Domestic violence. Child abuse - sexual, physical. Divorce (so sadly common.) Drug and alcohol addiction. Infidelity. Suicide. Every week I meet a new family that's struggling with one or more of these things. And I'll state from the outset, these are middle and upper class families - let's not kid ourselves as to how rampant these issues are in our world.
The children suffer, always. Both typical and special needs children are aware of these issues. I see an adult with DD's who's struggling with his father's abuse of 20 years ago and a typically developing teen struggling with a parent's infidelity. I found myself recently saying to one of the adolescents I work with: "welcome to adulthood." He was understandably sad that his parents had divorced. Depressed in fact, and understandably so. I didn't know what else to say. People divorce. People are sick with addiction. People make mistakes - grave and painful mistakes that effect their children for decades. And all we can do is try to cope.
Coping is tough. Easy to say - tough to accomplish. Indeed so much of what we want for our children (and selves) is to learn how to cope with the challenges in front of us. I just read and heard interviewed one of the survivors of the Boston Marathon bombing. She lost a leg. She sounded upbeat and positive. She was coping, at least for the moment she was being interviewed. She'll get support, one hopes, probably more support due to the fact that she was a victim of this particular terror. The kids and adults who live with the stressors listed at the outset of this submission however so often have much less support.
So, I'll continue to validate their pain, work on management - hopefully resolution of their anxiety and depression, their alcoholism and stress on their marriages and children. And all too often, welcome their children to adulthood.
Friday, April 26, 2013
Tuesday, March 19, 2013
Terrorism, Capitolism and "Parent Hygiene"
Whether a child has special needs or not - the issue of negotiations is a standard issue between children and parents. We want our children to advocate for themselves and have a voice, we want them to articulate and we want them to learn that if they do things they get things - also known as the "if...then" principle. "If" you do this, "then" you get that.
All of this is normal and appropriate. What we don't want is for them to get things before they do things. That's terrorism. It's terrorism (if you'll indulge the hyperbole) because if you get what you want without doing the work, the incentive to do the work is gone. Once that happens, parents lose their authority and kids KNOW when this is the case and it so often ends bad. It ends bad because a pattern develops, the dynamic repeated. And even if the dynamic isn't repeated every time, if it is repeated intermittently, it's enough to keep the child on his or her toes that "maybe this time" I'll be able to get what I want before I do the work and encourages more terrorism - let me do X and then I'll do Y.
Capitolism, on the other hand, is being paid for the job AFTER it's done. This is, admittedly, the old fashioned way, but just like lots of old fashioned things, it works. It works because, as we all know, it teaches that we have to EARN our rewards. Tried and true. The American Way.
Too often parents play catch up after negotiating with terror and realize it way too late. Thus, making sure we have good "parenting hygiene" is important. I'm allocating the phrase parental hygiene from other sources, but the point is that consistency, having a routine planned way of conducting ones parenting methodology and, hardest of all, making sure your partner and you have similar rules and styles of parenting. This is important not only for the parents, but for the kids who, after all, need - thrive - on consistency.
As the parent, you have permission to take charge. No regrets needed. And remember - cleaning up your parenting act - the sooner the better - will help everyone!
All of this is normal and appropriate. What we don't want is for them to get things before they do things. That's terrorism. It's terrorism (if you'll indulge the hyperbole) because if you get what you want without doing the work, the incentive to do the work is gone. Once that happens, parents lose their authority and kids KNOW when this is the case and it so often ends bad. It ends bad because a pattern develops, the dynamic repeated. And even if the dynamic isn't repeated every time, if it is repeated intermittently, it's enough to keep the child on his or her toes that "maybe this time" I'll be able to get what I want before I do the work and encourages more terrorism - let me do X and then I'll do Y.
Capitolism, on the other hand, is being paid for the job AFTER it's done. This is, admittedly, the old fashioned way, but just like lots of old fashioned things, it works. It works because, as we all know, it teaches that we have to EARN our rewards. Tried and true. The American Way.
Too often parents play catch up after negotiating with terror and realize it way too late. Thus, making sure we have good "parenting hygiene" is important. I'm allocating the phrase parental hygiene from other sources, but the point is that consistency, having a routine planned way of conducting ones parenting methodology and, hardest of all, making sure your partner and you have similar rules and styles of parenting. This is important not only for the parents, but for the kids who, after all, need - thrive - on consistency.
