How Do We See What We’re Looking At? Some Thoughts on Autistic Spectrum Disorder and Out-of-Home Care

The symptoms of Autistic Spectrum Disorder (ASD) in children who are placed in out-of-home care can often go unnoticed. Clinical psychologist and CCWT presenter Dr Brendan New provides valuable insight into how caseworkers can recognise the signs and respond accordingly :

It’s not what you look at that matters, it’s what you see. (Thoreau)

It is easy to miss Autistic Spectrum Disorder (ASD) in out-of-home care. Despite our best efforts, the needs of autistic children are often misapprehended as they move through complex and unpredictable care systems. Both childhood trauma and autism fundamentally shape the way a child relates to others, adapts to change and responds to their environment.

How then do we differentiate between autistic traits and sequelae of harm that look similar in childhood but stem from such different origins?

This is a pressing question as children with autism are over-represented in out-of-home care and poorly serviced by traditional ASD supports. Children’s developmental histories can become lost or confused as they enter care and change placements, making it easy to miss emerging autistic traits. As a result these children often accumulate tallies of social, emotional and behavioural labels that describe what is seen but misinterpret what is happening.

So how do we help these children whose difficulties are easier to describe than understand? Some ideas to start:

  1. Acknowledge that children with autism are over-represented and under-recognised in out-of-home care.
  2. Recognise that ASD is a single label used to describe a complex and evolving developmental disorder.
  3. Hold in mind a developmental and trauma lens when trying to understand what we are seeing.
  4. Incorporate an ASD and trauma informed approach where possible and know where to go for help.
  5. Give ourselves permission to get things wrong but don’t let this stop you trying.

As a practitioner, these principles help me hold onto a developmental health lens when I see an anxious child in care who struggles to connect with others, blows up at unexpected change or melts down in environments they can’t control. We know that ASD is difficult to recognise and meaningfully respond to, particularly when we feel we don’t have enough information to act on. However, all children in out-of-home care have experienced loss and grief and most have been harmed by adults they depended on for care. Autism is a developmental disorder that, at its core, translates children’s experience of other human beings. Children with ASD will therefore need more help, more often making sense of experiences but will by definition struggle to engage with support that is not adapted to their developmental needs.

Where to from here then?

We know what helps children with autism and we know what helps traumatised children heal. So why is this so difficult when it comes to out-of-home care? What seems to be missing is an acknowledgement that we misinterpret the autistic needs of children in out-of-home care and base our support on these misapprehensions. I propose that we can do better by incorporating what we know works and adapting this to the realities faced by children, families and professionals in out-of-home care.

Dr Brendan New will be presenting the upcoming CCWT workshop Making the Intolerable Coherent: Working with Children in Care with Autistic Spectrum Disorder for caregivers and professionals in Sydney on October 18.