The Real Enemy

Dr. Coplan emphasizes the importance of addressing parental mental health as a prognostic factor for children with ASD, and the obstacles to achieving this goal.

ASD in a child carries a substantial possibility that one or both parents have mental health issues, which have the potential to negatively impact the child’s prognosis (including risk of future criminal offending). And yet, 99% of the effort to improve outcome for children with ASD has been narrowly focused on children, while parental mental health has been almost entirely neglected. Why?

Educators and Therapists feel (with some justification) that they lack both the qualifications and parental permission to get into these areas. School psychologists, counselors, and social workers have the training and entrée, but seldom exercise their skills and prerogatives, because the public school culture in which they are embedded is not attuned to mental health as a relevant variable in the lives of children (unless a child is failing academically, or physically disruptive in the classroom). Pediatricians may feel that they lack the time or training, and/or that if they raise sensitive topics the family may become offended and take their business elsewhere.

Beneath the surface of each of these rationalizations, however, lies a whiff of stigma. Mental illness is our last taboo.

Given professionals’ discomfort with the subject, is it any surprise that parents themselves are reluctant to raise these issues? It is the rare parent who is able to say “I have a mental health issue that is interfering with my ability to function as a spouse and parent” – although I have a few shining examples of this in my practice. These parents tend to do well despite their mental health issues, because they are on top of things, and engaged. “Know your enemy, and know yourself, and in 100 battles you will never be defeated” — Sun Tzu’s advice to military strategists (http://en.wikipedia.org/wiki/The_Art_of_War ) — is equally apt in family therapy. And it is these exceptional parents, I believe, who hold the key to the way forward. They should serve as an example of the good that flows from addressing mental issues, rather than hiding from them. Stigma and secrecy, rather than mental illness per se, are the real enemy.

How do we get from “A” to “B”? More next time.

James Coplan, MD is an Internationally recognized clinician, author, and public speaker in the fields of early child development, early language development and autistic spectrum disorders. Join Dr. Coplan on Facebook and Twitter. Have a question for Dr. Coplan? Ask the doctor.