Getting through to kids and teens, particularly if they are on the autism spectrum, can be difficult. Just as difficult is getting through to them regarding the stigma of being "different." Nobody wants to be different. We all want to be normal, right smack dab in the middle of the bell curve. The reality is, however, that none of us are "average," or "normal." We're each unique in our own unique way and thus have an obligation to recognize our uniqueness and to accommodate for them.
One of the examples I use to help get through the stigma of "difference" is diabetes. Most everyone, even kids, has at least heard of diabetes, many folks have family members with it and I also work with kids who actually have diabetes - so they of course know firsthand the realities of the disease. Diabetes is caused by the inability of the pancreas to produce insulin, and insulin is what metabolizes the sugars in the system. Without insulin, ones' blood glucose levels go up upsetting the delicate chemical balance that sustains us. What's clear with diabetes is that it's nobody's fault, and despite the "unfair" aspect of having it, it has to be dealt with. (Even type 2 diabetes is not anyone's fault, obesity is a risk factor, but not directly causative of diabetes. Plenty of obese people never get diabetes.)
I start off explaining to kids that the first reality of diabetes or (fill in the blank: autism; ADHD; depression etc.) is that it is. It's a thing. It can be manageable, but one has to manage it. Having diabetes requires that one check one's blood glucose levels regularly. That usually means a small stick in a finger, a drop of blood in the glucometer and insulin per the doctor's instructions. If you don't do that you increase the risk of complications that can become life threatening. I often run through the litany of the things less severe than death that can happen with poor diabetes management like amputation of a limb, blindness, kidney failure, all the kinds of things that terrify any thinking person.
And then there's autism. People with high functioning (and even lower functioning) autism are at higher risk for things like ADHD, anxiety, depression and OCD and more. That doesn't mean people with autism will automatically have these problems, they just are at higher risk. And when one has one of these complications, it's incumbent on the person to recognize them and take action. That's why we have family members, therapists and doctors, to observe, comment and suggest. Part of the problem with suggestions is that they imply a responsibility, a weighty word to use for adolescents who are often not paragons of responsibility. And yet being depressed or anxious is no picnic, just like being in the hospital with diabetic ketoacidosis is not a fun activity.
The suggestions for managing the complications of high functioning autism like ADHD, anxiety and depression can be minor or major. My standard recommendation for anxiety and depression is exercise. For years studies show that 30 minutes of aerobic exercise 3-4 times per week helps reduce anxiety and depression. Mindfulness, the practice of self awareness is another recommendation that's been around for ....millennia. So I recommend practices like meditation (I like guided meditation) and/or yoga to help with that. And the combination of meditation and exercise shows great results in combating depression. Medications are often quite helpful as well, but no matter what the suggestion, like the diabetic, one has to actually take action to do what can help.
Lots of kids and adolescents (yes, and adults), struggle with compliance with suggestions like meditation, exercise or medication. Often as a response to their not fully recognizing the reality that they have. But I remind them, we all have something. Even the kid you think has it all, doesn't. Everybody has something they struggle with, something that needs attention and management. We all have diabetes.
Sunday, December 24, 2017
Sunday, November 19, 2017
About "Wonder"
I'm a sucker for tear jerkers. They're predictable, cathartic and appeal to my soft emotional underbelly. So I was expecting it when I saw "Wonder." It met all of the usual criteria; it was predictable, had heartstring tugging moments (my friend who also works with people with disabilities and I both found the dog scene, ironically, the tipping point.) It was star studded and Hollywood-y with a happy ending. But it had more, a lot more, and what it had makes it worth seeing by most anyone, particularly by typically developing kids who have siblings with different abilities or disabilities, their parents, friends, families, neighbors and yes, kids with differing abilities as well.
What was unique was its unanticipated focus on a number of the individual children in the story, both protagonist and antagonist, that revealed much more of the subtle and complex background kids in late elementary and high school endure. It's easy for adults to chalk up kids drama to "drama." But it's not drama for them, no more than our adult drama is to us. It's critical, compelling, gut wrenching and painful. "Wonder" did a superlative job in going behind the scenes of the children, highlighting the struggles children and adults of all stripes all have with loyalty, betrayal, forgiveness, ambivalence and persistence.
Siblings of kids with special needs should see it due to the compelling portrayal of the sister by Izabela Vidovic. Siblings of differently abled kids cope - they have to given the often universal demands their siblings present. But they don't have to like it and their hearts have limits. The mix of the love, resentment, anger, frustration, hopelessness and endurance of siblings of kids with disabilities was well presented and will ring true for kids who try their best to support through the challenges of their own adolescence.
Neurotypical kids who attend just about any school should see it as it presents the multitude of mixed emotions and rivalries that contribute to harsh bullying (which is actually a redundancy), whether of a child with a special need or of any kid at all. (I will say I thought one weakness of the film was its lack of mental health support at the school, but that's Tinseltown for you.) And for parents who have any discomfort with "differences" which is most all of us. The struggle of the power of the group and how peers influence one another to bully was well portrayed, reminding us that the bully may be a victim as well.
So , yes, it's tear evoking with a sugar coated ending. It has predictable parent figures representing caricatures from very good to very bad. It's Hollywood. But it's strengths greatly outweigh any weaknesses and it's appropriate for parents and kids who can cope with the realities of life in 5th grade and up. It will make for great conversation with your typically developing kids as well as with your kids with any kind of special need.
What was unique was its unanticipated focus on a number of the individual children in the story, both protagonist and antagonist, that revealed much more of the subtle and complex background kids in late elementary and high school endure. It's easy for adults to chalk up kids drama to "drama." But it's not drama for them, no more than our adult drama is to us. It's critical, compelling, gut wrenching and painful. "Wonder" did a superlative job in going behind the scenes of the children, highlighting the struggles children and adults of all stripes all have with loyalty, betrayal, forgiveness, ambivalence and persistence.
Siblings of kids with special needs should see it due to the compelling portrayal of the sister by Izabela Vidovic. Siblings of differently abled kids cope - they have to given the often universal demands their siblings present. But they don't have to like it and their hearts have limits. The mix of the love, resentment, anger, frustration, hopelessness and endurance of siblings of kids with disabilities was well presented and will ring true for kids who try their best to support through the challenges of their own adolescence.
Neurotypical kids who attend just about any school should see it as it presents the multitude of mixed emotions and rivalries that contribute to harsh bullying (which is actually a redundancy), whether of a child with a special need or of any kid at all. (I will say I thought one weakness of the film was its lack of mental health support at the school, but that's Tinseltown for you.) And for parents who have any discomfort with "differences" which is most all of us. The struggle of the power of the group and how peers influence one another to bully was well portrayed, reminding us that the bully may be a victim as well.
So , yes, it's tear evoking with a sugar coated ending. It has predictable parent figures representing caricatures from very good to very bad. It's Hollywood. But it's strengths greatly outweigh any weaknesses and it's appropriate for parents and kids who can cope with the realities of life in 5th grade and up. It will make for great conversation with your typically developing kids as well as with your kids with any kind of special need.
