A certain amount of ambiguity surrounds the term autism and often suggests a stereotypical image, but autism affects individuals uniquely. Over the years, professional theories about autism and other childhood disorders shifted to try to better capture what is now known as Autism Spectrum Disorders (ASD). Causes and treatments continue to be put forth to capture pieces of the mysterious puzzle. Though commonalities persist, each person with ASD experiences a unique level of impact on skills, intelligence, and capability and even the characteristics of siblings with ASD can vary widely. A few unique thinkers and accomplished artists that fall into this population are Albert Einstein, Thomas Edison, Emily Dickinson, Sir Isaac Newton, Beethoven, Mozart, de Vinci, Anthony Hopkins, and Jerry Seinfeld.

Early Warning Signs

Currently, one in forty-four children are diagnosed with ASD, with over 1 million reported to be in active-duty military families, according to 2021 CDC data (7) and Operation Autism (11). The American Autism Association offers some early signs and symptoms to be aware of for parents raising young children. (1):

Communication

• Delays in language development.
• Quirky repetitive language or sounds.
• Inability to initiate or maintain speech.
• Responds by repeating a question, rather than answering it.
• Difficulty communicating needs or desires.

Social Interactions

• Lack of appropriate verbal and nonverbal behavior.
• Lack of ability to develop peer friendships.
• Social and emotional exchange challenges, including maintaining eye contract.
• Minimal tolerance to being touched, held, or cuddled.
• Trouble perceiving or talking about feelings.
• Trouble sharing interests or successes with others (art, playthings).

Patterns of Behavior

• Restricted, repetitive and stereotyped behaviors.
• Difficulty in motor control
• Peculiar connection to objects.
• Distress with change in routine.
• Lining up toys.
• Head banging or rocking back and forth.

Looking Closer

Concerned parents are encouraged to speak to their child’s medical provider. Most communities offer free screenings to assess developmental progress and check for school readiness. The earlier an ASD screening occurs, the better, as this is the first step toward diagnoses which leads to important early interventions. Siblings of children with ASD screened, since ASD can present families. Military treatment facilities can assist through Educational and Developmental Intervention Services (EDIS). Once a screening determines risk factors and signs of ASD, a formal diagnostic evaluation is conducted to identify areas that may be addressed in treatment, such as challenges in social communication, behaviors, sensory issues, and the level of impact on daily functioning is assessed. (1)

Children on the autism disorder spectrum experience a unique combination of impacts on brain functions (i.e., thinking, memory) that may reflect some strong skills in one functioning area and low abilities in other areas. For example, a strong math aptitude may be coupled with a slow processing speed that appears as laziness to observers. Social issues may surface as peer conflict and loss of friends due to errors in interpreting social cues and sensory discomfort felt when looking others in the eye. A perceived lack of empathy may result from a child experiencing intense feelings of empathy, but not knowing how to identify or act on them, and then responding inappropriately. Inadequate verbal skills and meltdowns may occur when emotional or sensory stimulation floods the child, maxing their coping skills (as with loud noises or unexpected changes).

Easily knocked out of balance, these children struggle to identify and communicate their needs. Sensory sensitivity, such as the feel or fit of clothing fabric, food texture or taste, odors, certain sounds, temperature variations, and light levels can flood the brain at unbearable levels. Food refusals can make it difficult for them to receive adequate nutrition, complicating healthy development. Nearly half will run or wander off without warning and many struggle with physical tasks like writing or riding a bike. With 40% of ASD children lacking verbal skills, it can be stressful for both caregivers and child to understand each other despite access to communication assistance devices. (4)

Diving Deep

The five major types of disorders falling under the ASD umbrella are Asperger’s, Rett’s, Kanner’s syndrome, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder. It is very common to see other disorders accompanying ASD like Attention Deficit Hyperactivity Disorder (ADHD), Dyslexia, and Dysgraphia which can complicate the individual’s learning processes. Other concerns affecting this population in higher numbers are bullying, self-injurious behavior, anxiety, depression, schizophrenia, various health issues and physical disabilities.

Boys are four times more likely to be diagnosed with ASD than girls. (7) Professional theories have asserted that girls may be more likely to compensate by masking their symptoms resulting in a missed diagnosis or being misdiagnosed. (11). Girls may have subtle symptoms or higher functioning and do not always exhibit characteristics according to traditional ASD testing markers.

High functioning autism, (Asperger’s, ‘Aspie’), is seen in individuals with high levels of intelligence in some areas and deficits in others. The terms ‘camouflaging’ or ‘masking’ refer to sophisticated compensation skills where one notices, studies, and mimics the social skills of others, to compensate for natural tendencies. This can trigger remarks about them being too outgoing to have autism and undermine their self-awareness and identity. (5) ‘The invisible edge’ coined by Autism specialist Tony Attwood, describes these persons as flying under the radar resulting in either a late diagnosis or a missed diagnosis. (2) Delays in confirming the diagnosis hinder crucial access to early services and lead to the child facing expectations outside their abilities.

Compassionate Responding

Caring for a child with ASD can be quite physically and emotionally exhausting. Finding support can make a big difference. When a parent is stressed, it can be hard to be their best self for their special needs child and the rest of the family. Self-care for the caregiver is a necessary survival skill. Military installations offer respite care to help the caregivers and some states will offer pay for respite caregivers.

Emotional outbursts are common for children with ASD and challenging for parents to handle. It is helpful if the caregiver remains calm and models good coping skills from which the child can then draw to self-soothe. Using a distraction or special interest of the child (reading or playing with cars) can help calm the child. Raising voices and increasing tension can inadvertently prolong periods of challenging behaviors. Attuning regularly to the nuances of the child offers a parent greater ability to notice and appropriately respond to symptom escalation.

The American Autism Association identifies common interventions to include speech and language therapy; occupational therapy to address motor skills, sensory issues, and functional living; play therapy and floor time to aid in emotional and cognitive development; and social skills/ communication therapy to assist with socialization and emotional management. (1) Building a team of professionals around the child supports growth. It is vital to keep in mind that individuals with ASD can be quite gifted in areas of aptitude, enjoy life, and lead productive careers.

