Residential Treatment for Adolescent Autism-Spectrum Disorder

Many programs that treat emotional and behavioral disorders will not accept students with high-functioning autism-spectrum disorders like Asperger’s Syndrome, referring those students instead to programs that deal exclusively with neurobiological issues.  This effectively segregates young people with autism-spectrum disorders from other populations.  “I think that in many cases, this is a mistake…a missed opportunity,” says Utah-based psychotherapist, David Prior, LMFT.  “My preference is to judiciously mix different populations in a treatment setting so that patients are challenged to learn new styles of interacting with different kinds of people.  This is especially true with spectrum disorders.”

Prior, a program director InnerChange, a network of residential treatment facilities for adolescent girls, recommends a highly nurturing milieu as the foundation for treating all diagnostic profiles.  “The common denominator for our students is that they are motivated by relationships.  So we appeal to that powerful motivator by creating a place that feels very safe and nurturing—both in terms of staff culture and student culture.”  Once that sense of safety is established, says Prior, the stage is set for implementing specific strategies designed to help students on the spectrum succeed in a diagnostically diverse treatment setting.


Repetitive Cuing: Spectrum students benefit from clear instruction coupled with repetitive visual or verbal cue to help them routinize new behaviors.   In certain situations, this might cause embarrassment, says Prior, unless a positive peer culture is consistently maintained.  “That kind peer culture really pays off when, for instance, a girl posts notes in her bathroom to remind her of positive hygiene habits.”  Rather than causing ridicule, however, Prior says that his students routinely help each other remember and master even these potentially sensitive new habits.  “It’s just part of the culture.”

Talk Plus Experiential Therapy: Particularly with students suffering from a non-verbal learning disorder (NLD), talk therapy is coupled with experiential approaches.  “We want to meet these girls where they are and their neurological bias for processing thoughts and emotions is verbal, so we’re careful not to overload them with written or visual therapy assignments.”  The function of experiential therapies with NLD students is to help them put therapy into action, while the function of verbal processing is to help transform those experiences into sustainable relational habits.  “We want NLD students, in particular, to develop a ‘muscle memory’ for newly acquired relational skills.  This is done by pairing their verbal strengths with a physical/experiential activity.”

Consistency: Adolescents suffering from emotional and behavioral disorders can generally benefit from external consistency and structure.  But this is all the more true for those struggling with autism-spectrum disorders.  Consistency in routine, instruction, social interactions, and culture help create a sense of safety.  This consistency also reduces external distractions so that new behaviors and coping skills can be focused on, practiced, and mastered.

Customization: Staff should be trained to distinguish between behaviors that stem from oppositional tendencies and those that stem from neurobiological disorders.  Many young people with spectrum disorders have been chronically misunderstood by parents, teachers, and even therapists; in these cases, behaviors resulting from rigid thinking or misinterpretation of visual cues may meet with consequences instead of coaching.  Many spectrum students are suffering not only from neurobiological disorders, but also from anxiety, trauma and other co-occurring emotional problems.  This means that the therapeutic staff must construct therapies that are flexible, creative, and personalized.  This, in turn, requires robust communication.  “Customization requires extensive communication in order to maintain a balance of nurturance and structure,” says Prior.