Niche/Practice actually feisable? Too narrow or too wide?

[PsychNLife]

I really want to work with 14-30ish year old patients with ASD and ADHD. I am NOT interested in ABA, or focusing solely on academic progress or most things relating to special ed classrooms.

I am VERY interested in those with ADHD/ASD who are pretty sufficiently verbal, average IQ, and may in some circumstances be considered to be 'medium to high functioning' (though functioning labels aren't perfect) in certain areas, but maybe struggle to stay at this level of functioning at times or in other areas.

I want to work specifically with ADHD/ASD folks who are really struggling socio-emotionally, especially in regards to their relationships with friends and significant others, as well as struggling a lot with emotional regulation, perceptions of themselves, motivations, rejection sensitive dysphoria, social cues, etc.

Many of these folks come with some degree of trauma (family trauma, trauma from the school system, bullying, relational abuse), which I am also pretty interested in. Most of these folks also come with specific forms of anxiety and fear and depression relating directly to their disorders (fear about keeping up in school, fear about losing friends due to symptoms, anxious about 'masking' behavior), which also really really interests me.

Also a WHOLE lot of these populations are part of the LGBT+ community, which I would be REALLY interested in having as a subset.

So..... is this niche too narrow? To wide?

ALSO, if you can't tell, I am more interested in doing therapy than neuropsych evaluations. HOWEVER, if i am working with this population, wouldn't it be incredibly helpful for me to do those types of diagnostic neuropsych evaluations and assessments? To what extent would I need to be sufficiently trained in neuropsych in order to do this? Beyond the ADHD/ASD assessment, I'm pretty uninterested in neuropsych.

---

Members don't see this ad.

 

[Unipsychler]

Don't know much about this particular niche, so I'll give you my general take and hope that those with more specific knowledge will chime in, too. If the niche is too narrow or too wide depends, I think, on whether you want to work EXCLUSIVELY with this population, or if you want to specialize in them while also seeing other cases. And the more exclusively you want to work with them, the longer it will likely take you to build up a full caseload. It will also depend on whether you have a reliable referral stream for that specific niche. For example, if you have a referral source that will send you lots of ASD/ADHD cases but some of them are out of your age range or want to focus on academic progress, or a little lower functioning, would you want to take them? Or what about counseling centers who might send you a bunch of young adults who are working on socio-emotional development issues, but only some of them have ASD/ADHD?

To give you my own example, I specialize in personality disorders (about 70% of my caseload), particularly BPD (maybe 35%), with a sub-specialty of men with both borderline and NPD (only a handful at a time). I'm particularly good at my sub-specialty, but there just isn't a steady referral stream for something that specific, nor would I want an entire caseload of them. Some people find it monotonous or draining to work with the same sub-specialty all week long. Some people love it. You may or may not know the answer for yourself until you try things out.

Re: doing evals yourself, it's usually considered a dual role (i.e., not recommended) to do comprehensive assessment and therapy with the same cases. I'm talking about the multiple-hour batteries, not quick assessment tools that are designed for clinical use. No reason you can't do both types of work in the same practice, especially if you can tap additional referral streams by offering both services. Or, be so swimming in potential cases that you can pick and choose which role you'd be most helpful for in each case. But in most situations, you can't create more work for yourself by doing evals on your existing therapy caseload.

 

[AcronymAllergy]

I really want to work with 14-30ish year old patients with ASD and ADHD. I am NOT interested in ABA, or focusing solely on academic progress or most things relating to special ed classrooms.

I am VERY interested in those with ADHD/ASD who are pretty sufficiently verbal, average IQ, and may in some circumstances be considered to be 'medium to high functioning' (though functioning labels aren't perfect) in certain areas, but maybe struggle to stay at this level of functioning at times or in other areas.

I want to work specifically with ADHD/ASD folks who are really struggling socio-emotionally, especially in regards to their relationships with friends and significant others, as well as struggling a lot with emotional regulation, perceptions of themselves, motivations, rejection sensitive dysphoria, social cues, etc.

Many of these folks come with some degree of trauma (family trauma, trauma from the school system, bullying, relational abuse), which I am also pretty interested in. Most of these folks also come with specific forms of anxiety and fear and depression relating directly to their disorders (fear about keeping up in school, fear about losing friends due to symptoms, anxious about 'masking' behavior), which also really really interests me.

Also a WHOLE lot of these populations are part of the LGBT+ community, which I would be REALLY interested in having as a subset.

So..... is this niche too narrow? To wide?

ALSO, if you can't tell, I am more interested in doing therapy than neuropsych evaluations. HOWEVER, if i am working with this population, wouldn't it be incredibly helpful for me to do those types of diagnostic neuropsych evaluations and assessments? To what extent would I need to be sufficiently trained in neuropsych in order to do this? Beyond the ADHD/ASD assessment, I'm pretty uninterested in neuropsych.

Speaking to the bolded point specifically, regardless of the narrowness of a niche, if a provider is going to be performing neuropsychological evaluations in any context, they should be adequately trained. For neuropsych, the general "rule" would be some measure of training in grad school and internship along with a two-year fellowship.

That being said, I don't know that it's a neuropsych evaluation specifically you would want/need for diagnostic assessment of ADHD or ASD. Neither disorder has a specific neuropsychological "profile," and a neuropsych eval isn't necessary for diagnosis in either case.

 

[WisNeuro]

Re: doing evals yourself, it's usually considered a dual role (i.e., not recommended) to do comprehensive assessment and therapy with the same cases. I'm talking about the multiple-hour batteries, not quick assessment tools that are designed for clinical use. No reason you can't do both types of work in the same practice, especially if you can tap additional referral streams by offering both services. Or, be so swimming in potential cases that you can pick and choose which role you'd be most helpful for in each case. But in most situations, you can't create more work for yourself by doing evals on your existing therapy caseload.

