The Emotional Demand of Marital Communication

 In an era in which "overthinking" is an accepted concept, I frequently find myself going back to basics.  Today's basic marital communication principal is the emotional presence we have for one another which, ultimately creates the depth of our relational bonds.   

I have had this marital "talk" with men over the decades and again recently, focusing on some simple but pretty classic themes.  The couple is so often lovely, they clearly love one another and their kids.  They're working hard, very hard and they're exhausted.  We often don't know how exhausting any given project can be until we are in the middle of it, and with kids. once you're in the middle of it there's no going back (unless abandonment is your thing.)  There's not a lot of "me time" that can be had.  But of course, parents have to have it, both for themselves as an individual and for themeselves as a couple.  And like a lot of things, individual and couple time is easy to say and often hard to do.  But it's critical.  

So I instruct them in the basics (it's often the guy who struggles with these things.)  Ask about her day, how she's doing, respond with more than monosyllabic sounds, ask her to say more, and look at her, deeply.  As I said these words I often see her nodding and smiling in agreement and sumultaneously I see the fatigue in his eyes.  

Marital communication is so much more than just the words and the content.  It's the emotional investment.  I'll ever remember a medical director's group supervision sessions early in my career.  The staff loved him because in addition to his academic and practice knowledge, he brought his emotional self to our meetings.  We would pack ourselves into a small room, it was literally SRO for these meetings, and people would pour out their hearts about the struggles of working with patients on an intensive care locked psychiatric unit.  He would look at us and say "Yeah."  A simple word of agreement with a tone and demeanor of hearing deeply what we were saying, looking straight at us.  It was  the ultimate validation from someone we trusted and really needed in the midst of very demanding work.  He would, of course, go on to say lots of other things, but that "yeah" was the salve that comforted.

So too in marriage.  Listening, validating, being present are so important.  But I believe it's also the emotional availability that we bring to our marriages that are so critical, even when overloaded (maybe especially when overloaded).  It provides a critical salve for the relationship.  Yes it takes time, and certainly a lot of energy, and for those who struggle with being aware of their emotional selves it's a steeper climb, but having an emotional attachment is what marriage is, essentially, all about.  

Callousing to Divorce

 I'm on a number of professional "list serves" that exchange ideas, resources in which colleagues also seek referrals from one another.  Something just crossed my eye that saddened me regarding how calloused we have become to one another's pain.  

Callousing is not necessarily a bad thing.  Our feet are very calloused.  They endure great amounts of pressure and demands in carrying the weight of our bodies as we depend on them daily without our consideration to the demands made upon them.  Professionals learn how to callous as well.  The emergency physician has to learn to callous to the pain of the patient in order to properly diagnose and treat the problem.  A physician focusing only on the pain of the wound may not do very well in treating it.  That's why physicians are trained to not treat their families.

In the field of mental health we are trained to strike a balance.  We we have to create an emotional connection with clients - after all, that's a large part that motivates their first call.  They need to speak with someone who they can trust, someone who convincingly understands at an emotional and intimate level whatever they're experiencing.  At the same time mental health professionals must not get too drawn into the pain of their clients lest they lose their professional objectivity.  The balancing of these two things, objectivity with empathy is an ongoing and difficult balance to be struck.  

So, while reviewing my in-box, it caught my eye when a request for a therapist for a child was made.  The child, the note said, had "no underlying issues."  So far so good.  Some kids just want to talk having had no external crises or precipitant.  The next sentence, however, stated that the child's parents had recently divorced.  

Yes, divorce rates are high, and that's a valuable topic of discussion for another time.  But for it to be so commonplace that we describe a child who has suffered the dissolution of their family structure to not be an "underlying issue" seems to me a bit too calloused a presumption.  

Have you ever broken a bone?  A finger, wrist, arm or leg?  Or have you  brought a family member or friend to the hospital with a broken bone?  When it's yours, it's not so simple, even though broken bones are common and usually easily repaired.  

I will hold that a child's losing the structure of the family is indeed an underlying issue.  It's huge.  Let's remember what the function of parents provide a child:  A child from it's first moments in this world creates emotional bonds with parents.  Throughout it's infancy and for years to come it learns how to distinguish between it's primary caretakers.  Usually that involves two parents.  Sometimes it's one, or a parent and some other adult, maybe a grandparent.  Whomever the primary caretaker/s are is with whom the child creates a primary attachment that is the model of attachment in the future.  Parents provide the child with a foundation upon which the child depends.  When that foundation gives way the entire structure of the child's life is changed, regardless if the structure of the family is a single parent, same gendered, multi-generational or typical.  

Fascinating research has been done in the wake of children's experiences after severe earthquakes.  The one thing they had always been able to depend upon, the earth's stability, now having been compromised, effects the child's experience of security and safety.  So too the parental unit that becomes unstable, jeopardizing the entire emotional foundation upon which the child has build his or her emotional world.  

Regardless of the frequency with which such traumatizing events occur, I pray that we not become so calloused so as to diminish the weight of the value of typical family structure.  

What Does That Mean?