Military Families

Military lifestyle challenges are already difficult for the average family but for the family dealing with autism, essential care can be complicated. The process of confirming an ASD diagnosis can take up to 18 months to complete due to long wait times for testing. For the military family, duties, and permanent changes of station (PCS) moves can not only complicate this timeline but also delay the feedback process from providers and teachers who may have less opportunity to consistently observe and work with a child. Additionally, remote installations may not be able to offer access to all the necessary services, making participation in the Exceptional Family Member Program (EFMP), a significant benefit to the military child, less feasible. Operation Autism offers an in-depth resource Guide for Military Families and an interactive geographical map of resources. (11)

Many ASD symptoms can be intensified by stress and frequent changes that come with the military lifestyle as these children benefit most from a predictable routine and steady environment. Frequent relocations, changing homes, schools/ teachers, and making new friends, are especially difficult for children on the spectrum. With social skills already elusive, the ASD child may find these changes unbearable. Frequent social rejections and bullying can further frustrate attempts at making even a single real friend. Higher stress can lead to more health issues with these children who do not read their body cues well and even a loss of previously gained skills.

Magellan Federal Solutions

Magellan Federal provides counselors for many programs like the Military Family Life Counseling Program (MFLC) located on many installations within the US and overseas. The MFLC program is available to service members and their families for non-medical support. Although the medical nature of the ASD diagnosis causes the child to be out of scope for direct MFLC services, family members can be supported with counseling, resources, and referrals. The MFLC program offers a variety of including Healthy Steps Specialists working with parents of children 0-3 in pediatric clinics; Child and Youth Behavior Counselors working in the Child and Youth Program in CDCs/ school age services, and schools; and Adult MFLCs located in the family readiness centers. Other resources an MFLC might make referral to are Exceptional Family Member Program (EFMP), New Parent Support Program (NPSP), Tricare, and Military OneSource. Each of these assist parents with specific concerns related to their children.

EFMP is an installation-based program (offered by the Magellan Federal family in some locations) serving the military family with special needs members and is the best first stop for the family with a child newly diagnosed; offering support, resources, and information on assistance like respite care for parents. NPSP, also provided by Magellan Federal family at some locations, offers military families in home support to assist families with children under age five with visits by a nurse or social worker.

Regardless of when in the journey an ASD diagnosis is received, the military family does not have to travel the road alone. Magellan Federal is committed to providing support and guidance along the way.

This article was originally published on MFed Inform.

Resources and Bibliography

1. American Autism Association: myautism.org, https://www.myautism.org/information-kits https://www.myautism.org/informational-kits/general-therapies-for-individuals-with-autism
2. Attwood, Tony. Asperger’s Syndrome: A Guide for Parents and Professionals. Jessica Kinglsey Publishers 1998.
3. Autism Society: https://autismsociety.org/
4. Autism Speaks: autismspeaks.org
5. Abilities Workshop: https://special.abilitiesworkshop.com/autism-resources?gclid=EAIaIQobChMIiPj53OG9_QIVGXxvBB3CQg1tEAAYASAAEgJgTPD_BwE
6. Bargiela, S., Steward, R. and Mandy, W. (2016) ‘The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. Journal of Autism and Developmental Disorders 46, 3281-3294
7. Center for Disease Control https://www.cdc.gov/ncbddd/autism/index.html
8. Exceptional Family Member Program (EFMP), an installation-based program offered by the Magellan Federal family in some locations, serving the military family with special needs children, including autism and is the best first stop for the family with a child newly diagnosed with ASD; offering support, resources, and information on assistance opportunities like respite care for parents.
9. Military OneSource offers a special needs consultant at 888-342-9647, articles and information. militaryonesource.mil
10. National Professional Development Center on Autism Spectrum Disorder. (NPDC). https://autismpdc.fpg.unc.edu/national-professional-development-center-autism-spectrumdisorder. Develops free professional resources for teachers, therapists, and technical assistance Focused Intervention Resources and Modules (AFIRM), a series of free online modules.
11. Operation Autism website offers a resource Guide for Military Families including an interactive geographic guide to local resources at https://operationautism.org/autism-101/causes-and-prevalence-rates/. https://operationautism.org/resources/bases-map/.
12. Organization for Autism Research (OAR). https://researchautism.org/ Non-profit organization responsible for creating Operation Autism and guide and offers free resources either as a digital download or hard copy.
13. Tricare offers special needs liaisons and autism specific resources and information including providers and programs like Echo and Autism Care Demonstration.
14. Extended Health Care Option (ECHO) supplemental benefit for Active Military families with special needs. More information provided through Tricare.org
15. Autism Care Demonstration. https://www.tricare.mil/Plans/SpecialPrograms/ACD

It’s a commonly accepted perspective in the field of mental health that all behaviors have a goal. When it comes to understanding youth who are challenged with an autism spectrum disorder (ASD), the key is realizing that all behaviors represent efforts to communicate. Rigid expectations of social behaviors and decision-making based on age can interfere with supporting a person on the spectrum, especially when communication is expressed differently when compared to the general population. While the behaviors of someone on the spectrum may seem unusual or even at times disruptive, the best approach for understanding a person with autism, especially youth, is to determine the goal, how the goal is communicated through their behaviors, and the intersectionality of those behaviors with peer interaction, transitioning to adolescence and adulthood, and adapting to new environments due to a military permanent change of station (PCS) or sudden absence of a parent. Intentionally diversifying sources of support can improve outcomes for youth especially as they transition into adulthood.

Understanding Autism[1]^,[2]

Autism Spectrum Disorder (ASD) is defined as a neurological disorder that, because of its effects on brain functioning, can negatively impact daily interactions such as socializing, displaying affection, and communicating. This impact has far-reaching implications, spanning multiple domains and presenting in an unpredictable manner. The severity of the disorder is compounded by co-occurring conditions and adverse reactions to sensory stimuli, such as lighting and noise.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides further clarifying terms, using two identifying categories of symptoms to provide a basis for diagnosis of autism:

• Persistent deficits exist in social communication and social interaction across multiple contexts and restricted, repetitive patterns of behaviors, interests, or activities.
• Some of the characteristics include repetitive movements and speech, inflexibility, fixated interests, and hyper-/hypo-reactivity to sensory input.

