Saturday, September 26, 2020

The Lowest Hanging Fruit


The Lowest Hanging Fruit


This most unusual COVID period brings unheard of amounts of social isolation, worry for ourselves, our families, and the specter of quarantine in homes that seem to shrink the longer we are secluded.  These are challenges not seen in over 100 years.  It’s a perfect recipe for irritability, loneliness and sadness  - we’re hard wired for the social contact that’s dangerous right now.  The emotional cost is high, and as it affects you, it affects your loved ones.  One solution to these challenges has been documented for decades:  Aerobic exercise.  And the “lowest hanging fruit” in the exercise arena is, for most, brisk walking.  Yup, it can be that simple.

Researchers have repeatedly documented the mental health benefits of aerobic exercise.  A July 2020 Harvard article reports, “Exercise reduces levels of the body's stress hormones, such as adrenaline and cortisol. It also stimulates the production of endorphins, chemicals in the brain that are the body's natural painkillers and mood elevators.”  Please re-read that Harvard quote.  Exercise results in less stress and a better mood.   That’s a lot these days.   

If you’re now putting on your walking shoes, put this down and go.  If not, read on. 

The practice is simple: 30 minutes of aerobic exercise per day, 4 days a week to produce the benefits mentioned in the Harvard study.  The definition of “aerobic” is an elevated heart rate.  Few of us spend 30 minutes non-stop paying tennis, basketball or pumping iron, thus, they don’t check the “aerobic” box.  Running swimming or biking are the other activities that can provide us with the needed half hour – provided you have the equipment, inclination and skill.  Is it boring to you?  Plug in your favorite tunes or listen to a book, or a podcast.  Walk on a treadmill and watch a show, it doesn't matter.

Change, however, is admittedly hard.  Trying something different is a critical skill we use when confronting a problem.  Edison reportedly tried 1,000 different filaments before finding one that created the lightbulb.  That’s a lot of persistence.  So whatever excuses or rationalizations you have that get in the way of exercise, consider them to be puzzles in need of a different solution.

And if you don’t like the heat, walk in the early morning or late evening.  Unless your physician forbidding you from exercise, you’re likely eligible.  If you can’t walk briskly for 30 minutes comfortably, that’s proof that you need to work up to it. 

There’s nothing to lose trying it out for a couple of weeks, which is as long as it takes for the benefits to kick in.  And don’t forget – kids need this neurochemical support as much as anyone else.  They’ll not likely jump at the chance to just “go out for a brisk walk” so find ways to encourage them.  Walk with them, take them somewhere they can ride their bikes for a half hour.  Reinforce their participation with praise and whatever treats they like that you can live with.  It’s a challenging time.  Meet the challenge. 


Friday, April 17, 2020

COVID 19; It's Simple, Not Easy

I have always valued the phrase "simple but not easy."  It captures so much truth.  (As with all posts, materiel identifying information is changed to shield client privacy.)

I met with a young woman I'd not seen in about a year.  She's in college and doing well.  Quite well. She's found her area of expertise and has been excelling in it.  After we spent some time catching up and her sharing how well things were going, I inquired why she contacted me. 

She shared she had a major presentation of a paper she'd developed and spent a great deal of time.  She had  been chosen from many applicants to present at a prestigious conference.  She was in the early stages of hitting her professional stride in college, which is indeed an accomplishment.  She admitted she'd been a bit wishy washy about academics after her transition to college.  She responded by finding her bootstraps and pulling hard on them and has begun to see objective success that, with this conference, was about to put her in very good stead as her career developed. 

Her acceptance to present at this conference was a major validation of her efforts, her gifts and her accomplishments.  It's cancellation due to the CV 19 concerns that the world currently faces has deeply deflated her momentum regarding her identity as a professional. 
I suggested to her that she's facing a couple of things that many of us are coping with:  She's not in control of what happens, and bad things happening to good people. 

Her diligence at her academics had been totally in her control.  Even though she was surprised at being chosen to present at the conference - she had read the other submissions and found many of them to be quite impressive - she was learning that she could earn the right to be counted among the highly accomplished in her field.  Her academic gifts notwithstanding, she'd done the work.  She'd put in the hours, listened to her professors' advice as she progressed.  She was in charge and responsible, and she was enjoying that sense of authority over her subject matter and the recognition that was coming with it.  And now she's understandably struggling with the cancellation of the conference. 

She'd done all the right things, is active in her community, was raised in a loving family that has encouraged and supported her throughout her years.  She's active in her church, she volunteers.  And was confused at why something like this might happen to her. 

