The Explosive Child: Case Example and Upcoming Training

Moshe will be offering a parent training group on The Explosive Child by Ross Greene Ph.D.  The 4 week group will teach parents the fundamentals of Collaborative and Proactive Solutions, the methodology Greene developed.  It begins Monday January 25th, 2016 and continue for 4 consecutive evenings from 6:15-7:45 at the offices of ASCEND Pediatric Neurology.  The fee is $300 per individual or $500 for a couple.  Please contact Moshe for more information.  

If you know me, or have read these blogs, you know that I've become quite a fan of CPS.  Here's a recent example (as in all postings, materiel changes have been made in order to protect confidentiality):

Denise is a 7 year old who has no diagnosis of any kind that is discernible at this time, with the exception of a strong oppositional streak.  She refuses to do anything educationally except participate in selected group activities she enjoys through the home schooling network in which her mom has her enrolled.  She's not enrolled in any certified educational school program - parents had begun home schooling and she ratcheted down the expectations to include only social activites.  I educated parents in CPS and when I first met her she was openly hostile to me, even as I took a very "collaborative" position, assuring her that the only thing I was interested in was her input to solve problems that the family might be having.  I followed the CPS recipe carefully, withholding my impulses to put this young lady in her place (ODD kids are able to bring forth those urges in adults.)  I later admitted to parents that this kid actually scared me - she really did.  I wondered how I'd ever get through to her.  

Long story short - we were able to use the model to successfully collaborate on toy clean up and bedtime routines.  And despite her assurance to me that she would NOT attend school, she's begun to do so.  I did tell her we'd be needing to collaborate on a solution about school, adding, for her to consider, that when we did so we would have to address the issue of truancy, as she had not been enrolled in any certified program for over a year.

CPS, a hot knife through the butter of oppositionality.  How's that for a saying?

First Things First: Horses vs. Zebras and Basics

Any discussion of persons in this blog are materially changed for reasons of confidentiality.

We live in a world filled with subtitles and complexities that fascinate us.  The exception, the example that does not fit the rule, the kind of oddity that proves the case that makes for dramatic turns in a Sherlock Holmes story or a TV drama.  It is easy for us to veer to fascinating exotic topics, processes and causalities.  And while I too can be fascinated by them, I also like to remember that "when you hear hooves, think horses not zebras."  What's most common? What's most basic? I've had a run of these topics with kids and parents recently that I believe highlight this principle.

Sleep:  I've had a couple of kids who have been struggling with their morning routines - a common complaint for kids, particularly for kids with ADHD.  I always note that the largest transition we make in any 24 hour period is that from sleep to awake.  It's huge and verges on the traumatic for some of us.  Just think how much cultural time is spent on "Monday mornings" in joke, song, excuses and coffee.

So when discussing the challenges to the AM routine, I first search for the horses: "What's the bedtime routine like?"  I've received some interesting answers.  From one 11 year old child, lets call him Robert, now living with his mother and not his father (which is a whole 'nuther discussion).  On weekends he's been playing video games until 1:30 - 2 AM as his video gamer "friends" (another whole 'nuther discussion) are in different time zones.  Is there any surprise that his re-adjustment to a (still too late) 10 PM weekday bedtime is hard - taking 2-3 days in which to recover?  So despite the mom's and the school's desire to put him on the couch to delve deep into his psyche; his avoidance; his feelings about his father; double checking with his psychiatrist about his medications etc., I think the proper first start is to allow this young man the full compliment of sleep that he needs.  So I suggested the draconian: one bedtime, one wake up time 7 days a week.  Pleasant shock: he suggested a 9:30 bedtime.  My conclusion: he actually does want some structure in his life, it's just been hard - for lots of different reasons - for his parents to exert it.  As I learned years ago from my friend Sarah Ninan, a gifted psychiatric nurse practitioner  - young kids who have a lot of power in the family can become terrified at what they can do with it and the result can be a lot of ambivalence and a lot of bad behavior.

Lenny's morning issues were similar.  He's a 14 y/o boy from a pretty normal family. Mom and dad are married, dad works full time, mom part time to be able to take the kids to their activities etc.  He has anxiety that's pretty well managed by medication, but his waking up and getting ready for school is a notorious flash point for the family.  Alas, as we explored his "issues" his use of his phone/computer at bedtime came up.  You know the rest, texting, Facebook, Snapchat etc all eating away at his bedtime.  More horses.  

School:  Brenda is an engaging if mischievous 12 year old girl with ADHD that is fairly well managed, but she does have a penchant for some impulsive behavior that can get her in trouble.  She's been caught lying at school and more recently was suspected of cheating, which in her upscale private Atlanta middle school was a pretty big violation.  The school's response was, as my old choir professor Dr. Orland Johnson used to say when we over reacted to one of his instructions on how to sing the music "taking out a hammer 'cause there's a fly on baby's head."  Now I don't condone cheating or lying, but I do remember that Brenda has ADHD.  Thus, she's predisposed to impulsive behaviors.  Her folks who are not trained educators or mental health practitioners get this.  I get this. So why does her school not?  She's now in what amounts to detention for the rest of the year, to help her learn the character traits that this school is wanting to instill in its students.  She's close to being asked to leave.  And - how surprising is this - she now is shutting down with the school's counselor and administration, fearing that anything she says will get her in trouble.

Kids with ADHD do not have bad characters by definition.  They have a neurological disorder that effects from 5% to 10% of kids - the most common psychiatric diagnoses kids receive.  More horses.

With Robert and Lenny it's also the basics of what is called "sleep hygiene." Having a set bedtime and sticking to it.  Understanding how much sleep kids and adolescents need (adults as well) and experimenting a bit to find out whether a kid does better with a bit more or a bit less sleep.  The results can be surprising.

In Brenda's case it's about the basics of educating kids.  Given the numbers, this school may have close to 100 kids with ADHD enrolled.  Detention does not fix the basic signs and symptoms of ADHD: distractability, hyperactivity and impulsivity.   Nor would I say a year long detention is the fix for a lack of moral strength, not that a 12 year old kid cheating is a high level of moral defect in my book.  Isn't it more of a teachable moment?  Engage her in a discussion about morals and character.  Explore the context of what was going on for her that led her to the cheating (there was lots of valuable context that the school didn't bother to explore before using the detention stick.)  But they missed the opportunity.  They chose punishment over engagement.

An attending physician I once worked with in a hospital was bound and determined to find a kid with an obscure diagnoses he had read about and then was the focus of a popular movie.  He was all but giddy with fascination of the disease.  It was a good movie, but did it merit the cost of the lab tests he repeatedly performed on the kids on his service?  Did it distract from the other, more obvious and common issues kids have?  To my knowledge he never found one - but who knows, maybe if he continues to look, he'll find that zebra.  In the meantime, I'll continue to be on the lookout for horses before I consider the zebras.

On being "Proactive"

Ross Greene's book The Explosive Child in which he lays out his model of Collaborative Proactive Solutions was initially known as Collaborative Problem Solving.  Due to a legal curiosity that resulted in an institution laying claim to the title Dr. Greene chose for his method of helping kids and adults solve problems, CPS became Collaborative Proactive Solutions.  But I'm not so sure that's bad as far as understanding what CPS is really about.  As much as it's a problem solving methodology, it's also a "proactive" methodology.