 

I recall the astonishment when, as a student exploring a career in mental health, I entered counseling and was asked about a certain (now forgotten) topic: “What does that mean to you?”  It was so clear to me.  How could it not have been clear to him?  I believe myself reasonably articulate, so I couldn’t imagine what was not clear about what I had said.  I perceived a brashness in the question that caught me off guard to the point of offense.  I believed myself to have been quite precise.  Over time I’m not so sure I was. 

The question of "meaning" has stuck with me.  Finding meaning is, after all, a fundamental function of our higher brain.  It’s high on Maslow’s hierarchy of needs, not a primitive “shelter” function.  It drives us and pushes us.  It’s integral to our marriages and families.  Viktor Frankel’s seminal work Man’s Search for Meaning compels us towards understanding what things mean.  We are obligated to strive to define meaning, but it’s not always as clear as our first draft may appear. 

That search pushes us in a variety of ways, all of which I believe are healthy.  Whatever we might be talking about, whatever is on our mind may be the thing which we are attempting to clarify.  Once we do so, we might want to share with our spouse, our kids and friends the new awareness we have found.  Sharing what has meaning to us increases attachment between us and our loved ones.  And if we fear what we find, that means something too – probably something quite important.

The essence, I believe, of understanding what things mean to us is the demand it creates to articulate our beliefs, thoughts, and feelings.  That use of language, the crafting of our thoughts and emotions into words serves a critical function for us.  Language holds the ability to convey ideas with impact, strength, nuance, clarity and conviction to ourselves as well as to our intimates.  Thus, when you consider what things mean to you, it’s worth taking a moment to find the right words.  You’re not pouring concrete - you’re not married to the words.  Meaning is a lifelong evolution.  Use your friends or spouse to bounce the ideas off of.  Listen to their questions and comments.  Craft your message.  Ponder it.  Think about it.  It will mean a lot. 

 

The Unexamined Family of Origin

 

A colleague of mine posted in her office: “Parenting doesn’t come naturally.  What comes naturally you learned from your parents.  It takes work to do it differently.”  Most adults reach a point where they can objectively critique their parents’ style of parenting as well as their marital dynamics.  Socrates criticized “The unexamined life…”  We also have an obligation to examine the dynamics of our families of origin.  It is crucial for us to understand our patterns of communication and how they may reflect the imprint we received from our parents.  Without such examination, we can unknowingly influence the nature of our marriages and how we shape our children. 

How well did our parents communicate with one another?  How did they cope with the stresses, large and small, that life brings?  How did they negotiate parenting responsibilities or children’s challenging behaviors?     How did they cope with emotions?  And most importantly, how did they resolve conflict?  Solid research shows that parental stress effects the welfare and mental health of children – a particularly important point during this period of COVID causing all of us increased stress.   

Parent modeling can influence for the lifetime of the child and may be passed down for generations.  It is the source of the phrase “generational patterns of_______.”   Fill in the blank with words like “abuse,” or “addiction,” “emotional distance.” Contrast that with works like “scholarship,” “leadership,” or “kindness.”  

When parents lack the skill to reach a healthy and lasting resolutions in life, children know.  Children are sponges absorbing how happy parents are by something as benign as how parents ask one another to pass the salt.  And don’t think it’s all about volume.  Quiet resentments can be just as damaging - beware the chimera of silent anger as much as explosive anger.  The goal is to find true resolution of differences and mindful ways of conduct with spouses and children that ultimately leads to greater intimacy and thus, greater joy. 

 

The Lowest Hanging Fruit

 

The Lowest Hanging Fruit

 

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

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

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

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

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

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

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

 

COVID 19; It's Simple, Not Easy

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

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

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

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

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

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

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

How Much Academic Pressure Do We Put On Children?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Special Needs Kids, Special Parents and Marital Stress

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

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

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

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

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

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

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

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

What Do We Expect

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

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

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

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

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

• When should parents accept their HFA child's atypical behavior as a natural manifestation of autism and when should parents (and professionals) intervene?  Certainly we want to encourage as much independence as is attainable for the individual, and yet, not every person (with autism or not) is a good candidate for college, maybe not even for many work settings, maybe or maybe not for independent living.  What I would propose is that parents might need to sit back and reflect how reasonable it is for their children to continue to grow?  It's not a simple question, and I'm not suggesting that parents quickly give up on their kids.  I'm also not suggesting that they pester their kids either.  I'm not sure what the best medium path is, but at least for these two families, I'm thinking they will benefit from considering the question of what is "reasonable".

• We train children for lots of things like speech, manners, toileting, reading and other academic skills.  But how do we know when our HFA kids have hit their own personal wall of accomplishment?  That's quite a tough one and, of course, is dependent on the strengths and weaknesses of each individual.  Plenty of folks with HFA can grow throughout the course of their life, learning new skills, flourishing in education and career and love and family.  I would also hold that there are plenty of folks with HFA who, at some point in their development, reach some level of a maximum of their strengths that might challenge their success in these same areas.  They can work, be productive and live a whole life, but it may be a life that's less whole than their parents desire for them.  Parents' expectations for their children, those with HFA and those who are neuro-typical (NT) often have to accept the reality of their children's abilities.  Sometimes, as can be common with chronic conditions, they need to accept the reality repeatedly.  

