250 | How to Approach Autism Concerns with Parents as a Child-Centered Play Therapist

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You're listening to the Play Therapy Podcast with Dr. Brenna Hicks,

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your source for centered and focused play therapy coaching.

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Hi,

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I'm Dr. Brenna Hicks,

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The Kid Counselor.

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This is the Play Therapy Podcast where you get

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a master class in child-centered play therapy

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and practical support and application for your

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work with children and their families.

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In today's episode,

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I am answering a question from Bracha in New York.

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And

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her question is about

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kids that we think might be on the spectrum

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and how to handle that.

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So really important question.

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Thank you so much,

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Bracha,

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for the email.

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I'm really looking forward to this.

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Last reminder,

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it's so soon.

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January 3rd at 2 p.m. Eastern live event.

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Please register,

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click the link in the show notes,

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get yourself signed up.

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It is free,

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it costs you nothing.

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We just want to make sure that we have the capacity.

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And we're gonna have a lot of fun,

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a lot of really

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engaging dialogue,

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I'm sure,

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looking forward to answering your questions,

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putting faces to names,

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actually getting to see some of you.

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It's gonna be really exciting and we're hoping to do this more moving forward,

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maybe monthly or bi-monthly or quarterly.

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I don't really know.

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I guess depending on the demand,

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but

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anyway,

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we're looking forward to it,

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so please make sure that you sign up if you haven't already.

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I know many of you have,

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so

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can't wait.

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OK,

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so let's read parts of the emails together and then we'll dive in.

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I'm working with a child who seems to have ASD and I have a few questions.

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The clinic that I work at does not allow us to diagnose.

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That being the case,

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how do I help the mother understand the

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child's behavior without actually discussing the diagnosis?

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She's bringing him in for behavioral issues

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such as throwing things and banging doors

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and realizes that he is brilliant,

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but she has no idea what ASD is and is clueless as to why he's behaving this way.

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The client presents in session as very autistic.

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How do I know if the child is appropriate for CCPT if the

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behavior seems to be at the level of about an 18 month old,

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but the child is 4?

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And how do I adapt my language if they're not able to comprehend choices and limits.

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I wanted to thank you for your podcast.

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It gives me confidence as a new therapist that I

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can help and make a difference in my clients' lives.

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Oh,

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I'm so glad.

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Thank you for sharing that,

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Bracha.

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OK.

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So

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I am a huge proponent of not diagnosing.

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I'm asked to do it and the answer is always no at our center.

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I am ethically and legally able to,

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but I choose not to

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for a variety of reasons,

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which maybe I'll save that for a different podcast.

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But I'm actually very supportive of your clinic not diagnosing.

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And here's why.

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I don't think that that's our role.

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I don't think that that's our job.

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We have a very unique opportunity and position

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when a family brings us in as a play therapist.

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We are

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allied

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and we have the connection to the child.

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We

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support and psycho educate parents

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and we walk on the therapeutic journey with them.

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But our job is not to get into

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the business of diagnosing and medicating and labeling.

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I think that that's very dangerous.

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I think that it's a slippery slope,

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and unfortunately,

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I think that it happens far too often.

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I think almost every child is over diagnosed and overmedicated.

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So I just,

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I'm a huge proponent of not diagnosing actually.

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In this particular case though,

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let's be really clear.

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That

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to advocate for a child,

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that is,

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that's what we go back to all the time,

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right?

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We advocate.

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Our job is advocacy.

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In this particular scenario,

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it's our job to advocate on behalf of the child,

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and if you really believe that the child is on the spectrum,

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that is a warranted conversation with mom.

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So in scenarios like this at our center,

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what we've done is

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a couple of couple of approaches.

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The first is

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you ask mom in the consultation.

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So for us it's every 5 sessions with the child we meet with the parents.

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So at your next consult,

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I would bring up the idea and just pretty neutrally present it.

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So

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I wonder if you've ever had him evaluated or tested for

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anything.

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See what mom says.

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The answer is no,

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then you might proceed with,

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I'm wondering if you've considered

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that there might be something that we could rule out

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or that we could confirm

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if you think that that would be helpful.

