By: Ben Breaux, Bened Life Contributing Writer

What should a career in autism look like? Many professionals in the field of autism don't understand or see us. That is not the case with my cousin, Dr. Briana Traina (née Brukilacchio), a child psychologist who has been working with autistics and their families for over 15 years. 

Dr. Traina developed “Autism 101,” a program that works to help families navigate the autism post-diagnostic process. In her words, Autism 101 “supports parents of young children (aged 2-7) who have recently been diagnosed with ASD. The program draws from several approaches to intervention, including group psychoeducation, cognitive behavioral therapy, family therapy, and systems navigation. The intervention content was designed based on a thorough review of [scientific] literature and was piloted/revised over the course of several years using parent and clinician feedback.”

In this interview, I ask Dr. Traina about her illustrious career generally, but I also focus specifically on her Autism 101 goals and inspirations, as it is a great example of how personal experiences with autistics should inform professional intervention for not just autistics, but also their caregiving/support systems. I want to highlight the importance of autism professionals having not just educational experience, but also personal experiences with actual autistics.

For the sake of anybody reading in a hurry, I pared down and edited her responses. 

Dr. Briana Traina - Career highlights and formative moment

Ben: Would you mind summarizing your favorite highlights from your career, please?

Dr. Traina: Through each of the different positions that I've held, I have really wanted to get more insight into what things really are like for families and Autistic individuals throughout the lifespan and across all the different places that they go.  

I've had the opportunity to work with Autistic folks and their families in hospitals, specifically on medical floors if they were to have a surgery or undergo epilepsy monitoring. I've worked with folks in primary care, pediatrics settings, outpatient therapy, and emergency departments. I've also had a chance to work in several different school settings, in summer camps, in research labs, in the community, etc.

I think that's given me more perspective to help understand where families are coming from and all of the different settings that they move throughout as their child gets older. 

A few specific experiences that were uniquely challenging and rewarding were:

Primary care: I rotated through a primary care clinic when I was completing my predoctoral internship in psychology. I really loved being in frequent contact with pediatricians and with all the allied health professionals that were helping families meet the day-to-day health and education-related needs that were coming up. 

I found that that environment was so fluid. People were constantly changing the way that they did things and innovating models of care. There's a very grassroots "we'll figure it out" approach in primary care, and that really appeals to me. I’ve recently started working with primary care in a different healthcare setting and I find it just as rewarding and dynamic as I did during my internship.

Emergency department: A completely different opportunity that I really enjoyed, although it seemed overwhelming at first, was completing emergency psychiatric evaluations at a children's hospital. I was able to meet, see, and validate everything that was happening when this family was in crisis. 

Crisis is a horrible state to be in. It's overwhelming. It's overstimulating for everyone. It taxes every type of coping strategy that you have. Especially in that context, being a clinician who's able to connect with someone in that state and to help organize what they're experiencing - to help provide a bit of a roadmap for what's coming next - that felt like a really powerful role to play. I think a limitation is that it's so brief, there's no opportunity to continue to follow up with that family afterwards. 

I've been working with Autistic and neurodivergent folks and their families for almost 15 years at this point, so there have been quite a variety of experiences. Those are some of the ones that come to mind most recently.

Ben: What were your goals for your career when you first started studying psychology and neuroscience? 

Dr. Traina: I cannot remember for the life of me what my goals first were when I started. 

One of the really formative experiences happened when I was working as a high school student assisting with a music and movement therapy class. It was with the same small group of children each time, most of whom had a developmental disability or an autism spectrum disorder diagnosis. 

There was a very familiar child who I would often go off one-on-one with to help soothe or calm down if she was feeling overstimulated. One day, she was having a really tough day and she came over to me looking for squeezes, contact, and sensory input. When I got down on her level, she put her little face right up to my face, forehead to forehead. I wasn't really sure what to expect at that point. She barely made eye contact because you're so close, but she was staring right at me. She was apraxic so getting language out was very effortful, and I didn't often hear her use a lot of speech. In that moment, she asked, "What's wrong with me?"

It still gives me chills because it made me feel so many things at the same time. It shocked me. The amount of energy that she put into getting that question out to me using speech, on a day that was really dysregulating for her already, emphasized how important it was for her to get that across. 

The fact that she connected with me in that moment and asked me that question very directly made me feel a sense of personal responsibility to follow up with that question. That moment felt like a call to action. As a high school student, I felt one way I could try to better understand autism and try to better understand what was going on was through genetics, which was why I became interested in learning about and pursuing a degree in the sciences so that I could work as a geneticist or do genetics research.  When I ultimately landed on psychology and neuroscience, it was because of the recognition through the neurodiversity movement and through the research that one of my professors in undergrad was focused on - better understanding the cognitive strengths of Autistic individuals. 

