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The Gardner Family: Autism and the Developmental and Family Life Cycle Theory

The Gardners are a Caucasian nuclear family that live in a safe, surburban community. The family consists of the heterosexual coupled parents Doug and Elsa, and their two children, Sam and Casey, who all live in the household together. Their son, Sam, is autistic and yearning for more independence as he tries to navigate normal teenage life events, such as entering the dating world.


Meet the Gardners and their dynamics... Sam is an autistic high school senior, who is eager to search for love and more independence. He is navigating Erikson’s stage of Identity vs Role Confusion. Sam is trying to transition into adulthood, find his sense of self, get a girlfriend and have sex. He works part-time at a electronics store and spends most of his time learning about Antarctica. He has a close relationship to his mother, but is trying to not rely on her as much so he learns to reach out to other support systems, such as his father and his close friend Zahid. Doug is a father in his forties who works as an EMT. He has a more laid back parenting style than his wife ,which leads him to have a close relationship to his daughter, Casey. He is in Erikson’s Generativity vs Stagnation stage as he struggles with being a productive father. He has a difficult time connecting to Sam and feels that Elsa doesn’t let him develop a close bond to his son. When they discovered Sam was autistic, Doug abandoned the family, but later returned and assumed the father position. He has since been working to regain Elsa’s trust and become the father he wants to be. Elsa is an overbearing stay-at-home mom in her forties. Elsa is in Erikson’s Generativity vs Stagnation and has been a very contributing mother but is beginning to lose her maternal role. She is very controlling over her son and does everything for him, but lost her sense of self over the course of her son’s lifetime. She isn’t ready to let go of Sam and when he begins to explore independence and not need her as much, she spirals into an identity crisis, which leads her to an affair with a local bartender. She has a strained relationship with her daughter and has a hard time trusting Doug, since he briefly left her. Casey is a high school sophomore who excels in track and field. Although she is Sam’s younger sister, she guides and protects Sam while in school and stands up to any bullies that may bother him. She is currently in Erikson’s Identity vs Role Confusion stage and has a very good sense of personal identity and doesn’t rely on acceptance from her peers. Recently, Casey is struggling with deciding to pursue her dreams and expand her life past just being Sam’s sister. She always expresses a tough exterior but internally struggles with her relationship with her mother, her worries over losing her virginity, her brother’s diagnosis, and navigating her new relationship with her first boyfriend.


Autism Spectrum Disorder Autism spectrum disorder is a very complex disorder involving neurodevelopment that affects the person’s ability to interact and socialize with others. They can have distress with changes in routine, often prefer gestures over words, lack empathy, inability to adjust gaze and often avoid eye contact, they can have heightened and/or lowered senses, intense tantrums, aggressive behavior, repetitive movements, and more (Sommer et al, 2013). As the name implies, there is a spectrum of this disorder, which determines that person’s level of functioning.

Sam is high up on that spectrum, he is known as an adolescent with high-functioning austism spectrum disorder. He has a hightened sense of sound, for which he constantly wears noise-cancelling headphones. He get very anxious over zippers and soft touch. When he was initiating being intimate with his girlfriend, she touched him softly and he was so triggered by that touch that he punched her. Other than that experience, he doesn’t often display aggressive behavior. He is very awkward with social interaction and is very literal. He can sometimes be a little too honest and blunt, but he doesn’t understand that what he is saying is mean unless you


The Gardner’s Developmental Stage According to Duvall, the Gardner family is currently in the “families with adolescents” life cycle stage. During this time, the major task of the parents is to develop boundaries for the children and increase their flexibility in regards to their children’s autonomy (Kaakinin et al, 2015). The Gardner family is struggling with this transition because Elsa has a hard time giving Sam independence. She is resistant to his newfound interest in new things such as dating, changing his clothing style, and having a job. The family is going to need to negotiate new boundaries and goals that keep Sam safe and stable but allow him to explore independence and adulthood.

