Ben and Heather welcome special guest and child psychologist Amy Sketcher to talk about divorce and children on the spectrum. Amy practises with Seasons Allied Health in Coffs Harbour, and has many years’ experience in the non-government and education sector. She works with children as well as supporting and up-skilling parents and caregivers. Topics covered include:
Seasons Allied Health is based in Coffs Harbour and offers evidence based psychological treatment for families, children and adolescents.
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Benjamin Bryant: Welcome to episode 28 of The Family Matters Show. As always, we are here to answer the difficult questions about divorce and separation. I’m your host, Benjamin Bryant from Bryant McKinnon Lawyers. Today, my business partner and family law expert, Heather McKinnon and I are going to address a particularly difficult topic: divorce and children on the spectrum. We see families dealing with this issue quite often, don’t we, Heather?
Heather McKinnon: We certainly do, Ben. And there’s absolutely no doubt that it’s really difficult for parents to make decisions when kids are on the spectrum and in our role as independent children’s lawyers, as well, we often see children on the spectrum directly and have to help them make decisions about their families.
Benjamin Bryant: There’s no doubt it’s very difficult Heather, and that’s why we’re not going to try and attempt to tackle this alone. We are very pleased to be joined by child psychologist Amy Sketcher, who will give us a social science perspective. Amy practices with Seasons Allied Health in Coffs Harbour. She has had many years of experience in the non-government sector and education system, including early intervention strategies, complex and severe trauma. As well as her work with children, Amy also has an interest in supporting and upskilling parents and caregivers, which is exactly what’s needed for today’s topic. Amy, welcome and thank you for agreeing to come on today’s show.
Amy Sketcher: It’s a pleasure. Thanks so much for having me. Hopefully, I can provide some perspective for your parents today.
Benjamin Bryant: I’m sure you will Amy. We’ve got so many questions and we’d better get started. But first, I just want to remind everyone that they can send questions in confidence to familymatters@bryantmckinnon.com.au or message us on Facebook at any time. Also, please do share this show with any friends you have or family starting down the track of separation. It’s so helpful for people to have access to information early on in the process, so let’s get started.
Benjamin Bryant: Amy, to begin with, can you give us a bit more background about the type of work you were doing with children and their parents?
Amy Sketcher: Ok, I have a private practice predominantly focused with children, youth and families. I would say that the bulk of my practice at the moment is kids aged between three and 12 years. We work with a very wide range of presentations. Ranging from those experiencing really severe mental health challenges, children who are neurodiverse and those going through life transitions and adjustments such as divorce, chronic illness, loss of a family member or a pet right through to challenges with friendships or schooling issues. Often when we’re working with parents, it’s in the context of how they manage their behavioural, social, emotional difficulties with their kids. And we really want to enhance the parenting skills that they’ve already got so that they feel more capable and more confident in managing themselves and also their children.
Benjamin Bryant: And Amy, you do all this at Kimberly House on Little Street in Coffs Harbour. Seasons Allied Health.
Amy Sketcher: Yeah, that’s right.
Benjamin Bryant: In this work, Amy, you must frequently come across both children and parents who are struggling through a family breakdown. In your experience, what psychological and emotional difficulties do you encounter most frequently across the general population?
Amy Sketcher: I would say that when relationships and families break down or there’s a separation, the most common psychological challenge that brings somebody to therapy, whether they’re an adult or a child, would be adjustment and emotional distress that’s associated with that significant change or transition. It’s really normal to have very strong feelings or when we’re working with kids, we call them big feelings. And when you’re going through something that changes your world or changes the perspective that you have on the world. So, feelings of grief, feelings of loss, feelings of sadness, worry, stress: they’re all really normal. But when they start to take over day to day life or impact on daily functioning or become more frequent than not: that’s where psychological intervention is often sought from family members.