Similarities With Other Youth[3]^,[4]

Youth with autism are prone to experience the same desires for friendships and intimacy as their peers. They share the same right to have educators and family educate them on this topic. These youth will also experience peer pressure and bullying, as all youth do. Kids with ASD crave same-aged allies just like others their age. They are vulnerable to missing non-verbal cues that mask sarcasm, teasing and even malicious intent. Peers who are not on the spectrum but have demonstrated healthy social skills are ideal for helping youth with autism to communicate and understand communication.

Differences From Other Youth[5]

Understanding autism in youth is more than a simple exercise in definitions and categorizing symptoms—a concerted and diligent effort for research is needed across disciplinary domains. The CDC’s Study to Explore Early Development (SEED) has provided the most comprehensive study of ASD in the United States, examining the health, functioning, risk factors, and signs present in preschool-aged children. Such a study empowers others to support the ability of a person with autism to effectively communicate. Amid a scarcity of research exploring ASD among pre-/teens, the SEED’s usefulness has been further expanded to survey the families of 800 children between the ages of 12-16 who were a part of the initial phase of SEED. Although similarities between neurodivergent youth and neurotypical youth can easily be identified, this study shines a necessary light on the differences between adolescent cohorts.

The findings in this report reveal that adolescents with autism experience a need for greater support in the areas of physical and mental health, as well as extending the use of healthcare beyond the stage of adolescence, in contrast to peers their age.

In comparison to adolescents in the control group of this study, children with autism were 90% more likely to have co-occurring mental or physical health conditions and at the same time more than three times likely to not access appropriate health care for those needs.

Being included in general education classrooms is a boon to social competence in youth with ASD, but not a fix. Social deficits create a need for interventions that coach social skills for them, such as initiating or inviting others to play and engage, while these skills naturally occur in typically developing youth.

A peer helper can assist with bridging the gap between these differences, offering the chance for youth from both cohorts to experience and engage in friendly behavior in a variety of environments, such as classrooms, recreational areas, or after-school events.

It may be difficult for a child from either cohort to articulate the differences, but the relational tension will be present, nonetheless. Interventions should assist both children, equipping them with clearly defined choices that improve the likelihood of forming a healthy social connection between them.

Challenges for Military Families

Military sources indicate that more than 13,000 military dependents, the majority being children, have some form of autism. No matter where they go, their families will always be the immediate support system, a system vulnerable to emotions and challenges related to the difficulties of military life: a permanent change of station, frequently absent or deployed parents, changing primary care managers and parental/marital stress.

A diagnosis of ASD means that every day a caregiver must plan every activity to prevent behaviors that will likely be misunderstood by those untouched by ASD. Even when connecting the youth with an organization that can provide care and interaction outside of the home, the caregiver will need to provide specifics about their child’s needs and determine if the environment they are entering is an adequate fit. The environment should include staff trained to intervene and redirect especially by understanding what behavior that seems disruptive is trying to convey on behalf of the child. Most parents and caregivers find themselves repeatedly having to explain to other professionals why their child reacted the way they did.

Another frustrating factor that families looking for support outside of the home encounter is simply a lack of affordable and competent sites. The emotional toll on a parent or caregiver from frequently reaching a dead end can exhaust even the most resilient. The chances of finding a great fit for a youth with ASD is generally cut in half by the lack of behavior management services, the expense of the programs, and the sad reality of untrained staff.

Military families also encounter increased hardship introduced by the search for evidence-based treatment services, especially when a new duty station proves to be a disruption to receiving quality care. Not all stations have ease of access to needed services.[6] Military children and their families move every few years. These frequent changes hinder the ability to maintain secure relationships in the school setting and with each move, the rigors of advocacy for individualized services are reborn. Any family who has dealt with a military move can vouch that the process is replete with paperwork. A family who has a child with autism has their work nearly doubled. Important documents and steps to take include, but are not limited to, the most recent copy of an IEP, a current behavior plan, medical documentation, connecting with the receiving school play son, a new therapist, and finding a neighborhood accessible to community-based services.

Financial strain is another stressor faced by military families. Spousal unemployment can easily become a dynamic for a family with a child on the spectrum. It is often simpler and more cost effective to care for the child at home, especially when hours for paid time off become depleted due to frequent calls from the school for a parent to come deescalate the child.

Frequent moves, financial strain, and harried reintegration processes can mount into a tremendous pile of stress leading to feelings of isolation and marital discord in many cases. Finding and building a support system, albeit challenging, is not impossible and is worth its weight in gold. Despite all the barriers and challenges of a military lifestyle, friendships and systems that are built often turn out to be lifelong relationships. Military living means that a challenge posed for one is a challenge accepted by all.

How the MFLC Program Can Help with Communication

The Military and Family Life Counseling program supports service members, their families and survivors with confidential non-medical counseling where they are stationed. Recognizing behavior as a form of communication is a skill possessed by Military and Family Life Counselors (MFLC) counselors. MFLCs are in an excellent position to support families and schools by providing referrals and psychoeducation about the need for behavior to be interpreted rather than reacted to.

Anxiety for anyone is an emotion that disables executive functioning. MFLCs can equip staff and family with language that prevents and even deescalates anxiety in youth with autism. A person with ASD may look away for a moment or two before responding to directions. Rightly interpreting this behavior can prevent the wrong reaction and a misunderstanding. A pause in responding doesn’t necessarily mean unawareness or lack of intellect—for the person with ASD, looking away may mean, I need a quick break from stimuli.

MFLCs can also help by increasing awareness of incorrect assumptions, such as the aforementioned “pause” as a lack of emotionality, and biases built into labels such as low or high functioning. MFLCs can coach staff and family to ask, “what support do you need,” rather than assuming wrongly about the support needed at any point on the spectrum.

Effective communication is essential in at least two settings: school-based and healthcare. Data show a strong correlation between time spent in general education classrooms and increased academic skills and knowledge, receipt of a high school diploma, and/or increased access to typical peers, which promotes a primary desire for youth in general: healthy social relationships. The ultimate benefit is enhanced integration in the community. Youth participation in work opportunities, paid and unpaid, during high school is also connected to better outcomes in adulthood. To get started with the MFLC program contact your installation’s Military and Family Support center.