It felt to me like psychology was an area where I could bring together the different skills that I felt I was well suited for and that were interesting and enjoyable for me. I've always had in the back of my mind that moment with that little girl, as again, that call to action around this community and trying to better understand autism and other neurodevelopmental disabilities, trying to change societal stigma and misunderstanding, and trying to improve self compassion and self understanding.

Autism 101: A pediatric autism post-diagnosis program for parents

Ben: Can you tell me about your Autism 101 program?

Dr. Traina: Autism 101 is a program that I developed for parents and caregivers of an Autistic child between the ages of 2 to 7. When families get that autism diagnosis for the first time, it obviously brings up a lot of questions. There's a lot the parents need to learn, and they should have trustworthy information grounded in research and in what we know of people's descriptions of their lived experience.

The program initially consisted of 6 consecutive weeks, where families meet once a week virtually for 90 minutes each. In the past year, I’ve reduced it to 4 consecutive weeks so that we could reach more families throughout the year. 

It's a combination of the group leaders presenting information and generating group conversation, discussion, dialogue, and Q&A around different topics. We bust a lot of myths associated with autism and try to help families better understand what we mean by “the spectrum.” We cover a very wide range of different material, and the material is set up very intentionally. Even though we cover quite a bit, I've pared it down to as little as we could possibly cover.

The outline for the full 4 weeks:

Week 1: Understanding Autism 

• Introduction to group

• Group discussion: child’s preferred ways of playing 

• Developmental milestones

• Early signs of ASD

• Reflections on the diagnosis

• Definition of autism

• Etiology

• Overview of select scientific findings 

• Strengths associated with ASD

Week 2: Obtaining Interventions

• Group discussion: child’s current food preferences and eating habits

• Review of interventions 

• Identifying family values to guide treatment decisions

• Service navigation strategies 

• How to collaborate with therapist

Week 3: Working With Schools

• Group discussion: child preferred ways of interacting with books and reading

• Special education laws

• School advocacy training 

Week 4: Family & Community Support

• Group discussion: positive reflections from the past week

• Group processing: emotional reactions to the initial diagnosis

• Parenting stress and practical self-care

• Social support

• Strategies to maximize community inclusion

I initially developed Autism 101 in Austin, Texas, and since I've moved up to the Boston area, the program came with me. We've been providing it through Massachusetts General Hospital (MGH) since 2022 and it’s also been provided in the New Orleans, LA region since 2023. 

The other important expansion has been to provide the groups in Spanish. This has been a goal since the program’s initial development. Through the collective efforts of parents, providers, and graduate students over a period of four years, the Spanish version was finally made possible. I’m especially grateful to the Medical Interpreter Services at MGH as well as colleagues at the Lurie Center for Autism and across the MGH Community Health Centers for finally making this possible. 

Overall, it's been very successful and has probably reached over 300 families in three different states. Ideally, it'll just keep building outwards, and we can manualize and disseminate this so that other folks can provide parent support and education. 

(This is a pared down description of her program. For more details, watch the video above or read Dr. Traina's dissertation on Autism 101.)

Ben: What inspired you to start the Autism 101 program? 

Dr. Traina: What inspired me to start the Autism 101 program was the knowledge that when kids are diagnosed with autism, they are quite young, especially more recently as we’ve improved our diagnostic process. The majority of new diagnoses happen when kids are between 18 months of age and 5 years. The primary decision-maker responsible for these children is largely the parent or whomever is the primary caregiver for that individual. They have to figure out what autism is, what it means for this child, and what they are going to do with that information.

All of their emotional reactions to the diagnosis and making sense and meaning out of that are key in influencing the treatment related or education related decisions that folks are going to make. That’s why I felt like Autism 101 was an important program to develop, because most parents have a lot of really good and important questions, and it’s difficult to find answers to those questions right after the diagnosis.  When I talked to parents to figure out what their post-diagnostic support looked like,

A) many parents said it was really lacking and there was a giant hole in where they perceived there should be services; and

B) it sounded like a lot of parents were turning to Google or the internet. The internet has a lot of really valuable information on it. It also has a lot of information that is misleading or that is tapping into a fear-anxiety response in families that might be further impacting the way that the family is understanding this new diagnosis or the decisions that they make for their child.

As I was working in the pediatric healthcare field, I came to realize that parent and family education about a new diagnosis is often a pretty standard process for a lot of other conditions that might be diagnosed. 

For example, if a child receives a new medical diagnosis of type one diabetes, usually there's a diabetes educator who works with the family and helps them to understand diabetes and the way it impacts their child. Providers are equipping the parents and family to feel more empowered to handle this new normal of having a child whose diabetes care they need to be able to understand and manage. 