Amy Sketcher: Second to this, I would say, following separation another common challenge or occurrence that we see within our practice is increased anxiety, especially associated with contact visits. There’s generally naturally a primary caregiver within an environment, and that’s not meaning that the other parent has done something wrong. It’s usually just that the child feels or perceives a closer connection to one parent or feels more comfortable being comforted from one parent or even just the dynamics of the family has meant that one parent has been present in the home more often due to work schedules or decisions that have been made. And this is really tricky to navigate when it comes to contact schedules, as I’m sure you can imagine.
Benjamin Bryant: As we know.
Heather McKinnon: Thanks for that.
Amy Sketcher: Sometimes it can cause really high levels of distress and anxiety for the child navigating between both houses. And that, in turn, also causes a lot of distress for the parents involved as well.
Heather McKinnon: It’s really important we find to try and get parents working on the same page. Because that competition, if you like, is something that they can get into very early in the separation process. So, it’s so good to have someone with your skill level to actually talk about what happens for the kid. You can talk ’til you’re black and blue to parents, but you’ve really got to have that child advocate there who’s not tied into the conflict between the adults to help the parents look at what’s happening for their little ones.
Benjamin Bryant: It’s difficult for separated parents in such emotional conflict to take a step away and be child focused. It’s really difficult. And I was having this conversation with someone yesterday just on that thing and took them back into the relationship. It’s not because the legislation says there’s a difference between male or female or mom and dad. It’s just that as a society, that’s what it is. That’s the construct, I’ll just say it, you know, young children stay with moms. Not because the legislation says so, but that’s normally the default position, essentially even in the relationship. Another thing that came to mind when you were speaking, and it was also just how different children react after breakdown and also their age difference, how they can react in that age difference. Heather and I are both independent children’s lawyers and I met with four children and the three youngest children was so bubbly and so engaging and really, really fun, to be with and interview. And the older one kind of sat back, the 14-year-old just sat back and I thought, I’m not going to get much out of him. And then when the younger children left, he was so pleased to have my attention just, gave it all to me. It’s just so interesting, just the age difference as well, just how people cope and people have different experiences.
Amy Sketcher: Yeah. And it’s not uncommon for one child in the family to experience a lot of distress and another child, in the same family, to happily go between and not have any issues? And then that in itself creates a different dynamic.
Benjamin Bryant: It’s not one size fits all.
Amy Sketcher: Parents always want to do what’s best for their kids, but it’s just navigating the different perspectives within a family of what “best” looks like, because it can be very different.
Benjamin Bryant: And today, Amy, we specifically wanted to talk about the children and adolescents that are on the spectrum. In our experience, these children have a tougher time managing through the family breakdown. What are the common behaviours displayed by children on the spectrum and how would you expect these might change after separation or divorce?
Amy Sketcher: So, children on the spectrum with ASD often demonstrate delays and differences across two main areas of functioning, and that’s interacting and communicating socially with others and displaying behaviours or interests that are restricted, repetitive or fixated.
Amy Sketcher: Autism spectrum disorder is a developmental disorder that begins in early childhood and continues across the lifespan. Social differences revolve around that normal give and take of social interactions, and they’re both verbal and non-verbal. Kids often have difficulties in communication, in language, in developing and maintaining and understanding relationships. Sometimes you’ll find kids on the spectrum will do things that seem impolite or odd or strange. They might seem quite aloof or detached. And they tend to have quite narrow, unusual or fixated interests and play in unique or different ways compared to typically developing children.
Amy Sketcher: Many children, young people experience difficulties coping with change, but often do better when they’re prepared ahead of time for changes in routine. I’ve found transitions and changes to routine to be a particularly big trigger for young people on the spectrum when they’re navigating separation and divorce. It is often said that if you know one person with autism and what that looks like, then you know what autism looks like for that one person because it is a spectrum disorder and it can vary so significantly across individuals. Usually, kids on the spectrum have very unique special talents, skills, challenges and problems too. And it’s really good for those around them to use those special interests and skills when they’re trying to build strengths and help them to adapt to change.