Tips for Preventative Healthcare

The single greatest external factor in fostering support for a teen preparing to enter adulthood is preventative healthcare. While under the care of their family, youth with autism benefit from services such as the Exceptional Family Member Program (EFMP), Extension for Community Healthcare Outcomes (a virtual interdisciplinary network for providers which includes parental feedback), Tricare, and Individualized Education Plans (IEP)/504 plans. However, as discussed, youth with autism are less likely to continue healthcare into adulthood. The goal for preventative healthcare is to equip the person receiving the healthcare with an awareness of what their health can and should look like and the right to receive that care.

An ideal strategy for improving health outcomes and reducing service gaps for youth with autism involves interdisciplinary training promoting the use of evidence-based interventions. Operation Autism lists several, including the most widely used, Applied Behavioral Analysis (ABA), Picture Exchange Communication Systems (PECS), and Speech and Language Therapy (SLT) across multiple contexts. At a minimum, as recommended by the CDC, care should be timely, coordinated, and family centered. Practitioners and school administrators should encourage parents and caregivers to enroll youth early in services, such as insurance plans and residential living, that support the transition to adulthood.

According to measures included in the Health Resources and Services Administration Maternal and Child Health Bureau National Performance as reported by the CDC SEED 2 study, practitioners should ensure three elements are met when establishing a wholesome health care transition:

• The youth should spend time alone with the primary care provider,
• The PCP should actively work with the child to understand healthy living, and
• The parent should know how the child will be insured when they reach adulthood.

Conclusion

The research-to-practice gap is steadily closing with studies such as SEED and the increase of evidence-based practices (along with the collective disapproval of ineffective and harmful treatment practices). Understanding the needs of youth with autism has been difficult but is no longer the apprehensive feat it once was, and while military families with ASD may have additional stressors, there is a system of support available to help navigate these challenges. Ultimately, communication is a gift for all human beings to use in the quest to understand one another, and establishing healthy communication with youth with autism is not simply a matter of teaching them what to say but it largely entails the ability to interpret what they are already saying.

This article was originally published on MFed Inform.

[1] Low Functioning to High Functioning Autism: A Prescriptive Model for Counselors Working With Children Across the Spectrum. Katherine Feather, 2016. https://www.counseling.org/docs/default-source/vistas/article_11d2bf24f16116603abcacff0000bee5e7.pdf?sfvrsn=4ca9442c_4

[2] Operation Autism. (n.d.). Life Journey through Autism: A Guide for Military Families

[3] Autism Speaks. 2013. Leading The Way: Autism Friendly Youth Organizations. https://www.autismspeaks.org/tool-kit/leading-way-autism-friendly-youth-organizations

[4] https://www.plannedparenthood.org/planned-parenthood-massachusetts/local-training-education/parent-buzz-newsletter/parent-buzz-e-newsletters/sexuality-education-youth-autism-spectrum

[5] Health Status and Health Care Use Among Adolescents Identified With and Without Autism in Early Childhood — Four U.S. Sites, 2018–2020. Powell PS, Pazol K, Wiggins LD, et al. https://www.cdc.gov/ncbddd/autism/autism-spectrum-disorder-in-teenagers-adults.html

[6] Toward Innovative, Cost-effective, and Systemic Solutions to Improve Outcomes and Well-being of Military Families Affected by Autism Spectrum Disorder. 2015. Klin et al. https://pubmed.ncbi.nlm.nih.gov/25745376/

“Oh my! It’s raining cats and dogs out there!” A second-grade girl remarked as she stared out of a classroom window. Another child, wide-eyed and twirling her braid, turned and stared in shock and disbelief at the raindrop scattered windowpane. “What do you mean, those poor puppies!?” she cried. “Nooooo….” scoffed another classmate, “There are NO ANIMALS. She means it’s raining REALLY HARD.” The concerned child saddened about the well-being of the possible tumbling animals outside, slumped down in her chair, trying to avoid the gaze of everyone. Her eyes welled with tears, and she remained silent throughout the rest of the class. She continued to twirl her hair with more vigor. Soon the sun began to shine via the droplets on the windowpane, and she stopped twirling her hair to stare at the beautiful array of light. “This is a prism, a spectrum of light.” She whispered to herself.

Children with Autism Spectrum Disorders have their own unique struggle. Like the spectrum of light, Autism diagnosis defines a broad range of conditions that demonstrate marked struggles with language (expressive/receptive), repetitive/restrictive behaviors, social skills, and nonverbal communication. This vignette of an interaction between three 8-year-old children provides an example of a receptive language issue. For this little girl, she struggled to understand an idiom likening the raindrops to “cats and dogs falling from the sky.” Dr. Stephen Shore stated, “If you met one person with Autism, you have met one person with Autism.” He is an author, a professor of Education, and a member of the board of Autism Speaks, an organization created to educate and advocate for those affected by Autism throughout their lifespan. His quote incites awareness that while a child may be diagnosed with autism, their presentation and needs will be unique. (APA, 2013)

Autism Speaks shares statistics and trends that have shown a steady increase in the diagnosis of autism spectrum disorders (ASD). Diagnosis has become more comprehensive in recent years. Awareness and early detection have been associated with an increase in the frequency of diagnosis. The Centers for Disease Control (CDC) reported in 2021 that 1 in 44 children was diagnosed with an autism spectrum disorder in the United States. Autism affects children across all socioeconomic statuses and minority groups. Minority groups are diagnosed at a later age and at a lesser frequency than other demographic groups. Families face multiple challenges after diagnosis. These include parents having difficulty maintaining ‘out of the home’ employment while becoming full-time advocates for their children. The additional cost of providing treatment and care per child with ASD is approximately $60,000 per year (Autism Speaks, 2017).

Risk Factors of Military Children with Autism

While 1 in 44 children in the general population is reported to be diagnosed with Autism, the statistics are not entirely clear for military children. In 2020, TRICARE reported that across all branches of service, 34,361 military children were diagnosed with an autism spectrum disorder, with about 60% being children of active-duty Service members. It is suspected that these numbers are underreported (Klin et al., 2015). Military children with Autism and their families face unique stressors and struggles compared to their civilian counterparts. Military families must secure a treatment provider and participate in testing, diagnosis, treatment, and educational support while remaining mission-focused.  Stress is escalated with uncertainties about deployment, war, and geographic separation from their support systems in permanent changes of duty station (PCS) (OAR, 2019).

