I was thinking about a close friend who has some, let's just say "issues" re: life. They are not issues of his own making, they are circumstances beyond his control, but they effect him very directly. And I was thinking about him, I realized that he's struggling to cope. It's beginning to "get in the way." He's avoiding certain topics. It is impacting his social life because it's so hard to discuss anything without discussing the issue at hand.
A pause on "get in the way." I frequently will ask my clients whether the issue at hand is "getting in the way." If it's not, or if not too much, maybe it's not in need of a particularly therapeutic focus. Maybe it's just an irritant, and don't we all become irritated!? If it "gets in the way" we might have something important to discuss.
Back to my friend. As I thought about how this issue not of his own making and beyond his control are "getting in the way" I also thought about a family I've been working with. The couple has a teenager with a developmental disability (beyond their control, not of their own making) who has given them some pretty big behavioral challenges. This teen's parents have risen to the occasion. OK, not perfectly, after all, perfection is not really to be had in this world. But they've done a great job. Things have gotten better. There are no delusions about their child's challenges - or their teen's strengths. During the summer they took a vacation that was fun for them and fun for their teen - not always an easy task. Compromises? Sure. But they know who their kid is. They set their child up in this vacation and in school to have the best chance of success. And it's not perfect, but they work hard and they understand the child's diagnosis and how to best manage his needs with theirs.
Oh yeah, my friend. Well, he knows there are resources for him to go to where he might not feel so isolated, so alone with the circumstances that have befallen him. He knows of them, but is hesitant to use them.
Which got me thinking, what does it mean when we walk in whatever door that could help us - but are hesitant to do so? The door to therapy to talk about depression; to a medical doctor to discuss the high blood pressure; to the attorney to actually make a will that insulates our loved ones from the difficulty of the decisions that are ours. When we avoid doors, I think it's about our hesitance to accept the reality. It's when we are able to put aside - even for a brief time - our minimization or denial of the issue. It's when we consider that we might get/need help with the issue. It's a hard step. It's a step that can really change our lives, regardless of the door we're facing - or trying to not face.
And for the record, my "friend" is a melding of many many people, the family is not.
Wednesday, September 17, 2014
Does an Autism Diagnosis Always Matter?
As with all of my blog postings, materiel information about people is changed to protect their identity.
I received a call from a distraught mother yesterday. Her son's psychiatrist, having known this kid for many years, offered (seemingly in frustration) that "maybe he should be tested for high functioning autism." Mom was aghast. Her son certainly had cause for depression - there are lots of stressors in the family that don't need to be enumerated here. He may well have ADHD. The psychiatrist is treating for both, and that's fine. He's a bright boy, and bright can be a blessing as well as a challenge. He can be hard headed (not shocking for a smart young man who does well in regular education classes who is in early adolescence with some significant but not crippling family issues) but I'm not sure it makes for a diagnosis of high functioning autism (HFA). It makes for a kid who's "behaving badly" in the words of Ross Greene, author of The Explosive Child. If the boy even did have the diagnosis, which I'm quite sure he does not, as being hard headed and angry is way different from the rigidity that comes with classic autism, even HFA. And even if he was very rigid, would we not look at anxiety first, since there are no stereotypic (repetitive) behaviors or significant social impairments in evidence? It seems to me this off the cuff remark was someone who, at best, was thinking out loud and didn't have the "should I say that out loud" filter quite on tight enough. I've certainly been there, so I can't be too critical on that front. At worst, it is a reflection of the pathologizing of people who struggle.
And interestingly, the new DSM seems to, essentially, fudge together autistic diagnoses with one broad "Autistic Spectrum Disorder" brand with modifiers as to the need for more or less support, more or less impairment etc. which might be valuable for kids who are lower functioning, but I'm not so sure that it always matters for the very high functioning kids.
I saw a self referred law student a while back, certain he had Asperger's. I didn't bother the schpiel informing him that the DSM had done away with that diagnosis, not wanting to pop any bubbles. He was smart, doing well in school, was living with his girlfriend in a relationship that he described as working well. He admitted to worrying a lot. I suggested he might have anxiety issues. He was uninterested and went for another opinion and, no surprise, received a diagnosis of Asperger's. NIMH states that almost 30% of adults will meet diagnostic criteria for anxiety in the course of their life. This is in comparison with 2.3% of adults who will meet diagnostic criteria for autism, and that's according to the highest rate recorded, which could well be an over estimate of the incidence. Didn't we all learn that "when you hear hooves think horses not zebras" because horses are much more commonly found than are zebras? I thought that was standard diagnostic practice. Look at what's more likely, not what's trendy or intriguing.