Monday, August 21, 2017
Atypical: To Watch or Not To Watch
I usually avoid popular media stuff about autism - finding it to be too often inauthentic, and seeing kids and adults on the spectrum daily, I don't really have the patience for Hollywood's artistic interpretation of autism. But I heard about Atypical, Netflix's new show on a family of an 18 year old with High Functioning Autism and tried it. I liked it, mostly.
What I liked about Atypical was the quality of the acting by Kier Gilchrist playing Sam, the show's protagonist. He does an excellent job showing the subtleties of a young adult on the spectrum. From different sensory issues to missing social cues - sometimes broadly. From concrete thinking to depression and anxiety, to his perseverative and believable knowledge of Antarctica, its geography, wildlife and history he does a great job, as does the rest of the cast.
Parents should be quite aware, however, that the show has lots of adult content. Not explicit, but neither is it vague. It has all the vulgarity that one might expect from a realistic show about teens, which might be enough of a caution, but also delves into issues of teenage sexual activity and marital infidelity. Before you allow your child (on the spectrum or not) to view the show, know that the content is sometimes dicey. These issues carry the plot along well, but might be difficult for kids on the spectrum to digest without a lot of adult support that's prepared to face these issues head on.
Some of what the script calls upon in the lead actor seemed a bit too all encompassing. Sam has moments of brilliant clarity and a strong personal code with all the challenges we're familiar with in folks on the spectrum. This moves the character between the extremes of a total tantrum on a bus (sensory overload sparked by an emotional encounter that was not to his liking) to heartfelt apologies for insensitive behavior. His sometimes high level of insight and personal awareness seems to me to be more a function of moving the plot along than it does a reflection of the reality of the life of a teen on the spectrum. But, as we know, when you've met one person on the spectrum, you've met one person and it's difficult to extrapolate to what others might do.
What was worth it was not only Gilchrist's acting, but the earnest reality of his family orbiting around him trying to help him sometimes sensitively and successfully, other times clumsily. The dad who struggled with the early diagnosis now wanting a closer relationship to his family. A mom whose entire life has been wrapped up with caring for her kid with a disability who has to redefine herself as he becomes more independent. And most important that of his sister, Casey, played by Bridget Lundy-Paine. Siblings of kids with special needs so often become lost in the shadows of the family due to the demands placed upon them. Lundy-Paine plays the character well, coping with her own sense of loss of place via a dismissive and flippant attitude to most of her brother's irritating behaviors as well as her parents' attempts to manage them balanced by her high athletic achievements. And his girlfriend Paige, played by Jenna Boyd who presents as quite "quirky" but apparently missed the diagnosis boat. Her advocacy for a "quiet" school dance that would allow Sam to be included was touching and thought provoking.
So see it. Just be prepared for the standard Hollywood additives that spice up most of our media these days - and make sure your kids are prepared.
What I liked about Atypical was the quality of the acting by Kier Gilchrist playing Sam, the show's protagonist. He does an excellent job showing the subtleties of a young adult on the spectrum. From different sensory issues to missing social cues - sometimes broadly. From concrete thinking to depression and anxiety, to his perseverative and believable knowledge of Antarctica, its geography, wildlife and history he does a great job, as does the rest of the cast.
Parents should be quite aware, however, that the show has lots of adult content. Not explicit, but neither is it vague. It has all the vulgarity that one might expect from a realistic show about teens, which might be enough of a caution, but also delves into issues of teenage sexual activity and marital infidelity. Before you allow your child (on the spectrum or not) to view the show, know that the content is sometimes dicey. These issues carry the plot along well, but might be difficult for kids on the spectrum to digest without a lot of adult support that's prepared to face these issues head on.
Some of what the script calls upon in the lead actor seemed a bit too all encompassing. Sam has moments of brilliant clarity and a strong personal code with all the challenges we're familiar with in folks on the spectrum. This moves the character between the extremes of a total tantrum on a bus (sensory overload sparked by an emotional encounter that was not to his liking) to heartfelt apologies for insensitive behavior. His sometimes high level of insight and personal awareness seems to me to be more a function of moving the plot along than it does a reflection of the reality of the life of a teen on the spectrum. But, as we know, when you've met one person on the spectrum, you've met one person and it's difficult to extrapolate to what others might do.
What was worth it was not only Gilchrist's acting, but the earnest reality of his family orbiting around him trying to help him sometimes sensitively and successfully, other times clumsily. The dad who struggled with the early diagnosis now wanting a closer relationship to his family. A mom whose entire life has been wrapped up with caring for her kid with a disability who has to redefine herself as he becomes more independent. And most important that of his sister, Casey, played by Bridget Lundy-Paine. Siblings of kids with special needs so often become lost in the shadows of the family due to the demands placed upon them. Lundy-Paine plays the character well, coping with her own sense of loss of place via a dismissive and flippant attitude to most of her brother's irritating behaviors as well as her parents' attempts to manage them balanced by her high athletic achievements. And his girlfriend Paige, played by Jenna Boyd who presents as quite "quirky" but apparently missed the diagnosis boat. Her advocacy for a "quiet" school dance that would allow Sam to be included was touching and thought provoking.
So see it. Just be prepared for the standard Hollywood additives that spice up most of our media these days - and make sure your kids are prepared.
Wednesday, August 16, 2017
It's OK
As with all posts, identifying data has been changed to insure for confidentiality of clients.
A number of years ago I organized a support group for parents of kids who had autism and other disabilities. One of the women who spoke was a friend, more an acquaintance, whose daughter has autism and a number of other very serious challenges. At the time she spoke, her daughter was well into adulthood. She had always been described as "low functioning," having minimal spoken language, minimal self care skills and cognitive level of a preschooler. The challenges she and her husband faced raising and caring for their daughter are many, pervasive and really, really hard.
She related issue after issue that confronted them and their daughter. She needed to be bathed, sometimes by mom, sometimes by dad depending on their schedules and professional obligations. She noted the awkwardness that her husband had to deal with bathing their adult daughter. She discussed the inconvenience she and her husband had meeting their social and professional obligations, having to split their time between which of them would go to the event and which of them would stay home with their daughter. She went on to describe in some detail the many mundane yet demanding details required of them in their care of their daughter. And after each challenge she described she said a simple statement. She said, softly, convincingly, "It's OK." That was it. Calm. Believable. The acceptance she had with challenges most all of us can't even imagine and it moved me to wonder about the challenges in my life that made me crazy and how well I accept them.
Her story came back to me when I was recently meeting with a single mom me re: her only child, a son who was dealing with some sensory issues. Sensory issues, for those who don't know, have to do with the five senses we all learned about in Elementary school - sight, sound, touch, smell and taste. It's common for people with autism to have either a strong aversion to sensory input in one of these five areas, or to have a need for hyper input in one of these five areas. Think of fingernails on the chalkboard and how that sound makes the skin crawl for most of us, or a foul smell that leaves us fearing we will retch. Think also of how inviting something silken or soft is to touch and cuddle with or of a song or CD that you want to listen to over and over again. These are examples of wanting less or more sensory input.