There's lots more to discuss, but I offer this as a beginning to what I think is a worthwhile conversation, if a challenging one.  

The Devil Is In The Details

I recently had cause to remember a detail (one of the many below) that, for a client I recently saw that might be very important.  So here's some reminders for families of children with autism and other developmental disabilities.  Many of these things are applicable to "neurotypical" (NT) children and adolescents as well.

• Regarding school issues: is there an IEP?  Is the IEP up to date?  Is the IEP descriptive and realistic about how the child's issues should be addressed?  Are the goals measurable (and not subjective)?  Was an autism specialist involved in developing the IEP?  Is there a behavioral plan, and if so, is it measurable and realistic?  Was there a Functional Behavioral Analysis (FBA) and if so, was it performed by a board certified behavior analyst (BCBA?)  (Many schools have employees who have taken an in-service do FBA's, which I don't recommend.  FBA's can be complex.)  Does the teacher receive the proper in class support to implement the IEP?  Might a change in classroom placement help your child succeed - whether to a more restrictive or less restrictive environment?  If the school has already suggested it, consider re-evaluating the options.  Has the child's diagnosis been re-assessed recently?  Remember, according to practice standards, psychological testing should be repeated every 3 years for children who have disabilities.  Was the testing done by the school or by an independent psychologist?  Some school psychologists do a great job, but you can always request a second opinion (and often the school has to pay for it.)

• If your child is having behavioral challenges, might they be modulated with the use of medication?  Remember, trying a medication is not marriage, a short trial of medications is overwhelmingly safe (no I'm not an MD, but your MD will say the same thing re: most of the first line medications used for behavioral or emotional issues) - and there's decades of data on most of the medications used that have not indicated serious side effects.  If medication is currently being used, are you sure your child is taking it?  Has the dose been adjusted?  Remember, many of these meds are weight based, and as your child grows the dosage may need to be re-assessed.  Have you followed up with the prescribing physician per recommendations?  If your PCP (primary care physician) is prescribing the meds, and you don't think it's working well, consider consulting with a board certified child psychiatrist.  If you are already seeing a psychiatrist and feel that the meds have not been working, or that the psychiatrist is not paying proper attention, have you considered a second opinion?  (Best practice supports second opinions, don't be intimidated that the doc will not like you, he or she knows it's part of the business.)  If you're using herbal supplements to help with behavior, do your research.  As the FDA does not monitor them, supplements may or may not have the ingredients you think you are buying.  Have you researched the academic literature on the effectiveness of those supplements?

• At home: is there other stress in the home that could be negatively impacting your child (think behavior or mood changes) such as marital issues?  Drug or alcohol use?  Medical issues affecting a parent or sibling?  Other mental health issues affecting a parent, sibling or other close family member?  (Parents of kids with special needs are at very high risk for depression due to the great stress that can exist.  Be honest with yourself and with your spouse/partner.)  Other significant stress on the family such as legal issues, frequent job changes or moves (even if for good reasons these may be hard for your child to cope with.)  Don't think that a child with more severe impairments doesn't "get it."  They can and do.  Has there been a divorce?  Remember, no matter how "amicable" the divorce, kids always lose.  Even when the divorce is needed, kids tend to want a reconciliation and tend to take responsibility, no matter what you tell them.  They need time, space and often therapy to absorb the reality that they really had nothing to do with it.  If/as the marriage is struggling, seek help now!  It's a whole ton cheaper in time and money to do so compared to the time and money involved in divorce.  (Therapists are cheaper than attorneys!)  Parents, don't forget the value of support groups.  There's nothing like speaking to someone who's been there, and you don't know that until you go, even if you're "not a group person."  (In the metro Atlanta area, the Spectrum support group based in Gwinnett County is easily the best in the state and I'd not be surprised if it's the best in the nation.  Certainly it's among the best in the nation and worth checking out.)  

• Socially: Is your child being bullied by others (including siblings) in the neighborhood, the extended family or at school?  Has your child's mood or behavior seen a significant change?    Children with autism, whether high or low functioning, can exhibit signs of depression.  Look for a change in their normal mood, onset of irritability or of crying or a sad affect.  Have you considered the effects of puberty?  Have you explained these changes in a way they can understand?  Are they struggling with how to cope with their romantic feelings?  

This is a bit of a thought "dump" but all of these "details" are important and need attention.  The devil may be in the details, but ignoring the details can make life for you, your child and family a living hell.  

A Millenial Dilemma?

As in all posts, descriptions of individuals are materially changed to assure confidentiality.

She's in her mid 20's and dissatisfied in her 3rd job since barely completing 2 years of college.  She still lives at home, despite her ability to afford housing.  Her parents hope she'll "find herself" and launch to independence.  She's never been able to maintain a romantic relationship for any length of time, finding those she dates as "not compelling."  She states she's anxious, sweating each and every detail that comes her way, yet (despite the Zoloft her doctor prescribed) seems to repeatedly make poor decisions, such as at work where she tries, repeatedly, to assign her own responsibilities to those who are not her subordinates. 