We live in a world where being proactive is almost antithetical to the ADHD infused impulsive life so many of us live.  Some describe such poor ability to plan and anticipate as being "spontaneous" as a way of saving face, but it rings hollow.  We may meditate, pray or do yoga, all in the name of finding our "center" our "mindfulness" or our "observing ego" in Freud's terms.  But the nature of our distracting world that peppers us with so much visual and auditory "stuff" makes it quite difficult.  Sometimes it may be trying to fit too much into too little time, aided by the often heard motto of "doing more with less" and the potential to do more with "multitasking" (I write this while eating lunch, listening to my music, answering my phone when it rings.)

For example: while running errands just prior to an appointment recently, not having made a list of what I needed at the store, I (inevitably) left the store without something I wanted to buy.  Sound familiar?

When I discuss with parents the importance of being "proactive" with their kids, it can often be an uphill battle.  So often the response to this is a question inquiring as to how CPS can help once a child has faced problems that are greater than his/her skill level can manage, the point at which bad behavior so often occurs.  And as I learned asking the same question of Dr. Greene, this is a proactive model, not a reactive model.  So when a child tantrums, melts down or misbehaves in some way, the window for proactive planning has clearly passed. What has not passed is the realization that so often the problems being faced are predictable.  Whatever triggered this behavioral problem is likely to reoccur. Planning for the next time is the focus of CPS.  It's one of those things that is simple, but not always easily grasped by parents.

I suspect one of the reasons it's hard to grasp is due to, as mentioned, our distractable world which impedes our lack of planning as parents.  What is critical when parenting a child who has behavioral challenges is remembering that the cost of planning in advance far outweighs the cost to the child without planning when the child is predictably and inevitably faced with a situation in which they don't have a collaborative solution in place to at least try to cope with the situation.  It's impossible to weigh the burden on a child who is yet again facing a situation in which expectations exceed their skills.  How many of our kids struggle with tantrums over and over, and at what cost to their sense of self? And remember, that a collaborative solution is not a solution in which the child has 100% of the responsibility to simply not repeat the behavior.  Collaboration involves spending the time with the child to understand in a much broader way the child's experience of the problems at hand - that process known as the "empathy step" of CPS.  The interested reader is referred to Greene's www.livesinthebalance.com website.

We indeed live in a time where focus, planning and being proactive is very difficult.  We also have children for whom we are responsible.  And having children is a bit of a game of chance, a bit of a Forest Gump box of chocolates. We don't know what we're going to get.  Despite that, we are obligated to give our children all we've got.  It's not too much to include the time to be proactive.

A Path to Collaboration: Saving Face and Listening

As with all descriptions of client encounters, materiel changes are made to protect client confidentiality.

As a licensed professional, I'm required to participate in "continuing education" to keep my license current.  After 33 years in the field, I've seen a lot of CE unit offerings, some interesting, lots boring.  Some of the best were CEU's I constructed myself to address my own interests, including 2 weeks with Peter Fleming in southern Italy studying Contribution Training (see my website for more) as well as the CEU's received in pursuit of certification with Ross Greene Ph.D., author of The Explosive Child and Lost at School and a 5 year NIMH study recently published proving the efficacy of his method of "Collaborative Proactive Solutions."

I'd seen and heard of the "Explosive Child" book, but had no intent to enter Greene's room early last summer.  Getting the CEU's for my license renewal was all I wanted.  So I explored the vacation option, you know, the one where professionals get their CEU's and vacation at the same time.

Cape Cod, early summer, the beach, my wife could come, family in New England I could visit.  The dates worked.  So place and time was set.  Now to pick a class that I wanted to learn.  It was Ross Greene or some other class that I found to be a bit too touchy feely for my taste, so Greene it was.

I read The Explosive Child  on the trip north feeling some obligation to be a responsible student.  Well, I read most of it, it was vacation after all.  I could read the rest through the week of the conference, which is what I did (having little option, being laid up the entire time with a bad back.  It was that or lots of bad TV, so I compromised, reading some and watching some, not lots of bad TV.) When the class began on a high school campus with weathering on its buildings and trees from the thick Cape Cod moisture, the comfortable informality of The Cape was evident, flip flops and t-shirts abounding.

Greene was unassuming - as high end scholars can be.  He had been on faculty at Harvard, what else is there to say - or as so many from that most esteemed institution do, to not have to say.  Confident, soft spoken, not overbearing like some successful creators of methodologies.  Friendly.  I was not prepared to be impressed as he rolled out his experience of working with tough kids.   I thought he might be one of those guys with a great personality, a lot of charisma that can be so influential but so very hard to replicate.  I'd been working with tough kids for decades, so I figured there'd be some reformulation of principles and strategies that have become standard in working with hard kids like: Parents need to be in control and execute a clear behavioral plan centered around "if/then" contingencies such as: "Johnny, IF you clean up your room, THEN you get to go outside and play;"  A behavioral plan that is intuitive, scientifically validated by all of my Applied Behavior Analysis colleagues, the bedrock of family systems theory where the parents function as the "executive branch" of the family, setting the structure for the children.  How does collaboration fit into this?

I started to pay attention as Green repeatedly focused on the importance of carefully and accurately understanding the child's point of view - not from the parents, or the therapist, or the teacher, but from the kid.  I became more intrigued when Greene reinforced over and over the importance of avoiding describing the problem to be discussed in therms of "problem behaviors."  He then (had the audacity to) suggest we not present the child with our "theories" about "why" they are behaving in the fashion that's causing us such discontent. Imagine, denying us, the highly educated, very experienced therapists our moment to enlighten the child about their inner motivations.  Denying parents who know the kids best - why can't they communicate their expert point of view to their own child?!?  Teachers who often spend more time with the child than the parents - they have a real objective point of view to offer the child.  All of us adults know what's really going on. So why NOT allow us our moment to "communicate" our observations with the child?

The reason the Collaborative Proactive Solutions model doesn't encourage the sharing of our erudite "theories" with the child is because what we've done, inadvertent as it may be, is overwhelm and intimidate children with our theories. Theories that are often way over the child's cognitive level to understand anyway.  Theories that often demean or embarrass the child by pointing out in grand style their lack of judgement and lack of restraint.  We haven't left the child behind, we've used shame to attempt to change their behavior.  We repeatedly accuse our children of aggression, irresponsibility, bad intent and disregard for parents and siblings welfare.  The fact that sometimes the theories may be accurate is besides the point.  When the child's being overwhelmed by our power, they are much more likely to respond in a defensive and even hostile fashion, adding more fuel to the fire of the conflict.

Now shame may have some place in child rearing, but, in my view, only when children are very very young and in very proscribed circumstances.  We've all seen a small child erupt in tears when they've done something wrong and a parent simply looks at them in a disappointed fashion without saying a word. That's shaming.  It can have a proper function, when integrated into the child's emotional package, of self reflection. But the level of shaming that we participate in with our kids in the name of helping them is grossly misguided in my opinion. This is exactly what CPS avoids.  By asking children about their behavior in a way that doesn't focus on their behavior (not really as hard as you might think), we lower their defensiveness and heighten their willingness to participate. By dropping our theories, we create a much broader space for the child to tell us their views of the situation.  By validating what they say in a reflective, non confronting way, we encourage them to say more.  By not pressing them about "why" they did or did not do something (see my post of 3/2/15 "The End of the 'Why' Question") we draw them to tell us what's really on their mind.  And isn't that what we really want to know anyway??