So the mom in my office was discussing the sensory issues her son was having and how to strategize to best address the issue. Now for most of us, teeth brushing is a matter that requires a small amount of planning, and while many kids don't want to brush their teeth, it's usually not a heavy lift to get them . For this mom it was taking a whole lot of bandwidth, because her son hates - HATES to brush his teeth. It was unclear how much had to do with the flavor of the toothpaste, the sensation of the toothbrush in his mouth or maybe something else, but he would not brush his teeth. Mom had tried incentive programs, consequences, different flavors of toothpaste, different toothbrushes both electric and traditional, discussions, education from the dentist who indeed was concerned about the child's dentition and some small cavities that had been seen and would soon need to be filled - a whole 'nuther challenge she feared to face, and more, all with poor results. And I thought about my friend with a daughter who was almost completely reliant upon her parents.
So I shared her story with the mom, not to diminish her experience or minimize the challenges she had with her son, but to try to give to her what my friend had given to me and the others in the room when she spoke a few years ago. I got to the core of her presentation and said "It's OK." I wanted to reassure her. She is indeed facing a real challenge - teeth do need to be brushed and mom was working hard, using all the tools she could think of. She's doing a fine job and, as is so common with raising kids with special needs, is enduring very significant emotional costs in doing so. "It's OK" I said, wanting her to really take in that she is indeed doing all they could. Somehow, someway, as her son developed, the issue of dental care would find some kind of resolution, maybe as a result of mom's interventions or maybe not. It will resolve somehow, even if not fully to mom (or her son's) satisfaction, even if other challenges arose to make the dental care look like a walk in the park. I wanted her to take a moment to just know that. It's OK. It's a lesson I believe we all could benefit from taking in a bit more deeply despite the depth of the challenge we have in the midst of our struggles. It's OK.
A number of years ago I organized a support group for parents of kids who had autism and other disabilities. One of the women who spoke was a friend, more an acquaintance, whose daughter has autism and a number of other very serious challenges. At the time she spoke, her daughter was well into adulthood. She had always been described as "low functioning," having minimal spoken language, minimal self care skills and cognitive level of a preschooler. The challenges she and her husband faced raising and caring for their daughter are many, pervasive and really, really hard.
She related issue after issue that confronted them and their daughter. She needed to be bathed, sometimes by mom, sometimes by dad depending on their schedules and professional obligations. She noted the awkwardness that her husband had to deal with bathing their adult daughter. She discussed the inconvenience she and her husband had meeting their social and professional obligations, having to split their time between which of them would go to the event and which of them would stay home with their daughter. She went on to describe in some detail the many mundane yet demanding details required of them in their care of their daughter. And after each challenge she described she said a simple statement. She said, softly, convincingly, "It's OK." That was it. Calm. Believable. The acceptance she had with challenges most all of us can't even imagine and it moved me to wonder about the challenges in my life that made me crazy and how well I accept them.
Her story came back to me when I was recently meeting with a single mom me re: her only child, a son who was dealing with some sensory issues. Sensory issues, for those who don't know, have to do with the five senses we all learned about in Elementary school - sight, sound, touch, smell and taste. It's common for people with autism to have either a strong aversion to sensory input in one of these five areas, or to have a need for hyper input in one of these five areas. Think of fingernails on the chalkboard and how that sound makes the skin crawl for most of us, or a foul smell that leaves us fearing we will retch. Think also of how inviting something silken or soft is to touch and cuddle with or of a song or CD that you want to listen to over and over again. These are examples of wanting less or more sensory input.
So the mom in my office was discussing the sensory issues her son was having and how to strategize to best address the issue. Now for most of us, teeth brushing is a matter that requires a small amount of planning, and while many kids don't want to brush their teeth, it's usually not a heavy lift to get them . For this mom it was taking a whole lot of bandwidth, because her son hates - HATES to brush his teeth. It was unclear how much had to do with the flavor of the toothpaste, the sensation of the toothbrush in his mouth or maybe something else, but he would not brush his teeth. Mom had tried incentive programs, consequences, different flavors of toothpaste, different toothbrushes both electric and traditional, discussions, education from the dentist who indeed was concerned about the child's dentition and some small cavities that had been seen and would soon need to be filled - a whole 'nuther challenge she feared to face, and more, all with poor results. And I thought about my friend with a daughter who was almost completely reliant upon her parents.
So I shared her story with the mom, not to diminish her experience or minimize the challenges she had with her son, but to try to give to her what my friend had given to me and the others in the room when she spoke a few years ago. I got to the core of her presentation and said "It's OK." I wanted to reassure her. She is indeed facing a real challenge - teeth do need to be brushed and mom was working hard, using all the tools she could think of. She's doing a fine job and, as is so common with raising kids with special needs, is enduring very significant emotional costs in doing so. "It's OK" I said, wanting her to really take in that she is indeed doing all they could. Somehow, someway, as her son developed, the issue of dental care would find some kind of resolution, maybe as a result of mom's interventions or maybe not. It will resolve somehow, even if not fully to mom (or her son's) satisfaction, even if other challenges arose to make the dental care look like a walk in the park. I wanted her to take a moment to just know that. It's OK. It's a lesson I believe we all could benefit from taking in a bit more deeply despite the depth of the challenge we have in the midst of our struggles. It's OK.
Thursday, August 3, 2017
College and High Functioning Autism
It's that time of year when campus starts to buzz again. Schedules are reviewed, sometimes tweaked, social relationships renewed or sought and if we're lucky here in Atlanta, there's a small hint of autumn in the morning air filling us with a promise freshness and clarity that can be brought to the academic setting. For the college student with High Functioning Autism (HFA), it can also bring with it anxiety of academic challenges past. So here's a list, in no particular order, of topics and issues I've seen and possible solutions/suggestions as to how to cope with them.
First, a word about coping. Coping is what we do in this world. Most folks get that pretty naturally. Coping for a person with HFA can be a huge challenge, however. Anxiety, poor organizational skills, lack of support from others, ADHD, depression and even psychosis can inhibit our ability to cope. Not to mention dysfunctional family dynamics, the challenges of an unrecognized or untreated learning disability and so many more variables. The key, the point to focus upon is finding a balance in how we manage the stress we have. There are things we can effect and things over which we have absolutely no power. Understanding that is key (speak to any successful recovering alcoholic about the versatility of "The Serenity Prayer.")
Every college has their version of a student support center. It's a place where there's coaching, support, tutoring around the challenges students face with organizational skills, self advocacy, remediation, social and sometimes mental health resources all geared to help the student achieve both academic and personal success. These services, in my experience, are underutilized by the HFA community. Remember, in High School there are IEP's (Individual Education Plans.) Because the state is obligated to teach all students, even those with special needs, there are federal laws proscribing how to do so. In college there's still requirements, but the big difference is that the student must self identify and bring their requests for reasonable accommodations to the attention of the school. The school is not obligated to initiate, unlike in High School.