With the young man whose psychiatrist suggested autism testing, maybe it was the lack of effectiveness of the anxiety/anti-depression medications that were being prescribed. Not every kid responds so well, or so easily to medications. Why suggest autism testing and send mom into what seems an unnecessary tizzy when there are many other more obvious ways to understand his presentation? Why not look at the issues facing this guy, his strengths, his weaknesses, his family dynamics? It seems to me the answers are not to be found in finding (or is it creating?) an autism diagnosis for this kid.
I'm not opposed to testing, nor am I opposed to diagnoses. I refer for autism testing all the time and value my colleagues' input into how to best understand some kids. Yet I'm also in some agreement with the new DSM trend towards describing individual issues and challenges. But I'm becoming more interested in solving problems. I'm not at all sure chasing after a diagnosis is always the smartest move.
I received a call from a distraught mother yesterday. Her son's psychiatrist, having known this kid for many years, offered (seemingly in frustration) that "maybe he should be tested for high functioning autism." Mom was aghast. Her son certainly had cause for depression - there are lots of stressors in the family that don't need to be enumerated here. He may well have ADHD. The psychiatrist is treating for both, and that's fine. He's a bright boy, and bright can be a blessing as well as a challenge. He can be hard headed (not shocking for a smart young man who does well in regular education classes who is in early adolescence with some significant but not crippling family issues) but I'm not sure it makes for a diagnosis of high functioning autism (HFA). It makes for a kid who's "behaving badly" in the words of Ross Greene, author of The Explosive Child. If the boy even did have the diagnosis, which I'm quite sure he does not, as being hard headed and angry is way different from the rigidity that comes with classic autism, even HFA. And even if he was very rigid, would we not look at anxiety first, since there are no stereotypic (repetitive) behaviors or significant social impairments in evidence? It seems to me this off the cuff remark was someone who, at best, was thinking out loud and didn't have the "should I say that out loud" filter quite on tight enough. I've certainly been there, so I can't be too critical on that front. At worst, it is a reflection of the pathologizing of people who struggle.
And interestingly, the new DSM seems to, essentially, fudge together autistic diagnoses with one broad "Autistic Spectrum Disorder" brand with modifiers as to the need for more or less support, more or less impairment etc. which might be valuable for kids who are lower functioning, but I'm not so sure that it always matters for the very high functioning kids.
I saw a self referred law student a while back, certain he had Asperger's. I didn't bother the schpiel informing him that the DSM had done away with that diagnosis, not wanting to pop any bubbles. He was smart, doing well in school, was living with his girlfriend in a relationship that he described as working well. He admitted to worrying a lot. I suggested he might have anxiety issues. He was uninterested and went for another opinion and, no surprise, received a diagnosis of Asperger's. NIMH states that almost 30% of adults will meet diagnostic criteria for anxiety in the course of their life. This is in comparison with 2.3% of adults who will meet diagnostic criteria for autism, and that's according to the highest rate recorded, which could well be an over estimate of the incidence. Didn't we all learn that "when you hear hooves think horses not zebras" because horses are much more commonly found than are zebras? I thought that was standard diagnostic practice. Look at what's more likely, not what's trendy or intriguing.
With the young man whose psychiatrist suggested autism testing, maybe it was the lack of effectiveness of the anxiety/anti-depression medications that were being prescribed. Not every kid responds so well, or so easily to medications. Why suggest autism testing and send mom into what seems an unnecessary tizzy when there are many other more obvious ways to understand his presentation? Why not look at the issues facing this guy, his strengths, his weaknesses, his family dynamics? It seems to me the answers are not to be found in finding (or is it creating?) an autism diagnosis for this kid.
I'm not opposed to testing, nor am I opposed to diagnoses. I refer for autism testing all the time and value my colleagues' input into how to best understand some kids. Yet I'm also in some agreement with the new DSM trend towards describing individual issues and challenges. But I'm becoming more interested in solving problems. I'm not at all sure chasing after a diagnosis is always the smartest move.
Sunday, August 31, 2014
You "SHOULD" Feel
(As with all of these postings, critical facts and situations are blurred to protect client confidentiality.)