As the parent, you have permission to take charge. No regrets needed. And remember - cleaning up your parenting act - the sooner the better - will help everyone!
Thursday, February 7, 2013
S'wonderful....S'school!
Twice this week I've had wonderful experiences with our area's public schools. Those who know me know that I can be, er, um, critical, so I thought it appropriate to note these great encounters:
I had a conference with a school and parents who are concerned about their student and child who has autism. The specifics are much less important than was the openness of the school to create and implement a behavioral plan that would motivate the child in a positive way towards the goals that we had all agreed upon as important. The school was well represented by the special educators and special ed administration as well by the principal. They actively enlisted the help of other staff, confident that all the staff would be available to help. It was a joy.
The other experience was regarding a pre-school child with autism and ADHD who can have a lot of oppositionality with adults, as these kids often do. Mom showed me the daily schedule which could have been taken from a textbook on how to keep these guys on task. It had activities and academics that were clear, timed and varied throughout the day. No task lasted more than 20 minutes and transitions were a part of the curriculum. Mom said the teacher was implementing it well and that her son was doing great in the classroom, unlike the previous public school placement he was in which was much less structured and resulted in a much greater amount of his disruption. I haven't been this impressed with a pre-school intervention in 25 years. Literally.
My hats off to the schools and staff that put themselves out for the kids like this. As to the other experiences I've had....well....we'll save that for another time.
I had a conference with a school and parents who are concerned about their student and child who has autism. The specifics are much less important than was the openness of the school to create and implement a behavioral plan that would motivate the child in a positive way towards the goals that we had all agreed upon as important. The school was well represented by the special educators and special ed administration as well by the principal. They actively enlisted the help of other staff, confident that all the staff would be available to help. It was a joy.
The other experience was regarding a pre-school child with autism and ADHD who can have a lot of oppositionality with adults, as these kids often do. Mom showed me the daily schedule which could have been taken from a textbook on how to keep these guys on task. It had activities and academics that were clear, timed and varied throughout the day. No task lasted more than 20 minutes and transitions were a part of the curriculum. Mom said the teacher was implementing it well and that her son was doing great in the classroom, unlike the previous public school placement he was in which was much less structured and resulted in a much greater amount of his disruption. I haven't been this impressed with a pre-school intervention in 25 years. Literally.
My hats off to the schools and staff that put themselves out for the kids like this. As to the other experiences I've had....well....we'll save that for another time.
Monday, December 17, 2012
Aspergers/High Functioning Autism and Guns
I learned many years ago to assess gun safety in the homes after working with one very kind, nice boy who intentionally shot his stepmother in the head with a shotgun stored in her bedroom for safety. Another child found a gun in the home and killed his brother, having no intent to do so. And still a third was paralyzed from the chest down when his cousin discharged an unsecured weapon, also by accident.
Young adults with Asperger's and High Functioning Autims (HFA) often have a difficult time expressing their emotions. They also are often very pre-occupied with video games. And among the most popular are tens of millions of violently themed games with very realistic shooting of enemies, real and imagined, their realism increasing with the technology. The movies' ability to depict violence is even more striking and have broad audiences both on large and small screens. Kids, including kids with Asperger's and HFA are saturated with these increasingly realistic fictionalizations.
It is the nature of people with Asperger's and HFA to struggle with their emotions and emotional expression. It is often that they will express their emotions in action and not word. They often struggle with the skills involved to talk out their emotions which is why a significant number of them may end up tantrumming and even being violent instead of articulating their feelings as a way of discharging the emotional energy stored up. It is to this end that talk therapy, social skills groups and the like are so often recommended to individuals with Asperger's and HFA. It is also common for these folks to benefit from medications to lower their anxiety or to help organize their thoughts that can be distorted and illogical.
But not everyone in need of these services receives them. Many parents, for various reasons, do not pursue such services for their children and teens. Many people in need resist them. How, then, do they express their powerful emotions? It is not uncommon for this group of people to become depressed, and while signs of depression can include dispair that can lead to suicidal feelings, it can also lead to irritability and anger. The lack of ability to manage emotions, then, can be overpowering and the violent images (that might be normal for anyone to experience in a time of stress) can become all the more seductive, fueled by the images so rampant on our screens. Mix that with poor judgement, implusivity, social isolation and the possibility of distorted thoughts and logic and, well, you get the idea.
