Full Assessment for:
- Autism Spectrum Conditions
- Aspergers Syndrome and related conditions
- Conditions that don’t quite fit
Emotional and Behavioural problems explained
Autism Spectrum: hope for progress?
For ten years as a Consultant Child and Family Psychiatrist in the NHS and as a Clinical Director in two services I was faced with the conundrum of children referred because of social difficulties or behaviour-emotional issues that simply did not fit the rather loose diagnostic categories we had to work with.
There is a particular group of children who are sort of ‘Aspergerish’ but don’t quite fit the label. They are often shy, awkward in company, but unique. They often struggle at school because of emotional problems; they may have outbursts of uncontained behaviour – because their emotions ‘overflow.’ Or they may manifest quite marked anxiety symptoms. Is this your son? Or daughter?
In 2012 I met Sioban Boyce and it changed my practice. I had already realised that, quite often, these children have uneven cognitive profiles, sometimes called ‘spiky.’ The frustration of the NHS approach – place on a waiting list, eventually assess for ASD and then say they do not have it so no more to do – was infuriating and distressing. In our practice now we often offer full cognitive profiling to confirm the profile and then move to the next phase, fast.
Before I met Sioban, I would end up treating with anxiety-reducing drugs, or sometimes atomoxetine (a drug licensed for ADHD but with wider applications and probably working on the anxiety pathways). Sometimes it helped , sometimes it did not. I knew more was needed.
Siobhan has since retired but we have an excellent and experienced team that offers the interventions to help those children read non-verbal communication and cues better. Their contention, and I agree, is that these children are often lacking in these skills, through no fault of their own or their parents, but because of the modern world and child-rearing practices.
I would add that genetics also play a part in predisposition. I am proud to say that we now have a team of therapists to offer this intervention where necessary. It is short, focussed and relatively inexpensive. Because it is fun, the children like it. For more information see Sioban’s writing and publications (S. Boyce: Not Just Talking 2014 and others).
Like other areas of my practice, unfortunately, because we are trail-blazing, many insurance companies will not cover this. It is not (yet) ‘evidence- based.’ But it is no different in principle to many CBT-based approaches and therefore a puzzle as to why they will not do so.
We deliberately keep the costs as low as possible to make this accessible to as many as can use it. Again, no NHS services currently offer this, despite sterling efforts by Sioban over the years to get it adopted. I am in no doubt that it works.
Like all my practice (see Integrative Psychiatry) I offer this alongside the use of other approaches including medication where appropriate. I firmly believe that my expertise these days is in seeing the wider picture and integrating whole treatments from the many different areas of my knowledge and experience. So if a child does suffer with crippling anxiety I may suggest the SCC intervention, as we call it, alongside a small temporary dose of something to reduce anxiety, while the child’s knowledge-base is built up.
However, you do need to know, if this site has not already suggested it, that I really do not throw drugs around where they are not needed and willy-nilly. Judiciously used, in combination with other things, medicines are a wonderful resource and I would not be without them. But they are not the whole answer and SCC can be part of that answer.
The SCC Team
Alison Fry, Pauline Pierce, Andrea Stirling-Williams, Karen Stirling-Gibson