Asking the child in a neutral way welcomes participation.  Responding in confirming, supportive and non-judgmental ways will garner us much more information much more effectively.  Using "reflective listening" (which many parents have learned at some point in college or training), in which we reflect back what the child is telling us in a non judgmental fashion allows space for more communication - and isn't THAT our goal?  Remember, parents, listening reflectively isn't agreeing, it's just listening and creating a space for the child to trust and talk.

So I paid more attention to what Greene was saying.  And it was made more and more sense as the week continued.

I returned to Atlanta, much more thoughtful than I'd anticipated being after my mostly bedridden week in New England and gave it the old college try.  An 11 y/o boy with classic high functioning autism who had come due to some new behavioral concerns.  He sat looking at a random spot on the floor, typical for lots of kids on the spectrum who find eye contact difficult.  I asked, open ended questions, hoping for a thread of response to which I could "actively listen."  It was the longest 25 minutes of any session I've ever had.  I was trying to actively listen to shoulder shrugs, to monosyllabic grunts or to the ever present mumbled "I don't know."  Slowly, carefuly, I responded.  He responded. Repeat.  I worked hard; no theory, no behaviors, no "why" questions.  This went on for a while and after responding to concerns that actually sounded like a full thought, he looked up - making eye contact - long, lingering eye contact with me for the first time since walking in the door - and after a dramatic pause said with great emotional affect, "Finally, someone's listening to me!" (emphasis not added)  Well, that pretty much did it for me - I'd interviewed hundreds of kids on the spectrum without getting a response like that.  He's doing great now - really.  He still has autism, but we learned enough to put in place enough that provides him the supports he needs.

I was hooked and soon signed up for Greene's advanced certification program.

If you read this blog, you're likely to hear more.

Marital Jazz - Finding a Couple's Language

As with all postings, materiel changes to any descriptions of clients are made to protect their privacy.

I've been working with Hank and Mary for about a year.  They often struggle due to the confluence of a many challenges between them: diabetes, depression, ADHD, and a history of verbal fights that can be pretty sharp.  Divorce has been in the air, more, I believe, as a signal of desperation than intent.  When they're both calm, they genuinely express their love for one another.  And this has gone on for decades.

After one of their tougher disagreements - they didn't speak much for a couple of weeks following a disagreement on how to manage their business - they came in having reached the predictably calm after the storm state in their marital music. The atmosphere between them was soft and caring, unlike the last meeting we had when they were in the middle of their business argument.  So I made an observation, drawing on their mutual love of jazz - not that I'm a big jazz guy, my tastes go much more towards classical and classic folk, rock, blues - but I know enough about music and jazz to through around a few comments.

Hank and Mary riff back and forth with one another all the time on themes of her sense of guilt and responsibility - honed at the feet of her critical parents - and his accommodation of her penchant to feel guilty, often depressively so, by criticizing her actions, inactions, or whatever tune she throws to him.  One common topic of their conflict is their business - though somewhat surprisingly, given their frequent ups and downs, it's been very successful.

We discussed the subtle ways in which they can go back and forth on the theme of Mary's sense of guilt and the way she over performs in their relationship and business to try to make things better, to try to make Hank happy.  And Hank can be somewhat irascible, so she has a broad canvas (if I can mix metaphors) on which to paint.  The more Hank's unhappy about this or that issue, expressing his riff on their song, the more Mary will play back with her variation of her wanting to make it right by over functioning, trying to come up with a different, better, novel idea in their business or marital life, rarely to the mollification of Hank and, the improv is on.  She struggles to accommodate his dissatisfaction with his topic of the day, and her lack of success in molifying him breeds yet another reprise of the tune of her trying something else, ultimately leading to her fatigue, frequent depression and tears and so often a fight between them.

They've been at this for years, so I don't know if their participation in our discussion using their shared love of jazz might help them see the dance in which they're engaged (mixed artistic metaphor #3 if you're counting).  It's a discussion we've had, in one way or another, a few times already, but they have yet to inhibit their repetition of the chorus.  Maybe speaking their jazz language will help.

Standing In His Truth - A Neurotypical Sib's Strength

As with all postings, materiel changes to any descriptions of clients are made to protect their privacy.

Standing in his truth.  It's a phrase I always found a bit psychobabble-ish, so I rarely use it.  But recently, I sat with an 11 year old boy, Andy, who did so remarkably.

There was, let's say, a difference of opinion between the boy and the child's stepfather about a specific incident.  Andy, his sister Crystal, his biological mother and stepfather and  were reviewing the incident in my office, the mother, understandably, wanting to create an allegiance, a "united front" with her husband of many years.  Crystal is 15 and has high functioning autism and is often a challenge to her parents and step parents, but Andy generally stays out of the fray.  Crystal's done a lot of work on a lot of issues and, generally, is doing well.

Now I have to say, I'm overwhelmingly a fan of parents presenting a "united front" when they're dealing with their kids.  I've long held that parenting can be at risk of devolving to a game of football where the child "splits" the parents as effectively as a good offensive line can split the defense and scores a goal while parents proceed to fuss at one another about who did what when and why.  It's a very well established play that kids call upon given their highly sensitive ability to detect the potential for parental differences.  It also can, in the best of circumstances, help parents sharpen their team playing skills - which are often needed when dealing with kids.

But I'm not so sure that Andy was splitting.  This is a situation where step dad's depression has become worse we've been working in couple's therapy on the challenges that Crystal brings to the family.    Step dad's been using meds to treat his depression, but it's a hard slog, as depression can be, and additionally, Crystal's behavior is indeed a stressor.  Men, classically, can become irritable when depressed, which is what I think happened in this case.  I've seen stepdad's irritability arise in the office and he has a history of his anger flying a bit off the handle.

When reviewing the incident between Andy and stepdad, the conflict was evident and it looked like a "he said she said" situation, with Andy and step dad on either side of the line and mom wanting to support her husband.  Andy impressed me.  He related his version of the incident quietly and calmly - remarkably quietly and calmly.  Admirably, step dad did not raise his voice or try to leverage his adult role to make Andy submit.  He was calm as well, reviewing his view of the incident.  Crystal, mostly quiet sat and listened.

Andy's a typically developing kid, the classic "neurotypical" (NT) sib.  He and Crystal are shuffled back and forth between the mother's and father's home weekly.  There's very little tension between his biological parents and historically, Andy's coped well with the weekly transitions (not as much so for his Crystal), which says a lot for an 11 year old boy with an older sister on the spectrum.  Andy is the classic "opposite" of his sister.  He is well behaved, responsible about his schoolwork, doing well in scouts, active in sports.  Pretty much everything one might want in an 11 year old.  Andy has begun to participate in therapy in an extension of the family work mom and stepdad are doing with Crystal.

What impressed me the most was Andy's calm nature when he said his piece. He wasn't defensive, his story didn't waver or change as it was reviewed (and it had been reviewed a lot by the time they brought it to therapy.)  He just stated his view of what happened.  Strongly, softly.  It was quite a moment - and it left mom and step dad a bit befuddled.  Later it was step dad who walked his story back a bit, admitting that he's been on edge and struggling with his depression and how to deal with other stressors in his life.

Andy remained calm.  It was a bit of a moment, Andy showing his strength of character while mom and step dad re-evaluated what they thought was their united front.

The main thing I took from the exchange was Andy's ability to "stand in his own truth" of what happened.  Mom and stepdad will continue to work on their relationship and coping with a teenage girl on the spectrum - which can certainly be challenging to everyone.  Stepdad's come out of past depressive slumps OK before.