Yeah, this can get dicey. In some situations, doing an evaluation with someone, and then following up with therapy, would not always be a no-no in the dual role context. However, having someone as a regular therapy patient, and then doing an evaluation with them, is almost always a no-no. The biggest factor here is objectivity, which is crucial to an in-depth evaluation. After you've entered into a therapeutic relationship with someone, you've lost that objectivity as you are now an advocate for that person.

 

[summerbabe]

I want to work specifically with ADHD/ASD folks who are really struggling socio-emotionally, especially in regards to their relationships with friends and significant others, as well as struggling a lot with emotional regulation, perceptions of themselves, motivations, rejection sensitive dysphoria, social cues, etc.

In addition to what @Unipsychler said, I'd recommend trying to get some career-specific mentoring from previous supervisors of your ADHD/ASD experiences.

As a prac student, you're generally focused on getting hours and learning so it would also be helpful to get more info on the business side of things such as whether you'd need to be in private practice or if there are agency jobs, what insurance will cover versus what people/families typically pay out of pocket for and the locations that can support this, how to network and build up referrals, etc.

 

[ClinicalABA]

Client availability can be a big issue with specializing in school aged populations. They're doing something else from 8am-3pm, and there's only so many after-school slots. It can be tough to schedule evenings and weekends. Expect a fair bit of cancelations, reschedules, and no-call no-shows.

There certainly is a need for therapists who are at least knowledgeable and competent in working with teens with ASD. I'm sure you know that ASD and ADHD are very different populations with very different needs.

As to NP testing, you don't need NP testing to diagnose either condition. In the case of diagnosing ADHD, there is no formal testing that is generally accepted a valid for doing so. ASD testing can involve some NP, but not primarily or necessarily so. In either case, there are limits to the types of testing that insurance will cover, as anything academic related (including cognitive testing) is the responsibility of the school.

 

[cara susanna]

I really want to work with 14-30ish year old patients with ASD and ADHD. I am NOT interested in ABA, or focusing solely on academic progress or most things relating to special ed classrooms.

I am VERY interested in those with ADHD/ASD who are pretty sufficiently verbal, average IQ, and may in some circumstances be considered to be 'medium to high functioning' (though functioning labels aren't perfect) in certain areas, but maybe struggle to stay at this level of functioning at times or in other areas.

I want to work specifically with ADHD/ASD folks who are really struggling socio-emotionally, especially in regards to their relationships with friends and significant others, as well as struggling a lot with emotional regulation, perceptions of themselves, motivations, rejection sensitive dysphoria, social cues, etc.

Many of these folks come with some degree of trauma (family trauma, trauma from the school system, bullying, relational abuse), which I am also pretty interested in. Most of these folks also come with specific forms of anxiety and fear and depression relating directly to their disorders (fear about keeping up in school, fear about losing friends due to symptoms, anxious about 'masking' behavior), which also really really interests me.

Also a WHOLE lot of these populations are part of the LGBT+ community, which I would be REALLY interested in having as a subset.

So..... is this niche too narrow? To wide?

ALSO, if you can't tell, I am more interested in doing therapy than neuropsych evaluations. HOWEVER, if i am working with this population, wouldn't it be incredibly helpful for me to do those types of diagnostic neuropsych evaluations and assessments? To what extent would I need to be sufficiently trained in neuropsych in order to do this? Beyond the ADHD/ASD assessment, I'm pretty uninterested in neuropsych.

Just FYI we've discussed the ADHD and rejection sensitivity dysphoria topic here before, and from what I remember of the discussion there really isn't a lot of evidence that this is a specific issue with ADHD.

I agree that neuropsych testing is not necessary. I would definitely familiarize myself with ADHD testing (although WisNeuro is right that you wouldn't be testing therapy patients) and best practices for ADHD assessment. Even if you aren't doing it yourself, it will be helpful to be able to recognize if your patients had a good quality evaluation. Unfortunately there's a lot of non-evidence based practice being done when it comes to ADHD assessment,

 

[WisNeuro]

Just FYI we've discussed the ADHD and rejection sensitivity dysphoria topic here before, and from what I remember of the discussion there really isn't a lot of evidence that this is a specific issue with ADHD.

I agree that neuropsych testing is not necessary. I would definitely familiarize myself with ADHD testing (although WisNeuro is right that you wouldn't be testing therapy patients) and best practices for ADHD assessment. Even if you aren't doing it yourself, it will be helpful to be able to recognize if your patients had a good quality evaluation. Unfortunately there's a lot of non-evidence based practice being done when it comes to ADHD assessment,

We have a School "Neuropsychologist" in town who diagnoses it via qEEG.

 

[AcronymAllergy]

It's a good point RE: insurance and ADHD testing. You may or may not be able to somehow get services paid for by the school if said school can't provide them itself, although that's way outside my area, so I have no idea as to its feasibility.

There's definitely a need for good ADHD evaluations (and many prescribing providers love to have a second opinion, even if its just to reinforce what they've already told the patient), but a limited number of families/individuals who are able to pay for it out of pocket. I've never worked specifically in ASD, but based on what ClinicalABA and others have said on here before, I'd be surprised if there's also not a substantial need in that area. Not sure about the assessment/diagnostic aspect in the age range you've specified, though.

 

[PsyDr]

Have you ever met one of those guys who will only date redheads, and complains about his lack of options? And it's like, "Bro, you've decided that you can only date half of 1% of the population, AND you decided to complicate it more?" This isn't too far off from this.