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Here's what you're doing when you're asking these types of questions.

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I guess you're actually making I wonder statements to be fully clear,

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but

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I,

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I wonder with parents a lot,

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I wonder with everyone.

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The reason why we do this is we're assessing

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readiness,

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we're assessing receptivity.

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We're trying to figure out where the parent is with this,

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because if the reaction is,

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oh,

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I would never get my kid tested.

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OK,

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that's a very different

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next comment

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than,

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well,

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I guess I've just never really thought about it.

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I mean,

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I'm not opposed to it.

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OK.

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You need to get a sense of where the parent is,

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thoughts,

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feelings,

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impressions,

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just what,

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what's the vibe?

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And then what we have found helpful.

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is to give a preface.

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So,

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OK,

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at our center,

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we do not diagnose.

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We are not a proponent of labels.

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But some of the behavior that I'm seeing in the playroom

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makes me think that it might make sense to have a couple of assessments done,

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just to see if there's any confounding variables,

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in addition to just the emotional and the behavioral factors.

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Do you see how neutral that is?

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The goal is,

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it's not shock,

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it's not fear,

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it's not overwhelm,

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it's,

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this is normal,

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this is appropriate.

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I'm not pushing for a diagnosis,

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I'm not pushing for a label,

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but this is,

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this is my job.

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You are the expert.

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You play with kids all day long,

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you know what

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age appropriate behavior is and what isn't you

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know what neurotypical behavior is and what isn't.

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You know what constant consistent behavior is and what isn't.

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And when you see variances,

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when you see deviations

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it warrants bringing it up to parents that's advocacy.

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So

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I'm noticing a few things in the playroom that I

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think it might warrant just having a couple of evaluations done

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to

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see if we're dealing with anything other than emotional and behavioral stuff.

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If we rule everything else out,

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then we know what we're dealing with and we know that we're on the appropriate track.

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If something comes up,

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we'll navigate that at that time,

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but I think it would be helpful just to see.

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You know what an evaluation reveals.

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We have a couple of pediatric neuropsychologists that we refer to that we trust.

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And we typically refer out now

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some parents are hesitant to get a formal

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evaluation done understandably for a variety of reasons.

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Here are a couple of approaches for that.

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First,

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let them know

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that it doesn't matter whether a formal evaluation is done,

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they can choose to completely ignore it and never do anything with it.

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So let's,

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let's run a scenario here.

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Let's say that mom takes child,

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gets the evaluation,

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and it comes back,

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yes,

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ASD.

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Mom can

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burn the report.

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Mom can throw it away.

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Mom can throw it in the drawer and never look at it again.

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She doesn't have to tell the school.

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She doesn't have to get a 504 or an IEP.

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She does,

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it doesn't have to be on any record whatsoever.

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If you go to a private

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evaluator.

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It's,

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it's just

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in that person's office and it's in your hand,

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and it never goes further than that.

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So a parent can choose

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to do something with it or not do something with it.

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I think that gives parents peace of mind,

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because I think they see that there's only one path,

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which is if we get a diagnosis,

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that means this and this and this and this.

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No,

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it doesn't.

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It can be just for your awareness,

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so that you know what's going on,

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and then you handle it in your own way.

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That gives parents a lot of peace of mind.

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Another suggestion that we typically say if

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they're very opposed to a formal evaluation

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is we will say,

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I wonder if you'd be open to taking just a free parent report online evaluation.

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There are plenty of autism spectrum,

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parent report,

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free quizzes online.

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I mean,

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are they

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robust and

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empirically validated?

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Probably not super highly,

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but it at least gives parents a sense of they'll

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have some semblance of knowledge of what's going on.

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And I've had several families take it,

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and when it comes back,

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yes,

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it seems that it's leaning toward autism,

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then they're more willing to go get a formal diagnosis.

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And let me be really clear,

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this is not an easy conversation.

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OK,

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no parent wants to hear this,

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no therapist wants to say this.

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This is not easy,

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but here's where your confidence comes in,

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here's where your approach comes in.

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You are the expert,

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you are someone that this family is trusting

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and relying on

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to do what's right by their kid.