Parents of people with Asperger's and HFA, particularly those who are gun owners should, then, follow the basics of gun safety. The NRA advises that "dozens of gun storage devices, as well as locking devices that attach directly to the gun, are available." There is no better security than insuring that access to weapons is strictly controlled.
It seems intuitive that violent games and movies should be monitored, limited or even (gasp) not allowed to individuals who are unable to discuss and understand in detail the differences between the reality and fantasy of violent games and movies, and be able to well articulate their own emotions. This should apply to people on the Autistic spectrum as well as those who are not.
The issue of this entry is not gun ownership, but rather one of responsible gun ownership. And not just for families of children and young adults on the autistic spectrum, but families who have children or young adults who are typically developing, or families that have visitors, or anyone who might be burgled - which is everyone with a firearm.
Young adults with Asperger's and High Functioning Autims (HFA) often have a difficult time expressing their emotions. They also are often very pre-occupied with video games. And among the most popular are tens of millions of violently themed games with very realistic shooting of enemies, real and imagined, their realism increasing with the technology. The movies' ability to depict violence is even more striking and have broad audiences both on large and small screens. Kids, including kids with Asperger's and HFA are saturated with these increasingly realistic fictionalizations.
It is the nature of people with Asperger's and HFA to struggle with their emotions and emotional expression. It is often that they will express their emotions in action and not word. They often struggle with the skills involved to talk out their emotions which is why a significant number of them may end up tantrumming and even being violent instead of articulating their feelings as a way of discharging the emotional energy stored up. It is to this end that talk therapy, social skills groups and the like are so often recommended to individuals with Asperger's and HFA. It is also common for these folks to benefit from medications to lower their anxiety or to help organize their thoughts that can be distorted and illogical.
But not everyone in need of these services receives them. Many parents, for various reasons, do not pursue such services for their children and teens. Many people in need resist them. How, then, do they express their powerful emotions? It is not uncommon for this group of people to become depressed, and while signs of depression can include dispair that can lead to suicidal feelings, it can also lead to irritability and anger. The lack of ability to manage emotions, then, can be overpowering and the violent images (that might be normal for anyone to experience in a time of stress) can become all the more seductive, fueled by the images so rampant on our screens. Mix that with poor judgement, implusivity, social isolation and the possibility of distorted thoughts and logic and, well, you get the idea.
Parents of people with Asperger's and HFA, particularly those who are gun owners should, then, follow the basics of gun safety. The NRA advises that "dozens of gun storage devices, as well as locking devices that attach directly to the gun, are available." There is no better security than insuring that access to weapons is strictly controlled.
It seems intuitive that violent games and movies should be monitored, limited or even (gasp) not allowed to individuals who are unable to discuss and understand in detail the differences between the reality and fantasy of violent games and movies, and be able to well articulate their own emotions. This should apply to people on the Autistic spectrum as well as those who are not.
The issue of this entry is not gun ownership, but rather one of responsible gun ownership. And not just for families of children and young adults on the autistic spectrum, but families who have children or young adults who are typically developing, or families that have visitors, or anyone who might be burgled - which is everyone with a firearm.
Wednesday, December 5, 2012
DSM V and Asperger's
I'm not really worried about the upcoming changes in the DSM's categorization of Asperger's. In fact, I think it'll help clarify the many errors in how Asperger's, "high functioning autism" and pervasive developmental disability, not otherwise specified (PDD NOS) are currently diagnosed. Over time, it's seemed more and more rare to see kids who clearly fit the DSM IV's Asperger's criteria. I don't think that's due to the criteria being particularly vague. Rather, I think it's due to a combination of pressure from families and "mission creep" among professionals.
Diagnosing Asperger's requires a certain understanding of the population that increases by working with them - and the more one works with them, the more one understands what distinguishes someone with Asperger's from someone with PDD NOS or other diagnoses altogether. Yet, clinicians are often under a gun of sorts when parents bring their children, desperate for an answer to "what's wrong." Such pressure takes some strength to fight. Many parents are absolutely sure their child has Asperger's, and I believe clinicians have sometimes succumbed to that pressure.