Let’s get some estimates here. Prevalence of ASD is roughly 2%. Roughly 44% of individuals with ASD have average to above average IQs according to autism speaks. Prevalence of homosexuality is around 5% according to Gallup (Sorry, there's limited data on the prevalence of the queer spectrum). Messing with the numbers a bit, your age group of interest is about 36% of the population. Then there's about 10 cities in the USA with a population of over 1MM, about 25 with populations between 500-999k, 52 with populations 250-500, 225 with a population of 100-250k. Google says uninsured is about 8%. Because I'm lazy, let's say things are evenly distributed, the median insurance fee is $100/hr, everyone pays every time without fail, you get 100% of the relevant population, no one ever ages in this magical land, there are zero no shows, there are zero drop outs, your total overhead is $2k/month, you take 2 weeks vacation and one week of sick time, and you need 20 patients/week to make an income of $72k. I'm guessing that an income of $72k would be unsustainable in the cities with populations over 1MM.


Therefore, if you only treated high functioning individuals with ASD, who also happen to be homosexual, who also happen to be in your preferred age range, who also happen to be insured, who also happen to be interested and engaged in psychotherapy, your market would be limited to about 77 cities in the USA, which I'm guessing about 20 of those are too expensive to live off of $72k.

Or you could do better math yourself.

 

[erg923]

I really want to work with 14-30ish year old patients with ASD and ADHD. I am NOT interested in ABA, or focusing solely on academic progress or most things relating to special ed classrooms.

I am VERY interested in those with ADHD/ASD who are pretty sufficiently verbal, average IQ, and may in some circumstances be considered to be 'medium to high functioning' (though functioning labels aren't perfect) in certain areas, but maybe struggle to stay at this level of functioning at times or in other areas.

I want to work specifically with ADHD/ASD folks who are really struggling socio-emotionally, especially in regards to their relationships with friends and significant others, as well as struggling a lot with emotional regulation, perceptions of themselves, motivations, rejection sensitive dysphoria, social cues, etc.

Many of these folks come with some degree of trauma (family trauma, trauma from the school system, bullying, relational abuse), which I am also pretty interested in. Most of these folks also come with specific forms of anxiety and fear and depression relating directly to their disorders (fear about keeping up in school, fear about losing friends due to symptoms, anxious about 'masking' behavior), which also really really interests me.

Also a WHOLE lot of these populations are part of the LGBT+ community, which I would be REALLY interested in having as a subset.

So..... is this niche too narrow? To wide?

ALSO, if you can't tell, I am more interested in doing therapy than neuropsych evaluations. HOWEVER, if i am working with this population, wouldn't it be incredibly helpful for me to do those types of diagnostic neuropsych evaluations and assessments? To what extent would I need to be sufficiently trained in neuropsych in order to do this? Beyond the ADHD/ASD assessment, I'm pretty uninterested in neuropsych.

How many people do you you think fit this criteria in your particular practice location. And how why would they come to you vs others in your area?

Or you are wanting to do tele health across states?

 

[WisNeuro]

To build on what others are saying, it is great if you have a niche area that you are something of an expert on in the therapy realm. But, you should also be expecting that a portion of your patient load will be other, more general MH presentations. Otherwise, you may be struggling to fill your slots. Additionally, it's good to keep your skills up in several areas in case you decide you no longer wish to specialize in a certain area in the future.

 

[PsychNLife]

How many people do you you think fit this criteria in your particular practice location. And how why would they come to you vs others in your area?

Or you are wanting to do tele health across states?

Not quite sure. There is a program at MGH called "MGH Aspire" which is geared towards college age students with ASD who struggle socially, which I really loved the sound of. obviously not every client I take has to fit this criteria. Also yes I know ADHD and ASD are different conditions, but they have lots of commonalities and can be often comorbid. I just also really like the LGBT+ population, but it's not a necessity. What I get from these responses is that assessment would have to be a one time thing, only done with a select few non-therapy clients (or before therapy is initiated at al), and that finding enough clients would be difficult ??????

 

[PsychNLife]

How many people do you you think fit this criteria in your particular practice location. And how why would they come to you vs others in your area?

Or you are wanting to do tele health across states?

I would love to work at a hospital program part time, and do PP part time. I could do either in person or tele-health PP, though since telehealth is really 'in' right now, I might prefer that and skip on the building rent needed for in person (or sublet it when I don't need it)

 

[PsychNLife]

Don't know much about this particular niche, so I'll give you my general take and hope that those with more specific knowledge will chime in, too. If the niche is too narrow or too wide depends, I think, on whether you want to work EXCLUSIVELY with this population, or if you want to specialize in them while also seeing other cases. And the more exclusively you want to work with them, the longer it will likely take you to build up a full caseload. It will also depend on whether you have a reliable referral stream for that specific niche. For example, if you have a referral source that will send you lots of ASD/ADHD cases but some of them are out of your age range or want to focus on academic progress, or a little lower functioning, would you want to take them? Or what about counseling centers who might send you a bunch of young adults who are working on socio-emotional development issues, but only some of them have ASD/ADHD?

To give you my own example, I specialize in personality disorders (about 70% of my caseload), particularly BPD (maybe 35%), with a sub-specialty of men with both borderline and NPD (only a handful at a time). I'm particularly good at my sub-specialty, but there just isn't a steady referral stream for something that specific, nor would I want an entire caseload of them. Some people find it monotonous or draining to work with the same sub-specialty all week long. Some people love it. You may or may not know the answer for yourself until you try things out.

Re: doing evals yourself, it's usually considered a dual role (i.e., not recommended) to do comprehensive assessment and therapy with the same cases. I'm talking about the multiple-hour batteries, not quick assessment tools that are designed for clinical use. No reason you can't do both types of work in the same practice, especially if you can tap additional referral streams by offering both services. Or, be so swimming in potential cases that you can pick and choose which role you'd be most helpful for in each case. But in most situations, you can't create more work for yourself by doing evals on your existing therapy caseload.

