“We're not alone in this wonderful but often baffling world” – offering Non-Violent Resistance groups to parents of autistic adults
Authors: Sophie Doswell, Adanna Onyejiaka and Annemarie Trainor
Across the Adult ADHD and Autism pathway we have been reviewing and expanding the support we offer to family members of people referred to our services. As part of this expanded offer, we have been piloting an approach called Non-Violent Resistance.
What is Non-Violent Resistance?
Non-Violent Resistance (NVR for short) is a parenting approach, which was developed in Israel by Haim Omer and colleagues (Omer, 2004). NVR took concepts from socio-political movementsand considered how these could be helpful to parents.NVR started as an approach for addressing child to parent violence, and has expanded to address a wide range of challenges that families can face. NVR has been applied to support a range of mental health difficulties including anxiety (Lebowitz et al, 2014), obsessive compulsive disorder (Lebowitz, 2013) and suicidality (Omer & Dolberger, 2015). It has also been offered to families where there is neurodiversity including ADHD (Schorr-Sapir, 2021) and autism (Golan et al, 2014).
NVR is different to some other parenting approaches as it promotes a range of principles, which can be adapted to each unique family context.
Principles include:
- Connection before correction – with a focus on strengthening relationships within the family as a priority
- Strike while the iron is cold – focusing on de-escalating when things are getting challenging, and then returning to the subject when everyone is more receptive
- You cannot change other people’s behaviour, only your own – helping family members recognise they can only control their own behaviour, but by changing this it can impact on others, and also on how they feel about their parenting
- Recognising parenting is challenging – and ensuring parents both look after themselves but also reach out for support
An NVR group for parents of autistic adults
Using the NVR principles and associated strategies, alongside some adaptations recommended in relation to autism, we offered eight group sessions, each an hour long, to parents of autistic adults within local and National services across the Adult ADHD and autism pathway. Ten parents joined the group, and it was facilitated by three staff members trained in NVR.
- Drawing on the general NVR principles described above, we encouraged parents to reflect upon
- Parental presence – how ‘available’ are they to their child, both in person and considering ‘felt’ presence when they are apart
- What self-care activities they already do, and whether these are enough and what could be added, including barriers to undertaking these activities
- Building relationships through relational gestures – smalls acts demonstrating thoughtfulness and love, not given as a reward but ‘just because’
- How to de-escalation situations in the moment, and ways of addressing concerns with the autistic adult when things are calmer
- ‘Picking their battles’ and using ‘baskets’ to identify one of two key areas to focus on, letting smaller issues go for now
- The experiences of siblings within the family, and how to manage any rifts
- Mapping support currently received, noting gaps and making a plan to identify more support
- How to ‘draw a line in the sand’ with very problematic behaviour, using the more robust elements of NVR to resist these behaviours, while still maintaining a strong relationship with their adult child
We also drew on recommendations from NVR practitioners for making adaptations to NVR in line with the needs of autistic individuals, and additions to NVR that have been found helpful previously where a family member has autism (Doswell et al, 2020;Jakob & Shapiro, 2014; Golan et al, 2016).
Examples of adaptations are additional time and focus on topics focusing on finding supporters and on the experiences of siblings and other family members.
- Additions were across two areas;-
- Mentalisation – a framework parents can use to help autistic adults understand their own internal world and the internal world of others, in relation to particular behaviours
- Over-accommodation - when anxiety in the system can stop autistic adults being as independent as they could be
Outcomes from the group
Of the ten parents who started the group, one had to leave due to personal circumstances but asked to attend a future group. No parents ‘dropped out’ and on average attended six of eight sessions.
Formal measures (the Brief Family Distress Scale and Parental Anchoring Scale, which is an NVR specific measure) were taken at the start of the group and repeated at the end of the final session. These indicated that following the group, parents had an increased sense of social support and greater self-control.
Parents also provided some informal feedback. While the benefits of sharing particular NVR tools were recognised, the biggest value appeared to be linking up with other parents in a similar situation. A number of parents noted they had never had that opportunity before.
Parents fed back they would have liked sessions for supporters and for their children, so they can have a better understanding of NVR.
Our reflections
As the professionals running the group, we met regularly to reflect on how the group was going, and any changes that were needed, both within the current group and for any future groups.
We recognised how engaged the group members were, and how powerful it was for them to share experiences and hear from others in similar situations. We recognised the challenges for these families in finding supporters, and that it can be hard to offer direct advice as to how to help with this, especially when parents are from national services. This group of parents in particular had high ‘parental presence’ and were well engaged with their adult children, perhaps in response to the difficulties in finding wider support. We also noted that parents were thoughtful about ‘over-accommodation’ and engage in a helpful process of ‘calibration’, depending on the risk and support available at any one time. Our final reflection was that we would have appreciated more time within sessions to facilitate discussions.
Next steps
We are planning some follow up sessions to check in with group members, including a session for their supporters to hear more about NVR.
Our next group is planned for May next year, and we are going to be offering longer sessions (ninety minutes). We have been successful in getting a Maudsley Charity grant to fund a parent to co-facilitate our next group, and will be evaluating any added benefit from this.
We will also review the content of sessions around supporters and ‘over-accommodation’, to acknowledge the challenges of finding support for autistic adults, and also recognising the complex judgements that parents are making in relation to calibrating the support they give across the lifespan.
We remain committing to offering NVR to parents and believe this intervention is a helpful addition to the range of psychological activity offered across the ADHD and Autism pathway.
About the authors:
Sophie Doswell is a Consultant Clinical Psychologist, working across the Adult ADHD and Autism services
Adanna Onyejiaka is a Principal Clinical Psychologist, leading the Transforming Care in Autism Service, which supports autistic individuals in crisis
Annemarie Trainor is an Artspsychotherapist and Systemic Practitioner, who works in the National Autism Unit (an inpatient unit for autistic men) and in the National Adult ADHD and Autism Psychology Service (which offers outpatient assessment and intervention).
References
Doswell, S., Kokhar, L., McKillop, M., Quazi, P. and Oliver D. (2020) Non-Violent Resistance (NVR) for parents of adults with learning disability - A pilot group. The Bulletin of the Faculty for People with Intellectual Disabilities 18 (2) 40-47.
Golan, O., Shilo, H., & Omer, H. (2016). Non-violent resistance parent training for the parents of young adults with high functioning autism spectrum disorder. Journal of Family Therapy, 40.
Lebowitz, E. R. (2013). Parent-based treatment for children and adolescent OCD. Journal of Obsessive-Compulsive and Related Disorders, 2, 425-431.
Lebowitz, E., Omer, H., Hermes, H., & Scahill, L. (2014). Parent Training for Childhood Anxiety Disorders: The SPACE Program. Cognitive and Behavioural Practice,21(4), 456-469
Omer, H. (2004). Nonviolent resistance. A new approach to violent and self-destructive children . New York: Cambridge University Press.
Omer, H., & Dolberger, D. (2015). Helping parents cope with suicide threats: An approach based on nonviolent resistance. Family Process, 54(3), 559-575.
Schorr-Sapir, I., Gershy, N., Apter, A. & Omer, H. (2021). Parent training in non‑violent resistance for children with attention deficit hyperactivity disorder: a controlled outcome study. European Child & Adolescent Psychiatry, 31(6), 929-938.