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So you are doing them a disservice and an injustice,

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I would argue,

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if you say nothing.

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So of course,

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you don't want to have this conversation and neither do they,

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but you do it with love

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and with kindness,

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and with advocacy,

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and I want what is best for you and your child and your family.

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So I have to bring this up to you.

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And you do it gently and lovingly and with patience and with grace,

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and they receive it.

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So often they will be willing to do like a free unofficial diagnosis assessment

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just to see where they stand.

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And look,

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if they take one and it comes back that the self-report says no way for autism,

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then

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you might question whether or not there's denial,

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you might question whether or not,

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you know,

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the parent doesn't really have a handle on what's going on with their child.

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And then that warrants a different discussion.

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But regardless,

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you want to approach it in a way that the parent

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is going to receive it in the best way possible,

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and you do it with confidence because if they know,

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like and trust you.

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And if they have a relationship with you.

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They will deeply appreciate that you brought it up.

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No parent wants to wonder

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their whole lives what is going on with my kid.

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The why matters.

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If there's a why,

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not that the why is anything that anyone would want.

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I don't think any parent,

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even when they get the why,

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I don't think any parent goes,

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oh,

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I'm so glad that my child has autism.

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I'm so glad that my child has a congenital disorder.

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I'm so glad,

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whatever.

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But I'm so glad my child has a learning disability,

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whatever it is.

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But guess what?

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It gives them a path moving forward.

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Because once you know what it is,

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you then can take steps to do something about it.

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When you don't know what it is,

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everyone's just frustrated and confused.

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Child included.

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So that's why we have these conversations,

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even though they're not easy.

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OK,

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so how do you know if the child is age appropriate for CCPT if the behavior

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seems to be at the level of an 18 month old if the child is 4.

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We know that we can

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modify

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CCPT

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for

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toddlers.

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So in the most recent CPRT edition,

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the second edition.

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There is modification of CCPT for infants and toddlers.

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We know that it works.

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If the child is 4,

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even if he is on the spectrum,

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we know that the principles will still be appropriate.

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We know that the skills and the approach will still make sense.

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So I would not be concerned about the age appropriateness of CCPT

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for a 4 year old,

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even if he presents much younger.

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How do you adapt your language if he's not able to comprehend choices and limits?

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He is able to comprehend choices and limits.

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It's just he's probably not used to it and he's disregulated

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and he's potentially neurodivergent.

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So it's going to take a lot more rehearsal and a lot a lot more repetition.

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You're going to have to be more intentional

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about

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reminding and bringing it up and refreshing

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and kind of broken record approach,

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but at 4,

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even if the child is presenting younger,

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even an 18 month old can process choices and limits.

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Sometimes they might need

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repetition,

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like I said,

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they might need to kind of have some assistance,

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but it still is appropriate to use with that age of child.

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So I don't think you need to be concerned about adapting language either.

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You just may have to be a little bit more

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intentional and

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make sure that you're saying it enough times that it sinks in.

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All right,

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Bracha in New York,

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thank you so much for the question and I hope that that's helpful.

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We all have kids that

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we question whether or not they're on the spectrum.

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I actually,

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I was just in staff last week

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and

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we were discussing uh a child and you know,

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00:13:11,190 --> 00:13:11,739
it's like,

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I don't think mom and dad have any idea

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00:13:14,020 --> 00:13:15,429
that this is the possibility,

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but I really do think this child presents that they're on the spectrum

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and we were talking about how to address that in the consult.

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So this is certainly relevant and it's something that we face.

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So I'm glad we were able to talk about it.

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00:13:27,460 --> 00:13:27,659
All right,

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I love y'all.

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00:13:28,380 --> 00:13:29,299
If you want to reach out to me,

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please do brenna@thekidcounselor.com.

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I hope to see you on the live event on Friday.

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Talk soon.

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Bye.

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00:13:36,669 --> 00:13:39,429
Thank you for listening to the Play Therapy Podcast with Dr.

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Brenna Hicks.

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For more episodes and resources,

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please go to www.playtherapypodcast.com.