Right! I am open to other types of clients. Just when I see my 'ideal client', it looks like what I described above. It makes sense that my entire case load can't all look exactly like that.

 

[WisNeuro]

I would love to work at a hospital program part time, and do PP part time. I could do either in person or tele-health PP, though since telehealth is really 'in' right now, I might prefer that and skip on the building rent needed for in person (or sublet it when I don't need it)

Can be difficult as they probably won't want you poaching work and would likely have a non-compete while you are working, and for a time period after leaving employment, legal enforceability aside. Telehealth complicates this if there is a mile radius limit involved.

 

[PsychNLife]

Just FYI we've discussed the ADHD and rejection sensitivity dysphoria topic here before, and from what I remember of the discussion there really isn't a lot of evidence that this is a specific issue with ADHD.

I agree that neuropsych testing is not necessary. I would definitely familiarize myself with ADHD testing (although WisNeuro is right that you wouldn't be testing therapy patients) and best practices for ADHD assessment. Even if you aren't doing it yourself, it will be helpful to be able to recognize if your patients had a good quality evaluation. Unfortunately there's a lot of non-evidence based practice being done when it comes to ADHD assessment,

I would never want to do something not based in evidence. It does seem that even I am primarily not doing assessment, I might still OCCASIONALLY do an assessment, but that assessment would be of a very specific type, and would probably be related to school accommodations? But this would be only under certain circumstances?

 

[PsychNLife]

Can be difficult as they probably won't want you poaching work and would likely have a non-compete while you are working, and for a time period after leaving employment, legal enforceability aside. Telehealth complicates this if there is a mile radius limit involved.

Damn, so I have to choose between hospital work and PP? Going full on PP scares me, because you don't have a steady income right away or benefits. I would love to still have a steady income while easing into it (if I do ever do PP), and I love the idea of hospital programs with lots of colleagues, being able to collaborate, use hospital resources and facilities, and all of that related stuff.

 

[WisNeuro]

Damn, so I have to choose between hospital work and PP? Going full on PP scares me, because you don't have a steady income right away or benefits. I would love to still have a steady income while easing into it (if I do ever do PP), and I love the idea of hospital programs with lots of colleagues, being able to collaborate, use hospital resources and facilities, and all of that related stuff.

Not always, some places will not have a non-compete. But, if you are working with a very specific patient population, I can't see a specialized hospital program being too happy that you are poaching those same patients in an outpatient practice. I'd expect to possibly be fired for cause in some cases. As for the ASD/ADHD population, hospital programs having these services will significantly limit your options as to places to live. Many insurances will not cover any neuropsych testing for these evals, and the reimbursement is not great otherwise, with some caveats, so many hospitals choose not to set these programs up, as they can be a big revenue sink. I can't think of a single program in any of the major systems in our metro. Only option we have is PP providers and one for profit company who only sees pts up to age 18.

 

[ClinicalABA]

Have you ever met one of those guys who will only date redheads, and complains about his lack of options? And it's like, "Bro, you've decided that you can only date half of 1% of the population, AND you decided to complicate it more?" This isn't too far off from this.

I'm one of those guys. for the past 20+ years, I have exclusively been involved with women of combination Italian/French Canadian decent (It has been only one woman, but still!).

Professionally, I limit my practice exclusively to 1-4 year olds suspected of displaying ASD. I'm in a relatively rural area (~500k population spread across the 3 counties in my geographic coverage area). But the economies of scale, combined with there only being 2 clinics in the area who provide this services, mean that I have a 3-6 month waitlist at any given time.

As to the OP, s/he is still talking about a relatively underserved population (particularly the ASD), so there is a favorable supply/demand equation. However, establishing themselves as the "expert" in that area and competing with the LICSWs and LMHCs, not to mention other psychologists, who will take on such cases (and charge less) could be an issue. Good to have a back-up plan. Also, the OP mentions MGH, so I'm thinking they are in the Boston area where there's definitely a lot more supply.

 

[borne_before]

I think there is a huge market for the 14-30yo with ASD. Its all about getting the word out.

One issue is the ****ty understanding of ASD in the other helping providers (like counselors). They'll refer to you, but hardly any of them will be good referrals.

 

[Sanman]

I think there is a huge market for the 14-30yo with ASD. Its all about getting the word out.

One issue is the ****ty understanding of ASD in the other helping providers (like counselors). They'll refer to you, but hardly any of them will be good referrals.

Perhaps, but the OP wants only high-functioning ASD individuals and does not want to deal with academic issues. What would drive all of these relatively functional autistic individuals without academic issues to the OP's door? More specifically, what would drive the parents there and make them spend significant money on top of what they may already need to spend related to academics? If you do the assessments for the ASD person for academic needs, perhaps you can keep a small population for therapeutic treatment. It really depends on the day job, non-competes, SES of the area, etc.

 

[singasongofjoy]

Why stop at 30yo though??

I think it is definitely beneficial to be able to do assessment of the ASD yourself if only to confirm, as we have more than a few who come through at my autism center with very poorly diagnosed "ASD" that is really a mix of other things. But you don't need neuropsych to do that, or to rule ADHD in/out, so why would you?

For therapy i think it is very geographically dependent. In my neck of the woods, heck yeah- I could fill you with therapy cases from my referrals alone within a couple of months. I could refer at least 4 LGBTQ+ in that age range just by recent emails to me of ppl looking for resources or somewhere wiht a shorter waitlist. There is also strong market for couples counseling when one or both are on the spectrum, for the non-ASD partners, and for DBT groups with some ASD adaptations/accommodations... and if you really like working with the adolescents and young adults, preparing for and adjusting to whatever comes after high school - I assume you already know this if you're working in this area, but when high school is finished is when the wheels come screaming off the bus for many (most?) non-ID folks with ASD. I don't know what it is like where you are, but if you were working on transition to adulthood/independence and got your name in with the local school districts / high schools and vocational rehab - and maybe could consult with community direct care providers like ARC or Easterseals or whatever- you'd never reach the end of your waitlist.