Case Study/Expertise

Although there have been many systemic improvements in services for military children, there are still barriers that exist due to the high mobility nature of military life. Most military families move every 2-4 years, requiring parents to establish new care providers for their children once they arrive at their new location. For children who require specialized care, it is even more daunting. After months of treatment in their current duty station, they are required to “go back to the end of the line” once they locate a new service provider. High frustration levels were also reported due to a lack of satisfaction with the quality of the care their child receives at their new provider. Families not only geographically isolated from their previous providers, but military parents with children with autism reported higher stress levels and social isolation across qualitative research after relocation and during separation (Klin, et al, 2015).

Deployment cycles lead to increased behavioral and emotional issues for military children. Parents have reported that once their child’s problematic behaviors have stabilized after their parent has deployed, their behaviors may increase once again once the parent returns from deployment. Children exhibit increased emotional withdrawal and repetitive behaviors when their Service member parent is deployed. It has been reported that the parent left behind to manage the care of the entire household can experience feelings of guilt and worry about providing adequate parenting alone (Davis and Finke, 2015).

Permanent Change in Duty Station (PCS) also takes a unique toll on the military child with autism. Friendship and social interaction are protective factors and good for overall mental health. Military children move frequently and must make new friends in their new hometown and school. Autistic children innately struggle with making social connections, making it harder to establish new positive social connections with peers. Autistic children were reported to be lonelier and more withdrawn after relocating to their new location (Davis and Finke, 2015).

Magellan Federal Best Practices

As mission partners, Magellan Federal Military & Family Life Counselors (MFLCs) can become the help multiplier for these special families. MFLCs may serve as referral linkages, connecting families to the life-changing services locally or at their next duty station before moving. MFLCs may create an Autism Resource Connect (ARC)—a smooth connection to autism resources for military families from one base to the next. This proposed program component can partner with base resources to maintain an updated roster of local providers to ensure that before, during, and after the process of permanent changes of duty station (PCS), families can ensure a comprehensive and smooth transition to local support. Utilizing the current Military Family Life Counseling network of counselors, resource lists can be maintained locally and can be shared with their counterparts at other installations.

Although MFLCs do not provide direct support for the child diagnosed with autism, their families may benefit from the non-medical counseling support. MFLCs can provide support through individual, marriage, and family counseling. MFLCs can also connect with local Exceptional Family Members Programs (EFMPs) to provide MFLC briefings/presentations to families currently within the program advising of support that can be provided to the family unit. Although the child with exceptional needs is out of the MFLC program scope, the parents and siblings are not.

Another gap that appears to exist in care for these military families is the support of the siblings of children with autism. School MFLCs have particularly great advantages in identifying and serving these unique children. Siblings of children with autism, particularly older siblings, tend to externalize stress and frustration through negative behaviors. MFLCs situated in middle schools and high schools may be instrumental in providing support for these children. These siblings empirically have shown higher tendencies to experience loneliness, academic struggle, and aggression (Walton & Ingersoll, 2015).  MFLCs can create spaces of peer support in the groups.

In April, we celebrate the Month of the Military Child. We wear purple in support and solidarity-creating awareness of the unique challenges of the military child. Military children and families affected by autism experience these challenges compounded by navigating life’s daily routine challenges. While awareness is wonderful, awareness is the first step. Magellan Federal supports children diagnosed with an autism spectrum disorder and their families by bridging gaps in support and care. Specifically, MFLCs provide briefings and psychoeducation regarding available services to supportive base programs. Autism is a life-long disability. With support, every individual can reach their potential. The outcomes for children are exponentially better with early diagnosis and intervention. MFLCs can make a difference. One Team. One Mission.

Resources

OAR. A Guide for Military Families(2019) https://operationautism.org/wp-content/uploads/2019/12/A_Guide_for_Military_Families.pdf

Autism Speaks www.autismspeaks.org

Exceptional Family Member Program https://www.militaryonesource.mil/special-needs/efmp/

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

Autism Speaks(2019). Autism and Health Report https://www.autismspeaks.org/sites/default/files/2018-09/autism-and-health-report.pdfb

Davis, J., & Finke, E. (2015). The Experience of Military Families with Children with Autism Spectrum Disorders During Relocation and Separation. Journal of Autism and Developmental Disorders, 45(7), 2019-2034.

Klin A, Wetherby AM, Woods J, Saulnier C, Stapel-Wax J, Klaiman C, Jones W, Rubin E, Scahill L, Call N, Bearss K, Gunter C, Courtemanche CJ, Lemieux A, Cox JC, Mandell DS, Van Decar JP, Miller RA, Shireman CL. Toward innovative, cost-effective, and systemic solutions to improve outcomes and well-being of military families affected by autism spectrum disorder. Yale J Biol Med. 2015 Mar 4;88(1):73-9. PMID: 25745376; PMCID: PMC4345541.

OAR. A Guide for Military Families(2019) https://operationautism.org/wp-content/uploads/2019/12/A_Guide_for_Military_Families.pdf

Walton, K.M &Ingersoll, B.R. (2015) Psychosocial Adjustment and Sibling Relationships in Siblings of Children with Autism Spectrum Disorder: Risk and Protector Factors.

Those that raise their right hand to serve our country in the military, make a minimum of two huge transitions during their lifetime; the transition in by taking an oath to support and defend the Constitution of the United States against all enemies, foreign and domestic; and the transition out. Personally, I remember my transition into service being filled with a spectrum of emotions and above all, the feeling of being proud—proud to be able to make the commitment to my country; proud to say I was a member of the most elite military in the world; proud to become part of something bigger. Though each experience is unique, I believe feelings of pride are common with those that make the commitment to serve their country. Military members are immediately immersed in an unfamiliar world with new rules, language, friends, and many new opportunities. It is a time filled with excitement, change, growth, and fear of the unknown. Many military members look back on this time with fond memories—many with a yearning to go back, like the common wish to reunite with childhood. In contrast, the transition out of the military, also a huge transition point in one’s life, is not the same. I’d like to offer my unique personal experience of what I found most challenging and provide some excellent resources that are available to all veterans and family members through the Transition Assistance Program and Military and Family Life Counseling Program.