I fear some succumb to the pressure by short cutting and forgetting to look at the "whole" child, the whole picture and context of who the person is within the family and the family's functioning. I also believe that it's hard for many to say "I don't know" or "let's meet for a while to see how comfortable Johnny is with a consistent relationship and then review the issue of diagnosis." And one of my favorite short cuts (oft quoted by a former colleague:) "He's kind of quirky, it's Asperger's." Quirky - in and of itself - is not a code word for Asperger's.
It seems that the day of the classic Aspie are gone. Very often kids with the diagnosis come in with lots of strengths and skills socially and interpersonally - unheard of for an Aspie in years past. It was almost refreshing recently to have a 12 y/o Aspie walk in my office, breeze past me as if I was not even there when I extended my hand and said hello, look around the office and sit down, totally avoiding eye contact, and initiate a discussion about a favorite science fiction book in a hyperactive way that was as much a discourse as it was discussion. Now THAT's Asperger's. This child had all the classic criteria: he was very "adult" in his presentation. He has significant social challenges - just not knowing how to mix socially with his peer group. He's very rigid, exploding when small things don't go right. He had a lot of anxiety when it came to discussing his own behavior, and a very ADHD profile. He could discuss his preferred topics in detail and at length, but was quickly disinterested and easily distracted when structured to discuss a to a different one.
Over the years, folks diagnosed with Asperger's coming for therapy have a much broader presentation. They may have appropriate social skills; good eye contact; an understanding of the subtlety of communication; a wry response to a bad joke (I specialize in bad hokes - it's a bit of a test to see how socially astute they are); facility in the flow of conversation; a broad range of affect in the prosody of their speech (the musicality and stress of words in their speech); spontaneous, genuine and quick compassion in social settings. Some had received the diagnosis when relatively young, in early grade school, and no re-assessment of that diagnosis has ever occurred, even as they approach adulthood. These kids seem to have a diagnosis that sticks as The Scarlet Letter did - never to be removed. Some parents, it seems, even seem to be hesitant for such a review, as the diagnosis explains all of the issues they and/or their kid may have. It sometimes seems a badge of some honor - even when it is quite evident that the diagnosis given to this child so many years ago is in dire need of review as he or she ages into the mid and late teens.
So why are people who've been diagnosed with Asperger's no longer seem to fit the diagnostic criteria? The most frequent thing I've seen is kids (or adults) who have the very challenging combination of ADHD and anxiety that may include obsessive compulsive behaviors and can result in the stilted and over controlled presentation that many folks on the spectrum display. ADHD with anxiety is a tough combination - and as so many kids on the higher end of the autistic spectrum have both, it's an understandable conclusion. A learning disability, particularly one that is based in language processing (NVLD - Non Verbal Learning Disability is a common one) is another challenge that can be misdiagnosed as Asperger's. Folks with language based learning disabilities may take longer than usual to consider and respond in the course of conversation. Their responses may be over deliberate, or be a bit tangential, as they have difficulty with language comprehension of or formulation of language. That can be a very challenging issue, but not necessarily Asperger's. Mix in the distractability, hyperactivity and/or impulsivity of ADHD and a conclusion of Asperger's can easily be understood, though inaccurate. Not to mention the "quirky" kids.
Professionals trained to work with kids know that developing a relationship over time provides an important cushion against these errors. However pressures of time, money, parental anxiety and, if I may say, over confidence can result in a premature and inaccurate "answer."
So I think the DSM V may ease some - but not all of the challenges clinicians have when diagnosing what is soon to pass in the official nomenclature as Asperger's, but I just don't think it'll amount to much. Folks with the diagnosis will still have an "autism spectrum disorder" and be eligible for special ed services and disability. And there will continue to be those included in the autism spectrum who really don't belong there - that's certain not to change.
So whether it's pre DSM V or post DSM V, my recommendation to clinicians remain: Don't forget to take time with the child. Some typically developing kids are genuinely shy and need more than your allotted amount of time to warm up. Get to know the dynamics of child's family to see how much that may be contributing to the child's presentation. Very challenging dynamics such as bitter divorce, substance abuse can create havoc in a child's sense of stability. Living in an emotionally "dysfunctional" (sorry for the use of the word, but it does capture a lot) family creates tons of stress on kids, whether they are on the spectrum or not. If they weren't anxious children before such stresses, they certainly can become that way after those stresses. Look at all the data, then look again, particularly if the diagnosis is not crystal clear. Look for the child's emotional reserve and availability. And most important, don't be afraid to say "I don't know." I think that's the boldest comment a clinician can make.
