I learned many years ago to assess gun safety in the homes after working with one very kind, nice boy who intentionally shot his stepmother in the head with a shotgun stored in her bedroom for safety. Another child found a gun in the home and killed his brother, having no intent to do so. And still a third was paralyzed from the chest down when his cousin discharged an unsecured weapon, also by accident.
Young adults with Asperger's and High Functioning Autims (HFA) often have a difficult time expressing their emotions. They also are often very pre-occupied with video games. And among the most popular are tens of millions of violently themed games with very realistic shooting of enemies, real and imagined, their realism increasing with the technology. The movies' ability to depict violence is even more striking and have broad audiences both on large and small screens. Kids, including kids with Asperger's and HFA are saturated with these increasingly realistic fictionalizations.
It is the nature of people with Asperger's and HFA to struggle with their emotions and emotional expression. It is often that they will express their emotions in action and not word. They often struggle with the skills involved to talk out their emotions which is why a significant number of them may end up tantrumming and even being violent instead of articulating their feelings as a way of discharging the emotional energy stored up. It is to this end that talk therapy, social skills groups and the like are so often recommended to individuals with Asperger's and HFA. It is also common for these folks to benefit from medications to lower their anxiety or to help organize their thoughts that can be distorted and illogical.
But not everyone in need of these services receives them. Many parents, for various reasons, do not pursue such services for their children and teens. Many people in need resist them. How, then, do they express their powerful emotions? It is not uncommon for this group of people to become depressed, and while signs of depression can include dispair that can lead to suicidal feelings, it can also lead to irritability and anger. The lack of ability to manage emotions, then, can be overpowering and the violent images (that might be normal for anyone to experience in a time of stress) can become all the more seductive, fueled by the images so rampant on our screens. Mix that with poor judgement, implusivity, social isolation and the possibility of distorted thoughts and logic and, well, you get the idea.
Parents of people with Asperger's and HFA, particularly those who are gun owners should, then, follow the basics of gun safety. The NRA advises that "dozens of gun storage devices, as well as locking devices that attach directly to the gun, are available." There is no better security than insuring that access to weapons is strictly controlled.
It seems intuitive that violent games and movies should be monitored, limited or even (gasp) not allowed to individuals who are unable to discuss and understand in detail the differences between the reality and fantasy of violent games and movies, and be able to well articulate their own emotions. This should apply to people on the Autistic spectrum as well as those who are not.
The issue of this entry is not gun ownership, but rather one of responsible gun ownership. And not just for families of children and young adults on the autistic spectrum, but families who have children or young adults who are typically developing, or families that have visitors, or anyone who might be burgled - which is everyone with a firearm.
Monday, December 17, 2012
Wednesday, December 5, 2012
DSM V and Asperger's
I'm not really worried about the upcoming changes in the DSM's categorization of Asperger's. In fact, I think it'll help clarify the many errors in how Asperger's, "high functioning autism" and pervasive developmental disability, not otherwise specified (PDD NOS) are currently diagnosed. Over time, it's seemed more and more rare to see kids who clearly fit the DSM IV's Asperger's criteria. I don't think that's due to the criteria being particularly vague. Rather, I think it's due to a combination of pressure from families and "mission creep" among professionals.
Diagnosing Asperger's requires a certain understanding of the population that increases by working with them - and the more one works with them, the more one understands what distinguishes someone with Asperger's from someone with PDD NOS or other diagnoses altogether. Yet, clinicians are often under a gun of sorts when parents bring their children, desperate for an answer to "what's wrong." Such pressure takes some strength to fight. Many parents are absolutely sure their child has Asperger's, and I believe clinicians have sometimes succumbed to that pressure.
I fear some succumb to the pressure by short cutting and forgetting to look at the "whole" child, the whole picture and context of who the person is within the family and the family's functioning. I also believe that it's hard for many to say "I don't know" or "let's meet for a while to see how comfortable Johnny is with a consistent relationship and then review the issue of diagnosis." And one of my favorite short cuts (oft quoted by a former colleague:) "He's kind of quirky, it's Asperger's." Quirky - in and of itself - is not a code word for Asperger's.
