping skills are
beneficial to most people, it may take some trial and error before finding the right ones for you. Just like
any skill, they also require practice and grow stronger the more we use them. Give yourself some time
when trying out a new skill and be open with your therapist if you need to explore other strategies.

Written by: Dawn Ruane, LAC

Parenting is one of the hardest but most important jobs in the world. How you choose to communicate with your child or children shapes how they will choose to communicate with others. If you yell at your child when they are misbehaving or aren’t listening, they will also yell when others aren’t doing what they want them to do. If you don’t acknowledge what they are feeling, they won’t acknowledge what others are feeling. Children mimic behavior and are sponges so it is especially important that you as parents model the communication you are looking for from your child. Easier said than done right? I am a father of four young daughters so I understand how challenging it can be to practice what you preach! Here are four ways that may help you model the communication you would like to see in your child. These strategies will also help strengthen your child’s overall mental health.

1. Check In With Yourself

Stressors may feel like they are at an all time high between work, bills, and not enough balance in your life to do the things you want to do. After a long day, your child just wants to spend time with you, but maybe you don’t have the bandwidth to give them the attention they need. As a result, they may start to misbehave to get your attention. You ask them to clean up a mess they made or to do their homework but they don’t listen to you. You find yourself getting frustrated and begin to yell at your child only to escalate the situation. Before you even go down this path, check in with yourself. You may even need to remove yourself and self-isolate for a few minutes. Take some slow, deep breaths and ask yourself what you are feeling and what outcome you are looking for. By identifying your own emotions and focusing on the end results you are looking for, you will have a better time communicating with your child and other family members which will result in a more productive conversation. If your mood is elevated and you are having a difficult time identifying or coping with strong emotions, now may not be the best time to engage with others. Be sure to let your family know that you just need some time to decompress and/or meditate. Encourage your child to check in with his or her self as well during times of distress and follow the same course of action.

2. Listen First

Whether your child is expressing a need or emotion in a rational way or they are misbehaving because they are having a difficult time communicating a need or emotion, be there to listen first. Ask open ended questions and let your child talk. Try to acknowledge their perspective and validate what they are feeling. It is okay if you disagree with something they say or have a different opinion. If this is the case, you can problem solve and brainstorm solutions that work for both you and your child. Simply letting them know that their perspective and feelings matter shows your child that you value them. It also models healthy communication, relationships, and problem solving/conflict resolution skills. This requires patience. You may need to take a few deep breaths should your child’s mood become elevated if they are having a difficult time expressing what they are feeling to you. Keep in mind, if you remain calm and continue to listen, you will help your child express their need and emotions. You will also prevent things from escalating further which can lead to more time and energy invested in resolving whatever the issue is. If your child is not able to effectively communicate or is not ready to talk, let them know that you are ready to listen when they are ready to talk. Give them time to calm down and be available when they are ready to talk to you.

3. Spend time connecting with your child

You are your child’s hero and they just need your time. Sometimes it may feel difficult to consistently give your time to your child with all of the other responsibilities that parents have to manage. Try to incorporate some time each day even if it is just 10-20 minutes. Maybe it means having a catch outside or playing house or a board game. If possible, try to also make time to spend one on one time if you have multiple children as this really increases bonding and connection with each child. Try to connect at least once per month if possible even if just for an hour or two. Go to the boardwalk/beach, take a hike and fish together, go for a bike ride and picnic, or come up with a new, creative idea you haven’t done yet. By taking the time to bond and remain connected, your child is much more likely to look to you as you continue to model positive communication for them. Having healthy relationships with your children will have a positive impact on your mental health as well as theirs.