The fact of the bitter divorce that leaves the parents struggling to be civil to one another in public or private isn't the issue. The fact that they are continually in court with one another really isn't the issue either. And being in court a lot requires a lot of determination, anger, bad luck and mostly lots of money, but none of those things seem to fit as a cause. I could look at the stress of mom's "family of origin" issues - that she was raised in a critical home where despite her intelligence and accomplishments she was never good enough. But I can't see how that accounts for what I think is just her unwillingness or maybe its inability to accept reality. I think mom just has not sat down to deeply consider what autism means to her son.
Mom's upcoming marriage looms broadly on her high functioning autistic son's horizon. Daniel is 12 and continues to mourn the divorce, struggles with having to shuttle between two homes, one in which dad is happily remarried and his "primary" residence where mom, who never seems happy, but always is in control, has bestowed upon Daniel the high honor of being in the wedding party at mom's upcoming nuptials. Daniel has been clear from the beginning, he doesn't want the honor. He is conflicted, about the divorce and is just trying to digest what another marriage means, what kind of relationships he'll have with new step siblings who will now to be present in both places he's forced to call home. Daniel is simply frustrated with his mother's struggles to understand his needs, and his deteriorating behavior increasingly shows it.
Daniel's autism leaves him with a finite repertoire of emotional options. On good days he has a hard time managing the demands of his daily schedule, the very expensive private school his parents agree is best for him, extra curricular activities that have been pared down so he can cope with the stress of life better. An now mom's telling him how he should feel to be a part of her wedding party. On good days - and he's had them, Daniel is able to cope pretty well, with the understanding that he needs time outs - which he's learning to self prescribe - and with the help of medications to ease his anxiety. Additional stresses leave him emotionally and behaviorally spiraling down. And that's where he's at now.
Which is not to say that mom doesn't deserve her conjugal happiness, everyone does. What mom has, and continues to find difficult is that Daniel has, well, a disability. At best, he has what Ross Greene, author of The Explosive Child describes as "lagging skills" in coping with the flood of emotions he faces with his mother's wedding. Daniel states, with some, but not perfect clarity, that he is unprepared to face the attention, the sensory flood of faces, noises, smells, activity and the attention that comes with walking down the aisle. Mom thinks he should be honored.
Dad understands Daniel's plight but is stuck between a rock and a hard place. If he encourages mom to give Daniel some room, an "out" from this role to which he should be honored to fill, he is meddling in mom's so special day. He is expressing his jealousy of mom's moving on. He is accused of trying to turn Daniel against his mother, and fostering resentment for all that she does for him day in and day out. Dad is in a no win situation.
And I? The therapist? I'm in a bit of a tight bind as well. Mom comes faithfully to our sessions with Daniel, but has a very hard time with feedback, regardless of how softly it is presented. She's declined the individual sessions offered to assist in her "coping" and increase her understanding of kids on the spectrum - she's read the booksthankyouverymuch. I've told her directly that Daniel's hesitance to participate in her wedding IS how he feels. She responds by telling him he SHOULD feel honored to participate, even though this is besides the point. If I had a nickle for how much in the world "SHOULD" be different......I fear mom's needs to save face with her family, friends and community will outweigh her ability to be sensitive to her son's needs.
One of the most important lessons a therapist learns is to "accept the client where the client is." Daniel's mom is in a place where her needs outweigh his. I have to accept it, even though I see the hurt in it. I continue to be available and suggest that she's not really getting his point of view, but that's not "where she is" right now.
As Daniel's behavior continues to deteriorate in the weeks coming up to the wedding, I can only try to support Daniel, to pry mom's resistance to seeing who Daniel actually is as opposed to who she would like him to be. I just hope the wedding doesn't end up with a major embarrassing meltdown that ends up in another round of "shoulds" for him.
Sometimes things are just sad. And hard. My heart aches for Daniel.
Thursday, August 7, 2014
Finding Her Voice
(Note: As with all of these discussions, materiel changes have been made to the descriptions of the people being discussed in order to maintain strict privacy in accordance with all HIPPA and professional standards.)
When I met Nikki she had just been discharged from a local psychiatric hospital having experienced serious thoughts of suicide. She was a pretty, but clearly sad 16 year old young woman who admitted she had been struggling with depression for a number of months with more recent thoughts of killing herself. Her parents were concerned, available and admitted that they both came from families that were chaotic, distanced, and organized with lots of guilt as motivators. Nikki's parents were in their first marriage, having met in a self help group. I thought their mutual sensitivity a good sign They were appropriately concerned about their daughter's welfare and the frightening seriousness she had given to suicide.