We discussed the realities of not being in charge and being victimized by the seeming randomness of life in this universe.  I encouraged her to consider that such is the lesson we all have to learn, sooner or later, whether dealing with a global pandemic or a fender bender.  The lessons of living life on life's terms, where we are not in control, despite our efforts, despite doing all the right things is a simple reality.  Absorbing those lessons, digesting them, integrating them into one's conscious rhythm, that's not easy, but is the task at hand.

Wednesday, October 30, 2019

How Much Academic Pressure Do We Put On Children?

While speaking with a family recently, I learned that their middle school child was on an advanced academic track.  In middle school.  This child was not struggling at all with the content, but his behavior at home was atrocious.  This same family told me that the advanced programs were soon going to begin in elementary school.  In 3rd grade.  It was all I could do to not scream

There are lots of smart, high achieving and financially successful folks out there, and they, not surprisingly, have a lot in common with one another.  So also not surprisingly, they marry.  In the long list of what's logical, they have children, and those children may be, smart.  Quite smart.  I often see some very smart kids (both on the autism spectrum and those who are neurotypical) who are bored with school.  I often say that there's nothing tougher than a really smart kid with ADHD.  A smart, bored kid in a classroom who's unable to manage their impulses is often a real challenge.  And even if the child is smart and not a behavioral challenge, do we not want to afford them every opportunity to maximize their potential and strengths?  Well of course we do.

I know of one child who had learned to count in mid elementary school.  In base 8.  That's where 8 is a round number like 10 and if you want to know more about that, google it, because the last I learned it was over 50 years ago and it didn't really stick.  But this kid got it.  Before middle school he was doing algebra.  Well.  He's an awfully smart boy.  And, again, no surprise, his parents are really smart.  They worked hard to get him involved in enrichment programs in math so that he could excel in the areas he found naturally strong.  They did it on their own, outside of the regular curriculum.  It cost them money and time.  It was inconvenient.  But I think they made a wise choice of leaving him in his regular classroom, asking the teachers to provide him some enrichment so his boredom didn't turn into disruption.  His elementary school didn't have an advanced track and they, wisely I believe, didn't transfer him to one that did.  And I think that's OK for younger kids where their social development is so critical. 

On the other hand, what's the cost of so many advanced classes and advanced expectations?  Unfortunately I see lots of really smart kids (yes from really smart parents) who perform quite well, even when lots is asked of them.  They're smart, after all, so taking the AB classes and the AP's is within their academic reach.  It is not, however, always within their emotional reach, and this is my concern. 

So many of these adolescents are used to high pressure that by mid high school they've burned out.  They begin to learn to game the system, so they learn as much about what they do/not have to do to get the grade as they do about the content of the class.  Some excel in two areas: academics and anxiety.  They worry that they're not good enough, even when obtaining good grades, because they've known only pressure for years.  Others begin to have existential crises.  In high school.  They contemplate what the broader meaning is of these hoops they've been jumping through.  Sometimes, sadly they become depressed and suicidal.  Now I love philosophy and the self examination that comes with it, and I think high school is a decent place to do that.  But is the angst, the depression and anxiety that comes with it worth the cost or risk? 

And these kids don't only excel academically.  They become involved, very involved in their extra curriculars.  The scouts eye becoming Eagle Scouts - earlier and faster than their peers, because competition is embedded in the social culture of achievement.  The musicians need lessons, from the local symphony's professional musicians and compete for regional, state and national performance opportunities.  They compete in debate.  Nationally, not just locally.  Children's soccer, softball and little leagues have after season travel teams that demand more and more time (not to mention money from parents) to excel.  Middle school parents discuss sports scholarships in front of their children.  How much pressure do we want children to have? 

There must be a balance to strike, and I wish I had a brilliant balanced hand to guide in suggesting one.  Kids should be encouraged to work hard.  They should be allowed to follow their natural talents.  I also think they should be allowed, and encouraged to have down time (not screen time) with their peers in which they can be creative and even lazy.  I'm not extolling laziness, I'm suggesting that having time without the excessive expectations being placed upon them is valuable.  And there's a huge difference between adolescents who hunger for more and those who are told, from an early age, that if they don't excel for the purpose of attending a much better university, that their trajectory in life is at risk.  It's just not true, regardless of what their high achieving parents, school administrators, tutors or others may say.  It's time to reconsider the culture of never ending pressure and competition that we've created.  There is, after all, a lot more to life. 

Wednesday, September 25, 2019

How We're Minted: Growing Up With A Sibling With Autism

As in all posts, materiel changes are made in the descriptions to protect identity.