So I asked her recently, innocently, not realizing I was really on to something, "What are your expectations from life?"  She paused, thought for a minute and said earnestly, "I thought it'd be easier."  "You thought what would be easier?" I said, figuring out as I said it what she meant.  "Life" was all she said.  She thought life would be easier.

So there it is.  She's a bright woman, no learning problems or ADHD.  She did well in High School, never having to work to hard to get solid grades.  She's pleasant and has a good social group.  She gets asked out on dates from time to time.  But nothing seems to be engaging for her.

My concern for this person, and many (but certainly not all) with similar sentiments, is what they lose by underestimating and avoiding the critical life lessons of hard work.  They're bright, privileged, and struggle with how to get their life off the ground.  It's not just that folks like this hope to make the next best video game or app that takes off and sells for millions (or billions.)  It's that there seems to be no "plan B."  What happens when you don't become the next superstar?  This is, of course, not a new dilemma.  (I wanted to make it on Broadway after performing in a few HS musicals.)  But the lack of a realistic view of the world seems to be a common theme.

Alcoholics Anonymous is famous for the phrase "Accepting life on life's terms."  Acceptance, of course a primary theme of AA, is also a primary need in day to day life.  "It is what it is" is a cutesy current way of saying just that.  Reality.  Sometimes it stinks, but it is what it is, stinky or not. 

Viktor Frankl was a neurologist and psychiatrist and survived Hitler's death camps.  After the war he wrote a compelling book called Man's Search For Meaning, and while this forum is not close to being able to discuss such an important work, he encouraged people to consider more what life wants from them than what they want from life.  We are each charged with finding our own path to contribute - not sit back and wait for it to come to us. 

So I'm going to ask her (being a bit to dumbfounded at the moment it came up) to consider what Lord Rabbi Jonathan Sacks (former Chief Rabbi of The British Commonwealth) said of such issues in his book To Heal a Fractured World.  He suggests that in order to find meaning we find the place "Where what we want to do meets what needs to be done."  That seems to be as good a place to suggest to her to begin as any. 

What Success Feels Like

As with all posts, no specific client is identifiable.  The topics being discussed are generic and combine those things that are common to many people. 

She struggled, mightily, in High School, being teased unmercifully and ultimately forced to transfer to a home schooling program in her junior year.  She passed the GED without much difficulty, but her lack of social skills being a young woman with High Functioning Autism made her an outcast, despite her academic strengths.  Middle school and high school were, she admits, pretty miserable for her. 

Not surprisingly she took in all of the social rejection given her and thought poorly of herself.  So poorly she ended up inadvertently sabotaging her first year in college.  Like many individuals with HFA, she (and, I suspect her family) were eager for her to start over in college, hoping the slate would be wiped clean and that she'd develop her own sense of herself and realize her own potential.  She traveled far enough to dorm but close enough to come home on weekends and holidays.  She sunk deeper into the depression and anxiety that had taken root in her middle school years, began skipping classes her first semester, but despite that passed all of her classes.  Which did nothing to ease the depression and anxiety, as she was no more socially accepted or comfortable in her own skin in college than she had been in HS.  By spring break she was home. 

I began seeing her about a year later after she had begun medications and was re-establishing herself academically at a local college.  Living at home with parents who struggled between how to best support her while struggling with their frustration at her failure to launch into adulthood.  As an only child, her parents were hoping so much that they'd be able, finally, to move on with their lives as she moved on with hers.  They'd worked hard, been on top of her needs as best as they could, but couldn't protect her from the unfortunate and predictable pain of adolescence as a person with HFA.  Nothing they did could help her cope with who she was in a way that helped her adapt to social life in HS and college.  They feared her return home might be permanent.

She struggled, as do many people with HFA, with the executive functioning challenges from her concurrent diagnosis of Attention Deficit Hyperactivity Disorder (ADHD).  parents and while in HS her teachers, via her IEP made sure she received the support she needed to get her assignments done, handed in and for her to prepare on time for tests and longer term projects, she was loathe to utilize the student support services at her first attempt at college.  Her lack of organization had already been reflected in some very low grades in this second attempt and I encouraged her to reconsider utilizing the school's student support services.  She reluctantly obtained the permission she needed for extended time for testing - the only significant accommodation called for, and utilized it when needed.  And between that and the support I and her parents gave her, she developed a pattern of success. 

We spent lots of time discussing the issues she struggles with, similar to those many young adults have; the nature of her diagnoses and their impacts upon her as well as how to identify and understand her emotions; religion and philosophy, as her beliefs in these areas were significantly different from her parents'; sexuality; ; self worth; how to contribute in her academics and professional career in a way that was consistent with her strengths and, more importantly, not inconsistent with her weaknesses and challenges.  I have found her a thoughtful young woman, willing to deeply consider alternative narratives to the many assumptions she'd developed over the years. 