But Andy - won't he be a force to be reckoned with in the coming years - in very good and exciting ways.

King Solomon, Hillel and David Burns: If I Am Not For Myself.

As with all postings, materiel changes to any descriptions of clients are made to protect their privacy.

Pretty disparate title, no? King Solomon lived almost 3,000 years ago.  Hillel, a Rabbi authored many important opinions in the Jewish Talmud lived about 900 years later.  David Burns is a psychiatrist who is still living.  What on earth could they have in common?

Kim hs just started HS and has been working hard on dealing with anxiety.  Anxiety disorders occurs in 25% of all teens from 13-18 according to the NIMH.  That's a lot of kids.  So Kim's situation is pretty common.  Indeed, I see lots of kids with anxiety.

Kim's dad had, dutifully upon my recommendation, bought her a book about anxiety written by David Burns, the psychiatrist who wrote the seminal book Feeling Good about depression.  He's gone on to write about anxiety and panic disorders, and "cognitive behavioral therapy" to which he is a foundational contributor.  It's a well documented treatment for anxiety, depression and panic disorders.  His books have lots of information, worksheets and the like about anxiety - and Kim and I recently embarked on a detailed discussion about her experience with anxiety as she's begun to go through the book.  In the midst of our discussion, I was reminded of comments that seemed so apropos.  Historical comments that took us on a millennial trip.

She first observed that if Burns had known so much of this, there had to be a lot of people with these issues to study.  She noted that she's likely not as alone as she has feared.  I commented reflexively "There's nothing new under the sun," originally stated by King Solomon in Ecclesiastes, commenting upon the pursuits that occupy people's lives.  He didn't use the term "cognitive distortions" but, I dare say, would have understood the term in light of his writings about how we develop meaning.  Yes, Kim, there's been anxiety since we had to worry about being attacked by saber toothed tigers.  Our job is to balance when it makes sense to worry - and when it doesn't.  

We then moved on in our discussion about Burns' musings on anxiety and turned the corner into the burden many of us have prioritizing our own needs over the needs of others, and how, if we focus too much on the needs of others, our own needs become neglected.  Again, reflexively, I stated Hillel's famous comment from about 2,000 years ago:

              "If I'm not for my self, who will be for me?  But if I am only for myself,                who am I?  If not now, when?"

Kim and I discussed that indeed, we are not islands where we never need others, nor do we ignore others' needs.  Neither are we able to be a fountain of unlimited giving to others.  But we do have to connect and contribute to others.  Hillel's goal, if I may be so bold to say, is balance, a skill that many folks with anxiety (and depression) struggle to maintain.

And of Hillel's last statement: "If not now, when?"  I think that brings Kim right back to Burns' book.  He's quite clear in his books that they are not just for reading.  They're for using.  Using the tools, the worksheets and the exercises that are outlined to challenge the preconceived conclusions that we have that keep us anxious or depressed.  This practice enables learning - in the same way kids play catch with a parent - so they can master the skills involved in throwing and catching the ball.  They create muscle memory that sticks with them for a lifetime.  The practice with Burns has to do with creating the neural pathways - the neurological equivalent of muscle memory - in order to successfully address the anxiety/depression at hand.

So, Kim is, hopefully, on her way to the path of creating these different strategies to address her anxiety.  She's a good kid, a hard worker, and I have faith in her desire to challenge the current "cognitive distortions" that keep her anxious.  I was a bit surprised, however, that our discussion of her journey brought us from today, back 2900 years to the days of King Solomon with a short - but meaningful stop some 2000 odd years ago with Hillel.

A Look of Shame: Learning Disability Hints and IDEA

As with all of my postings, materiel changes in descriptions of clients are made to protect their identity.

Speaking with a typically developing teen and his dad (mom works late), we reviewed his end of year grades.  With a bit of a sheepish smile he said he had C's and B's.  Now I know this kid, he's not lacking smarts.  His parents are very successful in their jointly owned business.  And while genetics aren't everything, they do need to be considered.  Thus my hunch that the reason, we'll call him Harry, the reason Harry didn't perform better academically was not due to his lack of potential.

So I inquired how much he studies and does homework at home.  Again, with his sheepish, engaging smile "about 15 minutes" slid out of his mouth.  Nightly? No, Per week.  "So" I said,"That's about zero minutes per night, if we round it out."  We all smiled, laughed a bit, and as I explored his lack of persistence in his work ethic (an ethic he has for many other activities, some of them pretty technical) I suspected that he might be having troubles reading.

He admitted that he did mentioning that the only way he could get through his English lit class this year was to listen to the book on CD while reading it.  Hmmmm, another data point.  A classic compensation for someone with a learning disability.  I asked more: has reading always been hard?  Yes.  Do you read for pleasure?  No.  So I looked at dad and asked: Do either you or your wife have any history of challenges with reading?  And then it happened.

Now this dad is as gregarious a guy as you'll meet.  As I mentioned, he's quite successful, and his personality has clearly helped in his career.  We often banter, joke and he's never caught off guard.  Dad's look was one I wish I could have photographed.  Here's this man who I know to be worth many millions of dollars with a business that's likely worth many millions more.  And just at the moment I asked if he or his wife had difficulty learning he looked like a 4 year old kid who was caught with his hand in the cookie jar.  He was without words.  His chin looked like it was going to quiver. The tears of shame were close.  He looked so sad, like he needed to sit on someone's lap for comfort. Finally he squeezed out, shamefully, quietly, "Yes, I've never read well."

I reviewed with him, you went to college, right?  Yes, he replied, a couple of years at a technical college.  He did well in the tech classes as they demanded less reading.  I worked as hard as I could to normalize his challenges, and went on my LD schpiel, one that I and other professionals have given a zillion times.  It's about how LD's were very common and have nothing to do with intelligence - as evidenced by dad's broad knowledge about a plethora of topics.  I went on to add that LD's were often found in family trees, so the hypothesis was that Harry had an LD.  I asked how had Harry made it so far without being screened or tested for an LD?  Dad said that mom had been working with him, supporting him, reading with and to him, which gave him enough to make it through, so far, into high school.

So we went on to discuss psychological testing as the proper method to determine if there indeed was a LD, or possibly some other reason the reading was so difficult, but I told them I'd bet most of the farm that the son was walking in the steps of the father re: his reading challenges.  I continued my LD schpiel: if Harry has an LD, the school was obligated to provide accommodations as needed or recommended from the psychologist.  For the second time dad was caught up short.  He hesitated, awkwardly - started to speak..."what about" but couldn't finish the sentence.  I wondered if he was worried about Harry's being "the SPED kid" (special ed) and assured him that there was no stigma involved, that these type of accommodations were common these days due to IDEA and that the number of IEP's out there were too numerous to count.  I stated, for emphasis as I always do when discussing these things, that IDEA is federal law (accent on "federal") assuring accommodations for LD's.  Dad was shocked.  Really?  It's law?  I assured him that indeed, it has been the law for 25 years.  Dad was even more shocked.  So I gave him the info to read on line - he said he could read slowly.

I have fair confidence that Harry's parents will get him tested.  He learns great if he can listen to the materiel, which is a great way to compensate, and while discussing that many textbooks were available to be listened to - the son perked up saying he could certainly do that!

