Case Study 2: Working with an ASD Teen

  • Mitra Ahani, MA, CCC-SLP

    A journey of a thousand miles begins with a single step.


    Charlie had no interest in joining me in my speech center to conduct any sort of traditional therapy. That wasn’t his style. Don’t get me wrong, because we did make several attempts. But Charlie made it known he was not going to get out of the car and waltz into therapy with a new therapist.


    At the time, Charlie was obsessed with elevators and knew everything about them. We decided to start meeting downtown and riding the different elevators in the public parking garages, as we got to know each other. For about 2 months, we rode elevators and engaged in small exchanges about the numbers, symbols and types of elevators we were in. This was an initial investment in our relationship that would pay off in spades.


    Transitioning from elevators to my office was a challenge. But, with small steps and patience, we made it to the parking lot. He didn’t verbally protest, but he refused to get out of the car. This was progress. I brought materials and a chair outside and set them up by his car. I blew up rocket balloons and water balloons, and exploded Diet Coke and Mentos fountains.   I basically created my own comedy routine right there in the parking lot. Neighboring patrons would look at me quizzically since they couldn’t see the boy peering from the side of the window. I ignored them and persisted. I had to convince Charlie that he could trust that his needs and interests would take precedence in our time together. I barely spoke. I used affect and comedy to gain his attention and I let him decide when to reciprocate.


    One day, as I gathered my materials, Charlie opened the door and sat next to the large Oak Tree in the parking lot. Soon this became a daily practice. I wanted to encourage him to enter the building but I resisted mentioning it. I knew Charlie had to make the decision to go up himself. A few more sessions next to the tree and he made it upstairs, into the waiting room and onto the couch nestled close to his mom. More progress. All of this work was needed to create the foundation of a real relationship between us. A relationship that would lend itself to promoting communication and trust.


    There was a pivotal moment when Charlie laid at my front door and screamed for 90 minutes. I can’t remember why; I don’t know if Charlie really knew, but his anxiety and need of routine often disrupted his daily life. I sat with him, and allowed him to go through his process. For 90 minutes he screamed at the top of his lungs and when it was over, we hugged, closed the circle in a positive way and said goodbye.


    Form that day forward things were different. Charlie came into the office the next day, eager to be with me and worked hard at communicating. What I realized was that there is great power in connection and trust. We forget sometimes what life must be like for some kids on the spectrum. We forget how difficult it must be for them to develop relationships of any type, much less with strangers whom they see once or twice a week and who make difficult demands upon them. Without a connection and trust, real progress is nearly impossible.


    Even though Charlie had meltdowns daily, each meltdown was a different experience for him. After the 90-minute tantrum, Charlie would come in, ask his mom to stay in the waiting room, and with a simple star chart engage in activities of choice.


    Over time, I had to convince Charlie to take a break. He was communicating his frustrations, excitement and anxiety in a way that helped him co-regulate with me. The progress was steady for many months and enabled him to attend school and generalize his newfound behavior into other environments, including home.


    Then, unfortunately, for reasons unknown, Charlie clashed with his teacher and began to spend his school days, from drop off to pick up, in the corner of the classroom, screaming at anyone who approached. This went on the five months until Charlies’ parents, always his greatest allies, took a big risk and pulled him out of school.


    Charlie now joins us at Thrive for 4 hours each day of ABA, speech and OT. Initially, as is his way for new surroundings (especially given how he spent the last five months of his school-life), he protested, screamed and covered his ears at the mere sound of our voices. But I knew him and recalled what worked two years before, and we simply started there again. This time, however, because he knew me well, he had no problem entering the facility; he just wouldn’t do anything once he was inside. Charlie isn’t one to be forced to do anything, and so we gave him ample space, respect, and understanding. After the first week at Thrive he dropped his bags of toys and trains, looked at me and said, “I am happy!” And we all breathed a huge sigh of relief to match his.


    Once again, Charlie’s progress is steady and measured in small but meaningful gains. He loves to come to therapy and always wants to stay past his allotted time, and that, for Charlie, is more than half the battle. I look forward to his next chapter. While these past few months have been tough, I know he is in the midst of his success story. As many of our kids have periods of struggle, they also have periods of relief and gains. Celebrating the small steps towards a better life is the key to continuously thriving.



                Mitra Ahani is the founder of Route 2 Language (R2L), which originated in San Mateo and now operates also in San Jose at Thrive Therapy and Social Center. Mitra owns and operates Thrive with her husband David Tollner.


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