Amy Sketcher: Now, as can be expected, given the areas that make up autism, it makes sense that navigating divorce or separation is likely going to be a bit more of a challenge than those who are neurotypical. With separation, the family environment, the dynamics, the physical homes and those local places that they might visit, like shops or parks can often change in a really short space of time and managing the differences of routines across households and all of this sudden and intense change can cause a lot of distress for kids on the spectrum. It can be really hard for kids to generalise across environments when there’s a difference in behaviour management and routine and care provision, and that can cause increased stress and declines in mental well-being as well.
Amy Sketcher: On top of this, children on the spectrum often have communication difficulties that make it hard for them to be clear or communicate in a safe manner or in a way that their needs and wants are understood by people around them. This can lead to increased meltdowns, whether they’re behavioural or whether they’re emotional, and that’s also challenging for families as well as the child, and it can cause a lot of stress or distress within the household for both parents and also siblings too.
Benjamin Bryant: Amy, we know that separation for parents and breakdown of a family is stressful enough for most families, but for some families that Heather and I see, the family breakdown is happening at the same time that there may be a diagnosis or possible diagnosis for autism for children. How can parents distinguish between behaviours triggered by the trauma of the family breakdown and behaviours that are caused by the autism?
Amy Sketcher: Behaviours triggered by trauma due to family breakdown and what autism looks like share some similarities. Kids can have reduced social interaction or functioning. They can have heightened emotions. They might be more disinterested or detached with the world around them, which is similar for trauma responses as well as autism. However, they share some very different aspects as well. Autism is a neuro-developmental condition, and it’s present from a really young age. It can be diagnosed usually from around two years old. So the duration of the presentation or what you see in a child can be a really strong indicator because ASD doesn’t just show up following traumatic events or following separation, it’s going to be present prior and have a long history there.
Heather McKinnon: Amy, I’m interested because in Coffs, where we predominantly practice, there’s a whole lot of diagnosis on social media by parents. And my understanding is that there needs to be a team approach. So if the paediatrician is going to look at diagnosing, they’ll talk to caregivers, the schools, clinicians like yourself. Can you give sort of the local community here an understanding of how diagnosis should be made in best practice?
Amy Sketcher: Ok, yeah. There are definitely gold standards around how a diagnosis is made, and that’s through a multidisciplinary team usually spearheaded with a paediatrician making that final call. But the multidisciplinary team can include psychologists’ assessment, speech assessments and OT assessments. That’s all then collated together with a really detailed history of what that child or young person has looked like growing up, because the symptoms will definitely be there prior to the age of seven. Within Coffs Harbour that might mean that you need to go to a number of different professionals at different service centres and then see your paediatrician, whereas in bigger areas that can all be done under the same banner sometimes.
Heather McKinnon: What Ben and I see is that a lot of these little ones, they’re picked up initially at preschool when they enter the public sphere away from the family. So the preschool and early childhood educators are alive to looking at where little ones are struggling socially and that which may then lead to them having a talk to the parents. Is that your experience?
Amy Sketcher: Often it does come up when a child engages in childcare because that’s the environment where they’re with other kids socially. And sometimes parents might think things are normal development, because that’s their first experience of parenting and you don’t know what you don’t know, and that’s okay. We all learn along the way? So yeah, it is often childcare centres that do flag it initially. However, particularly for females on the spectrum, it can be a lot later that it starts to get picked up. They’re a lot better at masking behaviours. And they also have generally got better social skills. So it’s when those social worlds become a little bit more complex in middle to later primary school that girls on the spectrum tend to be picked on.
Heather McKinnon: Mm hmm. It’s really interesting.
Benjamin Bryant: And Amy, I was going to ask this question a bit later on, but I’ll ask it now. Something we see quite often, sadly, is one parent being in complete denial about an ASD diagnosis. How should the other parent go about dealing with the problem, especially once the relationship is ended?