For parents: What is the experience the clinician has with diagnosing and working with kids on the autistic spectrum? Do you "click" with the clinician and develop a trust with them to communicate freely and openly? Remember that you are the expert on your child. Also remember that you are the consumer - you have the right to move to another clinician if you are uncomfortable. Also despite everything you've read on the Internet, don't go in with a presumption of what the final diagnosis is, part of the process of becoming a professional is being able to distinguish subtleties.
Most important to parents: remember that what most needs attention with your child is the their symptoms, not their diagnosis. Nobody treats Asperger's. What is treated is the symptoms of Asperger's. Whether it's a presentation of anxiety, ADHD, poor social skills, sensory issues etc., it is the symptoms that are treated, not the diagnosis.
So, DSM V, bring it on!
Diagnosing Asperger's requires a certain understanding of the population that increases by working with them - and the more one works with them, the more one understands what distinguishes someone with Asperger's from someone with PDD NOS or other diagnoses altogether. Yet, clinicians are often under a gun of sorts when parents bring their children, desperate for an answer to "what's wrong." Such pressure takes some strength to fight. Many parents are absolutely sure their child has Asperger's, and I believe clinicians have sometimes succumbed to that pressure.
I fear some succumb to the pressure by short cutting and forgetting to look at the "whole" child, the whole picture and context of who the person is within the family and the family's functioning. I also believe that it's hard for many to say "I don't know" or "let's meet for a while to see how comfortable Johnny is with a consistent relationship and then review the issue of diagnosis." And one of my favorite short cuts (oft quoted by a former colleague:) "He's kind of quirky, it's Asperger's." Quirky - in and of itself - is not a code word for Asperger's.
It seems that the day of the classic Aspie are gone. Very often kids with the diagnosis come in with lots of strengths and skills socially and interpersonally - unheard of for an Aspie in years past. It was almost refreshing recently to have a 12 y/o Aspie walk in my office, breeze past me as if I was not even there when I extended my hand and said hello, look around the office and sit down, totally avoiding eye contact, and initiate a discussion about a favorite science fiction book in a hyperactive way that was as much a discourse as it was discussion. Now THAT's Asperger's. This child had all the classic criteria: he was very "adult" in his presentation. He has significant social challenges - just not knowing how to mix socially with his peer group. He's very rigid, exploding when small things don't go right. He had a lot of anxiety when it came to discussing his own behavior, and a very ADHD profile. He could discuss his preferred topics in detail and at length, but was quickly disinterested and easily distracted when structured to discuss a to a different one.
Over the years, folks diagnosed with Asperger's coming for therapy have a much broader presentation. They may have appropriate social skills; good eye contact; an understanding of the subtlety of communication; a wry response to a bad joke (I specialize in bad hokes - it's a bit of a test to see how socially astute they are); facility in the flow of conversation; a broad range of affect in the prosody of their speech (the musicality and stress of words in their speech); spontaneous, genuine and quick compassion in social settings. Some had received the diagnosis when relatively young, in early grade school, and no re-assessment of that diagnosis has ever occurred, even as they approach adulthood. These kids seem to have a diagnosis that sticks as The Scarlet Letter did - never to be removed. Some parents, it seems, even seem to be hesitant for such a review, as the diagnosis explains all of the issues they and/or their kid may have. It sometimes seems a badge of some honor - even when it is quite evident that the diagnosis given to this child so many years ago is in dire need of review as he or she ages into the mid and late teens.
So why are people who've been diagnosed with Asperger's no longer seem to fit the diagnostic criteria? The most frequent thing I've seen is kids (or adults) who have the very challenging combination of ADHD and anxiety that may include obsessive compulsive behaviors and can result in the stilted and over controlled presentation that many folks on the spectrum display. ADHD with anxiety is a tough combination - and as so many kids on the higher end of the autistic spectrum have both, it's an understandable conclusion. A learning disability, particularly one that is based in language processing (NVLD - Non Verbal Learning Disability is a common one) is another challenge that can be misdiagnosed as Asperger's. Folks with language based learning disabilities may take longer than usual to consider and respond in the course of conversation. Their responses may be over deliberate, or be a bit tangential, as they have difficulty with language comprehension of or formulation of language. That can be a very challenging issue, but not necessarily Asperger's. Mix in the distractability, hyperactivity and/or impulsivity of ADHD and a conclusion of Asperger's can easily be understood, though inaccurate. Not to mention the "quirky" kids.