Mental Health services are increasingly ubiquitous on college campuses. Many students have the need for mental health services ranging from psychotherapy to crises intervention, psychiatric services (for diagnosis and medication management) as well as support groups and more. Because there is a high incidence of anxiety, depression, ADHD (among other diagnoses) in the HFA community, utilizing these services is critical. If you needed these services in High School, you probably need them in college. Freshman year's a bad time to experiment living life without them.
The academic load in college can be daunting. Again, there is often a stark contrast between the expectations in High School and those in college. In High School it is quite common for teachers and other staff to be well aware of the needs of the student with special needs (reference the IEP comments above) and to be quite understanding and solicitous of students. Second chances (or more) may be quite common. Not so much in college. I tell my clients who are in college that the professors simply don't care about your personal issues or challenges. College is a place for grown ups. If the assignment was due yesterday, coming today with your hat in your hand may not cut it at all. This does not mean that professors are mean or unsympathetic, but unless there's a real extenuating circumstance, they may not be at all inclined to give a break. I also recommend to all but the most highly academically gifted student that they consider taking less than a full academic load for the first semester to get their feet wet. Being academically overwhelmed as a college freshman is a recipe for disaster.
College is a hotbed of social interaction. Many people find romance, spouses, business partners and lifelong business acquaintances and friends in college. For people on the autistic spectrum, social relationships are often the holy grail of challenges. So many HFA folks in college have great strengths academically, but struggle with social basics like eye contact or how to have a simple spontaneous chat while waiting on line. In an atmosphere where fraternities and sororities bind pledges in lifelong emotional connection, the person on the spectrum can be left to the sidelines without a clue as to how to form more than a passing friendship. This can lead to a great deal of personal pain and depression in the realization that their toolbox just seems to be missing some of the equipment that everyone else seems to have readily available. This is where the basics of social skills (which many kids on the spectrum are bludgeoned with throughout their childhood and adolescence) come into play and it may be time for a refresher on how to acquire and use these necessary skills. Again, the student support center is likely a good resource for these challenges.
Accountability and personal responsibility are cornerstones of independent college life. Even if living at home, the relationship between student and college doesn't usually include parents, the default source of structure and support for high schoolers. As a result, basics like attendance and completion of assignments fall entirely on the student. I've seen many HFA kids go away to college only to come home with their tails between their legs having spent the first semester isolated in their dorm room spending the bulk of their time surfing the net or playing video games to the exclusion of their academic responsibilities. Parents send them away in the hopes that their children's wings will fully extend and allow for flight, but they often need more support before they can fly on their own. This is why I almost always recommend that students live at home at least for the first year of college and that they include their parents in their academic lives in order to have some accountability. This is even more important if the student is not engaged in the school's student support center. Many HFA students can get the hang of college life, but they often need extended support from home to do so. On campus housing can still be an option, but I recommend the student show independence in a more supervised environment before doing so. The emotional hit for not succeeding independently in college is not to be underestimated - and this is on top of the ongoing burden that kids on the spectrum may have living with autism.
Common to most college campuses are the broad use of alcohol and drugs. College is where many students are first exposed to these substances and for people on (and off) the spectrum they can be a tempting social lubricant. Remember that alcohol and drugs dis-inhibit our brains. Thus we are more likely to say and do things we certainly might not have done sober. This can include engaging in "consensual" (in quotes due to the role the substances may play in one's consent) sexual activity for which the individual is not emotionally prepared, not to mention the concerns for sexually transmitted diseases and pregnancy. Horrifyingly, up to 20% of women and 5% of men report being sexually assaulted in college, one study showed that 15% of freshman women were raped while under the influence of alcohol. The devastation this can create is far beyond the scope of this discussion, but the destructive results (whether or not the victim is on the spectrum) cannot be underestimated. Beyond description in their potential for destruction is the continued availability of hallucinogens and narcotics raising these concerns. The toxic formulations of narcotics laced with fentanyl explonentially skyrocket the danger to levels that we struggle to comprehend.
College is a place where many people with high functioning autism can flourish with support and thoughtfulness. It's easy for individuals on the spectrum and their families to hope that the college experience will be a fresh start. And there may well be something to that, however it's critical to remember that we are who we are. Whatever our histories and challenges, they don't disappear just because we want them to. Forge ahead into college, but do it smartly. Insulate with support and realism.
Tuesday, June 20, 2017
Kids Do Well If They Can
All examples of clients in this and all blog posts are materially changed to disguise the identity of any individual.
Karen's a typically developing 6 year old girl. Typical for kids who have both anxiety and ADHD and a possibility of autism.
Her older brother has autism, without any question, and questions have come up about her being on "the spectrum" as well. I'm not too sure that she is, but other professionals have questioned it. I think that her anxiety has blurred the picture and made her presentation look quirky enough that the possibility was raised. But that's not the point of this story.
Karen is a kid who can be quite stubborn, even oppositional, not to mention significantly distracted when asked, or told after a while, to do things. As her mom relates, asking 4, 5, 6 and more times to go to bed, get in the bath, come to dinner, clean up her toys etc. can get old, and even mom, a well thought of teacher admits to losing her cool after a while and yelling at Karen.
I began seeing Karen right before her mom had brought her for a more formal evaluation for the anxiety and ADHD, which I fully supported. typical medication trials began with the typical changes of meds due to ineffectiveness or side effects. Mom and Karen are taking this in stride. Karen has some mild Cerebral Palsy as well, as evidenced by a hardly noticeable weakness in one of her limbs, so she's used to seeing professionals. But mom's main concern is the oppositionality, her refusal to comply with demands at home.
So of course, I recommended Ross Greene's book The Explosive Child (see elsewhere in these blogs for discussions of his Collaborative Proactive Solutions model of problem solving with kids.) Mom was quite open. Dad, not so much, for a variety of reasons. But as Greene says, that's not a deal breaker. One parent can successfully implement CPS without the participation of the other.
We began solving problems collaboratively and Karen was very interested in her ability to have input into the solutions. After the first problem was reviewed and she came back to my office I couldn't even finish the sentence asking how things went with the solution they came up with. She interrupted me with "That problem's solved." I looked at mom who smiled as she shook her head in agreement. So off we went to the next problem, and the next. Like dominoes falling we addressed getting dressed in the morning, going to sleep at night, teeth brushing and coming to dinner when called.
Mom comes in now intermittently for coaching on CPS and related the following anecdote which made me think of Greene's "kids do well if they can." Meaning, if they have the tools to behave properly, they're generally motivated to use them. And if the tools come from their own collaboration, they're more likely to use them. Mom related that she and Karen worked on a certain compliance issue that had come up and Karen, as sometimes happens with her, struggled with a clear and practical solution, but mom, not being too eager to suggest something, waited for a quiet time and wondered aloud a certain solution. Karen agreed, as she often does. She's bright, but coming up with an articulate and a practical solution has sometimes been difficult for her. So mom wondered aloud whether solution "X" might work. They tried it with some success.