It seems that the day of the classic Aspie are gone. Very often kids with the diagnosis come in with lots of strengths and skills socially and interpersonally - unheard of for an Aspie in years past. It was almost refreshing recently to have a 12 y/o Aspie walk in my office, breeze past me as if I was not even there when I extended my hand and said hello, look around the office and sit down, totally avoiding eye contact, and initiate a discussion about a favorite science fiction book in a hyperactive way that was as much a discourse as it was discussion. Now THAT's Asperger's. This child had all the classic criteria: he was very "adult" in his presentation. He has significant social challenges - just not knowing how to mix socially with his peer group. He's very rigid, exploding when small things don't go right. He had a lot of anxiety when it came to discussing his own behavior, and a very ADHD profile. He could discuss his preferred topics in detail and at length, but was quickly disinterested and easily distracted when structured to discuss a to a different one.
Over the years, folks diagnosed with Asperger's coming for therapy have a much broader presentation. They may have appropriate social skills; good eye contact; an understanding of the subtlety of communication; a wry response to a bad joke (I specialize in bad hokes - it's a bit of a test to see how socially astute they are); facility in the flow of conversation; a broad range of affect in the prosody of their speech (the musicality and stress of words in their speech); spontaneous, genuine and quick compassion in social settings. Some had received the diagnosis when relatively young, in early grade school, and no re-assessment of that diagnosis has ever occurred, even as they approach adulthood. These kids seem to have a diagnosis that sticks as The Scarlet Letter did - never to be removed. Some parents, it seems, even seem to be hesitant for such a review, as the diagnosis explains all of the issues they and/or their kid may have. It sometimes seems a badge of some honor - even when it is quite evident that the diagnosis given to this child so many years ago is in dire need of review as he or she ages into the mid and late teens.
So why are people who've been diagnosed with Asperger's no longer seem to fit the diagnostic criteria? The most frequent thing I've seen is kids (or adults) who have the very challenging combination of ADHD and anxiety that may include obsessive compulsive behaviors and can result in the stilted and over controlled presentation that many folks on the spectrum display. ADHD with anxiety is a tough combination - and as so many kids on the higher end of the autistic spectrum have both, it's an understandable conclusion. A learning disability, particularly one that is based in language processing (NVLD - Non Verbal Learning Disability is a common one) is another challenge that can be misdiagnosed as Asperger's. Folks with language based learning disabilities may take longer than usual to consider and respond in the course of conversation. Their responses may be over deliberate, or be a bit tangential, as they have difficulty with language comprehension of or formulation of language. That can be a very challenging issue, but not necessarily Asperger's. Mix in the distractability, hyperactivity and/or impulsivity of ADHD and a conclusion of Asperger's can easily be understood, though inaccurate. Not to mention the "quirky" kids.
Professionals trained to work with kids know that developing a relationship over time provides an important cushion against these errors. However pressures of time, money, parental anxiety and, if I may say, over confidence can result in a premature and inaccurate "answer."
So I think the DSM V may ease some - but not all of the challenges clinicians have when diagnosing what is soon to pass in the official nomenclature as Asperger's, but I just don't think it'll amount to much. Folks with the diagnosis will still have an "autism spectrum disorder" and be eligible for special ed services and disability. And there will continue to be those included in the autism spectrum who really don't belong there - that's certain not to change.
So whether it's pre DSM V or post DSM V, my recommendation to clinicians remain: Don't forget to take time with the child. Some typically developing kids are genuinely shy and need more than your allotted amount of time to warm up. Get to know the dynamics of child's family to see how much that may be contributing to the child's presentation. Very challenging dynamics such as bitter divorce, substance abuse can create havoc in a child's sense of stability. Living in an emotionally "dysfunctional" (sorry for the use of the word, but it does capture a lot) family creates tons of stress on kids, whether they are on the spectrum or not. If they weren't anxious children before such stresses, they certainly can become that way after those stresses. Look at all the data, then look again, particularly if the diagnosis is not crystal clear. Look for the child's emotional reserve and availability. And most important, don't be afraid to say "I don't know." I think that's the boldest comment a clinician can make.