In the course of the year that followed I have grown very fond of Nikki and her parents. We've explored both mom's and dad's families of origin, including one of Nikki's grandparent's financial boom and bust, leaving mom's family virtually desolate at the time of her father's (Nikki's maternal grandfather's) death. The issues of betrayal and rage that Nikki's mom grew up with were quite significant.
Nikki's dad also came from an emotionally challenging history, his parents having divorced and remarried to step parents with whom dad was cordial. Dad, however, was often caught in the ongoing friction between his biological parents that continued 30 years after the divorce. Nikki's parents willingly began coming for couple's sessions as well to deal with Nikki's hospitalization - a watershed event in their lives and with the family of origin challenges both brought to this marriage.
Nikki is a smart young woman and despite struggling mightily with her academics in the wake of time missed during her hospitalization and struggles with depression, she pulled out a very strong academic year. With a lot of support she asked for and received some latitude from her HS re: completing some assignments late. And yet, despite the accomplishments, she still struggled with feeling just OK (good was too high a bar) about her very significant accomplishments.
In addition to her academic strengths, she was very involved in sports spending many hours pursuing her expertise in gymnastics. She knew she was not destined for the Olympics and she was OK with that. But she enjoyed it and took her training and commitment to her team, coaches as well as her parents efforts on her behalf quite seriously. So when training resumed after a successful summer for the upcoming season, she resigned herself to the many hours per week required for training. But she worried.
Nikki was good at worrying and continued to struggle with just being happy despite her many strengths and accomplishments. So recently when she came in and voiced her concern about the upcoming academic load facing her, including a couple of AP classes, we began to explore what her motivation was to continue with gymnastics. She admitted it felt good to stay in shape, but added that there were certainly other ways to stay in shape that didn't require the degree of training and time that she had committed to. She hated to think that she'd be wasting the money her parents had already spent for her training and coaching. Her mom had been a pretty good gymnast when she was in high school and Nikki knew her parents both valued her extra curricular efforts. She worried about her "resume" for college, and that leaving gymnastics would take away from her chances for acceptance to a good college. (I'll spare you my rant about the pressure HS kids have these days, but trust me, I've got one.) She didn't want to let her coaches down who had been so supportive of her during her struggles last year. She had every reason to continue except her own desire to do so. Her motivation to continue was all based on factors other than her own. The theme of guilt ran strong as a motivator for her. She didn't know how she'd fit all of the needed time into the day or week to address both her academic and extra curricular load.
So I asked her what it would be like to consider dropping gymnastics - which she toyed with last year - again with her parents to see what their response would be. Communicating her concerns about how many hours there were in a day seemed a reasonable thing for her to do with them. They were supportive, concerned, available and she didn't have the seething resentment of her parents that some adolescents develop. She knew they were on her side, she just didn't want to disappoint them. She was unsure how to proceed.
In our next session, almost a year since her suicidal thoughts had taken root, Nikki came in and hesitantly but with confidence said she had finished with gymnastics. She spoke to her folks and to her coach and all were supportive of her. Never one for excitement or overstatement, I asked her how it felt and she said "OK."
"OK?, Not 'good?'" I asked. She let a small smile out and admitted that it was better than just OK. And then we talked about the role of guilt, the dangers of doing something for someone else's needs without doing it for one's own needs, and the importance of knowing when we were asking too much of ourselves. Nikki's confidence in herself is beginning to bloom. I suggested to her that she'd turned a corner in comparison to where she was a year ago when she didn't know how to communicate her needs and her parents were unsure what to listen to, or how hard to push her. She agreed, things were indeed different. So many of the things she worried about just hadn't come about. Her parents, her coach, all supported her decision to discontinue her athletics. I cautioned her in her fear of disappointing one of her teachers - she was changing out of one of the teacher's classes, but didn't want the teacher to feel bad. I suggested this was the virtually the same issue we'd been discussing - worrying about others' feelings instead of balancing her own needs. I could see the lights go on. She's learning how to find her voice, and I'm so proud of her.
When I met Nikki she had just been discharged from a local psychiatric hospital having experienced serious thoughts of suicide. She was a pretty, but clearly sad 16 year old young woman who admitted she had been struggling with depression for a number of months with more recent thoughts of killing herself. Her parents were concerned, available and admitted that they both came from families that were chaotic, distanced, and organized with lots of guilt as motivators. Nikki's parents were in their first marriage, having met in a self help group. I thought their mutual sensitivity a good sign They were appropriately concerned about their daughter's welfare and the frightening seriousness she had given to suicide.