4. Normalize negative feelings

Humans are emotional beings. How we act and communicate is a direct result of what we are feeling. The same goes for children. Wouldn’t it be great if everyone was happy all the time? Your children always got along and everyone listened all the time and followed through with chores and responsibilities. Adults have their fair share of struggles with emotion regulation between work, home, and other stressors. Don’t forget that children and adolescent brains look completely different than adult brains as the part of the brain that helps to control emotion regulation is not completely developed yet. As a result, your child, who is experiencing all sorts of heavy emotions, doesn’t know what to do with them! It is important that you as the parents provide a safe place for your child to express their feelings even if they are negative. Be the calm in your child’s storm and let them know it is okay to not be okay. Reassure them that all emotions eventually pass but do not try to fix what they are feeling. Simply being present, patient, and ready to listen and provide support will affirm that you care and that it is okay that your child is experiencing a negative feeling. Should your child’s negative emotions be persistent or should they struggle with emotion regulation regularly, it may be helpful to find healthy ways for them to cope including exercise, playing an instrument, or going outside and connecting with friends. If you find that nothing seems to be working, it may also be helpful to reach out to a professional as having an outside counselor can be a great outlet for anyone.

“Beneath every behavior, there is a feeling. And beneath each feeling is a need. And when we meet that need rather than focus on the behavior, we begin to deal with the cause, not the symptom.”

Have your feelings ever been hurt by a parent, spouse, coworker, friend or someone else in your life? The answer is obviously yes. You might lash out at that person or withdraw because you are feeling sad. Your aggressive behavior may trigger the other person and now you find yourself in an argument or conflict. The argument or conflict creates more sadness for you leading to more aggressive behavior. When people are experiencing a strong feeling, they may not immediately be able to identify what that feeling is. As a result, they aren’t able to communicate effectively with others what it is they are feeling and why they are feeling that way. Rather, they may act out aggressively or become withdrawn. This makes it challenging for the other person to fully understand what is going on which is why the situation typically leads to a conflict or argument. This can happen often in marriages, relationships, and especially with children and adolescents. Since the part of the brain that controls emotion regulation does not fully develop until your mid to late twenties, children and adolescents have a difficult time expressing what they are feeling which makes it difficult for parents to navigate through.

3 STRATEGIES That will help de-escalate negative behaviors

SHOW COMPASSION AND EMPATHY

If a child or partner is acting out aggressively or is withdrawing, you may be inclined to get angry and frustrated as well. Take a deep breath and remember that beneath the surface of the behavior is an emotional need. Offer support (a hug, being present, going for a walk together, etc.) and show compassion. Try to put yourself in the other person’s shoes so you have a better understanding of what it is they are experiencing. Did they transition back to school and may be overwhelmed and anxious? Maybe your coworker just lost a friend or relative and are grieving. Whatever the case is, if you show compassion and empathy rather than anger and frustration, you will help de-escalate negative behaviors. It is also more likely that the other person will begin talking about whatever it is they are experiencing and feeling rather than getting more aggressive and defensive.

ASK CLARIFYING QUESTIONS

When a person is showing aggression or withdrawing, it is challenging to maintain your composure. You may be confused why they are being aggressive or withdrawing and may even take their behavior personally. After all, their behavior is communicating with you that they are angry, not that they are feeling sad or something else. You may feel the urge to defend yourself, but make sure to resist from doing so as this will only escalate the situation. Rather, try to understand what is going on from the other’s perspective. Begin to ask questions to help you learn more about what the emotional need is. The more open ended questions you ask, the more the other person will continue to open up. Keep in mind, the goal is to show the person that you genuinely want to understand more about what is going on beneath the surface. If your questions are genuine and reflect compassion and empathy, the other person will let you in more. Otherwise, their walls will remain shut. Once you learn more about what the emotional need is, you can determine what you are able to do within your control to help.

ACKNOWLEDGE AND VALIDATE

Once you are able to identify what is going on from the other person’s perspective, make sure to acknowledge and validate what was said and what they are feeling. Whether you agree or disagree with the perspective, acknowledging another’s point of view and validating their emotions will help de-escalate negative behaviors. It will also help to build trust as you will become a safe place for the person to become vulnerable with. The more often you are able to implement these strategies, the more likely it is that the other person will open up more to you in the future as opposed to acting aggressively or withdrawing.