And now, with her undergraduate degree within reach, she has a new struggle, a new challenge that she's not faced previously.  She now is learning how to cope with, to understand and internalize the emotions wrought by the feelings of success, how they conflict with the inner narrative she'd developed over the past number of years.  How it feels to have job prospects for which she's qualified and, as it turns out, is a good candidate.  She deserves lots of credit and I share with her parents in particular a great pride in her growth and development.  The struggle of success - it has a nice ring to it. 

Kids, Exercise, Screens, Stress and Choice.

In mid November of 2018 the CDC published its newest studies on the connection between physical exercise and health - both physical and mental.  As has been proven in study after study, and again in this report (https://www.cdc.gov/physicalactivity/index.html), exercise is a critical factor in maintaining our physical and mental health.  And yet....how many of us take advantage of the easiest and most accessible of treatments for ourselves?  How many of us expect our kids to?

The study focused mostly on how much physical exercise helps medical issues, and mentions the mental health advantages almost as a secondary point.  Yet both are critical, to adults as well as children.  It states that "all cause mortality" is reduced with exercise.  Diabetes and insulin resistance.  Heart disease.  Hypertension.  Bone health.  Cognition.  All are helped.

Regarding mental health, the study confirms what has been studied, reported and replicated in the past regarding mental health.  Anxiety.  Depression.  Stress.  Tens of millions of us suffer from things that can be attenuated with exercise.  Sometimes significantly. 

We increasingly hear of the alienation that our children have from their peers.  Rates of suicidal thoughts and attempts have risen sharply, about 20% for 15-24 year olds since 2000, which roughly correlates to the explosion our use of devices.  People doubled their screen time in the 10 years from 2005-2015 and kids are a huge part of that.  The new report recommends that kids and adolescents from 6-17 get 1 hour of (mostly) aerobic activity daily.  (Meaning getting and keeping the heart rate elevated.)  The simplest way is by taking a brisk walk.  Yes, it's as simple as walking, for kids and adults.  (Can we even be so bold as to suggest that kids and parents walk together?) 

I've seen many parents act powerless in the face of their children's use of technology and I don't understand it, particularly in light of what we've been learning about how alienating excessive use of these technologies can be.  Parents: you are not victims of your child's devices.  You paid for them for heaven's sake.  It's OK to act like that.  Act surprised when your child objects to your exercising your rights of ownership, not defensive.

The evidence continues to mount.  Exercise helps both physically and mentally.  Screen time?  Well, it seems not so much.  But feel free to sit on your couch and surf the net (while your kid's in their room getting to the next level of the newest release of the must have video game of the month) and wait for a study that says increased screen time helps you and your kids both mentally and physically.  After all, it's your device.  Enjoy it.       

Engineers: Where Does Autism Begin?

A colleague of mine jokes (I think it's a joke) that NASA, at its height was the largest employer of special needs people - people with autism - in the world.  She was equating, essentially, engineers of a certain stripe, with having autism.

Indeed I've heard and read with some frequency that there's a correlation between parents who are engineers and their children who have autism and, in actuality, I've seen that often.  I've also seen children with autism whose parents are anything but the fact based, cerebral, math based, fascinated with complex problems and categorization making folks who are less emotionally based than the non-engineering population.  This is how we colloquially think of engineers.  This is not a piece on the objective research - some has been done without, to my knowledge, clear findings.  It is a piece on the spectrum of, well, of the spectrum.  Now I'm not assigning everyone at MIT and Georgia Tech with diagnoses, but rather am noting observations.

I know lots of engineers (some of my best friends....really.)  Many fit the same profile of strong analytic with weaker emotional capacity, including one who spurred this piece.

I'll call him Dave.  He's smart, successful, creative, kind, thoughtful, an overall great guy.  We've been friends for decades.  His wife is a mental health professional colleague of mine and she called me to discuss her frustration at his lack of emotional availability regarding a certain situation she was experiencing.  She noted that it had been a pattern through the decades of their marriage.  He was more of a "the facts are the facts, accept them, cope and move on" type of guy.  An engineer.  She's more of a "I'd like to discuss this, and then I might like to discuss how we discussed this.  What's the process we've gone through and the patterns we have about how we discuss our emotions...." type of gal.  Typical for many, including many therapists (not said critically - I'm the same type of guy.) 

I pointed out to her that as an engineer, his emotional bandwidth might be constrained a bit by his engineering sensibilities.  He didn't dismiss her emotional needs.  Rather, he heard them, acknowledged them and then expected some amount of "move on" from her.  I explained to her that Dave loves her (and their kids) dearly and would do anything for her (indeed, I could list many many things he's done for them all that were clear and open signs of love and compassion.)  But there were times, she said, that she just needed more emotionally. 

I offered to her the thought that she might consider getting some of her emotional scratches itched elsewhere.  In therapy, with friends or a consultation group, for example.  I suggested that as an engineer he might well be one of those guys who is built a bit differently regarding how he experiences the emotional realm.  He has emotional bandwidth and articulation, just not enough to meet all of her needs.  She appreciated the thoughts and, at least for the meantime, seems to be OK with a different understanding of her loving husband. 