In the course of the year that followed I have grown very fond of Nikki and her parents. We've explored both mom's and dad's families of origin, including one of Nikki's grandparent's financial boom and bust, leaving mom's family virtually desolate at the time of her father's (Nikki's maternal grandfather's) death. The issues of betrayal and rage that Nikki's mom grew up with were quite significant.
Nikki's dad also came from an emotionally challenging history, his parents having divorced and remarried to step parents with whom dad was cordial. Dad, however, was often caught in the ongoing friction between his biological parents that continued 30 years after the divorce. Nikki's parents willingly began coming for couple's sessions as well to deal with Nikki's hospitalization - a watershed event in their lives and with the family of origin challenges both brought to this marriage.
Nikki is a smart young woman and despite struggling mightily with her academics in the wake of time missed during her hospitalization and struggles with depression, she pulled out a very strong academic year. With a lot of support she asked for and received some latitude from her HS re: completing some assignments late. And yet, despite the accomplishments, she still struggled with feeling just OK (good was too high a bar) about her very significant accomplishments.
In addition to her academic strengths, she was very involved in sports spending many hours pursuing her expertise in gymnastics. She knew she was not destined for the Olympics and she was OK with that. But she enjoyed it and took her training and commitment to her team, coaches as well as her parents efforts on her behalf quite seriously. So when training resumed after a successful summer for the upcoming season, she resigned herself to the many hours per week required for training. But she worried.
Nikki was good at worrying and continued to struggle with just being happy despite her many strengths and accomplishments. So recently when she came in and voiced her concern about the upcoming academic load facing her, including a couple of AP classes, we began to explore what her motivation was to continue with gymnastics. She admitted it felt good to stay in shape, but added that there were certainly other ways to stay in shape that didn't require the degree of training and time that she had committed to. She hated to think that she'd be wasting the money her parents had already spent for her training and coaching. Her mom had been a pretty good gymnast when she was in high school and Nikki knew her parents both valued her extra curricular efforts. She worried about her "resume" for college, and that leaving gymnastics would take away from her chances for acceptance to a good college. (I'll spare you my rant about the pressure HS kids have these days, but trust me, I've got one.) She didn't want to let her coaches down who had been so supportive of her during her struggles last year. She had every reason to continue except her own desire to do so. Her motivation to continue was all based on factors other than her own. The theme of guilt ran strong as a motivator for her. She didn't know how she'd fit all of the needed time into the day or week to address both her academic and extra curricular load.
So I asked her what it would be like to consider dropping gymnastics - which she toyed with last year - again with her parents to see what their response would be. Communicating her concerns about how many hours there were in a day seemed a reasonable thing for her to do with them. They were supportive, concerned, available and she didn't have the seething resentment of her parents that some adolescents develop. She knew they were on her side, she just didn't want to disappoint them. She was unsure how to proceed.
In our next session, almost a year since her suicidal thoughts had taken root, Nikki came in and hesitantly but with confidence said she had finished with gymnastics. She spoke to her folks and to her coach and all were supportive of her. Never one for excitement or overstatement, I asked her how it felt and she said "OK."
"OK?, Not 'good?'" I asked. She let a small smile out and admitted that it was better than just OK. And then we talked about the role of guilt, the dangers of doing something for someone else's needs without doing it for one's own needs, and the importance of knowing when we were asking too much of ourselves. Nikki's confidence in herself is beginning to bloom. I suggested to her that she'd turned a corner in comparison to where she was a year ago when she didn't know how to communicate her needs and her parents were unsure what to listen to, or how hard to push her. She agreed, things were indeed different. So many of the things she worried about just hadn't come about. Her parents, her coach, all supported her decision to discontinue her athletics. I cautioned her in her fear of disappointing one of her teachers - she was changing out of one of the teacher's classes, but didn't want the teacher to feel bad. I suggested this was the virtually the same issue we'd been discussing - worrying about others' feelings instead of balancing her own needs. I could see the lights go on. She's learning how to find her voice, and I'm so proud of her.
Sunday, July 13, 2014
Summer Reading, Eye Contact and Collaboration
Having 20 some years working with kids on the spectrum, I'm pretty much used to it all and have probably become a bit too jaded. I recently went through a training with Ross Greene, you likely know of him, he wrote The Explosive Child which has been such a popular book for so many parents. I went with minimal expectations having been through 32 years of continuing education and finding much of it to be minimally informative and rarely inspiring. This was different.