The next day mom and dad were going out and a babysitter who had worked with Karen and her brother before was being given the routine orientation for the evening. Karen broke in. "Make sure to tell her about the new solution we came up with!" Mom smiled as she related to me that indeed, she then told the sitter about solution "X" per Karen's wishes. Karen reminded mom, "We need to use it, she [the babysitter] needs to know." The report from the babysitter, not surprisingly, was positive. Karen indeed is doing well.
Kids Do Well If They Can. Yup.
Karen's a typically developing 6 year old girl. Typical for kids who have both anxiety and ADHD and a possibility of autism.
Her older brother has autism, without any question, and questions have come up about her being on "the spectrum" as well. I'm not too sure that she is, but other professionals have questioned it. I think that her anxiety has blurred the picture and made her presentation look quirky enough that the possibility was raised. But that's not the point of this story.
Karen is a kid who can be quite stubborn, even oppositional, not to mention significantly distracted when asked, or told after a while, to do things. As her mom relates, asking 4, 5, 6 and more times to go to bed, get in the bath, come to dinner, clean up her toys etc. can get old, and even mom, a well thought of teacher admits to losing her cool after a while and yelling at Karen.
I began seeing Karen right before her mom had brought her for a more formal evaluation for the anxiety and ADHD, which I fully supported. typical medication trials began with the typical changes of meds due to ineffectiveness or side effects. Mom and Karen are taking this in stride. Karen has some mild Cerebral Palsy as well, as evidenced by a hardly noticeable weakness in one of her limbs, so she's used to seeing professionals. But mom's main concern is the oppositionality, her refusal to comply with demands at home.
So of course, I recommended Ross Greene's book The Explosive Child (see elsewhere in these blogs for discussions of his Collaborative Proactive Solutions model of problem solving with kids.) Mom was quite open. Dad, not so much, for a variety of reasons. But as Greene says, that's not a deal breaker. One parent can successfully implement CPS without the participation of the other.
We began solving problems collaboratively and Karen was very interested in her ability to have input into the solutions. After the first problem was reviewed and she came back to my office I couldn't even finish the sentence asking how things went with the solution they came up with. She interrupted me with "That problem's solved." I looked at mom who smiled as she shook her head in agreement. So off we went to the next problem, and the next. Like dominoes falling we addressed getting dressed in the morning, going to sleep at night, teeth brushing and coming to dinner when called.
Mom comes in now intermittently for coaching on CPS and related the following anecdote which made me think of Greene's "kids do well if they can." Meaning, if they have the tools to behave properly, they're generally motivated to use them. And if the tools come from their own collaboration, they're more likely to use them. Mom related that she and Karen worked on a certain compliance issue that had come up and Karen, as sometimes happens with her, struggled with a clear and practical solution, but mom, not being too eager to suggest something, waited for a quiet time and wondered aloud a certain solution. Karen agreed, as she often does. She's bright, but coming up with an articulate and a practical solution has sometimes been difficult for her. So mom wondered aloud whether solution "X" might work. They tried it with some success.
The next day mom and dad were going out and a babysitter who had worked with Karen and her brother before was being given the routine orientation for the evening. Karen broke in. "Make sure to tell her about the new solution we came up with!" Mom smiled as she related to me that indeed, she then told the sitter about solution "X" per Karen's wishes. Karen reminded mom, "We need to use it, she [the babysitter] needs to know." The report from the babysitter, not surprisingly, was positive. Karen indeed is doing well.
Kids Do Well If They Can. Yup.
Tuesday, May 16, 2017
The Power of Anxiety: Leaning Into Discomfort
Whether on "The Spectrum" (autism spectrum) or not, I've been impressed lately with how powerful anxiety is. Consider:
- The typically developing middle school girl whose anxiety is so powerful, that despite wanting to go to school, her body spontaneously vomits due to the fear of being bullied.
- The college student with high functioning autism who, despite very strong academic skills and competence, freezes during finals jeopardizing their academic standing.
- The typically developing adult woman who has lived in a sexless, loveless marriage for 25 years who (despite financial means) is frozen when she wants to address the sadness of her marriage with her husband.
- The person with high functioning who's asked by a co-worker why they always seem so nervous.
I don't know why suddenly I've become more aware of how powerful anxiety is, but it hit me recently that the anxiety people experience can be crippling. I often say to folks experiencing these levels of impairment with anxiety (or depression) that there's no therapeutic benefit from going through such mood disturbances. It doesn't make one stronger or a better person. It's just torture without profit. Which is why I am a strong advocate of doing anything and everything possible to dampen these anxious responses.
I am a believer in the benefits of the cognitive approaches that have become so strongly put forth in Cognitive Behavior Therapy CBT and Dialectic Behavior Therapy DBT. The only challenge is that the person has to show up and do the work, and in my experience, some do and some don't.
I am a believer in the use of medications that have a decades long track record of success in reducing depression. I'm NOT a fan of the addictive medications (benzodiazepines such as valium and xanax) that, while quite effective have a strong addictive potential. The non-addictive medications (the class of SSRI's, selective serotonin re-uptake inhibitors being those with the best track record) have a strong track record of success in managing anxiety and depression. The only challenge is that the person has to be committed to taking them daily and following up with a qualified medical professional and enduring the time - sometimes months - until a therapeutic level can be reached. They also might need to endure the time it takes for the sometimes needed medication changes.
And yes, I'm a fan of good old fashioned talk therapy. I've heard over and over that despite the hesitation to discuss things that are upsetting, anxiety producing, depressing, that afterwords people (kids, adults, on and off the spectrum) feel better. I still believe that people relieve their emotional pain by talking about it, as doing so reduces the pressure their emotions build up.
So yes, anxiety is powerful, very very powerful. And yet I continue to have faith in the power individuals have to change. There's lots of ways to change and most of them involve leaning into what is uncomfortable. It's hard, but it's do-able.
Wednesday, April 26, 2017
AUTISM and ADHD
ADHD is the most commonly diagnosed mental health disorder in kids effecting about 5% plus or minus. Autism's incidence is soaring, explained well by none. Autism strikes about 1 in 68 children (according to CDC's April 2017 posting.) People with autism have a 30% to 50% incidence of ADHD according to The National Institute of Health and US National Library of Medicine in 2014. (The interested reader is directed to the following link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010758/) though one study found the rate to be over 80%! Regardless of how often it happens, the combination of Autism and ADHD presents a very challenging package of symptoms for kids and parents.
Autism is so well known for the challenges it brings kids in the areas of communication, social relationships, symbolic play and repetitive, or "self-stimming" behavior. ADHD is famous for it's triad of hyperactivity, inattentiveness and impulsivity (as I've said elsewhere in these pages, why they don't call it ADHID, to include the "I" of impulsivity in the title I don't know.....) Now think of all of these issues, throw them all together, or even some of them together, and you have the potential for some very challenging behaviors.
The signs and symptoms of each combine with the other to create what parents sometimes experience as an almost toxic mix. For example, kids with autism can become perseverative - overly fixated on games, shows, toys to a point greater than annoyance. Combine that perseveration with the impulsivity of ADHD and you've got quite a behavioral package. Or consider a great deal of hyperactivity, which can make it difficult for some kids (and adults) to get to sleep (often a challenge with autism anyway) - and put with that a lack of ability to communicate well.