So Dave and his wife got me thinking.  How similar is Dave to folks on the spectrum who often struggle with identifying their emotions, not to mention with empathy, the ability to consider and join in another's emotional experience, often to such a degree that it really gets in the way of their social success?  And I don't know that I have an answer, but rather, a reflection. 

It seems that there may be a spectrum, pardon the word, for how folks have emotional capacity and range.  Again, I'm not suggesting this as a diagnostic issue, but rather as one of emotional style, admittedly a slippery description that is open to vast interpretation.  But we all know of folks whose emotional range and reserves are stiff and limited.  Folks who are quite uncomfortable, unaccustomed and even unable to describe their emotional responses to things with subtlety and precision.  Does that define them as having autism?  Hardly.  The accepted diagnostic criteria discusses many more aspects that surpass this relatively restricted issue of emotional availability. 

And yet, it makes me wonder where we'll be in 50 years as we learn more about how to make these definitions?  And how will we determine with accuracy the dividing line between functional and less functional emotional capacity and its intersection with the other aspects of what we understand autism to be? 

Please Don't Wait

It's happened again.  A couple married for 15 years comes in to see me and begins their story.  Embedded in the narrative is the phrase I hate to hear.  "We've known there's been problems for a long while now, but just thought we could get through it."  When working with couples, these are the words I fear. . 

What happens when there are problems in a relationship?  We build defenses.  We distance emotionally.  We try (our same, tried, old and generally unsuccessful techniques) to communicate with our partner in the best way we know how.  We reason.  We avoid, hoping it'll go away.  We express our frustration.  Ultimately, we express our anger.  Forcefully.  Hurtfully.  We set ultimatums.  Which helps resolve the problem not at all.  Or we can be just silent, usually in anger.  Any of these poor coping styles can last for decades.  All of them create ongoing hurt and emotional callousing to the hurt they are creating, callousing to the hurt of their partner and, so often, to their own hurt. 

Elsewhere in these notes I've referenced the connection between hurt and anger, and these dynamics are often a part and parcel of the struggles between people who try to avoid problems they've been having for a long time.  So what happens when the hurt/anger cycle goes on for years?  It's such a simple question even those couples in the midst of it can answer it, no matter how deeply they may be rationalizing their remaining in a relationship in which conflict is chronically not resolved. 

Remaining in such a relationship in which people distance themselves emotionally from one another on a frequent bases, in which they can't find workable, agreeable and mutual resolution to problems creates a breach that is difficult to bridge.  Indeed, many in these long term chronic distant marriages are vulnerable to extra-marital affairs.  Relationships in which emotional closeness, warmth and acceptance seems readily available.  Which, of course, muddy the marital waters exponentially.

If I could give a new couple one piece of advice it would be to contract with one another that they will always, under every circumstance, find, create or adopt some method of conflict resolution that is acceptable to both parties.  It sounds simple but it's often not and might need to be reviewed and worked on frequently.  Creating relationship is hard work, a lot harder than courtship or romance.  But the communication upon which creating that relationship is founded is structural cement that allows for enduring connection for a lifetime.

That couple I mentioned?  One's not sure they want to continue in therapy.  And the other says if they don't continue in therapy, it's all over.  So, if you know somebody who's struggling in their marriage, particularly if they're young in their marriage.  Tell them to not hesitate.  It won't get easier than it is now.

To An Old Friend: Attachment

I ran into an older friend - he's almost 90 - I've known for almost 35 years.  He's moved out of town and only visits on occasions and we chatted briefly.  He's always been a man with great insight.  And thus it was unsurprising that he asked about my work.  "So, what kind of things do you find in your work?  What issues, what themes do you find with your clients?"

His question triggered a lot of thought as I've been wondering myself about that.  Carl Jung discussed the term "collective unconscious."  It's considered to be a part of what, unconsciously, connects us.  It has its almost mysterious aspects, as one wonders what we, all different people, might have unconsciously in common.  Yet we indeed do often have a sense that there are underlying themes of awareness that are shared among us, regardless of the disparate nature of our lives. 

In response to my old friend's question I popped off something from the top of my head.  But after a bit returned to his question.  I realized that what I've been seeing a lot of lately is a lack of the ability of people to connect, deeply, to one another.  John Bowlby wrote of "Attachment Theory" in response to his experience in England during WW II when he worked with children who had been separated from their families in the chaos of war.  He saw then that the primary aspect of a child's attachment to parents is a fundamental need for children's security, stability and mental health. 

The sources of the attachment issues I've seen are varied, but with some common themes.  The most profound is the damage done when children are abused or neglected.  Those are easily discerned, if troubling and difficult to treat.  And, of course screen time, video gaming and social media are a part of it.  They can provide a pseudo sense of attachment.  Emotional nourishment of a sort, but it falls shy of actual emotional connection and attachment.  It can mimic the aspects of what so many of us recall from childhood as the need to be "in" the group.  The latest Tweet or Instagram often replaces the sense of connected-ness we felt on the playground or in the school cafeteria.  If you're "in" you have that sense of security and validation that we crave as humans.  If not, well....you're just as "out" as when you were picked last for the neighborhood touch football game, or not included in the birthday party of the most popular kid.  Rejection is a horrible feeling, but one that is all but inevitable in the process of social growth.  So the rejection a child today endures when their smart phone or computer time is withheld by a parent as a consequence can almost doubly isolate.  Not only is the child cut off from their perceived source of connection, their device, they've endured that cut off at the hand of a parent, another source of rejection.  And while that might not be terribly different than the "grounding" that had the same effect a generation or so ago, somehow it seems different.  Kids "attachment" to their devices feels addictive, and we know what happens when we cut off an addict.