Greene's focus is on Collaborative and Proactive Solutions (formerly Collaborative Problem Solving - it's a long story....) One aspect of CPS Greene focuses on building the relationship with the child, a skill he quickly wants parents to learn so they can do what they need to with their kids without therapy. There is a lot more to it and I plan to continue my study of CPS, but a couple of salient moments have already borne fruit in my sessions this week.
One HFA (high functioning autism) child and his mother came in with a(nother) fight, this one about his summer reading. I put on my best Greene hat and delved into emphatically trying to hear, just hear and thus validate, "what's up" for him. It was hard for him, and for me a bit. Greene is clear that drilling down to a specific, a very specific problem is quite important. So I drilled for specificity and the boy hung in there, squirming and citing his being "tired and hungry." But we perservered and came up with a collaborative plan that I wasn't too sure of. The next day I received a thankful text from mom stating that the boy had that night forged through what he said he would do within the next week.
Mom, who had already been through the book and Greene's DVD's with marginal success said she'd have to "reconsider" this whole "collaborative" thing in a more positive light.
So far so good.
I later met with a family new to me. Another HFA child who could say little in response to my most doggedly "Greene" like questioning except "I'm confused." He was a kid with classic lack of eye contact that so many HFA folks have. Even though I was sitting 3 feet from him, tried to engage him with some of my notoriously bad humor (it's a great measure of where a kid's at - an eye roll or smirk can reveal a lot, but on this guy it went nowhere), he stared almost exclusively straight ahead avoiding making any but the most glancing eye contact. So I went with "confused." That's what Greene said to do, so I did it. We were discussing it for a while, making what seemed like no great headway and then something quite odd happened. He turned and gazed at me. Square on, right in the eyes, for a long time and held my gaze as I again said "So you're feeling confused..." to my many questions. At that moment it seemed to go beyond eye contact. It was human contact. A visual confirmation that a relationship was building. Now I'm not going to start down "the CPS solves cancer" route, but for a HFA kid to just engage me visually like that is pretty significant. I'm used to these kids not visually engaging me at all. Ever.
So, if you see me, prepare for more. Re-read the book. I'll help you with the rest.
Greene's focus is on Collaborative and Proactive Solutions (formerly Collaborative Problem Solving - it's a long story....) One aspect of CPS Greene focuses on building the relationship with the child, a skill he quickly wants parents to learn so they can do what they need to with their kids without therapy. There is a lot more to it and I plan to continue my study of CPS, but a couple of salient moments have already borne fruit in my sessions this week.
One HFA (high functioning autism) child and his mother came in with a(nother) fight, this one about his summer reading. I put on my best Greene hat and delved into emphatically trying to hear, just hear and thus validate, "what's up" for him. It was hard for him, and for me a bit. Greene is clear that drilling down to a specific, a very specific problem is quite important. So I drilled for specificity and the boy hung in there, squirming and citing his being "tired and hungry." But we perservered and came up with a collaborative plan that I wasn't too sure of. The next day I received a thankful text from mom stating that the boy had that night forged through what he said he would do within the next week.
Mom, who had already been through the book and Greene's DVD's with marginal success said she'd have to "reconsider" this whole "collaborative" thing in a more positive light.
So far so good.
I later met with a family new to me. Another HFA child who could say little in response to my most doggedly "Greene" like questioning except "I'm confused." He was a kid with classic lack of eye contact that so many HFA folks have. Even though I was sitting 3 feet from him, tried to engage him with some of my notoriously bad humor (it's a great measure of where a kid's at - an eye roll or smirk can reveal a lot, but on this guy it went nowhere), he stared almost exclusively straight ahead avoiding making any but the most glancing eye contact. So I went with "confused." That's what Greene said to do, so I did it. We were discussing it for a while, making what seemed like no great headway and then something quite odd happened. He turned and gazed at me. Square on, right in the eyes, for a long time and held my gaze as I again said "So you're feeling confused..." to my many questions. At that moment it seemed to go beyond eye contact. It was human contact. A visual confirmation that a relationship was building. Now I'm not going to start down "the CPS solves cancer" route, but for a HFA kid to just engage me visually like that is pretty significant. I'm used to these kids not visually engaging me at all. Ever.
So, if you see me, prepare for more. Re-read the book. I'll help you with the rest.