I was taught many years ago that often, people in the helping professions come from dysfunctional homes.  And I have found in my career that indeed, many nurses, doctors, mental health professionals have family histories that include challenges such as addiction, chronic illness, trauma of many kinds and the like.  Many, but certainly not all.

Later in my career I was taught that the siblings of children with severe medical, developmental or mental health problems often become caring and emotionally rich adults.  And I found in my career that this has often been the case.  I've met many siblings of kids I work with and other adults who have sibs with disabilities who are indeed, kind, sincere, hard working, earnest and the like.  Those traits, that experience can lead to great inner strength and self confidence. 

This is true for many, but not all.  Susan's a college student who has a younger brother with moderate autism.  Her brother (and her family) struggles with his rigidity, his narrow emotional capacity, his frustration with his understanding that he has autism and his depression that he's not "normal."  They have dealt with her brother's behavioral challenges and Susan was always expected to help out, to accommodate, to help when asked.  And she did, faithfully.  She understood that her brother couldn't help having autism.  She saw her parents' struggles with him and tried whenever she could to pitch in to help.  Her parents appreciated her efforts on their and her brother's behalf. 

Now in college, Susan has been struggling with significant that anxiety that can be almost paralyzing.  It started as small worries when she was helping out with her brother, the tension in the home such that if things went wrong, someone was likely to yell.  Likely her brother, not infrequently her mother, less frequently, but sometime, her father.  And with the yelling came the sharp sense of responsibility that has grown, now all but out of control. 

She can't decide what to do or concentrate on her academics for fear of getting them wrong (despite that fact that by doing so her grades have indeed suffered, adding to the spiral of anxiety.)  Her social life is flat.  She won't go out when asked, fearing that anything and everything might go wrong.  She might say something wrong or do something wrong.  He probably won't like her anyway.  She's not pretty enough.  All the classic low self esteem stuff that is not at all consistent with what I learned about siblings who have significant disabilities and, as adults, flourish.  Susan's not flourishing.  She's deeply stuck.  She's fears doing all of the normal things that folks with anxiety benefit from, whether it's exercising regularly, learning simple meditation, reading materiel that can help, calling a doctor for medications. She's ambivalent about therapy as well. 

So when speaking with her recently about a problem she was having with a friend, where she was besides herself fearing she would hurt her friend's feeling with a very reasonable request, I asked her where she learned that her needs always came second to those of others.  She shrugged.  I asked her what it was like for her when she was a kid dealing with her brother and whether his needs came first.  She stopped.  She teared up, the pain of bearing more responsibility then she could bear for so many years, of worrying about whomever might yell next. 

And I showed her an ancient coin that happened to be on my desk.  The coin is a couple of thousand years old and has the look that when struck, the stamp that was used was just off center, as is common with such antiquities.  It has quite the imperfect look.  And yet, from the moment it was struck it was legal tender, as valuable as any. And I showed it to her, noting the imperfections of the coin.  Imperfections that reflect those that each of us may have, whether it's struggling with anxiety or depression or abrasive personality traits or whatever other imperfection we may have.  We've all been "struck," like the coin, by the cumulative events of our history.  Nobody really comes through the crucible of childhood unscathed.  Some of us may wear better than others, but we all carry scars of one sort or another.  It's OK to be who you are, whether the scars are large or small, whether you cope well or struggle with coping.  The key factor is to understand that, as the ancient, poorly struck coin, your value is exactly equal to whomever might be standing next to you.  I hope Susan hears that. 

Friday, July 12, 2019

Special Needs Kids, Special Parents and Marital Stress

I've recently been made aware (again) of the challenges marriage.  It has been shown to be a myth that 80% of couples with special needs kids divorce.  Studies are mixed, some showing a slight increase, some showing no increase at all, but these numbers sidestep the issue of stress upon marriage with kids with autism and other special needs.

The fact is that kids with special needs need special parents.  I've seen many parents who have gone to acrobatic lengths to meet their child's needs, often with wonderful results.  But such efforts cannot be compared to the NT (neuro-typical) parent's driving around the region for their child's extra sports activities.  Such efforts are commendable, and stressful, but of an entirely different quality and nature than coping with the challenges special needs kids can bring. 

There's likely no need to list here what those challenges are, but on the odd chance that the reader does not have a child with special needs, or has just received a new diagnosis and is preparing, the challenges can be severe.  Children with special needs may have erratic sleep schedules impacting parents' sleep schedules; challenging behaviors such as repetitive tantrums and severe oppositionality; self injurious behavior; aggressive behaviors; high levels of hyperactivity and impulsivity; frequent destruction of property, the list is too long to complete but the cost to a marriage and household are clear. 