And the poor parents, what are they do to?  Screens have become so ubiquitous that they are the obvious and tempting target for consequences.  Yet despite parents' efforts to monitor or restrict kids' online activities, kids today are so computer savvy that they can often outwit parents' interventions with a few simple key strokes which creates an escalation in the war of control and a resultant decline in the child's sense of trust and connection to both friends and family.  It's a spiral that has no clear answer or resolution, (though the interested reader would be referred to Ross Greene's work on Collaborative Problem Solving discussed elsewhere in these blogs and on his website www.livesinthebalance.com.) 

And as if this weren't enough - the distraction of these same devices, screens, apps and alerts is a huge distraction to parents.  We've all seen the jokes reflecting the sadness of a parent (or kid) wanting, longing for the connection with their family member only to be sidelined by the trance of a device in another's sights.  Multitasking has all but become an expectation of modern life, a skill in which most of us have experience, sadly often to the detriment of actual concentration and focus, of attention and presence.

I've also seen the cost to marriages.  People who are so devoted to their devices that they literally do not have time for their spouse.  I remember the first time - long ago, it seems - when I was with someone who didn't automatically pick up a ringing phone (they used to ring.)  It was an amazing awareness - we're not obligated to obey the ring.  So too now.  We're not obligated to obey the alert.  Our obligation is to be present in the relationship we are in.  At the moment.  Now.  Kids need to learn that.  Our wives and husbands need to see and feel that.  We need it as well.  There's no greater foundation in a relationship than the attached intimacy that develops over time.  We can easily see attachment in the magic that occurs between newborn and child.  In the inches between an infant being fed and the parent, we look, we communicate.  We love.  We experience the closeness and beauty of connection and attachment. 

To my friend, this is what I've not been seeing lately, and what concerns me.  And yes, it's hard to connect and be intimate.  It makes us vulnerable, and vulnerability can lead to rejection and pain.  It demands greater effort at communication.  But that's a part of the process, part of what enables us to reach out and grow, to develop attachment.  It's a primary task that we have to master in order to succeed in this world. 

The Most Vulnerable

For years it's been known that people with developmental disabilities are much more likely to be victims of sexual predators than the general population.  National Public Radio's Joseph Shapiro is in the midst of a series on this topic that is important for families and loved ones of our vulnerable populations.  If you have a member of your family with a developmental disability, you will benefit by listening to it.  (Copy and paste this link to access the series https://www.npr.org/people/2101159/joseph-shapiro)

16% of  typically developing men and about 25% of  typically developing women are known to have been sexually abused as reported by Perez-Fuentes et al in a 2012 study.  Think of that for a second.  One of every four women and more than one of every 6 men you meet have been sexually abused.  That's folks without any disability.  It's an astonishing number, one that's been known for a long time.

Now think of people with developmental disabilities.  It's a broad term including people with autism, Down syndrome and other chromosomal anomalies, intellectual disabilities.  It's a population of about 56 million people in the US.  Out of  321 million, it's almost one of every 5 persons in our country.  People with developmental disabilities are sexually abused at a rate that's 7 times higher than the general population.  And the victims are often, as Shapiro noted yesterday, unable to testify against their assailants as they are non-verbal.  Shapiro's report involved the incredulous account of a staff member in a residential home caught in the midst of a rape by a co-worker.  He's pleading innocent in court.  Imagine. 

I have worked with families who  have taken the responsible, but tragically sad decision to petition the courts to have their adult daughters with significant DD's sterilized so they can avoid the trauma of pregnancy should their children be raped when in residential care.  The sadness of having to take such measures to protect one's developmentally disabled child is incalculable. 

Due to the level of needed care, some people with DD's need residential care.  Public policy has encouraged de-institutionalization, the merits of which can be debated.  What is not up for debate are policies that limit the proper staffing, training and supervision of staff to ensure proper levels of care. 

It is said that as a society, we will be judged on the basis of how we treat our weakest members, how we care for those who cannot care for themselves and how we protect the vulnerable.  Protecting children and the disabled isn't a mission that has its time.  It is the mission of society for all time. 

We All Have Diabetes

Getting through to kids and teens, particularly if they are on the autism spectrum, can be difficult.  Just as difficult is getting through to them regarding the stigma of being "different."  Nobody wants to be different.  We all want to be normal, right smack dab in the middle of the bell curve.  The reality is, however, that none of us are "average," or "normal."  We're each unique in our own unique way and thus have an obligation to recognize our uniqueness and to accommodate for them.