Monday, June 23, 2014
With and Without TV and Marital Happiness.
We don't have a TV in our home. We did, but given work schedules and our viewing preferences, we canceled it and saved the money. Netflix gives me all I need. So I'm generally immune from the advertising that rules the airwaves. Until I travel.
So recently when I was at a conference I tuned it, caught up on World Cup play, which is thankfully commercial free, and then tuned in to a "world premiere" of a show I had seen advertised - at a movie no less. It had all the compelling aspects of shows I like. Action, military, science etc. The cost of watching it was re-entry into the world of commercial expectations. Boy do we have expectations.
In one car commercial, sequences of horribly damaged cars were accompanied by the statement "They lived." Wow. So now, regardless of how horribly I crash, I should have the expectation of living through it. And another commercial, also for a car, I learned that no matter how distracted I am, my car can and should correct for my mistakes. Veer too much from my lane, it informs me. Approach a vehicle in front of me too fast, it brakes for me.
Now I'm not opposed to smart(er) cars, just like I'm not opposed to smart(er) phones or computers. I am concerned that expectations of our own responsibility is being shaped to decrease our sense of self and relationship with the world.
Interestingly, I read an article recently about divorces in later life, after 20+ years of marriage. One of the professionals interviewed opined that the increase in divorce of this population is due to the increased frequency of people's expectations being raised about how much they deserve, how much they "should" get from life. This seems to be a (natural?) expansion of the selling of sex that has accompanied advertising for at 150 years. Google "Pearl Tobacco" if you need proof. I don't think even then that anyone would have actually thought that smoking a Pearl would cause naked women to approach. But the claims seem to have gone so much further now. Horrible auto crashes should be, not could be survived. Irresponsible driving should be intercepted by our machines. We don't need to be responsible any more.
I hope I'm not the only one who has a problem with that line of thinking.
So recently when I was at a conference I tuned it, caught up on World Cup play, which is thankfully commercial free, and then tuned in to a "world premiere" of a show I had seen advertised - at a movie no less. It had all the compelling aspects of shows I like. Action, military, science etc. The cost of watching it was re-entry into the world of commercial expectations. Boy do we have expectations.
In one car commercial, sequences of horribly damaged cars were accompanied by the statement "They lived." Wow. So now, regardless of how horribly I crash, I should have the expectation of living through it. And another commercial, also for a car, I learned that no matter how distracted I am, my car can and should correct for my mistakes. Veer too much from my lane, it informs me. Approach a vehicle in front of me too fast, it brakes for me.
Now I'm not opposed to smart(er) cars, just like I'm not opposed to smart(er) phones or computers. I am concerned that expectations of our own responsibility is being shaped to decrease our sense of self and relationship with the world.
Interestingly, I read an article recently about divorces in later life, after 20+ years of marriage. One of the professionals interviewed opined that the increase in divorce of this population is due to the increased frequency of people's expectations being raised about how much they deserve, how much they "should" get from life. This seems to be a (natural?) expansion of the selling of sex that has accompanied advertising for at 150 years. Google "Pearl Tobacco" if you need proof. I don't think even then that anyone would have actually thought that smoking a Pearl would cause naked women to approach. But the claims seem to have gone so much further now. Horrible auto crashes should be, not could be survived. Irresponsible driving should be intercepted by our machines. We don't need to be responsible any more.
I hope I'm not the only one who has a problem with that line of thinking.
Monday, June 9, 2014
Mom Gets a Sticker or Teaching Johnny to Swim.
So much of the work that I do with kids is centered on parents. A recent case in point is a mom of a precocious 1st grade boy who had been nervous about learning new things like learning how to swim, hesitance to learn to ride a bike, even spending time with other kids his age.
He was a cute kid, precocious, as I said, easily engaged in talk and play. Grades were good, behavior was OK. So.....what about that anxiety?
Well, as family therapists are wont to do, I began to explore the family of origin. Mom admitted that she was raised under a specter of "danger." Everything had a dangerous side to it. Really dangerous. This sense of danger was reinforced by a tragic nonfatal accident that one of her father's nephews had suffered as a young adult. Thus grandpa held his breath whenever this little boy did...well...just about anything. And of course grandpa lived close, transmitting his anxiety in a potent and frequent way to both his daughter and grandson. And of course mom felt great responsibility to not heighten her father's anxiety. So, it follows that mom held her breath - loudly -whenever her little boy attempted to do those things that are normal for little boys to do. He learned, in turn, to hesitate a bit, in deference to his mother's anxiety on behalf of her father. You get the picture. Thus, we have a recipe for a child with anxiety. Kind of.
