What can a psychologist do for autism?

[ReInventor]

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Like the title says, what can a psychologist do for an individual with autism? I am trying to decide if I should apply to clinical psychology programs or maybe attend a post-baccalaureate pre-medical program and try to go to medical school. I am interested in conducting research on autism, but also in working with affected individuals, so I don't see myself trying to get an academic position at a liberal arts college, etc.

In my understanding, if I wanted to work in a setting treating individuals with autism (maybe a developmental disabilities clinic at a medical center?), as a psychologist I would be involved in testing/evaluation for diagnosis, maybe therapy or social skills training in some higher functioning cases? Is my understanding of this somewhat in line with reality? Would it be very difficult to get this type of job?

I'm wondering if I might be able to do more for individuals with autism as a medical doctor (I imagine I would consider specializing in developmental-behavioral pediatrics or child psychiatry). I do not question for a second that behavioral approaches to autism are necessary and valuable, but it also seems that with such a significant biological component, maybe there is "more" that can be done as an MD? Child psychiatry is interesting to me, especially with the shortage of practitioners I keep hearing about, but I'm also concerned that I wouldn't be able to consider psychosocial and environmental factors adequately. Or maybe I'm completely off the mark--I'm just a youthful undergrad. 🙂 Anyone have any advice on this?

 

[FadedC]

Well I'm not sure what you mean by doing more as a MD. There is no medication that treats autism, although many autistic individuals have other comorbid disorders that may be treated through medication. But if your looking to address the autism disorder itself, then that's usually going to be through either behavioral work or skills training like you said.

I have a strong background in autism, but it's mostly research based so I can't talk as much about what a career involving it might look like, although your description matches what my best understanding would be. I ended up going the school psychology route rather then the clinical psychology route, because it was more in line with areas of research experience (and I have certainly worked with high functioning autistic children in the schools).

 

[ReInventor]

Ah, I understand what you mean--there is no medication for the core symptoms, so those require behavioral approaches.

On this forum I've seen some concern about the psychology job market--if one were to "specialize" in working with individuals with autism, is it possible this might have better opportunities?

How does your school psych work tie in with autism? Do you work in a school setting or are you purely involved in research? I'm actually considering a school psych PhD as an option as well, but I'm not sure.

 

[FadedC]

I can't tell you much about what the prospects would be for a clinical psychologist specialized in autism (other then that it's a area that gets a ton of research funding).

I've worked with autistic children in schools (assessment and therapy) as well as done research, although autism is no longer my research area. I can also work in clinics, hospitals, etc., school psychology doctorates are not restricted to working in schools, although our training focuses more on them. An added plus is that there is a shortage of school psychologists so in general our job market is much better then clinical psychology and we make a little more too. Although I've heard of certain states being harder to find work in at the moment due to all the budget freezes in schools going on.

 

[cara susanna]

We have a lot of people specializing in that here and it seems to work pretty well for them. I would get involved with ABA therapy for sure.

 

[ReInventor]

What would a doctoral level psychologist with ABA training actually do? Research and supervision of BA/MA level ABA therapists?

 

[cara susanna]

Yeah, that's what they do in our program.

 

[InYourHead]

I work with many autistic children in a day camp setting. It seems like my job is nothing more than a test of patience, and I feel like I constantly have to threaten the kids in order to get them to behave (ex.- stop repeatedly saying bad words that they do not even understand) or to participate in activities.

I have recently instituted a reward system with various daily goals for each child, but does anyone have any other suggestions/resources on how to work with these kids?

Any help would be appreciated- thanks!

 

[PsychPhDone]

I don't know much about this topic, but the prof who taught my undergrad ABA class ran a school for autistic kids and helped develop treatment plans for them. He supervised the other ABA therapists working most directly with the attendees.

 

[Marissa4usa]

If you are primarily interested in working with autistic individuals, you should look into getting your M.A. in Behavior Analysis and get your BCBA en route.

Or you could get your PhD in a ABA. However, just like any PhD, this is very research heavy and may be overkill for your goals.

Here is one program I know of

http://www.unmc.edu/mmi/msia.htm

 

[HenryHall]

We have a lot of people specializing in that here and it seems to work pretty well for them. I would get involved with ABA therapy for sure.

Oh, the ABA therapy which was created and promoted by that respected figure George Alan Rekers PhD. Along with reparative therapy for gay and transgender children at UCLA and CAMH Ontario. Yes, that might be a money spinner.
http://aebrain.blogspot.com/2010/05/my-final-word-on-george-alan-rekers.html

Just for the record, as the parent of a now grown-up AS kid, what I found actually helps is physical therapy. Balancing, lifting, swinging, scrambling over obstacles, even hiking, that kind of thing. And sometimes speech therapy for the more highly functioning.

 

[Ollie123]

?

I just had to google Rekers to jog my memory who he even was, and I taught Behavior Modification last semester. Just checked the textbook and he is mentioned once, and that was just because it was a clear example of a basic behavioral principle.

I'm unclear what the point in mentioning him was. He's an obscure character who has little/no relevance to mainstream ABA, and is by no stretch of the imagination hailed as one of the founders of ABA. Though I'm guessing he did his grad work with Lovaas, who certainly was. Regardless, what does he have to do with reimbursement for ABA and the poster's decision to pursue it?

 

[HenryHall]

With Lovaas, Rekers co-authored the book on ABA and also promoted the use of ex-gay reparative therapy on children, even modernly, under a diagnosis of Gender Identity Disorder.