Amy Sketcher: As with all assessment and intervention for medical and allied health supports, having both parents on board and consenting is always the ideal best practice. However, I’ve found, especially with separated parents, when there’s been some hostility, this can be really tricky. There might be one parent that is pursuing diagnosis and the other parent’s not yet ready for that to occur. The child might need care and treatment. And you can’t get consent from one of the parties, which is really tricky. And I can’t speak to all practices, but within our practice, if we have one parent who’s completely denying consent to medical care, we generally won’t continue because it puts the practitioner in some very messy legal hot water if they go against what a court order states. However, I’ve found even when there is a lot of challenge within families, if you have really open and transparent communication with both parents, regardless of who sets up the sessions or who makes the initial inquiry, you can generally get to a positive outcome and decision around how to proceed. Parents usually, most often, will want what’s best for their child, regardless of how they feel about the ex-partner and the relational histories. Sometimes there can be a lot of fear and a lot of worries about what moving forward can mean or what information might come out during assessment or during therapy, and when a clinician can talk through those concerns and worries with both parents, either separately or together, and highlight the pros and cons from a really child friendly or child centred approach. I’ve found it’s pretty rare that following those discussions, both parents will continue to deny access.
Benjamin Bryant: Interesting.
Heather McKinnon: Yeah. And I suppose Ben and I should just, for the listeners, indicate that our work in the role as independent children’s lawyer often comes about in the case you’re talking about. So one parent has applied to the court for orders that the parents must allow the child to get appropriate treatment and one parent’s saying no. So we’re appointed then, to look from the child’s perspective as to what’s needed and get the appropriate expert reports. And then the judge will make an order that the parents facilitate the child having treatment or as you really well explained at the beginning, if it’s a case where the child’s experiencing these problems as a result of the separation and it’s nothing to do with ASD, they will clearly in the judgment then say the child’s to gain appropriate psychological support to deal with the separation. But everyone’s got to stop running around trying to get a diagnosis when it’s clear there’s nothing there. It’s interesting work and as you said it, it depends on the clinical standards provided for by the experts because we certainly see a lot of cases where Allied Health and psychs will just go off on the basis of one parent, and they don’t even try and engage the other parent.
Benjamin Bryant: Heather, while Amy was speaking what really struck home to me was that, of course, we’re dealing with the very nasty three percent of cases that actually need a judicial decision, they’re in the court system. Amy, of course, has the benefit of separated couples with ASD children NOT going through that conflict. So it’s just really great to hear that fresh perspective
Benjamin Bryant: And so, Amy, once parents have the diagnosis, how can they make divorce and separation easier for children or adolescents on the spectrum?
Amy Sketcher: One of the best ways that parents can support their children when separating, or following divorce, is to remain friendly and speak positively about the relationship with the alternate parent. Separation can be really messy and hard and fuelled by a lot of complex emotions for the adults involved. And a positive or at least amicable relationship between parents is a really strong protective factor for children in reducing some of the stress or potential burden that they experience during separation. A lot of the time kids are already questioning their new realities, whether they played a role in it, and sometimes there can be expectations from parents around passing messages along. But this can lead to really poor outcomes for the kids because it blurs their role as a child in the relationship. So, trying to be proactive in staying calm, rational can go a long way and having good shared decision making with the other parent and also having a positive relationship with your own child and better mental health for all involved.
Amy Sketcher: And I’ve found that encouraging parents to keep the longer-term goals in mind can help to avoid some of those day-to-day disagreements that pop up. For children that are on the spectrum, it can be really important, even more so, to maintain regular routines and keep consistency across houses. So, trying really hard to have a similar parenting approach or behaviour management approach can reduce some of the confusion and increase some safety for your kid. During the separation or just following the separation, trying to minimise any changes that are occurring within their routines or within their schooling or friendship groups
Benjamin Bryant: Like the shopping centre you referred to earlier.
Amy Sketcher: You want to keep them as consistent as possible, particularly for kids on the spectrum, because you’re already introducing a lot of newness and change into their world. There’s a really strong benefit of schedules and organisation for kids with autism. So having visual contact schedules up at both houses. Maybe having the morning and the afternoon and the evening routine really clear so that it’s similar across both home environments. And also coming up, ideally, although they’re not always practical, with a consistent approach to behaviour management or reward systems in the house, so that it’s less confusing for the kid no matter where they are.
