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.

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.

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.