For parents: What is the experience the clinician has with diagnosing and working with kids on the autistic spectrum? Do you "click" with the clinician and develop a trust with them to communicate freely and openly? Remember that you are the expert on your child. Also remember that you are the consumer - you have the right to move to another clinician if you are uncomfortable. Also despite everything you've read on the Internet, don't go in with a presumption of what the final diagnosis is, part of the process of becoming a professional is being able to distinguish subtleties.
Most important to parents: remember that what most needs attention with your child is the their symptoms, not their diagnosis. Nobody treats Asperger's. What is treated is the symptoms of Asperger's. Whether it's a presentation of anxiety, ADHD, poor social skills, sensory issues etc., it is the symptoms that are treated, not the diagnosis.
So, DSM V, bring it on!
Diagnosing Asperger's requires a certain understanding of the population that increases by working with them - and the more one works with them, the more one understands what distinguishes someone with Asperger's from someone with PDD NOS or other diagnoses altogether. Yet, clinicians are often under a gun of sorts when parents bring their children, desperate for an answer to "what's wrong." Such pressure takes some strength to fight. Many parents are absolutely sure their child has Asperger's, and I believe clinicians have sometimes succumbed to that pressure.
I fear some succumb to the pressure by short cutting and forgetting to look at the "whole" child, the whole picture and context of who the person is within the family and the family's functioning. I also believe that it's hard for many to say "I don't know" or "let's meet for a while to see how comfortable Johnny is with a consistent relationship and then review the issue of diagnosis." And one of my favorite short cuts (oft quoted by a former colleague:) "He's kind of quirky, it's Asperger's." Quirky - in and of itself - is not a code word for Asperger's.
It seems that the day of the classic Aspie are gone. Very often kids with the diagnosis come in with lots of strengths and skills socially and interpersonally - unheard of for an Aspie in years past. It was almost refreshing recently to have a 12 y/o Aspie walk in my office, breeze past me as if I was not even there when I extended my hand and said hello, look around the office and sit down, totally avoiding eye contact, and initiate a discussion about a favorite science fiction book in a hyperactive way that was as much a discourse as it was discussion. Now THAT's Asperger's. This child had all the classic criteria: he was very "adult" in his presentation. He has significant social challenges - just not knowing how to mix socially with his peer group. He's very rigid, exploding when small things don't go right. He had a lot of anxiety when it came to discussing his own behavior, and a very ADHD profile. He could discuss his preferred topics in detail and at length, but was quickly disinterested and easily distracted when structured to discuss a to a different one.
Over the years, folks diagnosed with Asperger's coming for therapy have a much broader presentation. They may have appropriate social skills; good eye contact; an understanding of the subtlety of communication; a wry response to a bad joke (I specialize in bad hokes - it's a bit of a test to see how socially astute they are); facility in the flow of conversation; a broad range of affect in the prosody of their speech (the musicality and stress of words in their speech); spontaneous, genuine and quick compassion in social settings. Some had received the diagnosis when relatively young, in early grade school, and no re-assessment of that diagnosis has ever occurred, even as they approach adulthood. These kids seem to have a diagnosis that sticks as The Scarlet Letter did - never to be removed. Some parents, it seems, even seem to be hesitant for such a review, as the diagnosis explains all of the issues they and/or their kid may have. It sometimes seems a badge of some honor - even when it is quite evident that the diagnosis given to this child so many years ago is in dire need of review as he or she ages into the mid and late teens.
So why are people who've been diagnosed with Asperger's no longer seem to fit the diagnostic criteria? The most frequent thing I've seen is kids (or adults) who have the very challenging combination of ADHD and anxiety that may include obsessive compulsive behaviors and can result in the stilted and over controlled presentation that many folks on the spectrum display. ADHD with anxiety is a tough combination - and as so many kids on the higher end of the autistic spectrum have both, it's an understandable conclusion. A learning disability, particularly one that is based in language processing (NVLD - Non Verbal Learning Disability is a common one) is another challenge that can be misdiagnosed as Asperger's. Folks with language based learning disabilities may take longer than usual to consider and respond in the course of conversation. Their responses may be over deliberate, or be a bit tangential, as they have difficulty with language comprehension of or formulation of language. That can be a very challenging issue, but not necessarily Asperger's. Mix in the distractability, hyperactivity and/or impulsivity of ADHD and a conclusion of Asperger's can easily be understood, though inaccurate. Not to mention the "quirky" kids.