Professionals trained to work with kids know that developing a relationship over time provides an important cushion against these errors. However pressures of time, money, parental anxiety and, if I may say, over confidence can result in a premature and inaccurate "answer."
So I think the DSM V may ease some - but not all of the challenges clinicians have when diagnosing what is soon to pass in the official nomenclature as Asperger's, but I just don't think it'll amount to much. Folks with the diagnosis will still have an "autism spectrum disorder" and be eligible for special ed services and disability. And there will continue to be those included in the autism spectrum who really don't belong there - that's certain not to change.
So whether it's pre DSM V or post DSM V, my recommendation to clinicians remain: Don't forget to take time with the child. Some typically developing kids are genuinely shy and need more than your allotted amount of time to warm up. Get to know the dynamics of child's family to see how much that may be contributing to the child's presentation. Very challenging dynamics such as bitter divorce, substance abuse can create havoc in a child's sense of stability. Living in an emotionally "dysfunctional" (sorry for the use of the word, but it does capture a lot) family creates tons of stress on kids, whether they are on the spectrum or not. If they weren't anxious children before such stresses, they certainly can become that way after those stresses. Look at all the data, then look again, particularly if the diagnosis is not crystal clear. Look for the child's emotional reserve and availability. And most important, don't be afraid to say "I don't know." I think that's the boldest comment a clinician can make.
For parents: What is the experience the clinician has with diagnosing and working with kids on the autistic spectrum? Do you "click" with the clinician and develop a trust with them to communicate freely and openly? Remember that you are the expert on your child. Also remember that you are the consumer - you have the right to move to another clinician if you are uncomfortable. Also despite everything you've read on the Internet, don't go in with a presumption of what the final diagnosis is, part of the process of becoming a professional is being able to distinguish subtleties.
Most important to parents: remember that what most needs attention with your child is the their symptoms, not their diagnosis. Nobody treats Asperger's. What is treated is the symptoms of Asperger's. Whether it's a presentation of anxiety, ADHD, poor social skills, sensory issues etc., it is the symptoms that are treated, not the diagnosis.
So, DSM V, bring it on!
Monday, November 12, 2012
D*mn the Torpedos
I thought a Veteran's Day title appropriate, since parents do often feel like they're in battle when setting limits on their kids - even limits that have health implications.
I've been working with a certain young man for many years. He's a great guy, very social with some special needs. You couldn't find a nicer person. His parents also - as nice as you can find. His doctor recently told him that he needed to lose weight due to a number of medical issues - all of them with significant potential to hurt him.
Our first meeting after the MD appointment resulted in a simple but effective plan to inhibit his indulgent eating habits. He protested mightily, but, bless his heart, he's more bluster than anything. I told him that I too - indeed most all of us hate, HATE to have our preferred foods restricted in any way. But as we discussed in detail the potential harm that could come to him via his obesity, he conceded. Begrudgingly. Very begrudgingly.
Until he left my office. He has a long history - as many special needs kids do - of warfare with his parents/s. Some kids are violent, a tough situation to deal with, but it's do-able. In this case, it's exclusively verbal, thankfully. But it wears mom down none the less. She's understandably exhausted and, not surprisingly, ultimately succumbed to his verbal assaults and his open access to unhealthy foods on an almost daily basis resumed.
So we met again today and worked out a compromise that would allow continued social time at his favorite feeding holes - with him agreeing to brown bag his lunch and mom to supervise the pocket change he has to inhibit his access to foods that are harmful.
We'll see how this round goes. I'm anticipating more battles, but hopefully, mom will stand strong as the onslaught of complaints, bargaining, promises (lots of promises), pleading and refusal to comply with the agreement resumes.
So, my Veteran's Day message to all parents of all kids: Stand Strong. Stand By What You Know Is Right. You Are the Leaders of Your Family. You Can Win This Battle.
I've been working with a certain young man for many years. He's a great guy, very social with some special needs. You couldn't find a nicer person. His parents also - as nice as you can find. His doctor recently told him that he needed to lose weight due to a number of medical issues - all of them with significant potential to hurt him.