I often remark that impulsivity is, in my view, the hardest part of ADHD. The simplest example of impulsivity is one in when the adult gets the child's focus, including eye contact (already a tough one for lots of the spectrum kids) and gives a simple "don't" or "do" kind of instruction, immediately followed by the child's doing or not doing the exact opposite. Now sometimes kids will display what is called "oppositional" behavior with a bit of a glint in their eye trying to make it a bit of a game. That's hard, but not what I'm talking about. I'm talking about a more pure impulse, one that is almost lightning fast. It's a unique challenge - and many of the higher functioning kids with ADHD have the same challenge that kids with ADHD without Autism have: The KNOW what the rules are. They just "impulsively" acted. It's an explanation, but not an excuse. It's certainly maddening for parents and teachers and so very frustrating for kids who are not really "bad," they're just, well, impulsive (or hyperactive or fill in whatever blank you want.
So many of the parents I see all but tear their hair out with the Autism-ADHD combo. Meds can often help, sometimes a lot, but some kids have sensory issues making swallowing meds, even the liquids difficult, notching up the challenge to parents and teachers to a "whole nuther level." Positive reinforcement can be helpful as well, but that's generally precluded on a strong sense of emotional relationship between child and adult, not something that all those with Autism have. All are used, properly so, but the unique challenges that the child with Autism and ADHD bring makes it such an unusual hill to climb.
Despite the difficulty level of these challenges, parents of kids with Autism and ADHD can only do what they always do - their best; trying to be creative and advocate for their kids as much as possible; working with their physicians, teachers and schools. I always encourage families to find parent support groups, because it's unlikely that their challenge hasn't been met by another family, and so often that's where we can get not only ideas, but strength.
For so many parents and so many professionals, the Autism - ADHD combination is almost a boring fact of life. But ask any parent, it's never mundane. Exhausting? Yes. Mundane, never.
Autism is so well known for the challenges it brings kids in the areas of communication, social relationships, symbolic play and repetitive, or "self-stimming" behavior. ADHD is famous for it's triad of hyperactivity, inattentiveness and impulsivity (as I've said elsewhere in these pages, why they don't call it ADHID, to include the "I" of impulsivity in the title I don't know.....) Now think of all of these issues, throw them all together, or even some of them together, and you have the potential for some very challenging behaviors.
The signs and symptoms of each combine with the other to create what parents sometimes experience as an almost toxic mix. For example, kids with autism can become perseverative - overly fixated on games, shows, toys to a point greater than annoyance. Combine that perseveration with the impulsivity of ADHD and you've got quite a behavioral package. Or consider a great deal of hyperactivity, which can make it difficult for some kids (and adults) to get to sleep (often a challenge with autism anyway) - and put with that a lack of ability to communicate well.
I often remark that impulsivity is, in my view, the hardest part of ADHD. The simplest example of impulsivity is one in when the adult gets the child's focus, including eye contact (already a tough one for lots of the spectrum kids) and gives a simple "don't" or "do" kind of instruction, immediately followed by the child's doing or not doing the exact opposite. Now sometimes kids will display what is called "oppositional" behavior with a bit of a glint in their eye trying to make it a bit of a game. That's hard, but not what I'm talking about. I'm talking about a more pure impulse, one that is almost lightning fast. It's a unique challenge - and many of the higher functioning kids with ADHD have the same challenge that kids with ADHD without Autism have: The KNOW what the rules are. They just "impulsively" acted. It's an explanation, but not an excuse. It's certainly maddening for parents and teachers and so very frustrating for kids who are not really "bad," they're just, well, impulsive (or hyperactive or fill in whatever blank you want.
So many of the parents I see all but tear their hair out with the Autism-ADHD combo. Meds can often help, sometimes a lot, but some kids have sensory issues making swallowing meds, even the liquids difficult, notching up the challenge to parents and teachers to a "whole nuther level." Positive reinforcement can be helpful as well, but that's generally precluded on a strong sense of emotional relationship between child and adult, not something that all those with Autism have. All are used, properly so, but the unique challenges that the child with Autism and ADHD bring makes it such an unusual hill to climb.
Despite the difficulty level of these challenges, parents of kids with Autism and ADHD can only do what they always do - their best; trying to be creative and advocate for their kids as much as possible; working with their physicians, teachers and schools. I always encourage families to find parent support groups, because it's unlikely that their challenge hasn't been met by another family, and so often that's where we can get not only ideas, but strength.
For so many parents and so many professionals, the Autism - ADHD combination is almost a boring fact of life. But ask any parent, it's never mundane. Exhausting? Yes. Mundane, never.
Wednesday, February 8, 2017
Balancing the Physical and Emotional Protection of Our Children
Funny how personal and professional can often combine. This might be another example discussed by Jung regarding the collective unconscious. As always, descriptions of clients are materially changed to protect confidentiality.
A client contacted me re: his adult son with a longstanding history of emotional problems. The man, in his late 20's was wanting to travel to see his newfound girlfriend for an impromptu holiday get together, much to the consternation of his parents. The relationship was his first, and despite his age, his parents were concerned about his travelling to see her. In order to do so, he needed to borrow their car to drive hundreds of miles away from home despite his lack of experience in highway driving, concerning his parents re: his safety on the road. Ultimately he was convinced that driving was not the wisest choice to make the trip and she, with more driving experience, came to see him.
I've known the young man for a while and have competing concerns. One is for his independence. He is old enough to be independent. On the other hand, he's inexperienced enough as a driver that his parents understandably are cautious about giving him the keys to their car to drive. All in all, however, he deserves the chance to spread his wings some to experience the realities of relationships and life.
At the same time I'm travelling over the holidays, staying with friends who confide in me that their son, in his late teens, seems to have some poor judgement about his life. He's doing the right things: he's in school, doing well in his studies, but at the same time he's pretty immature as to how he's considering his life goals. He's unconnected with his emotions, despite being in therapy (which, after all, is supposed to help one focus on being in the present with both thought and feeling) regarding a number of key issues in his life.
In both cases my response has to do with the boundary between parents' responsibility for the physical safety of one's child and parents' responsibility for the emotional safety of one's child.
We hate to see our children hurt, but at the same time our ability to protect them from hurt is finite. Toddlers are bound to take their first steps, and will fall and scrape their knees. Or their elbows, chins or noses. These are indeed painful lessons, lessons that teach, hopefully, how to hold ones self in the world. I remember when my youngest was in his teens and we were playing catch - a reasonable activity for a father and son to do. The ball got away from me and when I ran to retrieve it I mis-stepped and fell, ripping open a patch on my elbow. Even as an adult we sometimes have to learn lessons of childhood about safety.
There are some things we can do to protect our children from physical harm. Giving the keys to an inexperienced driver is unwise. At the same time parents of children, both on and off the autism spectrum, have to assess carefully how much they can protect their children from the reality of life's scrapes and pain.