Professionals trained to work with kids know that developing a relationship over time provides an important cushion against these errors. However pressures of time, money, parental anxiety and, if I may say, over confidence can result in a premature and inaccurate "answer."
So I think the DSM V may ease some - but not all of the challenges clinicians have when diagnosing what is soon to pass in the official nomenclature as Asperger's, but I just don't think it'll amount to much. Folks with the diagnosis will still have an "autism spectrum disorder" and be eligible for special ed services and disability. And there will continue to be those included in the autism spectrum who really don't belong there - that's certain not to change.
So whether it's pre DSM V or post DSM V, my recommendation to clinicians remain: Don't forget to take time with the child. Some typically developing kids are genuinely shy and need more than your allotted amount of time to warm up. Get to know the dynamics of child's family to see how much that may be contributing to the child's presentation. Very challenging dynamics such as bitter divorce, substance abuse can create havoc in a child's sense of stability. Living in an emotionally "dysfunctional" (sorry for the use of the word, but it does capture a lot) family creates tons of stress on kids, whether they are on the spectrum or not. If they weren't anxious children before such stresses, they certainly can become that way after those stresses. Look at all the data, then look again, particularly if the diagnosis is not crystal clear. Look for the child's emotional reserve and availability. And most important, don't be afraid to say "I don't know." I think that's the boldest comment a clinician can make.
For parents: What is the experience the clinician has with diagnosing and working with kids on the autistic spectrum? Do you "click" with the clinician and develop a trust with them to communicate freely and openly? Remember that you are the expert on your child. Also remember that you are the consumer - you have the right to move to another clinician if you are uncomfortable. Also despite everything you've read on the Internet, don't go in with a presumption of what the final diagnosis is, part of the process of becoming a professional is being able to distinguish subtleties.
Most important to parents: remember that what most needs attention with your child is the their symptoms, not their diagnosis. Nobody treats Asperger's. What is treated is the symptoms of Asperger's. Whether it's a presentation of anxiety, ADHD, poor social skills, sensory issues etc., it is the symptoms that are treated, not the diagnosis.
So, DSM V, bring it on!
Monday, November 12, 2012
D*mn the Torpedos
I thought a Veteran's Day title appropriate, since parents do often feel like they're in battle when setting limits on their kids - even limits that have health implications.
I've been working with a certain young man for many years. He's a great guy, very social with some special needs. You couldn't find a nicer person. His parents also - as nice as you can find. His doctor recently told him that he needed to lose weight due to a number of medical issues - all of them with significant potential to hurt him.
Our first meeting after the MD appointment resulted in a simple but effective plan to inhibit his indulgent eating habits. He protested mightily, but, bless his heart, he's more bluster than anything. I told him that I too - indeed most all of us hate, HATE to have our preferred foods restricted in any way. But as we discussed in detail the potential harm that could come to him via his obesity, he conceded. Begrudgingly. Very begrudgingly.
Until he left my office. He has a long history - as many special needs kids do - of warfare with his parents/s. Some kids are violent, a tough situation to deal with, but it's do-able. In this case, it's exclusively verbal, thankfully. But it wears mom down none the less. She's understandably exhausted and, not surprisingly, ultimately succumbed to his verbal assaults and his open access to unhealthy foods on an almost daily basis resumed.
So we met again today and worked out a compromise that would allow continued social time at his favorite feeding holes - with him agreeing to brown bag his lunch and mom to supervise the pocket change he has to inhibit his access to foods that are harmful.
We'll see how this round goes. I'm anticipating more battles, but hopefully, mom will stand strong as the onslaught of complaints, bargaining, promises (lots of promises), pleading and refusal to comply with the agreement resumes.