I felt great at the end of the session, assessing, educating, advocating, but as I thought of it further, I didn't feel so great.  What remains with me was the look of shame on dad's face, followed by his shock that schools were obligated to accommodate LD's.  Kids with LD's no longer need to be ashamed like Harry's dad clearly was.  We've come a long way, I assured dad, from the time he was a kid.  And despite the great awareness about learning differences, as a colleague of mine re-frames LD's, this mom and dad didn't really know about the strides of progress that have been made.

But I wonder, where were the schools in seeing Harry's struggles?  Dad's struggles were written all over his face.  Thirty five years later, Harry's schools certainly should have noticed his difficulty reading!  How could educators have missed this over the course of so many years?  That's where the real shame lies.

Two Kids, Same Assessment: Work and Behavior

As with all of my postings, materiel changes in descriptions of clients are made to protect their identity.

I'm seeing a number of kids right now who flunk my Work and Behavior assessment.  It's a bit simple:  Kids have two main tasks in life; Work (which for them is school) and Behavior (meaning that their behavior needs to be within the bell curve of acceptable for their family and school.)  Lets look at two of them, Mike and Charlie.

Mike is a very easy kid to like.  He's very smart, has a sense of humor that's great (mostly meaning he laughs at my admittedly obtuse jokes) and he cares, a lot.  He lives with his mom, who's great.  She's on top of everything and as a single mom deserves awards for caring for Mike and his sister so well.

It's a bit of a different situation at dad's.  Dad's home is, shall we say, challenged.  His girlfriend is there, on and off.  Dad's sister lives there, (works part time), as does her daughter, and her daughter's 4 year old daughter.  Dad openly states to Mike that his obligations to care for Mike are just that, obligations.  The court order said he was in charge every other week, and he's fulfilling that obligation.  Minimally.  He openly states he doesn't have to like Mike, refers to Mike with a variety of epithets that aren't really fit for a family forum like this.  Maybe he's trying to be funny, but he's hurting Mike.  Deeply.  And Mike, good kid that he is, is loyal to his dad.  He's old enough that he could just stop going, but he loves his dad and is stuck on not wanting to impair that relationship further.

Mike and I have not yet had the talk that we will soon have regarding the difficulty growing up and realizing that parents are human.  Sometimes painfully so, as in Mike's case.  Sometimes we have to just face our parents' faults, as painful as it is.

But the issue here is assessment.  Assessing Mike is a bit easy, as he's such a good kid.  No behavior problems at mom's or dad's (though dad, who won't come to therapy, I'm sure would find fault with his son.)  Mike flunked most of his classes this year.  And that may be the best thing for my relationship with him.  As I'm trying to get Mike to see that his relationship with his dad is hurtful, the reflection of that is his grades.  Now as I said, Mike's a really smart guy.  Last year his grades rocked.  This year they tanked.  I don't know what happened between last year and this year, except that he's in high school now which might be a piece of it, as the classes indeed are harder.  But with the every other week custody thing (I don't usually see it working so well for the kids, but the parents get exactly what they want), and the harshness at dad's home, the semi-chaotic nature of dad's house, with his aunt coming and going, his cousin coming and going, and Mike being the back up baby sitter for the 4 year old, without warning or compensation, Mike's only response when he's at his dad's is to spend as much time in his room alone as possible.  The evidence is clear: he's not able to do his schoolwork the way he needs.  It's a mess.  Hopefully, Mike will have the strength to take care of himself first.  I'm actually optimistic.

Charlie is a different case all together.  He has great grades, even as he struggles with his parents' somewhat restricted expectations of him, and he responds not so nicely.  Charlie's not the sensitive artistic kid his parents, both artsy folks, really saw him becoming.  His time at piano lessons was, lets say, not terribly productive.  (Dad is a very accomplished pianist - when he's not doing really well in the advertising business.)  Charlie would much rather be playing lacrosse, or run on the cross country team, excelling in both.  Again, how to assess:  behavior?  Fine.  Work?  Not so much.

Charlie will quickly yell and scream at his parents when angry.  His anger is the kind that comes from depression - irritability is a classic (and often under recognized) symptom of depression, and boy can he be irritable.  It sometimes doesn't take much and he and I have been meeting to understand more of what triggers his irratibilty.  Fortunately, between his medications and the Collaborative Proactive Solutions model (see my other posts and posts to come on Ross Greene's model) he's doing better.  Much better, actually, and it's lovely to see.

Charlie was pleasantly easy to engage when it came to collaborative problem solving.  His dad did great at adopting the strategies, (his mom's been a bit more shy at trying it) and Charlie quickly and easily engages with them when using the method.  Charlie knew that his behavior at home was a problem.  He just didn't feel like his parents heard him well enough, which is what Greene's model helps with so well.

Now it's not over for Charlie, I'm sure there's more challenges to come, but he knows, and his parents certainly know, that good grades are not the ballgame.  He also needs to be able to manage his behavior.  Mike also needs help, but it's with his work (school) not his "behavior" per se.

I often tell parents and teens that the way I assess kids is their work and their behavior.  It's not a perfect model, but it sure works a lot.

Old Enough to do Stupid Things

As with all of my postings, materiel changes in descriptions of clients are made to protect their identity.

I've been seeing this really nice, smart kid from a really good family - his story is pretty irrelevant except for one thing he said recently.  We were discussing that as he has been getting older (late teens) his social life has gone the way that is so common.  He's smoked marijuana once or twice but hasn't really used alcohol and while he's still a virgin, he's been romantically involved and has engaged in what we might once have referred to as "heavy petting."  I'm sure he's interested in more when he has the opportunity.  We were discussing his life and some of the stress he's been under and I suggested that until he was stable for a bit longer, that he remain cautious about using substances and becoming sexually active.  I quickly qualified to him that I wasn't endorsing  or condemning these activities, rather I was acknowledging the realities of our society today.

According to the US National Library of Medicine National Institute of Health, as of March 2014, fully 34% of our youth under the age of 16 reported use of alcohol and marijuana.  21% of high school seniors are current users of marijuana according to the National Institute of Drug Addiction.  As we know from even a cursory review of the news, the brain doesn't really stop developing until somewhere in the early 20's.  So 34% of our kids are using psychoactive addictive substances when their brains are no more than 75% mature.  Not surprisingly, the study concludes that kids who have these habits are those with the higher rates of substance abuse problems.  It didn't say, but I'm supposing that the numbers of kids with mental health issues in this population is also high. The CDC reports that over 12% of kids over the age of 12 have used either illegal drugs or have used pharmaceuticals for recreation in the past month.  Of high schoolers, CDC reports that 47% have had sexual intercourse, 34% having had intercourse in the last 3 months and of that number, almost 15% didn't use a condom.  15% of high schoolers have had sex with 4 or more partners.  These are sobering numbers.

I recently spoke with a mom (dad's not in the picture) about some very troubling behaviors her teen daughter was engaged in - serious depression coupled with serious drug and alcohol use and casual sexual activity.  I flatly expressed my concern to mom that her child's emotional stability seemed quite inconsistent with the ability to manage  alcohol drug use and sexual activity.  Mom's response surprised me, to say the least.  She said "She's in high school - isn't that what she's supposed to be doing?"  Gently as I could, I clarified why a young teen with mental health issues is not "supposed" to drink, smoke pot and have sex. I'm not sure if it got through.

Which brings us back to the young man who used the phrase that is the title of this piece.  He's had some challenges - that are greatly outweighed by his strengths.  He's smart, does quite well in school and has great parental support. He understands that getting high, drunk and having sex are, in his words "stupid" things for someone of his station.  But these are things that most all adults have done.  The National Institute on Alcohol Abuse and Alcoholism reports that almost 87% of adults have used alcohol.  A Gallup poll reports that 38% of Americans have used marijuana.  And as only 4% of Americans die as virgins, most all of us, sooner or later, have been sexually active.  So virtually all of us engage in these activities, some of us have engaged in many of them.

