In 2022 the Survey of Disability, Ageing and Carers (SDAC) reported a 41.8% increase in Australians with a diagnosis of Autism Spectrum Disorder (ASD) compared to 2018, which included 4.3% of children 5-14 years and 3.0% 15 to 24 years. The increases are explained as due to both changes to DSM criteria for diagnosis and better screening of young children to identify signs and greater community awareness and acceptance of the diagnosis.
ASD is a neurodevelopmental disorder creating differences in thinking patterns, sensory processing, communication and social interaction. While clearly an ‘inside’ issue which requires focussed intervention, family members may experience depression, anxiety, isolation, marital discord, divorce, financial problems and sibling neglect and risks to the structure and functioning of the family.
Systemic Issues for Families
Families with a child with an ASD diagnosis face issues unique to the diagnosis. Anthony Pennant (2025) speaks of the ‘elevation of the diagnosis or behaviours enshrined in the diagnosis to one of power over all individuals in the system with a focus on the adjustment of family routines to ease transitions and behavioural emotional reactions. Where adjustments are made this may take significant time and emotional investment. Another issue is the lack of emotional connection and reciprocity between the child and parents and siblings with less attention given to deepening of interpersonal relationships. Siblings may feel dismissed and overlooked as their needs do not match that of their brother or sister which may fuel jealousy, resentment and distress. Attention to the needs of the child with an ASD diagnosis can result in a lack of attention by parents to other children, while parents can feel unsupported and the difficulties minimised.
What Can be Offered on the Outside?
Pennant (2025) has proposed a model integrating critical disability justice and Minuchin’s structural family therapy. Disability justice is ‘a theoretical framework that promotes the understanding of how disability is not necessarily the identification and examination of bodily and mental impairments, but how we categorise and normalise the characteristics and traits of these impairments onto individuals. Societal interactions define what a person can do and limits their capacity to communicate their capacity and needs.
Structural family therapy aims to address symptoms through the restructuring of the family system and was developed by Salvador Minuchin working with disenfranchised families of colour for whom traditional psychotherapy models were ineffective. The author notes a synergistic relationship between the models ‘allowing clinicians to utilise tools to challenge harmful stereotypes about autism and shift a family’s structure to support growth, independence and closeness’.
SFT for ASD
The model entails 6 steps beginning with a session for the parents alone to validate their feelings and experience followed by a child session to incorporate their perspective. The next 4 steps mirror the process proposed by Minuchin followed by challenges to unhelpful ideas about disability which can be unintentionally limiting. Identifying and embedding each person’s roles and rules and strengthening relationships with a child who is not primarily defined through a disability lens completes the process.
Is it Effective?
A study of 5 cases suggest efficacy in some areas of functioning but also an increase in anxiety in some children. The authors suggest that the approach is a valid first option that can support parental and family mental health and recommend more extensive research.
Pennant, A. (2025) SFT for ASD: A systemic intervention for neurodiverse families. Journal of Family Therapy, 47, e12475. Available from: https://doi.org/10.1111/1467-6427.12475
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