Amy Sketcher: Another thing that can be a bit tricky with kids on the spectrum is that they might seem to understand or get it one day when it comes to divorce and then the next day really seen as though it doesn’t make sense to them. So having a lot of patience and a lot of compassion in trying to help them to understand what’s happening can be really useful. And one way that you can do that is to have a social story that kind of explains the change that they’re experiencing, and that helps it to make sense for them in a child friendly way and normalises some of those feelings that they’re experiencing.
Amy Sketcher: So, for all I would say, all children and even adults, we sometimes struggle to find words to explain what we’re feeling and what we’re experiencing. But for kids on the spectrum, that’s a particular difficulty understanding themselves and expressing themselves, particularly when it comes to emotion. So sometimes that is put on to the parents or the caregivers in being really attuned to what’s happening for their child and noticing those cues and warning signs and triggers that are going to be really unique and specific to your individual child.
Heather McKinnon: I was just going to add Amy, that what we hear from parents with these little ones is things like the lunchbox. So the Red Lunchbox has to go to school every day. And so, if something happens and the Red Lunchbox doesn’t turn up at Dad’s, Dad’s got to ring Mum and go and get the Red Lunchbox all those little external things like that particular toy or that blanket or bundle of sticks. And we’ve seen the advent of parenting apps in the last five years, and I think they’re an excellent way for these families to be able to put up to date management plans. So they’re both in the same spot they’re looking at. Look, this week there’s been a change this dinosaurs now the one that’s got to be in the bag Any tools that parents can get that are going to keep them on the same page is critical.
Amy Sketcher: Yeah. And I think also sometimes that, falls back to the therapist because often kids that are autistic will be seeing one or many therapists at the same time. And lean into that and take the guidance and advice that’s given during those tricky times because that advice and guidance will be given to both sides and can be clearly communicated for both parties so that the same approach can be taken.
Heather McKinnon: That’s excellent.
Benjamin Bryant: And that’s a great segue into my next question, Amy. And that is we’ve said that, all children after the breakdown of a family will experience difficulties. And you’ve outlined some that children in the spectrum would experience. How do parents know when their child would need psychological help?
Amy Sketcher: I would say that the answer to this is similar to that of any other child. Parents know their kids best. They’re in a really good position to recognize where there’s a change and how significant that might be. As I said before, there’s a really wide range of normal emotions that come with being a human being when we experience significant stressful circumstances and events and divorce definitely falls into that. So it would be normal for your child to be experiencing sadness or worry, confusion, anxiety, but it’s around when that becomes more often than not. Does it stop them from doing things that they really enjoy doing or that they need to be doing, like going to school? Are they not coping across environments?
Amy Sketcher: Generally, when you start to see two or more of these things happening, it would be time to start exploring seeing a psychologist. On top of this, it’s important to remember that children on the spectrum may have additional problems in expressing their feelings, understanding changes and adjusting to shifts in life and routine. So, they might not be clearly telling or showing you how they’re feeling and you’ll need to tune into their individual cues that they’re not coping. That might be an increase in noise sensitivity, it might be increased meltdowns, it may be school refusal, head banging, more stimming than what you’re used to seeing. Whatever it is that your child does to show that they are distressed, you’re going to be best placed to know what that looks like. A lot of kids that are on the spectrum will already be accessing therapies: in speech or OT, psychology. So, keeping their usual therapist informed of changes within the family can be really helpful in attempting to have successful, smoother adjustments following separation. I think it’s also important to note that if you think that your child might struggle with this, it could be worth calling around to get your name on wait lists for psychologists. I know in Coffs Harbour we have very long wait lists and it can be just an additional peace of mind that you have to know that if you do need that support, you’re already listed somewhere for if the time comes and you can easily cancel if needed.
Benjamin Bryant: How can parents find the right psychologist for their child?