 

[thebalmofhurtminds]

Not always, some places will not have a non-compete. But, if you are working with a very specific patient population, I can't see a specialized hospital program being too happy that you are poaching those same patients in an outpatient practice. I'd expect to possibly be fired for cause in some cases. As for the ASD/ADHD population, hospital programs having these services will significantly limit your options as to places to live. Many insurances will not cover any neuropsych testing for these evals, and the reimbursement is not great otherwise, with some caveats, so many hospitals choose not to set these programs up, as they can be a big revenue sink. I can't think of a single program in any of the major systems in our metro. Only option we have is PP providers and one for profit company who only sees pts up to age 18.

Yeah, I don't have a non-compete, but I'm also the only provider at this AMC in a medium sized town who offers some specialized treatments. Trying to take PP patients on the side would likely not end well.

 

[PsychNLife]

Perhaps, but the OP wants only high-functioning ASD individuals and does not want to deal with academic issues. What would drive all of these relatively functional autistic individuals without academic issues to the OP's door? More specifically, what would drive the parents there and make them spend significant money on top of what they may already need to spend related to academics? If you do the assessments for the ASD person for academic needs, perhaps you can keep a small population for therapeutic treatment. It really depends on the day job, non-competes, SES of the area, etc.

I’m willing to work with academic issues, but I’d rather than not be my whole thing. I understand that all psychological issues can bleed into academic issues, but it’s just that I see the whole adhd/asd field SO hung up on ONLY academics, that I want to really differentiate myself. I can see myself sometimes helping my clients get organized and stop being overwhelmed by projects, but I don’t want to be an ADHD math tutor, or really be just helping people with homework or how to study.

 

[PsychNLife]

Why stop at 30yo though??

I think it is definitely beneficial to be able to do assessment of the ASD yourself if only to confirm, as we have more than a few who come through at my autism center with very poorly diagnosed "ASD" that is really a mix of other things. But you don't need neuropsych to do that, or to rule ADHD in/out, so why would you?

For therapy i think it is very geographically dependent. In my neck of the woods, heck yeah- I could fill you with therapy cases from my referrals alone within a couple of months. I could refer at least 4 LGBTQ+ in that age range just by recent emails to me of ppl looking for resources or somewhere wiht a shorter waitlist. There is also strong market for couples counseling when one or both are on the spectrum, for the non-ASD partners, and for DBT groups with some ASD adaptations/accommodations... and if you really like working with the adolescents and young adults, preparing for and adjusting to whatever comes after high school - I assume you already know this if you're working in this area, but when high school is finished is when the wheels come screaming off the bus for many (most?) non-ID folks with ASD. I don't know what it is like where you are, but if you were working on transition to adulthood/independence and got your name in with the local school districts / high schools and vocational rehab - and maybe could consult with community direct care providers like ARC or Easterseals or whatever- you'd never reach the end of your waitlist.

I’d be VERY open to couples as well. Also yes I’m very interested in transition periods (going to college, work world, starting high school), as it’s SO TRUE that support often changes suddenly.

 

[PsychNLife]

I’d be VERY open to couples as well. Also yes I’m very interested in transition periods (going to college, work world, starting high school), as it’s SO TRUE that support often changes suddenly.

Also, I kind of chose 30 as an arbitrary cut off. I’m willing to go older and younger, but I’d like to avoid working with like non-verbal preschoolers or geriatrics. I could see myself at youngest working with 8 year olds, and oldest working with 45 year olds probably. I just felt like the 14-30 covers the biggest transition areas. And being a young person I don’t know if I’d be super comfortable with someone quite significantly older than myself. Of course maybe that will change with time.

 

[Sanman]

I’m willing to work with academic issues, but I’d rather than not be my whole thing. I understand that all psychological issues can bleed into academic issues, but it’s just that I see the whole adhd/asd field SO hung up on ONLY academics, that I want to really differentiate myself. I can see myself sometimes helping my clients get organized and stop being overwhelmed by projects, but I don’t want to be an ADHD math tutor, or really be just helping people with homework or how to study.

That is fair, but I think the question you need to ask yourself is whether the field is so hung up on academics because that is where the money is or for other reasons. If the reason that the field is focused in that direction is that customers are willing to pay for such a service and not willing to pay for others, then you have a problem with practice goals. Now, do I see a niche for someone working with ASD folks (more likely adult) on something like dating, relationships, marriage? Perhaps a good market there. Will parents pay significant money for their 14 year old to work on dating, relationships, etc? Less likely, IMO. Remember, under 18 the parents are the clients that you are trying to target, not the child. There are many problems out there are are prevalent, but there is little no money in treating it. Not sure whether your idea falls under that umbrella. Only one way to find out, try it and see what happens.

 

[erg923]

but it’s just that I see the whole adhd/asd field SO hung up on ONLY academics

Huh??? What does this mean?

You already said you were NOT interested in ABA (which is already kinda weird if you are interested in working with the population).

The standard of care treatment for ADHD is stimulate medication combined with individual family and education/therapy. That wont change any time soon. The standard of care treatment for ASD (and ADHD) is ABA and family education/therapy. That wont change any time soon either.

What, exactly, are you proposing to do here beyond the standard of care treatments that already exist?

 

[PsychNLife]

Huh???

You already said you were NOT interested in ABA (which is weird if you are interested is with the population).

