Thursday, February 22, 2018

Self-Acceptance on the Autism Spectrum


What is Self-Acceptance?

Self-acceptance is an important component of cognitive-behavioral therapy (CBT). It means fully accepting yourself no matter where you are on the autism spectrum or how you perform or achieve. Self-acceptance is not the same as self-esteem, self-confidence or self-regard. These terms imply that you can accept yourself because you perform or behave in a specific way or because people accept you based on your achievements. Self-acceptance means that you non-judgmentally accept yourself for who you are without rating or evaluating yourself or requiring the approval of others.

Self-acceptance also means accepting one’s individual reality and combating perfectionism and unhelpful thinking habits. As human beings, we are fallible and highly imperfect. Demand and all-or-nothing thinking results in self-defeating behavior that invariably leads to feelings of anxiety and depression. The idea that there is an absolute and perfect solution to life’s troubles is unrealistic since few things are black and white, and typically there are many alternative solutions to a problem situation. Here are some general ideas derived from CBT for accepting your personal reality and remaining uniquely you:

  • Surrender the belief that you must perform competently in every situation. Challenge the assumption that you must always please others and achieve perfectly. Avoid the tendency to evaluate yourself and accept failure as undesirable but not awful or catastrophic. Accept compromise and reasonable rather than absolute and perfect solutions to life’s problems.
  • Strongly dispute the belief that you must feel accepted by every significant person for nearly everything that you do. Rather, keep the approval of others as desirable, but not an essential goal. Seriously consider other people’s criticisms of your traits without agreeing with their negative evaluations of you. Strive to do what you really enjoy rather than what other people think you must or should do.
  • When others behave badly towards you or in relation to themselves, ask yourself whether you should really upset yourself about their behavior. Will people change their behavior because you expect or demand that they do so? Telling yourself that the person or situation is unlikely to change no matter how much you think they should and accept that fact, will keep you from feeling inappropriately angry and resentful. People are independent entities. While we are in control of our own emotional destiny, we do not have control over the behavior of others.

Adapted from Wilkinson, L. A. (2015). Overcoming Anxiety on the Autism Spectrum: A Self-Help Guide Using CBTLondon and Philadelphia: Jessica Kingsley Publishers.
Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist (CCBT).  Dr. Wilkinson provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorder. He is also a university educator and trainer, and has published widely on the topic of autism spectrum disorders both in the US and internationally. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. Dr. Wilkinson's latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

© 2018 Lee A. Wilkinson, PhD


Monday, February 5, 2018

One Million Page Views - Thanks a Million!

I'm pleased to announce that BestPracticeAutism.com has reached the milestone of ONE MILLION page views! Many thanks to all of you for reading and commenting on my articles.               Please share and return often.
One Million Page Views


Saturday, February 3, 2018

Pharmacological Treatment of Autism Spectrum Disorder (ASD)

Pharmacological Treatment of Autism Spectrum Disorder

Prescription medications do not address the core symptoms of autism and are not considered to be "first-line" interventions or treatment for children with autism spectrum disorder (ASD). At present, early, intensive, and behaviorally-based interventions are considered the benchmark interventions for autism. Pharmacologic interventions are often considered for maladaptive behaviors such as aggression, self-injurious behavior, repetitive behaviors, sleep disturbance, anxiety, mood lability, irritability, hyperactivity, inattention, destructive behavior, or other disruptive behaviors in children with ASD. The most commonly prescribed medications are selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil; stimulants such as Concerta, Metadate, Methylin, Ritalin, and Adderall, and atypical neuroleptics such as Risperidone (Risperdal) and Aripiprazole (Abilify), both with FDA approved labeling for the symptomatic (aggression and irritability) treatment of children and adolescents with ASD. Although Methylphenidate (Ritalin) has been reported to be effective for reducing hyperactivity in some children with ASD, it has not found to be effective for treating restricted or repetitive behavior or irritability (Huffman et al., 2011). Some marginal evidence of benefit has been reported for various SSRIs in the treatment of restricted, repetitive behaviors, but more study is needed (Huffman et al., 2011; Warren et al., 2011). Although Risperdal and Abilify have been reported by caregivers to reduce problem behaviors such as irritability, hyperactivity, tantrums, abrupt changes in mood, emotional distress, aggression, repetitive behaviors, and self-injury, the risk of adverse (side) effects is considered to be quite high (Warren et al., 2011).
Research indicates increasing rates of psychotropic use and the simultaneous use of multiple psychotropic medications (polypharmacy) among children with ASD. A research study involving a large sample of children with ASD found 64% used psychotropic medications and 35% had evidence of polypharmacy (Spencer et al., 2013). Older children and those who had seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression had increased risk of psychotropic use and polypharmacy. Although co-occurring problems such as hyperactivity, inattention, aggression, and anxiety or depression, may respond to a medication regimen, as well as relieve family stress and enhance adaptability, there are general concerns about these medications. For example, there is a lack of evidence clearly documenting the safety or effectiveness of psychotropic treatment during childhood. Likewise, there is a paucity of information about the safety and effectiveness of psychotropic polypharmacy and potential interactions between and among medications that may affect individuals with complex conditions, including ASD (Spencer et al., 2013). Further research is needed to assess the value of these medications when weighed against their potential for harm. Likewise, there is an immediate need to develop standards of care around the prescription of psychotropic medications based on the best available evidence and a coordinated, multidisciplinary approach to improving the health and quality of life of children with ASD and their families. Because clinicians and school-based professionals may not be aware of the extent and effects of psychotropic use and polypharmacy when working with children with ASD, they should collaborate with parents, primary care providers, and others to carefully obtain medication histories and monitor treatment effects.
Adapted from Wilkinson, L. A. (2016). A best practice guide to assessment and intervention for autism spectrum disorder in schools (Second Edition). London and Philadelphia: Jessica Kingsley Publishers.
 References and Further Reading
Huffman, L. C., Sutcliffe, T. K., Tanner, I. S. D., & Feldman, H. M. (2011). Management of symptoms in children with autism spectrum disorders: A comprehensive review of pharmacologic and complementary-alternative medicine treatments. Journal of Developmental and Behavioral Pediatrics, 32, 56-68. Available from www.jdbp.org
Spencer, D., Marshall, J., Post, B., Kulakodlu, M., Newschaffer, C., Dennen, T., Azocar, F., & Jain, A. (2013).  Psychotropic medication use and polypharmacy in children with autism spectrum disorders. Pediatrics, 132, 833–840.
Warren, Z., Veenstra-VanderWeele, J., Stone, W., Bruzek, J. L., Nahmias, A. S., Foss-Feig, J. H…McPheeters, M. (2011). Therapies for children with autism spectrum disorders. Comparative Effectiveness Review, Number 26. AHRQ Publication No. 11-EHC029-EF. Rockville, MD: Agency for Healthcare Research and Quality. Available from http://www.effectivehealthcare.ahrq.gov/ehc/products/106/656/CER26_Autism_Report_04-14-2011.pdf
Wilkinson, L. A. (2016). Best practice in treatment and intervention. In L. A. Wilkinson, A best practice guide to assessment and intervention for autism spectrum disorder in schools (pp. 136-137). London and Philadelphia: Jessica Kingsley Publishers.
Wilkinson, L. A. (2016). A best practice guide to assessment and intervention for autism spectrum disorder in schoolsLondon and Philadelphia: Jessica Kingsley Publishers.
Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorders. Dr. Wilkinson is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest award-winning book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

© 2018 Lee A. Wilkinson, PhD

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