Amy Sketcher: When it comes to finding a psychologist who’s the right fit, I think that there are a few critical things to look for. Firstly, finding somebody who has experience and specialises in working with children or adolescents, depending on your kid’s age. Working with children is a very different kettle of fish to working with adults, and it’s really important that the clinician has done extra training and practices focused on a child centred approach. Also consider what goals or what outcomes you’re hoping for. And do some research on the clinician to find out what their focus is in terms of presentations or types of interventions that align with what you’re looking for as well? Most clinicians will be happy to have a quick chat to you and you can get a good gauge of what that might look like through that conversation.
Amy Sketcher: But the absolute most important and strongest predictor of success across any age or intervention type is the therapeutic relationship. So, you need to feel safe. You need to feel comfortable. You’re going to be sharing intimate parts of your life that you might not share with your greater world. So, you need to have trust, like them, feel comfortable in their presence. That’s probably the most important and the most critical thing. But bear in mind that it might not come immediately for you or your child, and it can be shaped from past experiences as well. I generally suggest at least three sessions for children to get a good feel of if somebody feels like a good fit for them. If you see a psychologist, you’re not locked into them forever. You can change. And if you need it, this is your permission that you’re allowed to do so. We all have different personalities and different ways of working, and we all recognise that we might not be the best fit for you. So, there’s never going to be, or there shouldn’t be, any offence taken if you do need to change. Because we know that it needs to feel really right for you.
Heather McKinnon: Any Amy, just the people who are new to this whole world, obviously the starting point will be talking with your general practitioner because most parents in this area will get a referral to someone like you under Medicare from their GP. And so a lot of parents that we see aren’t aware even that Medicare is available to help fund this intervention. So if you’ve got no contacts in the community and no way of finding out who might be a good fit. Talk to your general practitioner.
Amy Sketcher: Yeah, there’s lots of different options for accessing care outside of Medicare as well, particularly for kids on the spectrum that already have a diagnosis. They can access therapy and support through the NDIS. There also is Medicare. There’s the primary health network for families that are financially struggling because that gives them free access to treatment. And there’s a whole gamut of other ways to access care through victim services or Open Arms for veterans and veteran families. There is a lot of different ways that people can access.
Heather McKinnon: And it’s really good because so many people just stay in their four walls and are worried about how they might even start to navigate getting help.
Amy Sketcher: So just in alignment with what we’ve been talking about in regards to finding the right provider for care. I wanted to share a quote from Bessel van der Kolk and that is: “Being able to feel safe with other people is probably the single most important aspect of mental health”. And I think that’s something to keep in mind when you’re trying to find the right clinician.
Benjamin Bryant: Ladies and gentlemen, that was Amy Sketcher from Seasons Allied Health. Thank you, Amy, for your insights, they were incredibly helpful.
Amy Sketcher: It was a pleasure Ben, thanks for having me. It’s been really lovely to come in today.
Heather McKinnon: Thanks Amy. We have so many clients, and in this situation, we really feel for them. It’s so good to have this episode recorded so that lots of people in the community can get your wisdom.
Amy Sketcher: No problem, Heather, so glad to be able to help.
Benjamin Bryant: What an informative and helpful episode. I love doing this podcast. And next month, Heather, you and I are going to get into the weeds of the family law legislation. Listeners may have heard on the news that the Federal Circuit and the Family Court have officially merged in September this year. But listeners may not be aware that along with the merger comes a raft of changes to how the court will operate and how family law matters will be heard. On the next episode we are going to help you to understand what the new rules mean for couples who are separating or divorcing. If you already have questions about the new court rules, please either message us on Facebook or email familymatters@bryantmckinnon.com.au and we will make sure your questions get covered on the show.
Benjamin Bryant: Thanks again to Amy and to all of you for listening. We look forward to having your ears again next month. And in the meantime, remember, we’ve got a huge library of great podcasts available on our website: bryantmckinnon.com.au or wherever you get your podcasts. Good bye for now.