So, when are we old enough to begin to do stupid things?  I don't know.  It's obviously dependent on many variables.  And I'm not saying that responsible use of psychoactive substances or responsible sexual behavior is bad or good.  Sexual activity is a developmentally (not to mention anthropologically and biologically) normal behavior.  The use of alcohol (and in some cultures other psychoactive substances) is a part of many religious and social norms.  What I do know is that mixing these emotionally demanding behaviors (that statistically, most all of us do or have done) is a bad mix with a brain that's underdeveloped. It's worse for a kid who's experiencing mental health issues.  I'm also pretty sure that the kid who questioned when he would be "old enough to do stupid things" has a good shot at success.  After all, if he's smart enough to ask the question, he's already showing some wisdom.  

Children As Puzzles

We are all fascinated by puzzles of some kind or another.  Our professions are samples of different kinds of puzzles.  The brain surgeon has to figure out the puzzle of the next surgery, the warehouse worker has to figure out the puzzle of how to order the stock in the warehouse so it can be tracked and pulled when needed.  Kids thrive on puzzles.  My almost eight year old grandson is fascinated by jigsaw puzzles and Sudoku.  Since the days of "Pong" video games have gone through multiple generations of creativity engaging kids and adults into solving the problems in hi-definition.  Learning to read - to decode the meaning of letters and their combinations that make words, stories and communication is its own kind of puzzle.

I've been thinking about problems solving in the midst of my training with Ross Greene in his "Collaborative Pro-Active Solutions" model outlined in his The Explosive Child and Lost at School books that have taken root around the world. These books teach that to understand children's behaviors is best done in collaboration with them in defining the problems and then coming up with solutions to the challenges they can bring.

Greene's model of working with kids is one that I have found unique in a number of ways.  The most important thing is that it demands that we listen to kids in an extended way, a way that only ends when there is surety that the problem being discussed has been fully addressed by the child.  It's not a simple task, but one that is eminently do-able, as its not complex either.  It mostly involves listening and reflecting back to the child their statements (think "active listening") until the child convincingly can state that they have really addressed their opinion about the difficulty at hand.  Most of the skill is in having patience to let the child concentrate and express their thoughts.

Another unique aspect of the model: it does not include our theories on "why" kids behave the way they do (See "The End of Why Questions" post of 3/2/15) and the lack of theories - even when they are obvious, reasonable and maybe even correct, does something very important: they keep the child engaged in the process of discussing the problem.  When we tell kids our erudite conclusions, we run the high risk of excluding them from the process of the discussion.  We have, essentially, closed the discussion if the child states anything that is in opposition to our theory.  Shutting kids down is obviously a poor way of communicating with them - not a great strategy to solving the puzzle of the child's problems. After all, who better than the child can express their experience?

It seems an obvious position, but one that many clinicians (myself more frequently than I like to admit) often forget.  In the almost 9 months I've been using Greene's methodology I've learned a lot as I've left my theories behind.  I've learned that kids with autism like to be heard.  I've learned that a kid with impaired hearing feels doesn't feel normal when she wears hearing aides (which, by the way, she now regularly wears due to the "problem solving" aspect of the model - something I'm sure to discuss later.)  I've learned that a kid with a visual learning disability is much more willing to do his homework if it can be read to her.

Kids and their behavior are not an easy puzzle to figure out, but Greene's model is one that is making it much more successful.

Mortality and Kids

A robust literature exists on how children understand mortality, and rightly so. Adults struggle greatly with understanding the meaning of life - the meaning of death.  The matter cuts to a critical essence of who we are and our most basic questions of existence.  I couldn't help but notice that recently I've seen a couple of kids, one with autism and one without, who've confronted mortality.  In this, as with all posts, materiel changes in client descriptions are made for reasons of confidentiality.

Harry is a 12 year old boy, small in stature, quiet, whose sister died in a car accident last month when another car jumped the median.  His sister is described as a charismatic, smart and involved sibling and child.  She had finished college and had begun working in her chosen field, living with Harry and their parents in the meantime, saving her money for a while before getting her own apartment. Harry's parents are, understandably, devastated.  Harry, quiet, struggled with how to articulate his feelings at Dawn's death.  I asked him about his religious beliefs and he began to discuss his basic understanding about the afterlife, consistent with his religious upbringing.  It quickly became clear that his religious education had been thorough, but that this was one of those topics that called for a deeper review of the family's religious doctrine.  He wondered whether God was punishing Dawn, was this some Divine retribution for her behavior - though he admitted she was a great sister whom everyone loved.  Maybe, he wondered, he and his family were being punished for something - what, he didn't know.  Maybe there is no God at all?  How do we find meaning in this tragic and senseless loss of life?  These are questions that are normal, human and very difficult to answer.  Harry's parents, tearfully, are rallying with him to find meaning in something that admittedly does not easily make sense.  As we all know, the lessons Harry is learning are those that we all learn one day or another. Painful, but a normal part of human development.

Susie is a 10 year old girl who came to see me due to tantrums that began about a month ago, seemingly out of the blue.  She has High Functioning Autism (Asperger's) and has until now been a lovely young lady, her "little professor" presentation not withstanding.  It was mentioned in passing that her mom underwent a fairly routine surgery last fall that had unexpected consequences and ended up with complications that took a couple of months to resolve.  It was serious, but she was never in danger of death per her physician.  Susie was told that all was OK and had no follow up questions about her mom's status.  They went around their business, her mother recovered fully and all was well.  Until the tantrums began. 

As Susie, her dad and mom and I spoke, I learned that her mom's recovery hadn't really finished until about a month before the tantrums began.  I asked Susie whether she thought her mom was near death.  Not only did she say yes, but she feared that throughout mom's recovery (at home) that mom might at any second, die, inaccurately extrapolating that the tenderness mom had at her surgical site when she came home was permanent, an everlasting vulnerability through which her mom could die.  She also stated that she feared she could have the same need for the same surgery her mom needed and that feared dying from it.  Her parents' eyes grew wide.  

The good news for Susie is that she's smart.  We immediately began the education process, having learned that her silence upon being told that her mom's surgery was not as simple as hoped, did not mean she fully understood her mother's prognosis.  Her parents understood that they would need to be on guard as to any connection between Susie's behavior and other issues and engaged her multiple times afterwords in discussing what she really understood about lots of things, physical health being high on the list.  Two weeks later, Susie came back and the tantrums had stopped.  Cold.  

Mortality is very hard for us to understand.

Panic Attacks and Self Monitoring

As with all posts that describe individual clients, materiel changes in descriptions are made to insure client confidentiality.

Kevin is a pleasant 16 year old junior in high school.  He began seeing me due to depression and anxiety a bit more than six months ago and has generally done well, not needing medications for either, though I admit it was close there for a while.  He's insightful, thoughtful and a very enjoyable kid to work with.  He's struggled a bit with some panic attacks that have been (understandably) frightening.  He's smart, but the depression and anxiety distracted his ability to keep the good grades he'd been used to last fall - he's not on the autistic spectrum.  He needed to pull his academics up, anticipating the coming focus on college applications and the importance of junior year grades in that process.  Pressure, but the kind that most kids tolerate.  Since the beginning of the year with a new semester, he has done very well with his academics.  