The standard of care treatment of ADHD is stimulate medication combined with individual family education/therapy. That wont change any time soon. The standard of care treatment for ASD is ABA and family education/therapy. That wont change any time soon either.

I’m not interested in ABA because many of the autistic people and much of the psychological professionals I’ve known say that ABA isn’t great, and I find that it’s really about learning verbal stuff, which isn’t my thing. Also it’s Mostly used for younger kids that are severely affected. I am interested in social skills and other coping mechanisms and masking behavior.

I know the standard treatment for adhd is family Ed/ psychotherapy and stimulant meds. I’m totally on board with that. However, adhd is so much more than just academic learning. Adhd effects your relationships, how you process emotions, how you motivate yourself in your daily life, how you think about yourself, and so much more. I really want to go beyond “let’s get these kids to do math well” and go into “how can I help you become your best, happiest, and most comfortable self”.

 

[Sanman]

I’m not interested in ABA because many of the autistic people and much of the psychological professionals I’ve known say that ABA isn’t great, and I find that it’s really about learning verbal stuff, which isn’t my thing. Also it’s Mostly used for younger kids that are severely affected. I am interested in social skills and other coping mechanisms and masking behavior.

I know the standard treatment for adhd is family Ed/ psychotherapy and stimulant meds. I’m totally on board with that. However, adhd is so much more than just academic learning. Adhd effects your relationships, how you process emotions, how you motivate yourself in your daily life, how you think about yourself, and so much more. I really want to go beyond “let’s get these kids to do math well” and go into “how can I help you become your best, happiest, and most comfortable self”.

Understand that the goal you have stated requires all of your clients to be self-pay because insurance would never pay for that. How do you propose to get a group of people to pay you $100+ dollars/hr to do that. Can the ones who really need it afford $100+ dollars an hour. Do the ones that can pay you $100+/hr really need your help?

 

[sloh]

Understand that the goal you have stated requires all of your clients to be self-pay because insurance would never pay for that. How do you propose to get a group of people to pay you $100+ dollars/hr to do that. Can the ones who really need it afford $100+ dollars an hour. Do the ones that can pay you $100+/hr really need your help?

Wonder if there's even any evidence the OP's approach would lead to meaningful improvements wrt to "best, happiest, and most comfortable self."

 

[PsychNLife]

Understand that the goal you have stated requires all of your clients to be self-pay because insurance would never pay for that. How do you propose to get a group of people to pay you $100+ dollars/hr to do that. Can the ones who really need it afford $100+ dollars an hour. Do the ones that can pay you $100+/hr really need your help?

Okay, I guess i will have to look into that more. Sorry for being ignorant.

I just know that certain therapists I’ve had in the past have been really good about addressing my own specific forms of anxiety surrounding being a neurodivergent individual (scared of losing friends, anger at myself for getting distracted, shame). I’ve also seen groups for asd college students which I thought was neat. I just thought that could open into a more concrete specialization. I guess not though.

 

[PsychNLife]

Wonder if there's even any evidence the OP's approach would lead to meaningful improvements wrt to "best, happiest, and most comfortable self."

I’m really sorry everyone. I’m just applying to grad school now and trying to get down what I really want to do. I now understand that I guess it was really Ill conceived. I’m sorry.

 

[sloh]

I’m really sorry everyone. I’m just applying to grad school now and trying to get down what I really want to do. I now understand that I guess it was really Ill conceived. I’m sorry.

FWIW I think this thread is great. I think your perspective and outlook isn't unusual in fields outside of clinical psychology and within medicine.

 

[Sanman]

Okay, I guess i will have to look into that more. Sorry for being ignorant.

I just know that certain therapists I’ve had in the past have been really good about addressing my own specific forms of anxiety surrounding being a neurodivergent individual (scared of losing friends, anger at myself for getting distracted, shame). I’ve also seen groups for asd college students which I thought was neat. I just thought that could open into a more concrete specialization. I guess not though.

No need to be sorry, this is how you learn. Like I said before, it really depends on a number of factors. However, helping people and running a viable business don't always overlap. That is part of the reason that social workers, psychologists, etc are often poorly compensated. Look at your previous experiences and learn from them. What were you able to afford as far as help? Were your therapists busy with a waitlist? Did you ever stop going to them because you could not afford it? How did you or your parents pay for therapy sessions?

 

[AcronymAllergy]

I’m really sorry everyone. I’m just applying to grad school now and trying to get down what I really want to do. I now understand that I guess it was really Ill conceived. I’m sorry.

No need to apologize, folks are just trying to offer some additional information on the (sometimes unfortunate) realities of clinical practice.

This sounds like a topic that's close to you personally, which has potential benefits and potential dangers. My advice would be not to discard your interests, but to inform, refine, and adjust them as you pursue your training.

 

[ClinicalABA]

As someone who works in an ABA provider agency and who has also provided ABA, I often find that there is the need for additional, non-ABA therapeutic approaches to address a variety of psychological conditions and adjustment issues as these children age into teens and early adulthood. These needs go beyond what the typical ABA provider is trained to do, and it can be very difficult to find therapists who are comfortable and competent in providing psychotherapy to teens and young adults with ASD. There's definitely a market (though not sure it's big enough to support a full-time practice, even if combined with ADHD). depends on where you are located, I suppose. It's certainly worth pursuing the training and experience necessary to do so if the OP is interested in this area. It won't go to waste.

I would caution the OP about forming blanket opinions (especially un- or inadequately informed ones) about any treatment approach, including ABA. It's perfectly fine to not be interested in doing it- there are a lot of empirically supported and valuable treatments that I have no interest in. You just need to be careful about unfounded/or inaccurate beliefs and statements (e.g., "ABA isn't great", which is an opinion; or ABA "is really about learning verbal stuff", which just isn't true). Again- it's ok to not be interested in it- there is A LOT OF NEED for non-ABA clinicians who can work with ASD individuals, and I encourage you to pursue that line of work. You will, however, encounter a lot of ABA providers, as well as clients and families who were very happy with their ABA services, and will be a better clinician and more help to your clients if you are well informed, cautious with your criticisms, and just all around "play well with others".

