Department of Psychiatry and Human Behavior
Date November 3, 2023
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Clinician Cameo: Helping Kids with Autism Inside and Outside of Schools

The Clinician Cameo is a monthly interview series with a clinician in the Brown Department of Psychiatry & Human Behavior (DPHB).

David Lichtenstein, PhD

David Lichtenstein, Ph.D., is a staff psychologist at Bradley Hospital's Verrecchia Clinic for Children with Autism and Developmental Disabilities, as well as a school consultant with Project AWARE, a state program that trains educators in the needs of children with mental health problems. He is a clinical assistant professor of psychiatry and human behavior. 

Lichtenstein talks with DPHB about his experience working in a therapeutic day school, the gaps facing families of children with special needs, and the way he bonds with his own children.

For over a decade, you worked as a psychologist and classroom team leader at the Bradley Schools. What did that job entail?

My job was to be a hub between all the spokes – the kids, the teachers, the school administration, the parents, outside providers, the school district. There are a ton of different players when it comes to out-of-district therapeutic placement. My role was to try to interface with all those different people to best support the kid. I was running IEP [Individualized Education Program] meetings, having conversations with teachers and daily interactions with kids, running therapeutic groups for all the classrooms.

Based on what you’ve seen, what social supports are most needed for these children and families?

The most glaring thing for me – where there was just nothing – is after-school care. That kind of care is really, really hard to come by for these families. That has to do with behavioral and psychological challenges – these aren’t kids who can necessarily be dropped off at scouts – but it also has to do with their families not having the resources. Plus, there just aren’t enough after-school programs out there. If a parent has to work and can’t be there to meet their child off the bus, that can be an existential crisis for the family. 

Of course, there are other challenges, too. If public schools had more resources, they would have to refer fewer kids. Some of these [therapeutic] schools have closed, so there are fewer options. Then it can be challenging to find child psychiatry for some of our kids. Even finding sustained mental health in-home supports can be hard, because there are long waitlists for these programs. We end up with kids in crisis because there’s not enough support in prevention.

We end up with kids in crisis because there’s not enough support in prevention.

Dr. David Lichtenstein

You were at the Bradley Schools through the first year of the pandemic. What effect did it have on the kids there?

In the early days, when everything was virtual, we had some kids who could be on-screen and meet with their teachers. But we also had kids who just never, ever showed up and we couldn’t reach the family. Or they were traveling from one parent to another caregiver, because there was so much stress and disruption for the adults, too. We had a kid whose caregiver died. Putting a Chromebook in a kid’s house opened a window onto what some of our kids were going through.

When we returned to in-person learning, six months into the pandemic, some kids picked up where they left off. But for other kids, their lives were really disrupted. Some had traumas we didn’t know about. Some might have been really comfortable at home, because they could avoid other kids, school work, teachers, whatever made them anxious. If you’re a kid who’s already predisposed to feel anxious, you now have a situation where people are validating that anxiety. We’re seeing some families still coming out of that to re-engage with the world. 

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Dr. Lichtenstein with his Verecchia Clinic colleagues (from L) Dr. Karen Cammuso and Dr. Kristin Knapp-Ines

As a staff psychologist at the Verrecchia Clinic, you work with children with autism and developmental disorders. How did you get interested in that area?

For 13 years, I worked in the Bradley Schools with kids who had autism and developmental disabilities, but also with many other kinds of kids who came through our doors. When I started thinking about making a career change, I knew I wanted to have a different relationship with the families of these kids.

All child mental health involves some work with families. But autism especially so. You’re going to have some kids who are not going to participate in what you might traditionally think of as therapy. Some kids are nonverbal, so the bulk of the work there is going to be with family and caregivers. Autism just lends itself to a family-focused approach because of the range of kids’ needs. 

What are common challenges you encounter in educating families how to help kids with these needs?

On a certain level, all of our families have a child who’s responding to the world differently than they do. Some things that might come easily to other kids in the family or to the parent are not easy for these kids. So the parents are reckoning with that. There are a lot of parental emotions – grief, frustration, hopelessness, anger. 

Then there are the concrete challenges: A parent who can’t get their child off of a screen or who faces a battle every time they try to get them to come down for dinner or get ready for school or come to an appointment with me. 

As a consultant with Project AWARE, you’re educating schools, as well. What does that look like?

We work to build systems at a school-wide or grade-wide level to support teachers and staff to support the kids. Teachers might not realize the mental health underpinnings to certain behaviors, for example. So we do schoolwide trainings to increase the use of positive behavior strategies that we know are successful. We also try to help teachers see how trauma or other developmental disabilities may affect a kid, and we work with them to make the classroom feel more safe and consistent. 

What do you do in your down time?

I play guitar – it’s a side joy of mine. I have friends I’ve played with for a long time and we get together once a month. Between their kids and my kids, it’s not just us who are playing, anymore. The kids are surpassing us.