So, my Veteran's Day message to all parents of all kids: Stand Strong. Stand By What You Know Is Right. You Are the Leaders of Your Family. You Can Win This Battle.
I've been working with a certain young man for many years. He's a great guy, very social with some special needs. You couldn't find a nicer person. His parents also - as nice as you can find. His doctor recently told him that he needed to lose weight due to a number of medical issues - all of them with significant potential to hurt him.
Our first meeting after the MD appointment resulted in a simple but effective plan to inhibit his indulgent eating habits. He protested mightily, but, bless his heart, he's more bluster than anything. I told him that I too - indeed most all of us hate, HATE to have our preferred foods restricted in any way. But as we discussed in detail the potential harm that could come to him via his obesity, he conceded. Begrudgingly. Very begrudgingly.
Until he left my office. He has a long history - as many special needs kids do - of warfare with his parents/s. Some kids are violent, a tough situation to deal with, but it's do-able. In this case, it's exclusively verbal, thankfully. But it wears mom down none the less. She's understandably exhausted and, not surprisingly, ultimately succumbed to his verbal assaults and his open access to unhealthy foods on an almost daily basis resumed.
So we met again today and worked out a compromise that would allow continued social time at his favorite feeding holes - with him agreeing to brown bag his lunch and mom to supervise the pocket change he has to inhibit his access to foods that are harmful.
We'll see how this round goes. I'm anticipating more battles, but hopefully, mom will stand strong as the onslaught of complaints, bargaining, promises (lots of promises), pleading and refusal to comply with the agreement resumes.
So, my Veteran's Day message to all parents of all kids: Stand Strong. Stand By What You Know Is Right. You Are the Leaders of Your Family. You Can Win This Battle.
Sunday, November 4, 2012
The Mouths of Babes
We recently had guests and I observed one older sister teaching her younger sister (they were about 11 and 10) a critical lesson on how to put the socks on their 2 year old brother. The 10 year old was struggling with the task, speaking to the boy trying to calm him down, trying to reason with him, as he was strongly resisting. The older sister took the boy on her lap, took the socks, and quietly explained to her sister that "You just have to ignore him and put the socks on." Simple, clean, straight forward. And low and behold, within seconds the task was complete. Now this girl is the eldest of 5, soon to be 6, and all the children were nicely behaved. There was very little squabbling between them. And this is not unique to this family or these parents. I also know the mother's sister who has 10 (yes, you read that correctly, 10) children and they are all similarly behaved. The parents go to great lengths to act when needed and not act when not needed - and the children learn from them.
This lesson is one that so many parents with kids - whether on the autistic spectrum, whether they have developmental disabilities or not, struggle with. (My wife and I certainly did when our kids were young.) I can't count the times I've seen parents - even those who've been trained on how to "ignore" - maintain an ongoing dialogue with their child explaining, rationalizing, asking, pleading and/or almost begging their children while in the midst of a "time out" or other trial of parenting.
Whether it is a of time out or getting the child to comply with a demand that has been made, the message that the parent is in control is critical. In time out, the goal is to isolate the child, momentarily, from the social connection that he or she has with his caretaker. Speaking to the child at any length during the time out totally undercuts its purpose. When a demand has been made, the parent must know the child and increase the likelihood that the request is reasonable and that the conditions are ripe to ensure compliance. (How many of us ask kids to do a task knowing they are hitting the wall of hunger or fatigue that makes it quite unlikely they can comply?)
These can be very hard lessons to learn, even harder when we - and our children - have to unlearn other lessons. But the payoff is the child and parents both learning who is in control in the family. And that is ultimately a comforting thing for a child who has been able, through tantrumming or obstinance, be able to be in control the family.
This lesson is one that so many parents with kids - whether on the autistic spectrum, whether they have developmental disabilities or not, struggle with. (My wife and I certainly did when our kids were young.) I can't count the times I've seen parents - even those who've been trained on how to "ignore" - maintain an ongoing dialogue with their child explaining, rationalizing, asking, pleading and/or almost begging their children while in the midst of a "time out" or other trial of parenting.