Good luck- I really hope you continue to pursue this area of work. There's a big need for interested, trained, eager, and- equally as important- empirically informed- providers of psychotherapy services for this group of clients.

 

[erg923]

I’m not interested in ABA because many of the autistic people and much of the psychological professionals I’ve known say that ABA isn’t great”.

What does "isn't that great" mean? How is that measured?

ABA is very much behavior therapy. It could probably help everyone, ultimately.... whatever the diagnoses. ABA could probably help me lose weight, make better diet choices, and/or stop rubbing my thumb against my index finger when anxious...if there were not a more efficacious way to accomplish this. Which there is. And where is the "verbal" thing coming from?

The family therapy I am talking about doesn't have much do to with what you are seemingly taking about? Please read the NIMH MTA studies. You seem hung- up on academic stuff/interventions. I do not know what this is about???

 

[ClinicalABA]

I’m really sorry everyone. I’m just applying to grad school now and trying to get down what I really want to do. I now understand that I guess it was really Ill conceived. I’m sorry.

NO! Don't apologize. It's a great goal. Your at the point where you SHOULD be identifying and refining your interests. I love working with this population, and see the need for more clinicians who want to to do the same. As others have said, it's a great thread and interesting topic. If affect could be better conveyed through electronic text, I think you'd see that the responses you are getting would be in a respectful and encouraging tone!

 

[PsychNLife]

As someone who works in an ABA provider agency and who has also provided ABA, I often find that there is the need for additional, non-ABA therapeutic approaches to address as variety of psychological conditions and adjustment issues as these children age into teens and early adulthood. These needs go beyond what the typical ABA provider is trained to do, and it can be very difficult to find therapists who are comfortable and competent in provider psychotherapy to teens and young adults with ASD. There's definitely a market (though not sure it's big enough to support a full-time practice, even if combined with ASD). depends on where you are located, I suppose. It's certainly worth pursuing the training and experience necessary to do so if the OP is interested in this area. It won't go to waste.

I would caution the OP about forming blanket opinions (especially un- or inadequately informed ones) about any treatment approach, including ABA. It's perfectly fine to not be interested in doing it- there are a lot of empirically supported and valuable treatments that I have no interest in. You just need to be careful about unfounded/or inaccurate beliefs and statements (e.g., "ABA isn't great", which is an opinion; or ABA "is really about learning verbal stuff", which just isn't true). Again- it's ok to not be interested in it- there is A LOT OF NEED for non-ABA clinicians who can work with ASD individuals, and I encourage you to pursue that line of work. You will, however, encounter a lot of ABA providers, as well as clients and families who were very happy with their ABA services, and will be a better clinician and more help to your clients if you are well informed, cautious with your criticisms, and just all around "play well with others".

Good luck- I really hope you continue to pursue this area of work. There's a big need for interested, trained, eager, and- equally as important- empirically informed- providers of psychotherapy services for this group of clients.

I have a lot to learn about ABA, but I suppose it was just that the first image that comes to mind when I think of it is working with severely affected children on things like "touch nose", "repeat my name", and "look me in the eye". I've never encountered it used in adults. Overall though, it seems like other approaches might be better suited for my interests. Always evidence based though.

 

[PsychNLife]

What does "isn't that great" mean? How is that measured?

ABA is very much behavior therapy. It could probably help everyone, ultimately.... whatever the diagnoses. ABA could probably help me lose weight, make better diet choices, and/or stop rubbing my thumb against my index finger when anxious...if there were not a more efficacious way to accomplish this. Which there is. And where is the "verbal" thing coming from?

The family therapy I am talking about doesn't have much do to with what you are seemingly taking about? Please read the NIMH MTA studies. You seem hung- up on academic stuff/interventions. I do not know what this is about???

I mean, It wasn't an experiment, I didn't measure anything, just a general sentiment i've noticed when talking to the autistic community. I don't know every detail, but it just seems like theres a large amount of animosity towards it within the community. As for it being verbal, it's just the first thing that comes to mind from what I know about it (again, not much). Is it not largely focused on having the kids repeat words and make eye contact in order to get to play with their toys? that's the main way I've heard it being used.

I am a bit hung up on academic stuff, because I want to avoid becoming something akin to a tutor, or someone who just helps with homework, or making sure they learn their math and vocab in the classroom. I'd rather focus on how they are feeling, what they've been experiencing, and the other aspects i've mentioned previously. That said, if they're feeling overwhemled by starting college classes or feeling burnt out from online learning? Yeah i'd love to talk about that (partly because that's very emotionally rooted).

 

[PsyDr]

Okay, I guess i will have to look into that more. Sorry for being ignorant.

Don't be sorry. You're thinking about the monetary aspects of the career. That is NOT a bad thing. Like anything else in life, you get better by making mistakes, refining, making better mistakes, refining, and repeating. .

 

[erg923]

I mean, It wasn't an experiment, I didn't measure anything, just a general sentiment i've noticed when talking to the autistic community. I don't know every detail, but it just seems like theres a large amount of animosity towards it within the community. As for it being verbal, it's just the first thing that comes to mind from what I know about it (again, not much). Is it not largely focused on having the kids repeat words and make eye contact in order to get to play with their toys? that's the main way I've heard it being used.

