Article:
Author: Kavitha Murthi, Yu-Lun Chen, Stephen Shore, Kristie Patten
Journal: AJOT
Year: 2023
This article reviews research on strengths-based approaches for autistic individuals, focusing on mental health outcomes.
strengths-based practice (SBP) is defined based on an autistic perspectives, presuming competence, and focusing on strengths over deficits
the authors identified three critical features of SBP: 1. presuming competence by focusing on the strengths of autistic individuals, instead of only on their deficits 2. collaborating with the autistic community 3. creating supportive environments
a scoping review methodology was used to map the literature on SBP for autistic people; studies were categorized into interventions, descriptive studies, exploratory studies, and commentaries
key mental health outcomes of SBP included reduced anxiety and stress, positive mental health, and increased self-advocacy skills
SBP also increased skills and knowledge in areas of interest and created more supportive environments for autistic adults
implications for occupational therapy include using SBP to reduce anxiety, build on interests, developing self-advocacy, and create inclusive environments
Let's take a closer look into the critical components of strengths-based practice.
On presuming competence by focusing on strengths over deficits.
There is currently a shift occurring in practice and research moving away from medical model or deficits-based practice and towards strengths-based practice. Traditional medical model practice works well for medical conditions and a medical system, where the objective is to find the dysfunction and fix it. However, that type of remediation-based practice is not a good fit for working on skills and challenge areas of the autistic population. The problem with a deficits-based view with autistic individuals is that the lens through which they are seen is negatively biased. Resultingly, this negative view limits their ability to learn. When people around them, such as their family, educators, therapists and the like focus on what they cannot do, it forms a myopic view of their capabilities. A strengths-based lens, however, says "they can do this, it might just look differently than the way neurotypical people do it." Or, "they can do this, but they might need more support in order to do it successfully." They might have a hard time with abstract concepts such as use of sarcasm in social conversation, but they might instead be great and noticing details and patterns with peoples' voices or speech. How can that strength be leveraged and cultivated, instead of trying to mold them to neurotypical norms? A focus on strengths does not mean ignoring their challenge areas. Rather, it means using their strengths and interests as a tool to help their challenge areas, and frankly, re-thinking what norms they are being told to fit. They face constant comparison against neurotypical norms, but this often dulls their strengths. They might have difficulty adapting when changes occur to their established routine. Instead of punishing behavioral outbursts or reactively addressing their behavior, how can they be given tools to adapt to changes and practice successfully working through possible changes, thus setting them up for success proactively instead of having to mitigate a meltdown reactively. The strengths-based view, in focusing on strengths, forces neurotypical people to think about the reason, the why, behind their preferences. Instead of finding all the ways that they are different from neurotypical individuals, let's examine their preferences, their interests, and cultivate their strengths.
Instead of assuming that autistic individuals cannot do certain tasks or do not have certain skills, the strengths-based view presumes instead that they can or that they simply do it in a different way from neurotypical people. The strengths-based movement is all about seeing and acknowledging different learning styles and then finding creative ways to support the autistic individual to achieve the goal or acquire the skill. It is understanding that they might need more movement, more sensory breaks, more regulation strategies, more time for information processing. But it doesn't mean they cannot do whatever "it" is. This calls neurotypical individuals to be patient and open to learning other ways of being and doing. Presuming competence is not presuming that they do not need support or help, but presuming that they can. This then implies that personal biases ought to be examined (i.e. what limitations am I putting on this person subconsciously?) and our environment ought to be adapted.
On collaborating with the autistic community & creating supportive environments.
Collaborating with the autistic community sounds obvious, but so often in research and clinical practice, the autistic voice is drowned out by academic or clinical opinion. The first step is acknowledging the autistic voice, their experience, and their opinions. The next is viewing them as valuable. From this inherent value, comes a desire, no an impetus, to collaborate. This collaboration involves every level. At the level of the researcher, including stakeholder voices and including more research on the autistic lived experience. Research is then what informs clinical practice. At the level of clinical practice, finding out what their interests and their strengths are in the initial evaluation. These strengths and interest areas should guide intervention, they should be used to create and cultivate interventions, rather than using their interests as reinforcement for displaying an expected behavior. Building intrinsic motivation is far more sustaining and more ethical than relying on using extrinsic motivation. And humans are intrinsically motivated by what naturally interests them. In clinical practice, involving the autistic voice and opinion in goal setting is strengths-based. Rather than creating goals without them based on what the therapist deems is important to learn, being strengths-based is about learning and incorporating what is important to the autistic individual and their family, and building goals around that. Collaborating with the autistic community is important in clinical practice even down to the physical set up of the space. Sensory processing differences abound in the autistic community, finding ways to honor those differences and examine what might be a more regulating environment is vital (i.e. are they more regulated when they've first received proprioceptive input? Are they more regulated when the lights are dimmed? Are they more regulated when they're in a more private space away from other people?). All of these ways include being sensitive to autistic communication, and completing actionable steps to move them towards regulation and collaboration.
Strengths-based practice requires a change in the use of language. Start pondering ways that autistic individuals are talked about, both within and outside of clinical practice. When researchers and practitioners use strengths-based language that affirms the autistic experience, behavior change will follow. When the components of strengths-based practice are followed and honored, mental health outcomes of autistic individuals will increase. And what is the ultimate purpose of therapy (occupational, behavioral, speech, counseling, etc.) than to improve mental health outcomes and well-being of the individuals served?
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