Emma* is a 12-year-old girl diagnosed with autism spectrum disorder (ASD) and anxiety who was referred to JF&CS Children’s Behavioral Health Services by her outpatient therapist. Emma’s initial acting out behaviors were described by her mother, Judy*, as tantrums and outbursts where she would become upset and cry, pace around the apartment, and throw items. Emma was a solidly built 12-year-old and Judy was noticeably smaller. Judy was initially worried about the behaviors because she didn’t know what to do or how to calm Emma down, which frightened Emma’s younger sister. Judy reported that most of these behaviors were due to being denied something or changes in her schedule resulting in not being able to participate in a preferred activity.

After an assessment period, a behavioral therapist from JF&CS In-Home Behavioral Services put together an action plan that included having consequences for acting out, setting schedules, and enforcing limits. Judy was the primary caretaker of the family but due to her cultural background, she perceived her maternal role as a duty to keep her daughters happy and entertained. As a result, she found it difficult to follow through on the plan.

It soon became apparent that not only was Judy scheduling too many activities for Emma but she was also becoming overly accommodating, buying her too many things and allowing her to eat whatever she wanted for dinner so that Emma never had a chance to be bored or unhappy. By making these accommodations for the peace of the family, Judy was feeling emotionally exhausted. At one point, the clinician learned that Judy had mentioned that she wanted her daughter to have chicken for dinner but then made a separate dinner for her to avoid an outburst.

The therapist worked with Judy to implement the plan and empowered her to set limits, follow through on consequences, and stick to schedules. When the therapist talked about setting limits, Judy asked what that would look like. The therapist reinforced the concept that she, as the parent, should decide what dinner would be and that she should be firm in her expectations of her children. It seemed that Judy finally realized in that session what the clinician had meant by “setting limits” and in the next sessions appeared confident and reported that she was able to set and hold limits with Emma. Judy explained that it was as if a lightbulb had gone off for her.

After she had begun to set limits for Emma, there was about a two week period in which Emma acted out but Judy trusted the therapist’s recommendations and remained consistent in her limit-setting. The services the family received empowered Judy to create structure and change behavior. Their family reported that Emma’s unstable behaviors had decreased dramatically and that the therapy “made a huge impact on their family life.”

*Names changed to protect privacy.

Originally posted on the JF&CS blog.

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