I am a bit hung up on academic stuff, because I want to avoid becoming something akin to a tutor, or someone who just helps with homework, or making sure they learn their math and vocab in the classroom. I'd rather focus on how they are feeling, what they've been experiencing, and the other aspects i've mentioned previously. That said, if they're feeling overwhelmed by starting college classes or feeling burnt out from online learning? Yeah i'd love to talk about that (partly because that's very emotionally rooted).

You have talked to the "Autistic Community?" And they are are all in agreement here? This would be despite the fact that social-pragmatic communication is not their strength? Is that correct? Other than this, you do not have any specific information about this claim? Is that fair to say?

You are objectionable to an "academic focus" of the treatment these disorders...is that correct? And, you are not interested in the evidence-based treatment for ASD, is that correct?

 

[PsychNLife]

So you don't know really know what is actually going on to justify saying that there is "animosity towards it within the community? "You do not have any specific information about this claim? Is that fair to say?

You are objectionable to an "academic focus" of the treatment these disorders...is that corrected?

Well I know bits and pieces. Different autistic people I’ve talked to (some are autistic parents of autistic kids, some are clinicians and aspiring clinicians) have told me they believe Aba to be traumatic in a number of ways (including withholding of self soothing toys, discouraging naturally self soothing behavior such as stimming, feeling a lack of personal autonomy physically and mentally).

Now, I don’t know if I agree or disagree with all of these points yet. I’m still learning about it. However, seems like there are other things that would suit my practice better.

I’m obviously not opposed to studying these disorders academically, why on earth would I go to graduate school if I didn’t like studying and learning? All I meant is that I don’t want to be a special Ed teacher, or an academic tutor. A lot of the current services for asd/adhd are all about getting them to be better at homework and school. There’s people who want to do that, and clients who need that, but it’s less interesting to me.

 

[erg923]

Well I know bits and pieces. Different autistic people I’ve talked to (some are autistic parents of autistic kids, some are clinicians and aspiring clinicians) have told me they believe Aba to be traumatic in a number of ways (including withholding of self soothing toys, discouraging naturally self soothing behavior such as stimming, feeling a lack of personal autonomy physically and mentally).

Now, I don’t know if I agree or disagree with all of these points yet. I’m still learning about it. However, seems like there are other things that would suit my practice better.

I’m obviously not opposed to studying these disorders academically, why on earth would I go to graduate school if I didn’t like studying and learning? All I meant is that I don’t want to be a special Ed teacher, or an academic tutor. A lot of the current services for asd/adhd are all about getting them to be better at homework and school. There’s people who want to do that, and clients who need that, but it’s less interesting to me.

Ok. You want to work with/study people only like you and your (apparent) Autistic experience? Is it fair to that this is what this is about??

 

[Therapist4Chnge]

It's good to ask questions learn, and revise views. I wish more prospective students actually looked at the economics A LOT MORE before diving into training.

 

[PsychNLife]

Ok. You want to work with/study people only like you and your (apparent) Autistic experience? Is it fair to that this is what this is about??

I mean I’ve been diagnosed with adhd since childhood, I have some strong but not fully investigated asd traits. I’m not going into this profession to fix my own problems, as that’s what my own personal therapy is for. My experiences somewhat directly and somewhat indirectly relate to those of my ideal clients.

I just happen to be interested in some of the same problems that I’ve experienced myself and taken much time to try to overcome. I feel some sense of camaraderie without feeling vicarious. I have put great thought into making sure my own issues would not interfere with my clinical work.

As I believe I mentioned before, what I describe is only my “ideal” client. I’m totally open to other issues and pathologies, but these interest me the most. I’ve mentioned in this post several other somewhat related things that also interest me (trauma for one, lgbt+ as well).

Also, I love evidence based practices, such as CBT, some of the supported psychodynamic stuff, but just not very interested in aba.

 

[PsychNLife]

You have talked to the "Autistic Community?" And they are are all in agreement here? This would be despite the fact that social-pragmatic communication is not their strength? Is that correct? Other than this, you do not have any specific information about this claim? Is that fair to say?

You are objectionable to an "academic focus" of the treatment these disorders...is that correct? And, you are not interested in the evidence-based treatment for ASD, is that correct?

No, the autistic community is not all in consensus, just seemingly largish portions of it. Despite social issues, autistic people can and do run blogs and social medias and can talk to each other.

I don’t object to the academic focus. Kids need those services. Do I want to be the one to provide those specific services? Probably not. They are needed though.

 

[MAClinician]

I have put great thought into making sure my own issues would not interfere with my clinical work.

To be fair, some of the statements you’ve posted indicate the opposite of this. Several posters have encouraged you to research some of your “theories” such as ABA being bad and treatment interventions for ADHD. You might experience things a certain way but it doesn’t mean every client with ADHD/ASD/anxiety will experience the same as you. As others have mentioned there is a definite need for individuals with these diagnoses to get appropriate help with social skills, emotional regulation, and self-advocacy skills. It’s important to be open to the evidence-based practices available.

Despite social issues, autistic people can and do run blogs and social medias and can talk to each other.

Anyone can start a blog/social media account and claim anything they want. Doesn’t mean because someone says they have autism means they were actually diagnosed with autism. The nice thing about ASD is that it’s a spectrum and the variability can be wide on presentation and needs. Blogs also aren’t the same as academic peer reviewed journals who, in theory, have a process to ensure data is tested appropriately to support or question ideas/hypotheses.

Based on your post history it could benefit you to take some time off between undergrad and applying to grad school to further refine and explore your career goals. See if that MGH program takes research volunteers (or has paid research coordinator positions) and get a sense of what types of research AND clinical work is done with your preferred populations. Or look for research positions elsewhere and try to get some experience working in settings where you are exposed to the spectrum of abilities in the ASD population. If your goal is to get the most flexible degree and a doctorate is what you want to pursue you will definitely need better research experience than what you have previously posted. Good luck!