The Challenges of Transitioning Out of Service

For me, the “transition out time” was a period filled with excitement and opportunity for growth, but it was not at all easy to navigate. Although I had always had a plan in my head for what I would do once I was discharged, the guidance and resources were not as formulaic as the transition into military life. I was excited to become a civilian free to take any job I wanted, but it was overwhelming not to have concrete steps for how to get there.

It is widely known that the military has a way of building its members up to feel as though they can accomplish anything and believe that they have a step up when it comes to the civilian population. While this may be true, it can be harmful to solely rely on this expectation. It is better to be aware of the potential challenges in advance so you can arm yourself with available resources and tools to navigate a successful transition.

In my experience, these are the top three challenges when transitioning back into civilian life:

1. Unrealistic expectations

• It will be easy to get any job I want.
• I will get paid more as a civilian doing the same thing.
• Working 40 hours a week will be east compared to being on call 24 hours a day.
• My experience will be respected; everyone loves military members.

I will get paid enough retirement that I won’t need to work.

2. Loss of identity

• No longer a leader or looked up to by others daily
• Loss of purpose
• No one really understands what you did in the military
• Bored with the new job
• Loss of connection to your familiar support system
• Work no longer makes a difference on a large scale
• Communication style in the civilian world is not the same

3. Limited immediate support 

• Just a number to the VA
• No longer have a chain of command to help
• Waiting list to get support
• Navigating resources alone

Combat Veteran’s Careers states, “The military provides a sense of purpose, well-defined roles and hierarchy, camaraderie, honor and mission—things that can be hard to find or define in the civilian world.” In my experience, this could not be more true. Although I planned and prepped for my exit, I still fell victim to some of these common beliefs and challenges. So, if you have a plan—or even if you don’t—I encourage you to take advantage of the programs and resources available to you while you are still in service to get a jump start on your transition to a successful civilian career. Here are a few I found helpful, and that Magellan Federal assists in delivering.

Available Career Resources

Transition Assistance Program (TAP)
The Department of Defense TAP provides lots of information, tools, and training to share tips on everything from resume prep to financial planning. For example, I remember them bringing in models to our installation from a local suit store to help us prepare for business dress. TAP is available to all transitioning service members and has a wealth of eLearning guides, trainings, and workshops. Connect with your local Transition Assistance Office or view more information on the DoD TAP website.

Military and Family Life Counseling Program (MFLC)
Military and Family Life Counselors (MFLCs) are on the ground at installations around the world providing confidential non-medical counseling to service members and their families to address issues such as improving relationships, stress, parenting, and grief. MFLCs are also armed with a plethora of training resources specific to making the transition from the military to civilian life. I highly suggest connecting with an MFLC at least a year out from your final separation date, even if it is just to help you organize your thoughts and help you more clearly define the path to your future. Contact your installation’s Military and Family Support Center to get started.

Education and Employment Initiative (E2I)
E2I is a Department of Defense program that assists wounded, ill, and injured Service members with education and career opportunities as part of their recovery and transition to civilian life. E2I’s Regional Coordinators work with Service members to identify skills and match those skills to a desired career path. Contact your Regional Coordinator to request an application, or visit the E2I website.

Tips for Successful Transition
While these programs and other resources will help you build a good foundation, it is ultimately up to you to put a detailed plan in place and complete the necessary steps to prepare for your civilian career.

1. Learn about careers—complete a self-assessment, compare occupations, and research industries
2. Find training—research basic adult education, apprenticeships, certifications, and scholarships
3. Network—connect with professionals in your career of choice to help with advice, job leads, and contacts; inform them of your skills and employment goals

It’s never too early to get a head start on preparing for a career that’s best for you and your family after service. I hope these tips will get you started planning today with confidence.

References
• CombatVeteranstoCareers.org, “5 Reasons Veterans Struggle to Transition to the Civilian Workforce,” view article
• Military OneSource

Have you ever been so happy or upset that it was difficult to function and go about your daily tasks and responsibilities? Or maybe something was bothering you and you didn’t feel quite right, but you couldn’t pinpoint exactly why. Sometimes it’s easy to identify our emotions, especially when they are very strong or overwhelming, like in the case of grief or joy. Other times, it can be more difficult, such as when experiencing shame or even love.

Identifying our emotions is a first step in managing them, and both are important skills in getting through life’s ups and downs and feeling more in control about how we approach and react to people and situations. Of course, we must feel our feelings. We should acknowledge and celebrate happy times, listen to our instincts if we are afraid, and otherwise give ourselves the time we need to fully experience our emotions. In this post, we’ll focus on and provide support for when we are struggling with nagging or intense emotions.

Recognizing your emotions

You might be wondering why recognizing your emotions and feelings is important. Maybe you think it’s obvious what you are feeling at any given moment. In some cases, it is. Even then, it is important to name the emotion or feeling. This allows you to get what you need from it and effectively manage it so it doesn’t become disruptive in your life. It can be difficult to deal with an emotion and move on if you haven’t identified what it is.

For example—You’re sitting at your desk at work and not feeling like yourself. You’re anxious about the work you must complete. You could sit there and continue trying to push through with the nagging feeling. Or you could take a moment to identify and name the emotion so you can take the appropriate steps to move on from feeling less than your normal self. This could be as easy as saying to yourself, “I am overwhelmed.” Now that you’ve identified the emotion and given a name to it, you can use your knowledge about how to deal with feeling overwhelmed and seek additional help if necessary.

A great resource for helping to identify your emotions is an emotion wheel. Magellan provides a tool you can use here. Print it or keep it open in your web browser so it’s handy when you need to name an emotion that may be distracting you or getting you down.

Accepting your emotions

You’ve recognized and named the emotion you’re feeling. Now what? What do you do to get to a better place of focus and contentment? You can start with accepting what you’re feeling is legitimate and worthy of your attention. And while you may not be happy about the situation that is causing your emotional response, we know that situations will arise that are out of our control. For instance, we may experience negative emotions due to a breakup with a partner, seeing a child make a poor decision, or watching a friend go on the vacation we so badly want. No matter the situation, fighting our emotions only serves to give them more fuel to thrive, which may not be exactly welcomed.

A tool to help you accept your reality and let go of resentments is called radical acceptance. Find more on this technique along with a short video and helpful exercise worksheets linked on our website for Mental Health Month.