Whether it is a of time out or getting the child to comply with a demand that has been made, the message that the parent is in control is critical. In time out, the goal is to isolate the child, momentarily, from the social connection that he or she has with his caretaker. Speaking to the child at any length during the time out totally undercuts its purpose. When a demand has been made, the parent must know the child and increase the likelihood that the request is reasonable and that the conditions are ripe to ensure compliance. (How many of us ask kids to do a task knowing they are hitting the wall of hunger or fatigue that makes it quite unlikely they can comply?)
These can be very hard lessons to learn, even harder when we - and our children - have to unlearn other lessons. But the payoff is the child and parents both learning who is in control in the family. And that is ultimately a comforting thing for a child who has been able, through tantrumming or obstinance, be able to be in control the family.
Monday, October 22, 2012
What's a parent to do? Diagnostic Conundrums
It's not uncommon for some children to be diagnosed differently by different professionals, all of whom are qualified and well meaning, wanting to help unravel the complicated presentation that some kids bring. But when these diagnoses, or diagnostic impressions conflict, what's a parent to do?
First, it is important to remember that kids are very often being assessed in a relatively short snapshot of time. Even during psychological testing, which usually takes a number of hours to accomplish, there are a number of challenges that have to be overcome: The child has to find comfort with the tester in a relatively short time, the child has to be able to properly process the commands being made etc. Also, if the child will ultimately need meds for attention (which is very common among kids on the spectrum, or who are suspected of being on the spectrum) if those meds are not given, or if the recommendation for those meds has not yet been made, the child will test differently than if the meds were on board. There are many variables that can affect the clinician's view of the child.
Second, kids change rapidly. A child's presentation from today to six months from now can be very different. I often tell parents to consider the percentage change six months (for example) represents in a child's life. If a 5 year old child is seen today and again in 6 months, that 6 months represents 10% of the child's lifetime. That's a lot of time! Thus, we can see lots of changes in relatively short amounts of time. Reconfirmation of a diagnoses, particularly in the "high functioning" range is very important.
And finally, what if, despite all of the variables being taken into consideration there's still confusion as to the child's presentation. It's common enough for me to see psychological testing from experts in the field who can only speculate as to the child's diagnosis. Is this a reflection on the psychologist or MD doing the testing or evaluation? Not necessarily. It sometimes means that the child is, maybe just for this snapshot in time, one who falls in the "grey area." Some kids are, indeed, difficult to diagnose.
What's a parent to do? Well, I think that whether there is or is not a clear diagnosis, the key intervention that needs to be made is regarding the primary symptoms the child presents. Speech delay? Focus on language acquisition. Non compliance? Work on increasing compliance. Inability to relate to peers? Place the child in situations where peer interaction is a part of the curriculum. Tantrumming? Tantrum management (yes there is such a thing!)
Remember, it is the presenting behaviors that we treat when it comes to most developmental disabilities, not the diagnoses.
First, it is important to remember that kids are very often being assessed in a relatively short snapshot of time. Even during psychological testing, which usually takes a number of hours to accomplish, there are a number of challenges that have to be overcome: The child has to find comfort with the tester in a relatively short time, the child has to be able to properly process the commands being made etc. Also, if the child will ultimately need meds for attention (which is very common among kids on the spectrum, or who are suspected of being on the spectrum) if those meds are not given, or if the recommendation for those meds has not yet been made, the child will test differently than if the meds were on board. There are many variables that can affect the clinician's view of the child.
Second, kids change rapidly. A child's presentation from today to six months from now can be very different. I often tell parents to consider the percentage change six months (for example) represents in a child's life. If a 5 year old child is seen today and again in 6 months, that 6 months represents 10% of the child's lifetime. That's a lot of time! Thus, we can see lots of changes in relatively short amounts of time. Reconfirmation of a diagnoses, particularly in the "high functioning" range is very important.
And finally, what if, despite all of the variables being taken into consideration there's still confusion as to the child's presentation. It's common enough for me to see psychological testing from experts in the field who can only speculate as to the child's diagnosis. Is this a reflection on the psychologist or MD doing the testing or evaluation? Not necessarily. It sometimes means that the child is, maybe just for this snapshot in time, one who falls in the "grey area." Some kids are, indeed, difficult to diagnose.