Our first meeting after the MD appointment resulted in a simple but effective plan to inhibit his indulgent eating habits. He protested mightily, but, bless his heart, he's more bluster than anything. I told him that I too - indeed most all of us hate, HATE to have our preferred foods restricted in any way. But as we discussed in detail the potential harm that could come to him via his obesity, he conceded. Begrudgingly. Very begrudgingly.
Until he left my office. He has a long history - as many special needs kids do - of warfare with his parents/s. Some kids are violent, a tough situation to deal with, but it's do-able. In this case, it's exclusively verbal, thankfully. But it wears mom down none the less. She's understandably exhausted and, not surprisingly, ultimately succumbed to his verbal assaults and his open access to unhealthy foods on an almost daily basis resumed.
So we met again today and worked out a compromise that would allow continued social time at his favorite feeding holes - with him agreeing to brown bag his lunch and mom to supervise the pocket change he has to inhibit his access to foods that are harmful.
We'll see how this round goes. I'm anticipating more battles, but hopefully, mom will stand strong as the onslaught of complaints, bargaining, promises (lots of promises), pleading and refusal to comply with the agreement resumes.
So, my Veteran's Day message to all parents of all kids: Stand Strong. Stand By What You Know Is Right. You Are the Leaders of Your Family. You Can Win This Battle.
Sunday, November 4, 2012
The Mouths of Babes
We recently had guests and I observed one older sister teaching her younger sister (they were about 11 and 10) a critical lesson on how to put the socks on their 2 year old brother. The 10 year old was struggling with the task, speaking to the boy trying to calm him down, trying to reason with him, as he was strongly resisting. The older sister took the boy on her lap, took the socks, and quietly explained to her sister that "You just have to ignore him and put the socks on." Simple, clean, straight forward. And low and behold, within seconds the task was complete. Now this girl is the eldest of 5, soon to be 6, and all the children were nicely behaved. There was very little squabbling between them. And this is not unique to this family or these parents. I also know the mother's sister who has 10 (yes, you read that correctly, 10) children and they are all similarly behaved. The parents go to great lengths to act when needed and not act when not needed - and the children learn from them.
This lesson is one that so many parents with kids - whether on the autistic spectrum, whether they have developmental disabilities or not, struggle with. (My wife and I certainly did when our kids were young.) I can't count the times I've seen parents - even those who've been trained on how to "ignore" - maintain an ongoing dialogue with their child explaining, rationalizing, asking, pleading and/or almost begging their children while in the midst of a "time out" or other trial of parenting.
Whether it is a of time out or getting the child to comply with a demand that has been made, the message that the parent is in control is critical. In time out, the goal is to isolate the child, momentarily, from the social connection that he or she has with his caretaker. Speaking to the child at any length during the time out totally undercuts its purpose. When a demand has been made, the parent must know the child and increase the likelihood that the request is reasonable and that the conditions are ripe to ensure compliance. (How many of us ask kids to do a task knowing they are hitting the wall of hunger or fatigue that makes it quite unlikely they can comply?)
These can be very hard lessons to learn, even harder when we - and our children - have to unlearn other lessons. But the payoff is the child and parents both learning who is in control in the family. And that is ultimately a comforting thing for a child who has been able, through tantrumming or obstinance, be able to be in control the family.
This lesson is one that so many parents with kids - whether on the autistic spectrum, whether they have developmental disabilities or not, struggle with. (My wife and I certainly did when our kids were young.) I can't count the times I've seen parents - even those who've been trained on how to "ignore" - maintain an ongoing dialogue with their child explaining, rationalizing, asking, pleading and/or almost begging their children while in the midst of a "time out" or other trial of parenting.
Whether it is a of time out or getting the child to comply with a demand that has been made, the message that the parent is in control is critical. In time out, the goal is to isolate the child, momentarily, from the social connection that he or she has with his caretaker. Speaking to the child at any length during the time out totally undercuts its purpose. When a demand has been made, the parent must know the child and increase the likelihood that the request is reasonable and that the conditions are ripe to ensure compliance. (How many of us ask kids to do a task knowing they are hitting the wall of hunger or fatigue that makes it quite unlikely they can comply?)
These can be very hard lessons to learn, even harder when we - and our children - have to unlearn other lessons. But the payoff is the child and parents both learning who is in control in the family. And that is ultimately a comforting thing for a child who has been able, through tantrumming or obstinance, be able to be in control the family.
Subscribe to:
Posts (Atom)