Managing your emotions

When we know what we’re feeling, have accepted it, and are giving ourselves grace to deal with it, we’re in a better place to act and feel better. One technique that can help you do this is looking at your thoughts from a different perspective. For example, if you’re feeling lonely, think about the supports that are available to you—some may be just a phone call away. When you flip that lonely feeling and remember there are people who are there for you, your thoughts become more rooted in reality. You can then take action to feel less lonely by calling upon family or friends or searching online for ways to meet new people.

Throughout the often-challenging process of dealing with emotions, it’s important to be kind to yourself and practice self-care. Take time to do the things you enjoy. While you’re doing them, you can revel in the positive emotions you feel in the moment.

Support is also available in the form of mood tracking apps, which can help us understand the stressors and triggers that cause negative emotions. Find a clinically-reviewed list of these apps linked on our website for Mental Health Month.

Finally, when emotions are overwhelming and causing distress in your life, like causing changes in your personality, eating or sleeping habits, it’s important to seek the support of a therapist or other mental health or medical professional. You don’t need to suffer. There is help available that can make a difference.

Additional emotional support resources

For more on recognizing, accepting and managing emotions, visit our website for May Mental Health Month, MagellanHealthcare.com/Mental-Health-Month, and be sure to check out the Mental Health Awareness Campaign Toolkit.

According to the National Institutes of Health’s (NIH) National Institute on Alcohol Abuse and Alcoholism, alcohol contributes to more than 200 health conditions and about 99,000 deaths in the U.S. each year.[1] According to the CDC, one in six adults in the U.S. binge drinks with 25% doing so at least weekly.[2]

April is National Alcohol Awareness Month, which is a time to increase your personal awareness about alcohol abuse and alcoholism and to recognize these disorders, which can be treated.

Magellan Federal’s Senior Manager in the Adolescent Support & Counseling Services (ASACS), Allison Welliver, LMHC, MCAP, shares her insights on why this month is important. Welliver is a licensed mental health counselor and a master’s level certified addiction professional.

Q: Why is National Alcohol Awareness Month important?

Allison Welliver: National Alcohol Awareness Month is important because it brings awareness to alcohol abuse and dependency and allows people to be screened to see where their use of alcohol falls (low, moderate, or high risk for alcohol abuse or dependence). It also allows people to see how their use of alcohol compares to alcohol use by other people of the same age and sex.

Since alcohol is a legal drug, and so often used in social situations and celebrations, it can be difficult to see when alcohol abuse is happening.

Q: What are signs that someone is addicted to alcohol?

AW: Signs of dependence on alcohol can be behavioral/social or physical. Behavioral/social signs include secretive use, heavy drinking, drinking alone, drinking at inappropriate times of the day (in the morning), and continuing to drink despite the negative impact it has on your relationships, job, and health. Physical signs may include developing a tolerance, developing the “shakes” when not drinking alcohol, disrupted sleep, lethargy, or headaches, and needing a drink to alleviate negative symptoms.

Q: What is the connection between this addiction and mental health?

AW: Addiction and mental health problems are frequently comorbid, meaning that they often occur at the same time. It is a question of which comes first – does the mental health problem cause the addiction or vice versa? Many times, people turn to alcohol or other drugs to cope with mental health concerns that they are having. They could use alcohol to cover up depression or other pain underneath.

Q: What are some steps someone should take if they recognize they need help and what does Magellan offer to support someone who is dealing with alcohol addiction?

AW: First, reach out to a therapist. A therapist can evaluate your use and determine what setting is best to treat your alcohol use. Surround yourself with a positive, supportive network who understands that you need help. You may identify support through connecting with your company’s Employee Assistance Program (EAP), if one is available to you. When contracted with an employer, Magellan offers EAP services to employees and their household members who may question if their use is abnormal, or if they have been having problems related to drinking. EAP services, including counseling, are free and confidential.

Q: Is there anything you would like to add or any resources you want to provide?

AW: There is a free online screening tool that anyone can use to gauge their level of alcohol use. https://alcoholscreening.org/

Additional Resources

• NIH Rethinking Drinking
• Work Stress and Drinking: A Vicious Cycle?
• How to say no to drugs and alcohol
• Maintain Your Recovery During the Pandemic

[1] Helping Your Patients with Alcohol-Related Problems: https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol?utm_source=twitter&utm_medium=social&utm_campaign=jul-2022

[2] Centers for Disease Control and Prevention: https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm

On March 30, we are celebrating National Doctor’s Day where we honor all physicians for their dedication and contributions to the health of their patients. With the healthcare industry becoming more complex than ever with so many advancements, tools, and information, doctors continue to manage the overwhelming responsibility to be able to accurately diagnosis and treat their patients and continue to pave the way to better healthcare options. We’re spotlighting three of Magellan Health’s doctors who each explain why they chose to become physicians, and what are some of the most rewarding and challenging aspects of working in this field:

• Doris Lebischak, M.D., medical director with the California plan, has been with Magellan since September 2020.
• Lyle Forehand, M.D., medical director, has been with Magellan since July 2022.
• Anjali Yeolekar-Dasari, M.D., medical director BH Presbyterian/ Magellan Health (NM), has been with Magellan since June 2021.

Continue reading to learn more from Drs. Lebischak, Forehand, and Yoelekar-Dasari on their experience as physicians:

Why did you become a physician and what is the most rewarding aspect of working in this field?

Dr. Lebischak: There is nothing more important than our health. When you have your health, you have everything. Anything that I do that contributes to collective or individual health makes me happy.

Dr. Forehand: This is what I was born to do. I really think I’m blessed to be doing this, especially after so many attempts when I was younger to do something else. Being a physician is great because I get to listen and improve at that skill as I’ve always talked more than listened. Especially as a psychiatrist, I must be good at hearing what people are saying and what they aren’t saying. The best part for me is when I have helped someone, not because of something I know as a doctor, but because of who I am as a person. Meaning, all the things I’ve done, or thought, or said all added up to who I am in that moment which helped change someone’s life for the better. I think those of us working in the behavioral health fields get that experience more than most – and it’s awesome!

