Finding and participating in treatment for a child with autism spectrum disorder can be challenging under the best circumstances. At the outset of treatment or even in the course of it, barriers to progress may become evident. One of the most difficult barriers to overcome is a situation in which a child’s parents disagree with the choice or course of treatment. As a result, much of the interaction with the provider may be dominated by resolving conflict and managing the adults in the session, rather than focusing on the child’s needs and well-being. Thus, the child’s treatment needs may be overshadowed, and progress is slowed or halted altogether.
As a provider, if you find yourself in such a situation, it may be helpful to provide as much evidence-based information as possible and to present a benefit-risk analysis in as unbiased a manner as possible. It will be important that both parents be present for each session, so that information is distributed as consistently and as efficiently as possible. It may also be helpful to suggest starting with a conservative treatment, to encourage a “trial period,” or even to suggest beginning with an observation period during which parents gather “baseline” information (i.e., no treatment, just observe).
It will then be helpful to assist parents in examining the “evidence” for and against (and to weigh the pros and cons) of a particular treatment. It is also important to give the child a voice in the discussion when appropriate and/or by law (in WA State at the age of 13). Finally, it will be highly beneficial to provide prompts to focus on the overall goal of treatment and to highlight times during which this is being overshadowed.
As a parent, while this may be a highly emotional experience for you, it will be extremely important to remain focused on the overall goal — your child’s progress in treatment and improvement in functioning. Frequent self-reminders about the “big picture” will help keep emotions managed and progress moving. The other thing to consider is that nothing is permanent; you can decide to “pause” or discontinue treatment. If risks are not high, you may agree to “trial periods” of two different treatments or even a treatment versus “no treatment” period. It may be helpful to take some data regarding “pre-treatment” observations and “during treatment” observations. You may decide to track side effects, frequency/duration/severity of symptoms, and/or even teacher observations during these times. You can then discuss these concrete observations with both your provider and your child’s other caretakers.
In sum, agreeing on a treatment for your child with autism spectrum disorder can be an emotional experience. The challenge for both parents and providers is to remain focused on the overall goal of treatment and to keep in mind what is in the best interest of the child. Thus, the child’s needs are preserved as the primary priority and progress is made as quickly and efficiently as possible.