How does a marriage survive this?  One of the mistakes I've frequently seen is a dynamic described in the Family Systems Literature of "triangulation."  Triangulation is when a parent has an overly close relationship with a child to the exclusion of their partner.  The implications are clear.  The triangulated partner is left "out" of the decision making process.  The child's role in the family may be elevated.  All sorts of problems can result. 

In the case of a child with special needs, however, the "boundary blurring" may be about the demands the child brings the family as opposed (or in addition) to other factors for NT families.  The results to the marriage, however, can be similar.  Estrangement, emotional and the resultant physical distance from one another that, over time may or may not lead to divorce.  But it certainly leads to a lonely life for each member of the couple. 

It's a frequent yet dangerous path that can be taken.  The tougher the kid, the easier it is for the parents' to drift from one another as one (classically the mom) may be forced to spend more time with the child.  Yes, forced.  The pressures on these families is not something easily understood if one has not experience them. 

What's a couple to do?  My basic suggestions, even in the face of severe behavioral challenges are:

  1. Build time in for each parent to have some alone time to regenerate.
  2. Find and build supports from family, community and friends to provide some (even small) amount of time for parents to go out as a couple, even if it's for an ice cream cone after bedtime.  Small amounts of time can be jam packed with quality.
  3. Be realistic about what can be accomplished for your child.  Ask the professionals involved for their views on your child's prognosis.  Such views are opinions, not predictions and not perfect, and it's proper to keep your goals set high.  But be realistic.  
  4. Remember the importance of forgiveness.  Giving your spouse the benefit of the doubt can be the kindest gift of all, and the best thing for your relationship.
  5. The most important in my book: communicate.  There's nothing better in a relationship than the ability to communicate honestly, particularly about the hard stuff.  

Tuesday, June 18, 2019

What Do We Expect

Jung discussed the collective unconscious.  I've never been a big Jung groupie, but time and again I see evidence of this.  Recently it had to do with what our expectations of the high functioning autism (HFA - used to be called "Aspergers") population could/should be.  

(Note that any identifying information has been disguised to protect confidentiality)

I see a young woman with HFA who is quite happy when she discusses her preferred, restricted menu of topics.  The specifics of what she prefers to discuss are besides the point, but she becomes pretty uncomfortable when discussing things like some of her own challenges in the workplace or within the family.  Her tolerance for such discussions are quite finite.  What is seemingly infinite is her willingness to discuss her preferred, restricted menu of topics.  

Another high school young man that I see also has (to some) quirky limited topics he likes to discuss.  His parents structure him about this with some frequency.  He asked "Why do people always tell me what to do?"  I thought it a good question and we discussed how, given the fact that he has autism, a lot of adults want to help him do as well as possible so that, as an adult he'll have the best shot at success.  He understands that most adults don't spend the amount of time discussing his preferred topics the way he does, but he likes what he likes.  He responded "It's not like what I talk about is against the law."  And I had to agree.  

Restricted interests are quite common among the HFA population.  To a greater or lesser extent, it's what certain people do, how they're wired.  These two people with HFA have their respective idiosyncrasies, but their families struggle.  These two discussions brought up a couple of interesting questions that I share:

  • When should parents accept their HFA child's atypical behavior as a natural manifestation of autism and when should parents (and professionals) intervene?  Certainly we want to encourage as much independence as is attainable for the individual, and yet, not every person (with autism or not) is a good candidate for college, maybe not even for many work settings, maybe or maybe not for independent living.  What I would propose is that parents might need to sit back and reflect how reasonable it is for their children to continue to grow?  It's not a simple question, and I'm not suggesting that parents quickly give up on their kids.  I'm also not suggesting that they pester their kids either.  I'm not sure what the best medium path is, but at least for these two families, I'm thinking they will benefit from considering the question of what is "reasonable".
  • We train children for lots of things like speech, manners, toileting, reading and other academic skills.  But how do we know when our HFA kids have hit their own personal wall of accomplishment?  That's quite a tough one and, of course, is dependent on the strengths and weaknesses of each individual.  Plenty of folks with HFA can grow throughout the course of their life, learning new skills, flourishing in education and career and love and family.  I would also hold that there are plenty of folks with HFA who, at some point in their development, reach some level of a maximum of their strengths that might challenge their success in these same areas.  They can work, be productive and live a whole life, but it may be a life that's less whole than their parents desire for them.  Parents' expectations for their children, those with HFA and those who are neuro-typical (NT) often have to accept the reality of their children's abilities.  Sometimes, as can be common with chronic conditions, they need to accept the reality repeatedly.  
There's lots more to discuss, but I offer this as a beginning to what I think is a worthwhile conversation, if a challenging one.  