Dr. Yoelekar-Dasari: I was brought up by a family of doctors in India. I would spend my summers helping my grandfather, a general practitioner, who practiced medicine in rural India. It was watching him interact with his patients and in turn the patient’s gratitude towards his work that made a deep impact on me. I started focusing on science and found the discipline intellectually challenging. I wouldn’t be who I am today if it were not to be for my mother’s constant encouragement to achieve my goal of being a physician and a psychiatrist. The field of medicine and psychiatry has allowed me to meet new people and has given me the opportunity to help make people feel better.

What are some challenges you face being a physician and how do you overcome them?

Dr. Lebischak: Becoming a physician was an impossibility when I first considered it. I started as a candy striper and believed that women could only become nurses or teachers. Following others that have braved the path before me (especially my sister) has helped me overcome the challenges. Today the challenge is implementing what we know. We have never had better healthcare, yet our life expectancy is decreasing. Lifestyle medicine can prevent 80% of all chronic medical conditions, including mental health conditions. Our collaborative care model gives us a way to support our members to make those connections and make good decisions to support their health.

Dr. Forehand: Everyone has an opinion about health. The Internet has now bred two generations of people who think they know about medicine as much as their doctors. People aren’t simple, and our problems aren’t easy.

Dr. Yoelekar-Dasari: I have spent my entire career practicing psychiatry in northern New Mexico which is very rural. There are shortages of doctors, psychiatrists, primary care doctors, and specialty physicians. This sometimes puts psychiatrists in positions of being everything to everyone and frequently having to cope with being the sole resource for the community. It is the gratitude from my patients that has kept me going.

Is there anything you’d like to highlight about working in this field? 

Dr. Lebischak: You have no health without mental health.

Dr. Forehand: It’s great to be in any helping profession. I see everyone in similar helping professions from first responders, teachers, to other health professionals as my colleagues. I’m proud to have them as colleagues.

Dr. Yoelekar-Dasari: Since joining Magellan, I have focused on improving services to the population diagnosed with Autism Spectrum Disorder (ASD). In the underserved and rural areas of New Mexico, members with diagnosis of ASD face challenges accessing services leading to poor outcomes. I have worked with my team on providing education on the importance of early intervention and working on improving services to this population.

What does National Doctor’s Day mean to you?

Dr. Lebischak: What a privilege it is to be a psychiatrist. It’s a time to reflect on all those who support us and the goal of mental health.

Dr. Forehand: I understand the first Doctors’ Day was established by the wife of a physician. I can relate to this as this is what means the most to me: that my wife, who has spent decades seeing what I gave up helping my patients and having to sacrifice with me, would honor the choice I made when I became a physician.

Dr. Yoelekar-Dasari: It is a day celebrated to recognize contributions of physicians to communities. In the past I have marked the day by making donations to underserved communities.

Discussions about mental health in the Black community shouldn’t be limited to Black History Month in February and BIPOC Mental Health Awareness Month in July. The conversations and action steps geared toward providing education, support, and resources require a year-round effort.

A recent article published by the Kaiser Family Foundation, shares that although Black people have made great contributions and achievements in the United States, “they continue to face many health disparities that adversely impact their overall health and well-being,” which have been “exacerbated by impacts of the COVID-pandemic, ongoing racism and discrimination, and police violence against and killings of Black people.”

What impact do these factors have on the mental health of individuals in the BIPOC community? Magellan’s medical director Rakel Beall-Wilkins, M.D., MPH shares her perspectives on depression and suggestions on ways to be supportive.

What is depression and what are some signs or symptoms?

Dr. Beall-Wilkins: Depression is a clinical illness characterized by:

• Prolonged periods of low or sad mood.
• Loss of interest or pleasure in activities.
• Changes in appetite, sleep or energy levels.
• Feelings of worthlessness or hopelessness.
• Thoughts of death or suicide.

Depression can be caused by medical illness, substance abuse, and stressful social, academic, or occupational situations, but it can also develop more readily in individuals who have a family history of depression or other mental health conditions.

Other signs of depression may include:

• Withdrawing from social activities, relationships, or hobbies.
• Escalating drug or alcohol use.
• Declining self-care in the form of poor personal hygiene and grooming.
• Expressing feelings of hopelessness, worthlessness, and/or helplessness.
• Neglecting to attend to chronic medical conditions or maintain follow-up with healthcare providers.

How does depression impact individuals in the Black community?

Dr. Beall-Wilkins: As of 2020, the National Survey on Drug Use and Health found that 6% of Black American adults and 12.9% of Black American adolescents experienced a major depressive episode within the last year. Despite increasing levels of depression within the Black community, studies also show that Black Americans are less likely than their White counterparts to receive psychotherapy or medications for their depressive symptoms. This disparity is largely attributed to limited access to healthcare coverage and culturally competent behavioral health providers, as well as pervasive cultural stigma.

Is it possible for someone to experience depression that is triggered by external factors and societal issues, such as violence, police brutality, political unrest, and racism? If so, how?

Dr. Beall-Wilkins: Yes, it is possible for depression to develop as a result of exposure to sociopolitical strife. In fact, during the week following the highly publicized death of George Floyd in May 2020, rates of depression and anxiety spiked from 36 to 41% among Black American respondents to the Census Bureau’s 2020 Household Pulse Survey.

Likewise, a 2018 study published in The Lancet found that police killings of unarmed Black Americans resulted in an increase in poor mental health days among Black American respondents. Though they may not know the victims of these circumstances personally, it is very common for Black Americans to collectively internalize the trauma of these events and feel despair over the possibility that a similar fate could befall them or their close family members and friends. Moreover, the repeated nature of these events can elicit sadness, hopelessness, and fear that things will never change.

What are tips for an individual that recognizes they are showing signs of depression?

Dr. Beall-Wilkins:

• Visit your doctor and seek treatment: Regularly follow up with a primary care provider to ensure there are no untreated or undertreated medical conditions that may contribute to the development or worsening of depressive symptoms.
• Stay connected: Stay connected to close friends, family, and spiritual community for support.
• Diet and exercise play a role: Eat a balanced diet and engage in physical activity for at least 30 minutes a day, three times per week.

Resources:

• National Alliance on Mental Illness’s (NAMI) cultural dimensions website for BIPOC/AAPI communities.
• DSM-5 (American Psychiatric Publishing, Copyright 2013 (American Psychiatric Association) 
• Stanford University 
• Anxiety and Depression Association of America