One of the examples I use to help get through the stigma of "difference" is diabetes.  Most everyone, even kids, has at least heard of diabetes, many folks have family members with it and I also work with kids who actually have diabetes - so they of course know firsthand the realities of the disease.  Diabetes is caused by the inability of the pancreas to produce insulin, and insulin is what metabolizes the sugars in the system.  Without insulin, ones' blood glucose levels go up upsetting the delicate chemical balance that sustains us.  What's clear with diabetes is that it's nobody's fault, and despite the "unfair" aspect of having it, it has to be dealt with.  (Even type 2 diabetes is not anyone's fault, obesity is a risk factor, but not directly causative of diabetes.  Plenty of obese people never get diabetes.)

I start off explaining to kids that the first reality of diabetes or (fill in the blank: autism; ADHD; depression etc.) is that it is.  It's a thing.  It can be manageable, but one has to manage it.  Having diabetes requires that one check one's blood glucose levels regularly.  That usually means a small stick in a finger, a drop of blood in the glucometer and insulin per the doctor's instructions.  If you don't do that you increase the risk of complications that can become life threatening.  I often run through the litany of the things less severe than death that can happen with poor diabetes management like amputation of a limb, blindness, kidney failure, all the kinds of things that terrify any thinking person.

And then there's autism.  People with high functioning (and even lower functioning) autism are at higher risk for things like ADHD, anxiety, depression and OCD and more.  That doesn't mean people with autism will automatically have these problems, they just are at higher risk.  And when one has one of these complications, it's incumbent on the person to recognize them and take action.  That's why we have family members, therapists and doctors, to observe, comment and suggest.  Part of the problem with suggestions is that they imply a responsibility, a weighty word to use for adolescents who are often not paragons of responsibility.  And yet being depressed or anxious is no picnic, just like being in the hospital with diabetic ketoacidosis is not a fun activity.

The suggestions for managing the complications of high functioning autism like ADHD, anxiety and depression can be minor or major.  My standard recommendation for anxiety and depression is exercise.  For years studies show that 30 minutes of aerobic exercise 3-4 times per week helps reduce anxiety and depression.  Mindfulness, the practice of self awareness is another recommendation that's been around for ....millennia.  So I recommend practices like meditation (I like guided meditation) and/or yoga to help with that.  And the combination of meditation and exercise shows great results in combating depression.  Medications are often quite helpful as well, but no matter what the suggestion, like the diabetic, one has to actually take action to do what can help. 

Lots of kids and adolescents (yes, and adults), struggle with compliance with suggestions like meditation, exercise or medication.  Often as a response to their not fully recognizing the reality that they have.  But I remind them, we all have something.  Even the kid you think has it all, doesn't.  Everybody has something they struggle with, something that needs attention and management.  We all have diabetes.

About "Wonder"

I'm a sucker for tear jerkers.  They're predictable, cathartic and appeal to my soft emotional underbelly.  So I was expecting it when I saw "Wonder."  It met all of the usual criteria; it was predictable, had heartstring tugging moments (my friend who also works with people with disabilities and I both found the dog scene, ironically, the tipping point.)  It was star studded and Hollywood-y with a happy ending.  But it had more, a lot more, and what it had makes it worth seeing by most anyone, particularly by typically developing kids who have siblings with different abilities or disabilities, their parents, friends, families, neighbors and yes, kids with differing abilities as well.

What was unique was its unanticipated focus on a number of the individual children in the story, both protagonist and antagonist, that revealed much more of the subtle and complex background kids in late elementary and high school endure.  It's easy for adults to chalk up kids drama to "drama."  But it's not drama for them, no more than our adult drama is to us.  It's critical, compelling, gut wrenching and painful.  "Wonder" did a superlative job in going behind the scenes of the children, highlighting the struggles children and adults of all stripes all have with loyalty, betrayal, forgiveness, ambivalence and persistence.

Siblings of kids with special needs should see it due to the compelling portrayal of the sister by Izabela Vidovic.  Siblings of differently abled kids cope - they have to given the often universal demands their siblings present.  But they don't have to like it and their hearts have limits.  The mix of the love, resentment, anger, frustration, hopelessness and endurance of siblings of kids with disabilities was well presented and will ring true for  kids who try their best to support through the challenges of their own adolescence.

Neurotypical kids who attend just about any school should see it as it presents the multitude of mixed emotions and rivalries that contribute to harsh bullying (which is actually a redundancy), whether of a child with a special need or of any kid at all.  (I will say I thought one weakness of the film was its lack of mental health support at the school, but that's Tinseltown for you.)  And for parents who have any discomfort with "differences" which is most all of us.  The struggle of the power of the group and how peers influence one another to bully was well portrayed, reminding us that the bully may be a victim as well.

So , yes, it's tear evoking with a sugar coated ending.  It has predictable parent figures representing caricatures from very good to very bad.  It's Hollywood.  But it's strengths greatly outweigh  any weaknesses and it's appropriate for  parents and kids who can cope with the realities of life in 5th grade and up.  It will make for great conversation with your typically developing kids as well as with your kids with any kind of special need.