Alongside the increased prevalence of autism spectrum disorders (ASD), there is a greater likelihood of clinical psychologists having a role in the treatment of children with these disorders. Population heterogeneity with respect to ASD-specific symptomatology, comorbid medical and psychiatric issues, level of cognitive functioning, and presence of adaptive behaviors, all add to the complexity of providing treatment to this population. Consequently, psychologists often find themselves in multiple roles in order to effectively manage treatment for children with ASD and their families. The purpose of this article is to increase awareness of three major roles for clinical psychologists working with this population: assisting families with treatment coordination, identifying and treating comorbid psychopathology, and addressing parental stress.
The term autism spectrum disorder (ASD) refers to individuals who meet the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, 2000) criteria for either autistic disorder; Asperger's disorder; or pervasive developmental disorder, not otherwise specified. The use of this umbrella term reflects the current conceptualization of these disorders as occurring along a continuum (or spectrum) comprising impairments in communication and social interaction, presence of repetitive or perseverative behaviors, and a restricted range of interests/activities. Given the relatively high prevalence of ASD (i.e., 1 in 150; CDC, 2007), there is an increased likelihood of clinical psychologists coming into contact with families of children with this disorder. Furthermore, although many psychologists specialize in ASD treatment with children, the demand for psychological services from this growing population will likely outpace the current availability of experts in the area.
Importantly, children with an ASD vary tremendously in their presentation across the core areas of impairment described above. Similarly, there is a wide range in intellectual functioning, motor and adaptive living skills, and psychiatric and medical comorbidities across the ASD spectrum (Beglinger and Smith, 2001, Bonde, 2000, Filipek et al., 1999, Mandell et al., 2006 and Mattila et al., 2010). Given this heterogeneity, a comprehensive treatment approach for children with ASD often requires a team of professionals in which the clinical psychologist plays a critical role. Indeed, clinical psychologists possess a broad set of skills, experiences, and expertise that make them uniquely qualified to address many of the myriad needs of this population. Thus, psychologists who are considering opening up their clinical practice to this population can have significant impact on children with an ASD and their families.
There are many roles for psychologists in managing effective treatment for children with an ASD; we have selected three that are perhaps most important and for which the clinical psychologist is aptly trained: (a) assisting families with the process of treatment coordination, (b) identifying and providing treatment for comorbid psychiatric disorders in children with an ASD, and (c) addressing parental stress.1
Assisting Families With Treatment Coordination
After receiving the diagnosis of an ASD, families embark upon the challenging road of coordinating care for their child. This can be an overwhelming process for many families, as there are over 400 available interventions that purportedly treat ASD (Romanczyk, Gillis, White, & DiGennaro Reed 2008). A clinical psychologist can assist families with treatment coordination by (a) providing psychoeducation regarding empirically supported treatment options and assisting families with the process of making the complex decisions involved in treatment selection; (b) working with the family and their multidisciplinary team of treatment providers; and (c) monitoring treatment and child progress in the short- and long-term. Clinical psychologists who assist families with these aspects of treatment coordination serve the role of consultant. The degree to which a family seeks consultation from a psychologist largely hinges on the specific treatment needs of the child, family resources, existing systems for children with an ASD (e.g., early intervention, school, etc), and other resources available in the community, region or state.