I often say to my clients' parents that the older the child, the less influence a parent has, parental influence fades as children age. The amount of influence we have on a twelve year old is very different than the influence we have on that same seventeen year old. Knowing the individual strengths and challenges of one's child is skill that parents have to practice is an ongoing challenge, and some parents are better at it than others. Some kids make it easier for parents to learn than do other kids.
Providing safety is the number one job of parents - think of the care parents take with their newborns. Over time, however, the ability we have to protect our kids grows thin. Our job as parents is to measure, with care and accuracy, when we do, and when we do not have power over re: our ability to protect our children both physically and emotionally. It's a tough balance, but it's what parents are charged with in parenthood.
A client contacted me re: his adult son with a longstanding history of emotional problems. The man, in his late 20's was wanting to travel to see his newfound girlfriend for an impromptu holiday get together, much to the consternation of his parents. The relationship was his first, and despite his age, his parents were concerned about his travelling to see her. In order to do so, he needed to borrow their car to drive hundreds of miles away from home despite his lack of experience in highway driving, concerning his parents re: his safety on the road. Ultimately he was convinced that driving was not the wisest choice to make the trip and she, with more driving experience, came to see him.
I've known the young man for a while and have competing concerns. One is for his independence. He is old enough to be independent. On the other hand, he's inexperienced enough as a driver that his parents understandably are cautious about giving him the keys to their car to drive. All in all, however, he deserves the chance to spread his wings some to experience the realities of relationships and life.
At the same time I'm travelling over the holidays, staying with friends who confide in me that their son, in his late teens, seems to have some poor judgement about his life. He's doing the right things: he's in school, doing well in his studies, but at the same time he's pretty immature as to how he's considering his life goals. He's unconnected with his emotions, despite being in therapy (which, after all, is supposed to help one focus on being in the present with both thought and feeling) regarding a number of key issues in his life.
In both cases my response has to do with the boundary between parents' responsibility for the physical safety of one's child and parents' responsibility for the emotional safety of one's child.
We hate to see our children hurt, but at the same time our ability to protect them from hurt is finite. Toddlers are bound to take their first steps, and will fall and scrape their knees. Or their elbows, chins or noses. These are indeed painful lessons, lessons that teach, hopefully, how to hold ones self in the world. I remember when my youngest was in his teens and we were playing catch - a reasonable activity for a father and son to do. The ball got away from me and when I ran to retrieve it I mis-stepped and fell, ripping open a patch on my elbow. Even as an adult we sometimes have to learn lessons of childhood about safety.
There are some things we can do to protect our children from physical harm. Giving the keys to an inexperienced driver is unwise. At the same time parents of children, both on and off the autism spectrum, have to assess carefully how much they can protect their children from the reality of life's scrapes and pain.
I often say to my clients' parents that the older the child, the less influence a parent has, parental influence fades as children age. The amount of influence we have on a twelve year old is very different than the influence we have on that same seventeen year old. Knowing the individual strengths and challenges of one's child is skill that parents have to practice is an ongoing challenge, and some parents are better at it than others. Some kids make it easier for parents to learn than do other kids.
Providing safety is the number one job of parents - think of the care parents take with their newborns. Over time, however, the ability we have to protect our kids grows thin. Our job as parents is to measure, with care and accuracy, when we do, and when we do not have power over re: our ability to protect our children both physically and emotionally. It's a tough balance, but it's what parents are charged with in parenthood.
Pushing Past Comfort, Spectrum or Not.
As with all postings, materiel changes to description of individuals is made to protect confidentiality.
A client of mine (neurotypical) recently told me of a coined phrase he learned from his sales team. His sales were OK last year, but not at the pace he wanted to meet the needs of his family causing not a small amount of stress at home. The phrase is "pushing past comfort" to get the desired sales results. He's been doing that with his supervisors and has weekly and monthly sales goals and marketing strategies he's responsible for to keep him on track. So far he's optimistic about the system and has a positive, active plan to increase his productivity this year.
That same day another (neurotypical) client of mine came in, struggling with a new relationship she was in. She's been in a number of relationships in the past and has found herself in a pattern where the pace of the physical relationship is faster than the pace of the emotional relationship. This is not uncommon in our society, a result, I believe of the "free love" explosion of the 60's and 70's when sexuality became an end unto itself, creating a great wave of permission for communication before, during and after physical intimacy which is a good thing. But in her case (and in the case of many people), she's ended up in a pattern where the physical has preceded the emotional and she's struggling with how to change that with her new boyfriend. She didn't use the language, but is also "pushing past the comfort" of her old patterns, of which I'm very supportive.
The same day (really), another client came in who might be on the autism spectrum - I know lots of clinicians who might diagnose him with high functioning autism, though I'm personally more conservative about throwing the label around without more clear data (happy to discuss that elsewhere if you want). He's one of these guys who's extremely bright and extremely anxious - his anxiety first evidenced since some emotional challenges, not trauma, he experienced at an early age - but he's never been able to treat the anxiety effectively despite great efforts on his part and the part of his mom, step dad, many psychiatrists and therapists. He's about to venture into a new career at which he's eminently qualified, but it will demand some social schmoozing within the professional network in his field. He's ready. He's planned out what to do, how to do it, even though doing so "pushes past his comfort" to which his anxiety traditionally restricts him.
The day before a (neurotypical) woman in my office was struggling with her role as a step mother to her husband's two young children. She fears if she doesn't bend over backwards - and then some - for the kids, her husband will be upset with her. We began to discuss where and how she learned that kids needed to be indulged (as her mother did with her) and whether that's a necessary pattern to continue in her current family. It's painful for her for a variety of reasons, and I thought about "pushing past comfort" zones to accomplish one's goals. I think she's doing this as well.
Carl Jung, a psychoanalyst who famously broke with Freud in 1913 was a proponent of "the collective unconscious," a phenomenon positing that different people can have shared unconscious experiences. I've not really studied Jung, but from time to time I have a "collective unconscious" experience. Recently, it seemed to span these four clients....maybe.... Why maybe?, Because as I consider it "pushing past our comfort zone" is a common part of the human condition. Isn't it what we do when we're tired of whatever status quo we're in and want something more in our lives? I don't know the answer. I only know that last week, when I had these four folks in the span of two days, all of whom had this theme in their lives, it gave me pause to wonder about how they, and I, push past comfort zones for the sake of positive change.
A client of mine (neurotypical) recently told me of a coined phrase he learned from his sales team. His sales were OK last year, but not at the pace he wanted to meet the needs of his family causing not a small amount of stress at home. The phrase is "pushing past comfort" to get the desired sales results. He's been doing that with his supervisors and has weekly and monthly sales goals and marketing strategies he's responsible for to keep him on track. So far he's optimistic about the system and has a positive, active plan to increase his productivity this year.