Challenges ● Doug has diffuclty talking to people about his son’s autism and bonding with Sam ● Casey and Doug do not receive adequate time or attention from Elsa, who spends all her energy on Sam ● Elsa does not give Sam room to grow and throws herself into a crisis when he enters the dating world and wants autonomy ● Elsa and Doug have deep rooted problems in their marriage because of Doug leaving the family, which creates ongoing trust issues and Elsa’s affair

Strengths ● Casey protects Sam and does anything she can to help him live a normal life ● Doug is supportive to Casey’s track star dreams (he runs with her weekly, attends her events, etc), Sam’s interest in dating (gives Sam advice and assists him in dating issues he comes across), and Elsa in making new friends (he encourages her to take dance classes) ● Elsa is a stay-at-home mom which allows her to dedicate herself to her family and Sam’s care, she is also involved in their school and attends group support therapy ● Each member has good stress coping strategies


Their culture and religion Although the Gardner family does not affiliate with any religion, they do have family traditions they particpate in such as: dinner at the table as a family, Casey and Doug go on runs on the weekends, and the family keeps track of their schedule with a big family calendar in the kitchen.

Their communication Sam has a hard time with verbal and nonverbal communication, which impacts how the entire family communicates with each other. He is very literal, and often misinterprets what people say to him because people talk to him in everyday slang or metaphors and he doesn’t understand that. Elsa has mastered therapeutic communication with him and knows exactly what to do and say when he is having a breakdown. When it comes to nonverbal communication, Sam doesn’t feel comfortable with eye contact and he has a hard time interpreting body language. Doug and Elsa are both very careful and aware of what they say to Sam so that he fully understands them, however, his sister Casey talks to him like any other sibling would. She teases him, is blunt, and doesn’t pay much attention to how he would interpret what she is saying; she likes to treat him like she would with anyone else. Casey and her mother have strained communication, Casey is very sarcastic and passive aggressive toward her when they don’t agree, which is often. Doug is awkward when he communicates with Sam both verbally and nonverbally, but he expresses his love for him by doing things for him such as making an igloo for him and taking him to the Zoo. Doug and Casey have a great relationship, and Casey shares a lot of her personal thoughts and feelings with her father. He is very loving and supporting of her.


Developmental and Family Life Cycle Theory

The Developmental and Family Life Cycle Theory is very applicable to nuclear families which is why I think it is appropriate for the Gardners. It is also appropriate because they have are trying to successfully transition through the traditional family life cycles like any other family. This theory outlines normal family changes and the family’s experience over their lifetimes, paying attention to the entirety of the family as well as each individual member (Kaakinen et al, 2015). Common and predictable transitions through stages bring about great stress on the family, for which they will need to find ways to adapt and adjust. Concept 1: “Families Develop and Change” meaning over time, interactions, structure and roles all change within the members. Transitions can be predicted and families need to be prepared for what change will be taking place. Overall, families have a natural and predictable course of life, and they develop and change with each transition (Kaakinen et al, 2013). Concept 2: “Families Experience Transitions From One Stage to Another” meaning there are a set of transitions each family goes through which causes disequilibrium in the family. The normal progressional transitions are known as “on time” (normative) events. An unexpected or possibly negative transition is considered an “off time” (nonnormative) event. Doug and Elsa getting married is an on time event, having a baby is an on time event, but that child growing up to be autistic is considered an off time event. The Gardner family is experiencing multiple normative and nonnormatie events. Their normative events include their adolescent son learning adulthood and dating, their adolescent daughter dating and thinking about her career future.. Their nonnormative events include their son’s autism and Elsa’s affair.


Intervention one A pressing issue the Gardners have is the neglect that Casey feels since her needs are shadowed by her brother’s needs. When a healthy sibling has a sibling with a mental health condition, the parents often give their time and focus to the affected child, which ultimately leaves the healthy sibling feeling ignored (Kaakinin et al, 2015). Casey is a rising track star with an incredible scholarship opportunity being offered to her, but she feels a lot of guilt and conflict about accepting it because it would mean that she would leave Sam’s school and focus on herself and her success. Her mother also points this out and makes it very clear she does not approve of Casey accepting the offer because she wants Casey to continue watching over Sam.

Intervention:

Although Doug has one-on-one time with Casey on their weekend runs, Casey still gets neglected from her other parent. It is important for Elsa to also spend quality time with Casey, without Sam there, so that Casey will be able to get the time and attention she deserves from her mother. Rationale: Because the sibling of a child with ASD has extra responsibilities involving care for the child, as well as less attention from their parents, it can easily feel like everything revolves around the child with ASD (Mandleco and Webb, 2015). Giving special time and recognition to Casey will make her feel more involved in the family and more noticed.