In 2010, after practicing on kids for many years Rekers was exposed as a closeted gay member of NARTH, and someone who buys rentboys for sex.

They both were mentored by Green of the Sissyboy project scandal.

It is a stretch to distinguish ABA from ex-gay aversion therapy, though since you teach (and we may assume promote) it then we shall have to agree to differ on that.

 

[Ollie123]

Actually I'm far more of a cognitive than a pure behaviorist, but that's a story for another day. I'm a grad student and don't get overly much say in what I teach🙂

Lovaas wrote several books and was hugely prominent, though even within the ABA field there is and has been much disagreement with his methods and many alternative approaches - even he has moved a long way from his early techniques. I have yet to see anything that indicates Rekers played any role in ABA beyond that of ex-gay aversion therapy, gender roles, etc., which even at the time wasn't exactly a mainstream use of ABA. Heck, do a google scholar search - compared to the dominant forces in ABA, he isn't exactly widely cited.

I don't question that ABA techniques was used in the ex-gay aversion therapy they promote. Actually there is no question - I looked up a couple articles and they did. However, ABA is a general technique, ex-gay aversion therapy was just one application of it. Thankfully, a rather obscure one that was never "mainstream" and has basically nothing to do with what 99.9% of people using ABA are doing. Let's not throw the baby out with the bathwater. If memory serves, you are either a lawyer or in the legal field somehow. Your stance is akin to pointing out one situation where someone used the legal system/legal research/other random lawyering to justify doing something horrible (and I can point out many) as a reason that lawyers will not earn significant income and that one shouldn't become a lawyer.

 

[futureapppsy2]

With Lovaas, Rekers co-authored the book on ABA and also promoted the use of ex-gay reparative therapy on children, even modernly, under a diagnosis of Gender Identity Disorder.

In 2010, after practicing on kids for many years Rekers was exposed as a closeted gay member of NARTH, and someone who buys rentboys for sex.

They both were mentored by Green of the Sissyboy project scandal.

It is a stretch to distinguish ABA from ex-gay aversion therapy, though since you teach (and we may assume promote) it then we shall have to agree to differ on that.

😕

I work with people who tend to be at the more "radical"/pro-disability or pro-autism side of things, and while I've heard some criticism at how ABA is sometimes practiced or viewed/sold (as a "cure"), but as long as it is treated as a way to improve functioning and reduce distress and not a way to "get rid" autism, I haven't heard ABA demonized or criticized as an entire concept, even from the most skeptical, radical sides of the issue. The current thinking from them is that autism is not something that needs to be cured or pathologized but that there's nothing inherently wrong with trying to improve someone's functioning, communication, or comfort, whether it be through accommodations, assistive technology, ABA, or other interventions--in other words, helping someone to better function within the context of their disability is not considered to be anti-disability/anti-autism (though it can, admittedly, be a fine line times). Most of the criticism I've heard of ABA is that it can be done in a "de-humanizing" manner, but it does not have to be. I'm involved with a fair bit of "mainstream" autism research (ABA, AAC, and other bx interventions), and I've been continually impressed with how much respect and acceptance all the ABA therapists and others involved have towards our clients/participants as individual *people* with value (and that wasn't necessarily something I was expecting coming in to this research team, so it's really been a very pleasant surprise in that regard).

ETA: I should add, AFAIK, that we don't practice pure Lovaas-style ABA, but rather incorporate a lot of functional analysis, for example, to more closely assess and directly target the function of challenging behavior so that the same function can be met or can be resolved in a way that's satisfactory to both the child and others. Also, I've never been involved in a study that used punishment, at least not that I recall.

 

[FadedC]

Interesting the hear about some of the darker roots of ABA, but I'm not sure how it's relevent to it's effectiveness in the treatment of autism. It's definitely the treatment with the most research and empirical support for improved outcomes in children with autism, and if it helps children get better I wouldn't care if one of it's founders was a serial killer.

 

[IT514]

I do not question for a second that behavioral approaches to autism are necessary and valuable, but it also seems that with such a significant biological component, maybe there is "more" that can be done as an MD? QUOTE]

Allow me to suggest a different way of conceptualizing behavioral and medical approaches. The process of treatment in autism is similar to that of dyslexia because what must be done, fundamentally, is creating the neural space to interact appropriately with a given stimulus. This cannot be done in either case with medication. The way to change the brain in both cases is very time consuming, requiring gradual, guided training and tons of patience from a very experienced therapist. Dyslexia is of course a much simpler example because the stumulus is words (basically) and not the whole world as with autism. In sum, the biological change in autism can be done only through a behavioral means.

In terms of meds, low dose SSRIs can help kids respond to the very intense behavioral therapies they need, but are hit or miss as the side effect profiles are hard to predict in this population. I've heard of new research suggesting that aricept may improve verbal discourse skills (search for Nichols & McCracken...not sure what year), but I'm skeptical until more research comes out on that. Characterizing medication responders and non-responders is an interesting avenue of reasearch for both MDs and psychologists.

My role (I'm a neuropsych student) has been in the diagnosis, treatment planning, and tracking of improvement over the course of therapy. Its often hard for parents, therapists, and teachers who work with these kids everyday to see improvements so its always good to have an objective voice to help them decide whether to continue with what they're doing or change course. Even though a dont do a ton of direct ABA treatment, and I dont prescribe the meds, I believe that the role of psychologist/neuropsychologist is the most crucial in terms of treatment outcomes.

You can do a lot with autism in either case, you just need to decide if med school or clinical psych is a better fit for you overall.