Monday, April 8, 2019

The Devil Is In The Details

I recently had cause to remember a detail (one of the many below) that, for a client I recently saw that might be very important.  So here's some reminders for families of children with autism and other developmental disabilities.  Many of these things are applicable to "neurotypical" (NT) children and adolescents as well.
  • Regarding school issues: is there an IEP?  Is the IEP up to date?  Is the IEP descriptive and realistic about how the child's issues should be addressed?  Are the goals measurable (and not subjective)?  Was an autism specialist involved in developing the IEP?  Is there a behavioral plan, and if so, is it measurable and realistic?  Was there a Functional Behavioral Analysis (FBA) and if so, was it performed by a board certified behavior analyst (BCBA?)  (Many schools have employees who have taken an in-service do FBA's, which I don't recommend.  FBA's can be complex.)  Does the teacher receive the proper in class support to implement the IEP?  Might a change in classroom placement help your child succeed - whether to a more restrictive or less restrictive environment?  If the school has already suggested it, consider re-evaluating the options.  Has the child's diagnosis been re-assessed recently?  Remember, according to practice standards, psychological testing should be repeated every 3 years for children who have disabilities.  Was the testing done by the school or by an independent psychologist?  Some school psychologists do a great job, but you can always request a second opinion (and often the school has to pay for it.)
  • If your child is having behavioral challenges, might they be modulated with the use of medication?  Remember, trying a medication is not marriage, a short trial of medications is overwhelmingly safe (no I'm not an MD, but your MD will say the same thing re: most of the first line medications used for behavioral or emotional issues) - and there's decades of data on most of the medications used that have not indicated serious side effects.  If medication is currently being used, are you sure your child is taking it?  Has the dose been adjusted?  Remember, many of these meds are weight based, and as your child grows the dosage may need to be re-assessed.  Have you followed up with the prescribing physician per recommendations?  If your PCP (primary care physician) is prescribing the meds, and you don't think it's working well, consider consulting with a board certified child psychiatrist.  If you are already seeing a psychiatrist and feel that the meds have not been working, or that the psychiatrist is not paying proper attention, have you considered a second opinion?  (Best practice supports second opinions, don't be intimidated that the doc will not like you, he or she knows it's part of the business.)  If you're using herbal supplements to help with behavior, do your research.  As the FDA does not monitor them, supplements may or may not have the ingredients you think you are buying.  Have you researched the academic literature on the effectiveness of those supplements?
  • At home: is there other stress in the home that could be negatively impacting your child (think behavior or mood changes) such as marital issues?  Drug or alcohol use?  Medical issues affecting a parent or sibling?  Other mental health issues affecting a parent, sibling or other close family member?  (Parents of kids with special needs are at very high risk for depression due to the great stress that can exist.  Be honest with yourself and with your spouse/partner.)  Other significant stress on the family such as legal issues, frequent job changes or moves (even if for good reasons these may be hard for your child to cope with.)  Don't think that a child with more severe impairments doesn't "get it."  They can and do.  Has there been a divorce?  Remember, no matter how "amicable" the divorce, kids always lose.  Even when the divorce is needed, kids tend to want a reconciliation and tend to take responsibility, no matter what you tell them.  They need time, space and often therapy to absorb the reality that they really had nothing to do with it.  If/as the marriage is struggling, seek help now!  It's a whole ton cheaper in time and money to do so compared to the time and money involved in divorce.  (Therapists are cheaper than attorneys!)  Parents, don't forget the value of support groups.  There's nothing like speaking to someone who's been there, and you don't know that until you go, even if you're "not a group person."  (In the metro Atlanta area, the Spectrum support group based in Gwinnett County is easily the best in the state and I'd not be surprised if it's the best in the nation.  Certainly it's among the best in the nation and worth checking out.)  
  • Socially: Is your child being bullied by others (including siblings) in the neighborhood, the extended family or at school?  Has your child's mood or behavior seen a significant change?    Children with autism, whether high or low functioning, can exhibit signs of depression.  Look for a change in their normal mood, onset of irritability or of crying or a sad affect.  Have you considered the effects of puberty?  Have you explained these changes in a way they can understand?  Are they struggling with how to cope with their romantic feelings?  
This is a bit of a thought "dump" but all of these "details" are important and need attention.  The devil may be in the details, but ignoring the details can make life for you, your child and family a living hell.