He came in and discussed another panic attack after a 4 month respite from them.  So we discussed what was going on around the time of the panic attack that might have triggered it.  He was quite clear and didn't hesitate - he had been having a bad day anyway, having not done well on a paper he had worked on and invested a lot of time in.  His friends and parents noticed he was a bit edgy but he couldn't really put his finger on the problem.  Then he was asked to go to the store by his mom to purchase an item for a recipe she was working on and needed right away.  It wasn't there.  She needed it.  He panicked. Shortness of breath, pounding chest, fears of death.  Another panic attack.

He managed this one pretty well.  He called his mom who was understanding and quickly helped him see that the priority was his emotional stability much more than the recipe she was making.  She encouraged him to just come home, reassuring him that the recipe was not that important.  With that, he was able to calm down more quickly then he has in the past.  He came home (while his mom went to another store, understanding, to her credit, that he was more overloaded than she had anticipated), and was soon fine, but perplexed about having had another panic attack after having been doing so well.

So Kevin and I began to talk about how self monitoring might be a useful tool in helping him see when and where he's vulnerable to panic attacks.  We reviewed past panic attacks and saw a couple of themes - when he feels pressure to meet the needs of others and when he's unhappy with himself.

He rightly asked: now that I know what the triggers might be, what do I do? Which led us to a discussion of self monitoring.

Self monitoring is one of those things that's easy to discuss and easier to advise, but not near as easy to do.  Despite that, Kevin has some important insights:  He knew he wasn't feeling good about his academic work either time he's had the panic attacks.  Last week it was a paper.  Then really tried to help his mom - he feared disappointing her when she needed him.  The  panic attack of 4 months ago had similar themes - his friends were desperate for him to join in an activity when he had schoolwork he needed to do in his weakest subject at a time his grades were slumping.  Again the themes of not feeling good about his academic performance connected to the pressure to please others.

Kevin's a good kid.  I can't say that he'll never have another panic attack, but he's aware, wanting to learn and seeing that there are times he's vulnerable to emotional distress.  I think that's a great start.

The End of "Why" Questions

There is a question that I've long struggled with, despite its standard use in most of our lexicons, therapist and parent alike.  It is arguably our most frequently used question: "why."  "Why did you (fill in the blank)." This is a standard parenting and therapeutic question.  It so frequently comes up with kids, particularly those with ADHD in response to their "impulsivity."  (See my post of 7/17/13 on "The Missing 'I' In ADHD").  

Asking "why" to a kid with ADHD is almost always silly question, albeit understandable.  Impulsivity means action without thought.  If I was thinking, I wouldn't have bleached the dog's fur.  It’s the Dennis the Menace response that lands him sitting in the corner – to no long term avail.  We ask "why" because we're programmed from infancy to do so.  If we understand why, we understand a lot.  But in the arena of human behavior, "why" often leads us down a dead end.  We've all been there - we ask "why" and receive no real satisfaction with the answer.  We are quite satisfied, however, with OUR answer of "why" which, as Ross Greene points out, is usually a theory, often creative, sometimes accurate, but used often as a figurative club to beat sense into the child.  Now I don't know about you, but I struggle enough with regular questions. When I'm being emotionally clubbed, I have a much tougher time.  When kids are being emotionally clubbed with our theories, they shut down.  

Indeed, the "why" question has been choice in my quiver of questions until recently. I'm using it less and less, and I may be even approaching the end of "why" questions altogether. The corner I've turned with "why" questions has come under the tutelage of Greene who wrote The Explosive Child and Lost at School.  I'm taking a certification program with him in the model outlined in these books. "Collaborative Proactive Solutions" (initially developed under the name of "Collaborative Problem Solving" until Greene's rights to his own intellectual property was challenged in court.  Another topic for another day.)

In the CPS model Greene asserts that "why" questions so often lead to a dead end. "Why did you hit your brother?" is likely to be responded to with a "He's a jerk" (often said much less graciously) or "He started it" or "He said I'm a jerk" and the like.  How does a parent or a therapist follow up to such a response?  Do we believe that knowing "why" will inhibit the problem from happening in the future?  That thinking is rooted in the Freudian theory of finding the "kernel" of the problem that, when explored, extricates the problem like a dandelion pulled from the ground extricating the entire root system.  The problem with dandelion pulling is that it invariably leaves a fragment of the root in the ground that regenerates.  Like the regenerated dandelion, the answer to “why” does not uproot the behavior which will invariably rear its ugly head again.  Knowing "why" does not give us the solution - the behavioral change - we want.  

We ask "why" I believe, due to our own inquisitiveness and desire, our need to figure things out and understand how things work. Why does the apple fall from the tree?  Gravity.  Why did my tennis serve not make it over the net? Simple, if I'm able to learn the mechanics of how to serve a tennis ball.  Why did I leave dirty dishes in the sink?  That's actually a complicated question with many variables and influences.  And that's just the dishes!  When exploring the cause of human behavior, it's quite difficult to find a satisfying answer to "why" mostly because the answer to "why" doesn't lead to behavioral change.  Maybe I didn't do the dishes because I was tired.  Maybe I didn't do the dishes because I'm angry at my wife for what(ever) happened yesterday and not doing them is my way to get back at her.  Maybe I didn't do the dishes because it's an expression of my sublimated rage for my mother's ignoring my emotional needs when I was three.  Yes, theories can be very creative.  

Greene famously talks about a child who he treated who was quite the behavioral challenge and had gone through many therapists, more interventions, all to no avail.  The common narrative about the child had to do with the "theory" (code for "why") of the tragic death of his father when he was a toddler.  It was taken as faith that if he could fully explore his grief, his behavior would be wholly uprooted and all would be well.  When Greene asked the child about his father's death, the kid looked at him quizzically and responded that there were no real memories of his dad.  The child was two years old when he died.  The theory connecting the behavior to the loss of the mother was not applicable.  This is not to say that dads are unimportant – or that the child might not benefit from some “dad” based discussion, but we have to include what kids' experience is in solving the problem.  

What's a therapist (or parent) to do?  That, says Greene, involves engaging the child in a very specific definition of what the problem actually is and then collaborating with the child to find a solution.  Which is a discussion for a different post (stay tuned).  In the meantime, I encourage you to consider: is the payoff for the "why" questions getting you where you want with your kids? 

 

Strong Parents

It's been a week where I've seen a number of strong parents, some of whom I've known for years, some who I've just met.  Just thought I'd share some vignettes. As always, materiel changes to identifying data have been made to protect confidentiality.

I've known one mom on and off for a while.  She has a 9 year old boy on the spectrum who has a lot of strengths, but the oft found challenges of rigidity, difficulty transitioning and difficulty when the plan he anticipates changes.  He struggles with anxiety for which he receives medications that help some.  His younger sister, 8, is NT (neuro-typical) and while they've never discussed "autism" or "Asperger's" or "spectrum" outright, they have broadly discussed "differences" that people have.  Mom, to her great credit, has been "seeding" the family environment with kid friendly books about developmental differences, working to normalize her son's experience for him as well as for his sister.  She's also done a great job with "narrative" stories she's found.  For example, a story about the kid who was unable to comfortably speak with strangers (no coincidence this is one of her son's challenges.)  The story tells of a child who struggles with this, and who gradually learns that his anxiety about speaking to strangers is able to be surmounted.  Her son's begun, like the boy in the story, to speak more comfortably to strangers.  Mom's job is flexible.  She has the time to investigate, research and advocate for her son and has done so admirably.