Desired outcome:

If Elsa spent special time with Casey, they might be able to foster a healthier relationship and Casey could develop the same comfortability with her mother that she already has with her father. She will feel more supported and listened to by her mother which will make her happier and feel more appreciated. It will also decrease the guilt she feels over following her dreams and she will foster more confidence in her successes rather than hiding them.


Intervention two Since Sam is trying to transition into adulthood and gain independence, it has thrown Elsa in a spiral. For the entirety of Sam’s life she has been the “mom of an autistic child” and she lost her true identity in being Sam’s mom. When he gets a girlfriend and a job and starts having more of a voice, Elsa starts to have a crisis that results in her having an affair with the local bartender, which is a maladaptive coping strategy. Elsa has a lot of uncertainty about Sam’s future and is not fostering a healthy transition for him into adulthood because she is not ready to let go of him.

Intervention:

Elsa needs some direction in order to stay grounded. She should connect with someone in her support group who has already experienced their child transition through adolescence so that she can have an idea of what is ahead for herself and Sam. Rationale: Sandra O’Brien recommends that parents of an autistic child transitioning through the end of adolescence should reach out and connect with their community resources, especially families of older children with ASD so that they can have someone to relate to and mentor them through this and lead to better psychological outcomes (O’Brien,

Desired outcome:

By Elsa having some information and direction for the future, it will make her feel more in control. She will also regain her purpose and be able to regain her focus back to herself and participate in self-care activities. This will also lead her to be more encouraging of Sam in his dating experiences and promote his yearn for independence. It will also help her marriage because with regained control and direction in her life, she should be able to refocus her loyaity to Doug and be a more active partner in her marriage.


Intervention three Sam’s is a high school senior who wants to grow into adulthood and participate in adult behaviors such as being in a relationship and having sex. Although it is not thought of frequently, this is common amongst ASD adolescents, who reported to desire sexual and romantic relationships and display sexual behaviors, such as masterbation (Chan, 2012). When Sam begins dating Paige, she drops hints to him about wanting to spend alone time at her house while her parents are gone, but he doesn’t understand that she is hinting at sex or even how to have sex. He needs guidance and education on the topic of sex. Elsa protects him so much and censors so much of his information, so he desires sex but is getting misinformed by his male peer.

Intervention:

Sam needs to be properly educated by a healthcare provider or counselor on what safe sex is, how to express his needs and boundaries to Paige, the physical changes happening to his body during puberty, and sexually appropriate behaviors. Rationale: Adolescents with ASD need guidance in “learning healthy ways to fulfill their sexual needs.” (Chan, 2012) Discussing the changes that will happen in their body during puberty and giving guidance on appropriate behaviors in a relationship will help ease the person with ASD into the new changes and transitions in their life.

Desired outcome:

Ideally, after proper education, Sam will be able to understand what behaviors are appropriate in a relationship so that he can have meaningful companionships. He will feel empowered with his knowledge and validated as an adult with sexual needs. He will be able to communicate with Paige his boundaries and how he prefers to be touched so that he is not triggered. He will know how to engage in safe and appropriate sex at appropriate times and locations. Most of all, knowledge about his body and of sexuality and sexual relationships will promote his independence and confidence in himself.


References Chan, J., & John, R. M. (2012). Sexuality and Sexual Health in Children and Adolescents With Autism. Journal For Nurse Practitioners, 8(4), 306-315. doi:10.1016/j.nurpra.2012.01.020

Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., Hanson, S. M. H. (2015). Family health care nursing: Theory, practice and research. Philadelphia, PA: FA Davis Co..

Mandleco, B., & Webb, A. M. (2015). Sibling perceptions of living with a young person with Down syndrome or autism spectrum disorder: An integrated review. Journal For Specialists In Pediatric Nursing, 20(3), 138-156. doi:10.1111/jspn.12117

O'Brien, S. (2016). Families of Adolescents with Autism: Facing the Future. Journal Of Pediatric Nursing, 31(2), 204-213. doi:10.1016/j.pedn.2015.10.019

Sommer, S., Johnson, J., Roberts, K., Redding, S., Churchill, L., Elkins, C., Roland, P. (2013). RN Nursing Care of Children. Assessment Technologies Institute, LLC.


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