What's a parent to do? Well, I think that whether there is or is not a clear diagnosis, the key intervention that needs to be made is regarding the primary symptoms the child presents. Speech delay? Focus on language acquisition. Non compliance? Work on increasing compliance. Inability to relate to peers? Place the child in situations where peer interaction is a part of the curriculum. Tantrumming? Tantrum management (yes there is such a thing!)
Remember, it is the presenting behaviors that we treat when it comes to most developmental disabilities, not the diagnoses.
Tuesday, October 2, 2012
Fatigue
I'm tired right now. It's been a long couple of days. I'm cranky. Taking a walk around 6:30 this evening, I saw a mom trying to herd a child to walk away from where dad was. "I want to be with my daddy" he screamed and laughed at the same time playing a bit of a "you can't catch me" with mom who was good naturedly trying to herd him home. The game, however, was quickly turning to more tears than laughter. I only saw this for a moment as I went by, but thought of how hard the "witching hour" of the late afternoon was for kids. But by that time of day parents are tired too! So I recall what parents of kids with autism and other disabilities tell me, that it's a dreadful time, more than with their typically developing kids.
What's the answer?.....well.......I don't know there's a perfect or a simple solution. It seems patronizing to tell any parent, not to mention the parent of a special kid to simply find time to relax, to remain calm, to remember that the child's tired and cranky too - though I always try to reinforce for parents to do just that whenever they can - you never know when you may need to turn the parenting "afterburners" on. I also think another aspect of the solution may be through having empathy. The parent will hopefully strive to empathize with the child's fatigue, hunger, confusion or whatever may be happening. So too can the parent spend a moment - maybe the briefest moment - to empathize with themselves and how fatigued they are. Sometimes just taking a moment to consider one's own fatigue can facilitate finding a bit more strength, a bit more patience for the child.
What's the answer?.....well.......I don't know there's a perfect or a simple solution. It seems patronizing to tell any parent, not to mention the parent of a special kid to simply find time to relax, to remain calm, to remember that the child's tired and cranky too - though I always try to reinforce for parents to do just that whenever they can - you never know when you may need to turn the parenting "afterburners" on. I also think another aspect of the solution may be through having empathy. The parent will hopefully strive to empathize with the child's fatigue, hunger, confusion or whatever may be happening. So too can the parent spend a moment - maybe the briefest moment - to empathize with themselves and how fatigued they are. Sometimes just taking a moment to consider one's own fatigue can facilitate finding a bit more strength, a bit more patience for the child.
Wednesday, September 19, 2012
The Importance of Mom and Dad
This is directed to those parents who are both involved in their children's lives, whether living in the same home or not, and whether the kids have developmental delays or not. There are some basic lessons to remember:
1. Kids are sponges - they know how happy mom and dad are by how they ask one another for the salt at the dinner table. Kids are great gauges of a marriage.
2. Kids need, desperately, for parents to be happy, and if not happy, communicating with one another, whether married or not. The ability to "fight to resolution" is key. Disagreements in marriages are normal. Disagreements in divorce are obvious. Showing your child that you can communicate with your (ex) partner in a civil way with and all the more so with your ex, sends a profound message of safety, yes, safety to them. (Safe in that if mom/dad can manage their strongest emotions, so can I.)
3. You've heard it before, but that's because it's true. Don't air your dirty laundry about your ex to your kids. Kids have to have at least an image of both parents in their head. Badmouthing your spouse or ex to the children is just plain hurtful.
Whenever I'm seeing a child in therapy, usually with a parent, I always check to see how the marriage is (or how the divorce is.) The more challenges, the more the child suffers. It's basic. Parents fighting hurts kids. Go to any lengths to avoid it, and to further lengths to shield your child from your differences with your (ex) partner. It's that important for a child's emotional safety.
1. Kids are sponges - they know how happy mom and dad are by how they ask one another for the salt at the dinner table. Kids are great gauges of a marriage.