That same day another (neurotypical) client of mine came in, struggling with a new relationship she was in. She's been in a number of relationships in the past and has found herself in a pattern where the pace of the physical relationship is faster than the pace of the emotional relationship. This is not uncommon in our society, a result, I believe of the "free love" explosion of the 60's and 70's when sexuality became an end unto itself, creating a great wave of permission for communication before, during and after physical intimacy which is a good thing. But in her case (and in the case of many people), she's ended up in a pattern where the physical has preceded the emotional and she's struggling with how to change that with her new boyfriend. She didn't use the language, but is also "pushing past the comfort" of her old patterns, of which I'm very supportive.
The same day (really), another client came in who might be on the autism spectrum - I know lots of clinicians who might diagnose him with high functioning autism, though I'm personally more conservative about throwing the label around without more clear data (happy to discuss that elsewhere if you want). He's one of these guys who's extremely bright and extremely anxious - his anxiety first evidenced since some emotional challenges, not trauma, he experienced at an early age - but he's never been able to treat the anxiety effectively despite great efforts on his part and the part of his mom, step dad, many psychiatrists and therapists. He's about to venture into a new career at which he's eminently qualified, but it will demand some social schmoozing within the professional network in his field. He's ready. He's planned out what to do, how to do it, even though doing so "pushes past his comfort" to which his anxiety traditionally restricts him.
The day before a (neurotypical) woman in my office was struggling with her role as a step mother to her husband's two young children. She fears if she doesn't bend over backwards - and then some - for the kids, her husband will be upset with her. We began to discuss where and how she learned that kids needed to be indulged (as her mother did with her) and whether that's a necessary pattern to continue in her current family. It's painful for her for a variety of reasons, and I thought about "pushing past comfort" zones to accomplish one's goals. I think she's doing this as well.
Carl Jung, a psychoanalyst who famously broke with Freud in 1913 was a proponent of "the collective unconscious," a phenomenon positing that different people can have shared unconscious experiences. I've not really studied Jung, but from time to time I have a "collective unconscious" experience. Recently, it seemed to span these four clients....maybe.... Why maybe?, Because as I consider it "pushing past our comfort zone" is a common part of the human condition. Isn't it what we do when we're tired of whatever status quo we're in and want something more in our lives? I don't know the answer. I only know that last week, when I had these four folks in the span of two days, all of whom had this theme in their lives, it gave me pause to wonder about how they, and I, push past comfort zones for the sake of positive change.
Tuesday, January 24, 2017
Tears for Kids I Never Met: Autism and Grief
As with all posts on this blogs, materiel changes in the descriptions of clients have been made to insure confidentiality.
It happened somewhat suddenly. She's a 10 year old child with high functioning autism who has been coping pretty well with her parents' divorce last year. We were discussing, again, the death of a grandparent a couple of years ago - a topic she often revisits, her child's view of heaven where grandma is, where grandma will greet her when it's her time to go to heaven. The topic of prayer came up and she casually mentioned her prayers for a child she knew from her school who had been injured in a freak accident and was in the hospital.
Mom mouthed to me that the peer had actually died that morning while her daughter's head was turned in my direction clearly hoping to avoid the discussion right now when suddenly, innocently, she turned to her mother and asked if her friend would live. Mom was caught a bit by surprise, just as the accident and death of the classmate had caught her by surprise. She gathered herself strongly, softly, and told her daughter that her friend had, actually, died that morning.
The pain was honest. Immediate. She cried out after double checking what mom had said the way we do when we're preparing to absorb something for which we are unprepared, and then buried her head in her mom's lap, crying and talking at the same time about how sad it was. She then came to me, her arms spread open looking for the physical validation of life a hug provides and cried on my shoulder before returning to the comfort of her mom's arms.
Mom went on to note with sadness about another child who had died in another freak accident a couple of years before. Coincidentally I had known of that tragedy via another client who had known that child. It all came back to me; the description of the circumstances of the child's death, the mother's attempts to cope, my client's struggle to absorb the reality that mortality brings to the forefront in the face of a tragedy. A surprising and sudden turn of events that moved us so deeply.
And all three of us were suddenly tearful together. My 10 year old client, openly crying at having to learn the lesson of death again. Her mom, having had to tell her what no parent wants to tell a child - the inherent message that challenges the assumed safety we expect from life. Me, adjusting to the rapid sequence of events that afternoon; the tragic death of my client's friend and my concern as to how this sweet little girl would cope with the complexities she suddenly faced; the coincidental review of the another child's death with the immediate recall of the pain that loss brought to another client.
It was not quite bittersweet - there is nothing much sweet about death. Yet as I consider the meeting now, there was such love in mom's eyes for her daughter, and the daughter's seeking comfort from her mom as she struggled to comprehend the frailty of existence. My fullness of emotion at the depth of connection this child with autism has to her friends and family. Maybe, as I think of it, there was an unlikely and unexpected kind of sweet to the moment.
It happened somewhat suddenly. She's a 10 year old child with high functioning autism who has been coping pretty well with her parents' divorce last year. We were discussing, again, the death of a grandparent a couple of years ago - a topic she often revisits, her child's view of heaven where grandma is, where grandma will greet her when it's her time to go to heaven. The topic of prayer came up and she casually mentioned her prayers for a child she knew from her school who had been injured in a freak accident and was in the hospital.
Mom mouthed to me that the peer had actually died that morning while her daughter's head was turned in my direction clearly hoping to avoid the discussion right now when suddenly, innocently, she turned to her mother and asked if her friend would live. Mom was caught a bit by surprise, just as the accident and death of the classmate had caught her by surprise. She gathered herself strongly, softly, and told her daughter that her friend had, actually, died that morning.
The pain was honest. Immediate. She cried out after double checking what mom had said the way we do when we're preparing to absorb something for which we are unprepared, and then buried her head in her mom's lap, crying and talking at the same time about how sad it was. She then came to me, her arms spread open looking for the physical validation of life a hug provides and cried on my shoulder before returning to the comfort of her mom's arms.
Mom went on to note with sadness about another child who had died in another freak accident a couple of years before. Coincidentally I had known of that tragedy via another client who had known that child. It all came back to me; the description of the circumstances of the child's death, the mother's attempts to cope, my client's struggle to absorb the reality that mortality brings to the forefront in the face of a tragedy. A surprising and sudden turn of events that moved us so deeply.
And all three of us were suddenly tearful together. My 10 year old client, openly crying at having to learn the lesson of death again. Her mom, having had to tell her what no parent wants to tell a child - the inherent message that challenges the assumed safety we expect from life. Me, adjusting to the rapid sequence of events that afternoon; the tragic death of my client's friend and my concern as to how this sweet little girl would cope with the complexities she suddenly faced; the coincidental review of the another child's death with the immediate recall of the pain that loss brought to another client.
It was not quite bittersweet - there is nothing much sweet about death. Yet as I consider the meeting now, there was such love in mom's eyes for her daughter, and the daughter's seeking comfort from her mom as she struggled to comprehend the frailty of existence. My fullness of emotion at the depth of connection this child with autism has to her friends and family. Maybe, as I think of it, there was an unlikely and unexpected kind of sweet to the moment.
Subscribe to:
Posts (Atom)