I wondered whether this family and parent education model that we have in things like chronic illness, could apply to things like disability, including autism. I approached a group at the Children's Hospital that I was training at, and I spoke with the section chief for developmental behavioral pediatrics. I told them I wanted to put together a curriculum helping parents to learn all this information about autism and how to understand different treatment decisions and educational decisions and the way that it might impact family dynamics. Could I put that curriculum together and try it out and offer that as a free program? The developmental behavioral pediatricians said to go right ahead. That was the beginning of this. 

I realized that I wanted to not just provide this as a free service, but I wanted to study this, do research on it, and carefully develop through trial and error and incorporating feedback changes to this program over time so that it's best meeting the needs of families of young children who are recently diagnosed. 

I turned this into my dissertation for my PhD and did a lot of research to better understand what should be in this curriculum.

Ben: It seems you've done a lot of work with Autistic children, but what made you want to turn to helping the parents?

Dr. Traina: When children are quite young, especially when they haven't yet established or figured out what communication tools they might be best suited for, parents are the advocates. Parents are the child's voice, the child's diplomat or representative in the world, and are making a lot of decisions for their child. 

I think it's really important that that process is not cookie cutter or templated. There is no one size fits all model for how best to support the development of any child, in particular a child with autism. Each and every kid presents really differently and has their own interests and their own potential set of trajectories. 

I wanted parents to be able to have a sense of agency in developing a plan for their child and managing their family's time and resources in a way that was aligned with their own goals. We talk with parents about how to be in the role of “captain of the ship” rather than having to do all the different activities on board. 

For example, a lot of parents of kids with autism feel burnt out very quickly because they're trying to learn how to do every different type of skill that might help their child develop more language or regulate their emotional and behavioral presentation when things are over stimulating or overwhelming. 

We talk with parents about how you don't need to be the one who is the keeper of knowledge and skill in all of these areas. What you need to do is be able to communicate with and guide and provide feedback to all these different folks who are involved in your child's care. 

Ben: Did you ever expect to do all that you have done now, particularly in the autism field?

Dr. Traina: Yes, because there is so much to do in the autism field. There are so many needs that are unmet within this community and there is a strong sense of motivation or desire to help create more programs and to fill in some of the gaps. 

There are so many different things that we could improve upon. For me, I feel like the place to start is at the beginning of a family’s journey, the beginning of an individual’s journey with autism. My training has really been around diagnosis or clinically, so that was the natural place to start. 

The more that I learn from colleagues around me who specialize in other aspects of autism related care throughout the life span, the more interested I become in different spin-offs, different projects that would be helpful to do some work around.  So, yeah, I did expect that I would do things like Autism 101, and I hope that this is only the beginning of what will end up being a longer career of collaborating on projects that are impactful to the community and that are needs and priorities that are being expressed by the autism community and other stakeholders that are connected to individuals who are Autistic themselves. I hope I do much more than this.

Thank you for letting me share all of this with you, for talking so extensively about all these topics that are really important to me. And I’m excited to have had this platform through you, Ben, to be able to share some of this work. 

About the Author:

Ben Breaux is a 25-year-old nonspeaking Autistic from Northern VA. He has written many articles for Autism and Disability Advocacy groups both in the US and worldwide. Ben is a very proud representative for the nonspeaking community on several advocacy boards and committees, both in the state of VA and nationally. He is currently working toward a high school diploma via “ACCESS,” an online academic and support program for Alternative Learners. He strives daily to show the world that a disability will not hold him – or others like him – back.

About Dr. Briana Traina

Dr. Briana Traina (she/her) is a licensed clinical psychologist in the state of Massachusetts. She is passionate about providing culturally sensitive and neurodiversity-affirming autism diagnostic evaluations and supporting individuals and families as they navigate the next steps in autism-related care. 

Readers may also be interested in following along with the programs that Dr. Traina and her colleagues are developing through aTypical Community, a new nonprofit organization. The mission of this new organization is to empower neurodivergent individuals and their families by fostering connections, providing strengths-based education, and promoting inclusivity in a supportive community.

About Autism 101

Individuals residing in the state of Massachusetts whose children are between the ages of 2-7 and are navigating a new autism diagnosis can enroll in upcoming Autism 101 classes offered through the Lurie Center at Massachusetts General Hospital. A full list of Parent & Caregiver workshops and instructions for enrollment are available on the MGH Lurie Center website. 

Clinicians who are interested in learning more about the Autism 101 protocol and how to support families in similar situations are encouraged to contact Dr. Traina directly at [email protected].