Another couple came to me recently with their son who's on the spectrum and also has borderline cognitive functioning.  They were well aware of the impact and limitations of both diagnoses.  They have been most diligent in following up with recommendations, particularly after their son said - let's call them unwise things - at school when he became angry.  They jumped way out ahead of the curve understanding that such statements can be misinterpreted, particularly in the "small world" environment in which we now live.  They understand that threatening talk of any kind has been seen as preceding horrific behaviors and though there are no indications of this child's potential for violence, they are being most proactive in searching for solutions.  They quickly follow up on recommendations and have a very good comprehension of their child's needs.

One single mom I've known for years always impresses me.  She has a full time job that isn't particularly challenging or fulfilling, but allows her the flexibility to be there for her son with autism.  She plans ahead - not in an anxious way (professionals who work with challenged populations are quite familiar with the questions about "will he/she be able to get married, have children, live independently when the child's ages is still in single digits.  I understand the anxiety the absorption of the implications of the diagnoses has....)  She plans, for example, for spend the night company.  "What kinds of things do you think your friend might like to know when spending the night in a new home?"  Then she suggests that her son give a house tour to the guest.  She suggests her son inquire of the guest about food preferences.  Suggestions about how to be a host and allow the guest to pick out the game to be played on the x-box among many other suggestions.  All of this led to, no surprise, a very successful sleepover.

These may seem like simple, obvious examples of parent strength, but having seen lots of parents who struggle mightily with the stress of raising kids on and off the spectrum, it's nice to see.

Fatigue Redux or "Follow Through" Lessons from Golf

As in all of my postings, materiel changes have been made to fictionalize the description of the person and circumstances for reasons of confidentiality.

In one of my posts about 2 1/2 years ago I discussed parent fatigue.  It again comes to mind in the wake of a meeting I had recently with a great young lady, we'll call her Judy, who's about to graduate High School.  Judy's a smart young lady.  She's applied to and been accepted to some good colleges and has a very balanced view of the world.  She doesn't date much, believing that dating's something that can be a pretty serious thing, and can lead to pretty serious things, so despite the overtures from her peers, she's keeping her social activities social, not intimate.

Among the issues Judy's struggling with as she stands on the threshold of her next chapter of life is her relationship with her mother.  Mom's divorced and dad lives out of town.  Mom doesn't make a lot of money - she may be underemployed, and maybe drinking too much (I've not met mom so all I can do is speculate from what Judy has observed) and often seeks out her daughter - and only child - for support.  Lots of support.  Mom asks Judy to help her at odd hours with chores (mom's job involves odd hours).  Mom proposed to Judy going into business together to pursue an idea mom had for income.  Judy demurred (quite properly, in my view.)  Mom opines that Judy doesn't confide in her any more, as Judy is involved with her friends, studies, a job and the potential for an exciting future.  Judy is torn between following her own life and dreams and the emotional responsibility she feels for her mom's well being.

What brought things into focus for Judy was her recent illness with one of the seasonal crud viruses that is going around.  She stayed home from school and after a couple of days in bed dragged herself to the kitchen for something to eat after finally regaining her appetite .  She found little in the cupboard, as usual. While mom's underemployed, she's not poor and certainly has the means to provide the basics in shelter and food.  Mom no longer keeps the kitchen well stocked for a teenager.When Judy's feeling well, she'll fend for herself with whatever's in the kitchen, or use monies she gets from dad to augment the lack of food in the home.  Sometimes she'll eat at the restaurant where she works, or at friends' homes. But this day, after being sick, she acutely felt the absence of mom's attention.

What Judy is coming to see is that mom's needs for Judy's attention are about mom's needs, not Judy's needs.   What Judy needed that day was, in my ethnic language, a pot of chicken soup simmering on the stove or whatever the equivalent is for suburban Atlanta.  (Trust me, an appetizing pot of chicken soup is an amazingly easy thing to make.)  Judy reflected that when visiting her dad, also not married, there's always food available for her.  She longs to live with him, but he lives out of state and she has 3 months until she graduates high school.

So what's going on here?  Probably a lot, but all I know is what Judy tells me.  At the very least, we have a mom who's struggling with her role of "follow through."  I learned about follow through when taking golf lessons (I'm a terrible golfer.)  I was taught that after hitting the ball my belt buckle should be facing where I wanted the ball to go. And boy was that good advice (but I'm still a terrible golfer.)  For Judy's mom, follow through has to do with keeping the parenting hat firmly fastened on her head at least until she goes to college.  Yes, that means a full fridge and some TLC when Judy's sick.  It also means being there for Judy, not having Judy being there for mom.  I have no other conclusions about Judy's mom, but have to wonder if the alcohol use is an issue that needs to be addressed - it could be key.  But I can't address that, Judy's mom is not my client.  And never having met mom, I'm in no position to draw conclusions. Judy's drawing plenty of them, however.

The Shirt on the Chair in the Office

I have two offices, one in my home and one in Alpharetta, a northern suburb of Atlanta.  My home office is comfortable, built out to my specs.  It happens to have the laundry room attached to it.  Sundays is normally laundry day, so there's no real conflict in the use of my office for folding and organizing laundry.  But this week my wife was home, and while I had no clients scheduled, she did some laundry.  Big deal.  Later that day when I was seeing a client I saw a shirt that had been laundered hung over the back of the chair to my desk.  My professional life had suddenly been invaded and sullied by her lack of attention to detail.  I noticed it just as a session was ending and was prepared to be wholly embarrassed.  My client, fortunately, either didn't see it or was gracious enough to not comment.

Now I've been at this marriage thing for 35 years.  Lucky for me.  Because years ago I might have really laid into her about her lack of sensitivity to my professional life, about the sanctity of my office, the embarrassment it did (or could have) caused me.  My temper was not my best friend (nor is it now.)  But this week I was able to practice what I preach a bit and consider my wife's experience.

She works hard.  She means well.  She's a good person.  She respects me, my work and my need to have control over my own space.  Further, I remembered she'd just been to the doctor for a small procedure and thus may have not been feeling her best.  Most importantly I love her and have found that it's true what they say, our love really has grown over the years.  So after a small (but critical) analysis, I did the right thing, I forgave her for being, well, for being human.

Make no mistake, my temper can lead to grudges being held, consistent with the part of me that's still somewhere in his teens.  But I'm an adult now, and I hold no grudge (this time.)  I forgive her for being human and leaving a shirt in my office.   This is not as simple as it sounds - how many partners struggle with forgiveness of their spouses for being just people.

I just met with a couple discussing the household chores (among many more important subjects.)  She just doesn't understand why he can't put his shoes away when he kicks them off.  She's asked, reasoned and pleaded.  I suspect she's resented his lack of just simply understanding how simple it is to put your things away when you're done with them.  His response?  "It's just not who I am.  I have so many things on my mind, I just can't keep track of my shoes when I take them off at the end of a hectic day."  My suggestion to the wife (not in these words, mind you) was to just forgive him for being who he is.  The earth will not stop rotating due to shoes being on the floor (or a shirt being on the back of my office chair - though that is, of course, much closer to stopping the rotation of the earth than mere shoes on the floor.)  I'm hopeful that she'll take my advice.  Time will tell.

Now, as to the pair of socks that a client found on the couch last week from when I was folding laundry - that's different.  Totally different.