"Why Is My Child So Angry?": Therapeutic Assessment for Early Childhood Autism

Therapeutic Assessment with Children (TA-C) is becoming more widely known, but to date there are no published case examples of TA-C with children suspected of having severe developmental disabilities. This workshop will illustrate how TA-C can be used in the assessment of early childhood autism, with videos from an assessment recently done by the presenter in her private practice in Copenhagen. The 4-year-old boy was referred due to daily extreme tantrums, which put the whole family as well as the foster parents’ marriage under severe pressure. The boy was very difficult to test, so attendees will see how the assessor, through the Therapeutic Assessment process, built alliances with both parents and the child by carrying out micro-therapeutic interventions and scaffolding the parents’ and the child’s sense of safety and competence. The presenter will also discuss how the TA process helped clarify the child’s complex differential overlapping symptoms to arrive at a differential diagnosis, as well as how the parents’ marital dynamics were adressed and worked with. The presenter will show videotapes from multiple sessions of the TA-C, including administration of the ADOS-2, extended inquiries of the Parental Stress Index and NEO-PI-3, family intervention session, and presentation of the personalized fable to the child at the end. Attendees will also work in small groups on interpreting test materials and formulating a case conceptualization.

Presenter:

Dr. Mette Kyung Reacroft | Private Practice 

Learning Objectives: 

At the end of the workshop, participants will be able to: 

1. Describe how to help parents formulate Assessment Questions, including systemic questions about themselves and their couple dynamic, while taking into consideration level 1, 2, 3 information.
2. List 2 ways to build alliance with a young child who’s having difficult externalizing behaviour and with the parents as well, utilizing continuous micro therapeutic interventions.
3. Explain how an assessor may use their relationship to create a positive triangulation in the family dynamics.
4. Explain how the presenter reached her systemic case conceptualization using the ADOS together with the WPPSI and the clinical observations.
5. Describe how the presenter interpreted the complex differential diagnostic hypotheses from the test results and gave level 2 feedback to the parents. 
6. Describe thepersonalized fable Given to the child in this case and how he and the family reacted to it.

Skill Level: Intermediate 

References: 

•    Bal, V. H., Kim, S. H., Fok, M., & Lord, C. (2019). Autism spectrum disorder symptoms from ages 2 to 19 years: Implications for diagnosing adolescents and young adults. Autism research: Official journal of the International Society for Autism Research, 12(1), 89–99. https://doi.org/10.1002/aur.2004
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•    Hyman, S. L., Levy, S. E., Myers, S. M., & Council on Children with Disabilites, Section on Developmental and Behavioral Pediatrics (2020). Identification, evaluation, and management of children with Autism Spectrum Disorder. Pediatrics, 145(1), e20193447. https://doi.org/10.1542/peds.2019-3447
•    Kinnear, D., Rydzewska, E., Dunn, K., Hughes-McCormack, L., Melville, C., Henderson, A., & Cooper, S.-A. (2020). The relative influence of intellectual disabilities and autism on sensory impairments and physical disability: A whole-country cohort of 5.3 million children and adults. Journal of Applied Research in Intellectual Disabilities, 33(5), 1059–1068. https://doi.org/10.1111/jar.12728
•    Martin, K. B., Haltigan, J. D., Ekas, N., Prince, E. B., & Messinger, D. S. (2020). Attachment security differs by later autism spectrum disorder: A prospective study. Developmental Science, 23(5), e12953. https://doi.org/10.1111/desc.12953
•    Olson, L., Bishop, S., & Thurm, A. (2024). Differential diagnosis of autism and other neurodevelopmental disorders. Pediatric Clinics of North America, 71(2), 157–177. https://doi.org/10.1016/j.pcl.2023.12.004
•    Perry, E., & Flood, A. (2016). Autism spectrum disorder and attachment: A clinician's perspective. In H. K. Fletcher, A. Flood & D. J. Hare (Eds.), Attachment in intellectual and developmental disability: A clinician's guide to practice and research (pp. 79–96). Wiley. https://doi.org/10.1002/9781118938119.ch5
•    Rosen, N. E., Lord, C., & Volkmar, F. R. (2021). The diagnosis of autism: From Kanner to DSM-III to DSM-5 and beyond. Journal of Autism and Developmental Disorders, 51(12), 4253–4270. https://doi.org/10.1007/s10803-021-04904-1
•    Sohn, E. (2020). The blurred line between autism and intellectual disability. Spectrum | The Transmitter. https://www.thetransmitter.org/spectrum/the-blurred-line-between-autism-and-intellectual-disability/
•    Tharinger, D. J., Rudin, D. I., Frackowiak, M., & Finn, S. E. (2022), Chapter 5: Phase III: Case Conceptualization. In Therapeutic Assessment with children: Enhancing parental empathy through psychological assessment. Routledge.