Psychotherapy for children with neurodevelopmental differences (autism, ADHD, seizures; processing, memory, and communication differences)

In my practice, I see many children with neurodevelopmental conditions. If a child has a neurodevelopmental condition, psychotherapy often needs to be adjusted to the child's profile. In this blog, I discuss ways to adapt therapy process for children with neurodvelopmental challenges. This is important for all of my clients, but especially with those who struggle with anxiety, phobias, or OCD and need to understand their anxiety, learn specific coping strategies, and undergo Exposure and Response Prevention.

Visuals

Many children with neurodevelopmental differences struggle to process spoken language. They might also struggle to pay attention to it, or to remember what they have heard. I often create visual supports specifically for each client that connect directly with their experience. These can be books that I put together, visuals of coping strategies, or images that help illustrate important information about child’s challenges.

Many of my clients require repetition of information with consistent visual supports in order to understand it and integrate it into their lives. Specifically, clients with history of seizures, require consistent visual anchors to promote recognition and retention of families information. An example can be a card with an image of a coping strategy that we practice over and over, that the child can take home and to school, where parents or teachers can support the use of the strategy using the same card. For some children, I create resource boxes or put cards with coping strategies on a keychain for them to take along as needed.

I also create psychoeducational resources for children that I share with families. The child and I can then review these resources (for example, read a picture book) in the office, and parents can read the same book to the child at home. Consistent wording and visual anchors help the child recognize and subsequently retain the information.

Multi-sensory format

For many children, it is useful to present information in more than one format, so it can be processed via more than one channel. It is also helpful to let a child create their own resources to add the motor piece to the process.

For some children, I create games that incorporate psychoeducational information at their level of understanding in a play format. For other children, this can be too much of a language demand. It can also create confusion as information is being presented in different formats, and any additional information that I need to provide verbally cannot be processed and/or retained. Sometimes I use play to communicate important information through the activity, rather than verbally.

With some childnren, we create and decorate affirmation cards with reminders and encouragement specific to the child, that the child can carry with them to school, community, and other places where they have to be brave to cope with anxiety or a phobia.

Terminology

It helps to use their own language with children who have neurodevelopmental differences. While as therapists we have our clinical terminology, the vocabulary that they already have is much more accessible to a child. I always want to know what the word means to the child. If it fits, we will be using it instead of clinical terminology.

Technology

Children and teens these days are “digital citizens.” Using technology in therapy is an evidence-based approach and can help children “buy into” therapy or approach it on their terms.

I use a virtual sand tray for children who do not like the texture of sand, or who have a strong connection to technology and benefit from having access to it in order to build a therapeutic relationship. I additionally use a selection of video clips specifically created to present information about mental health and coping strategies to children. With some children, I use Canva to create images and collages to share and process their experiences without having to use language.

Play

I use different types of play and art materials. Examples are sand tray, doll house, puppets, clay, and drawing. Children will often express their challenges symbolically and indirectly through play materials. Whether or not a child chooses to process their sand tray or a drawing, the experience of creating it is therapeutic in itself.

I also use drawing, clay, sand tray, and doll house as ways for children to share and process their experiences, or to visualize aspects of coping strategies they are learning.

Respecting the neurology

Many children with neurodevelopmental challenges cannot be seen in therapy virtually. This is the reason I offer in person therapy.

Additionally, children with these conditions can struggle with attention and self-regulation. I respect and accommodate for those challenges in my sessions. My office offer different seating options, movement opportunities, and fidgets. I do not require eye contact, orientation towards me, or sitting still. I encourage children to move, and teach them to notice when they need breaks.

While it is important to have treatment goals in mind, it is also very important to respect and honor the child’s needs in a moment. Sometimes children show up for their session tired, preoccupied with something that happened in school, or just not wanting to focus on their anxiety or phobia. I respect my child clients’ need for regulation and play and will do my best to help them find things to do in my office that will feel refreshing or regulating. Honoring their needs contributes to the safety of our therapeutic relationship. Often, after the child feels regulated or more rested, they initiate work on the therapeutic goals explicitly related to their anxiety or phobia. Even if that does not happen, providing a safe and regulating environment is of tremendous therapeutic value to a child.

Parent Involvement

For many younger children, parents are their most important support in making progress. Even for teens, parent support is very important. I regularly include parents or caregivers in sessions to explain their child's condition, share what we are working on, explain and demonstrate the coping skills the child is learning, and teach parents when and how those strategies can be used at home and at school. Parents learn to understand the principles of Exposure and Response prevention and can support their children by organizing exposure opportunities at home and in realistic situations according to the plan that we make and review together.

Collaboration with schools

It is important to collaborate with counselors or school psychologists, so that any work done with the children is coordinated and consistent, and supported across the environments where child spends their time. Otherwise, things can get very confusing and overwhelming for the child, and progress is impeded.

Additionally, the process of collaboration allows an opportunity to share neurodiversity-affirming approach and understanding of the child and their struggles with their school.