2. Kids need, desperately, for parents to be happy, and if not happy, communicating with one another, whether married or not. The ability to "fight to resolution" is key. Disagreements in marriages are normal. Disagreements in divorce are obvious. Showing your child that you can communicate with your (ex) partner in a civil way with and all the more so with your ex, sends a profound message of safety, yes, safety to them. (Safe in that if mom/dad can manage their strongest emotions, so can I.)
3. You've heard it before, but that's because it's true. Don't air your dirty laundry about your ex to your kids. Kids have to have at least an image of both parents in their head. Badmouthing your spouse or ex to the children is just plain hurtful.
Whenever I'm seeing a child in therapy, usually with a parent, I always check to see how the marriage is (or how the divorce is.) The more challenges, the more the child suffers. It's basic. Parents fighting hurts kids. Go to any lengths to avoid it, and to further lengths to shield your child from your differences with your (ex) partner. It's that important for a child's emotional safety.
Wednesday, September 12, 2012
What are we teaching?
At the playground with my granddaughter last week, I observed a woman (sitter? grandmother? but too old to be mom) who was caring for a 2 1/2 or so year old boy. He was on one of those small structures that has multiple slides and stairs that all lead to a large platform upon which he was grandly sitting and ignoring her repeated demands. She demanded him to go down the slide. He ignored. She demanded he come down so they could go home, that he move to accommodate my granddaughter (who he was not bothering), he ignored. She repeated these demands over and over. He ignored, and then I saw a smile on his face, reveling in the glory of his power to ignore the demands of his caretaker. Curiously, the woman could have easily walked up the stairs and scooped him up and forced his compliance, but didn't. Maybe she has a bad back? She certainly has taught him an important lesson about what happens when demands are made of him. Absolutely nothing. By the time we left, he was still king of the hill.
Tuesday, September 4, 2012
Putting the "Early" in Early Intervention
It's a well known fact that the earlier we begin educating our children the more they learn and the better they do. This is so much more for children with developmental disabilities who have extra challenges in their cognitive, physical and/or behavioral growth. I was reminded of this when working with a mom who discussed how to best manage her 3 year old girl's aggressive behavior - the girl would hit mom when upset or not getting what she wanted. Mom understood the challenge in setting limits for this child, as her tantrums would surely escalate before finding another more "adaptive" way of expression. (Not to mention finding positive ways of engaging the child so she's less likely to seek attention by hitting.) It's one thing to teach a 3 year old how to regulate their emotions. It's another thing altogether to do so with a 6, 10 or 15 year old.
Friday, August 24, 2012
EXPECTATIONS OF OUR KIDS
8/24/12 EXPECTIONS OF OUR KIDS
Twice this week I've been in meetings with parents who want their high functioing kids with autism to have more "insight" about their own behaviors, manipulations and the burden they bring to the family. This is an experience I've seen repeatedly, particularly in families with HFA/Aspie kids. They seem so darned close to "getting it" the "it" being the sublties of social relationships and it's so frustrating for the family members when the person then resumes their rigid thinking or soon repeats the very same behavior or dynamic that was just discussed.
What these folks tend to forget is that the subtlties of relationships are in the very heart of the social and communication delays that folks with HFA have. Remembering that the person, no matter how insightful or bright they may be in other areas, still has autism. Thus, they are always likely to exhibit this lack of personal awareness. It's not done to make you crazy, it's just who they are.
Twice this week I've been in meetings with parents who want their high functioing kids with autism to have more "insight" about their own behaviors, manipulations and the burden they bring to the family. This is an experience I've seen repeatedly, particularly in families with HFA/Aspie kids. They seem so darned close to "getting it" the "it" being the sublties of social relationships and it's so frustrating for the family members when the person then resumes their rigid thinking or soon repeats the very same behavior or dynamic that was just discussed.
What these folks tend to forget is that the subtlties of relationships are in the very heart of the social and communication delays that folks with HFA have. Remembering that the person, no matter how insightful or bright they may be in other areas, still has autism. Thus, they are always likely to exhibit this lack of personal awareness. It's not done to make you crazy, it's just who they are.
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