I recall so clearly that at the end of the first meeting mom anxiously sat forward on her seat and asked, tears forming and beginning to roll down her cheek, if there was "hope" for her beloved son. I wasn't sure what she really meant. Sure there was hope, I responded, curious why she was so concerned. The tears of relief flowed as I used one of my favorite lines: "I'm not going to lose sleep about you or your son this weekend." I did not predict horrible things in the life of her son. (As if we have crystal balls through which we can predict all coming events!)
Mom quickly came to understand the dilemma she created in transferring anxiety "down the generational line" from her father to her to her son. The solution was pretty straightforward, as mom now admits. The first thing mom agreed to do was to check her own anxiety at the door. Family therapy theory discusses pushing the dysfunction "up" the generational ladder. She, not her father was the parent of this boy. She knows kids need to learn how to swim, bike etc. despite her father's trauma with his nephew. But how to reverse the tide? The answer was a simple behavioral intervention - understanding what was "reinforcing" to her son.
She said she'd tried lots of rewards to motivate him to participate in activities about which she had been giving big mixed messages. She signed him up for swim lessons, and he, in perfect form, cried about swimming. He had a bike, but was afraid to learn to ride it. Motivations? Stickers failed. Food (often a dangerous reinforcement, but not universally) was not a first choice as her son was already large for his age. So I asked him - what would HE like to get if he participated in the upcoming swim lessons He drew a blank. It's better if kids of almost any age come up with their own reinforcement when trying to get them to participate in something. This was about developing or increasing a new behavior, not inhibiting a "maladaptive" behavior. But when a child is a bit on the shy side, I'll toss out some of the tried and true options.
So I went fishing - it didn't take long. Stickers were out, TV and video games were appropriately limited by mom, so I was hesitant to go there. Food? Nope. Going to the pool is a great reinforcement for some kids, but not this one, not yet. Extra "play dates" with peers can be a good draw, but this boy has a record of being a bit shy. How about staying up a bit late after participating in the swim lesson? His eyes lit up. Bingo.
Mom was game, and in 2 weeks the report was perfect. He not only had participated in the swim lesson but was now swimming on his own, head in the water and on those days he did so, mom or dad stayed up with him an extra half hour - an easy accommodation during summer break. The reinforcement combined two most powerful reinforcers: staying up late, a sign of maturity, growth and responsibility, and parent attention during that extra half hour. Parents were aware that they needed to begin to wean the "reinforcement" pretty quickly which they had spontaneously begun to do - once he was swimming. We discussed that "reinforcements" are establishing an economic model. Now as my son the economist will tell you, I know diddly about economics. But I know enough to know that parents are the rulers of economics with children. Reinforcements can be established, changed or cancelled, as the situation demanded. These parents understood that there is no need to waste a working reinforcement when a behavioral goal (swimming) is established. Save it for other goals. Mom continues to be aware that the anxiety specter loomed, but was working hard at keeping her goal on the child's needs, not her father's anxiety. That'll be a work in progress that we can address as needed.
Mom's still nervous about her dad's anxiety, but is giving a strong signal to her son of what is of real value. The bike's next. The shyness? Who knows where that will end up? Mom? She got a sticker and her son didn't even want one.
He was a cute kid, precocious, as I said, easily engaged in talk and play. Grades were good, behavior was OK. So.....what about that anxiety?
Well, as family therapists are wont to do, I began to explore the family of origin. Mom admitted that she was raised under a specter of "danger." Everything had a dangerous side to it. Really dangerous. This sense of danger was reinforced by a tragic nonfatal accident that one of her father's nephews had suffered as a young adult. Thus grandpa held his breath whenever this little boy did...well...just about anything. And of course grandpa lived close, transmitting his anxiety in a potent and frequent way to both his daughter and grandson. And of course mom felt great responsibility to not heighten her father's anxiety. So, it follows that mom held her breath - loudly -whenever her little boy attempted to do those things that are normal for little boys to do. He learned, in turn, to hesitate a bit, in deference to his mother's anxiety on behalf of her father. You get the picture. Thus, we have a recipe for a child with anxiety. Kind of.
I recall so clearly that at the end of the first meeting mom anxiously sat forward on her seat and asked, tears forming and beginning to roll down her cheek, if there was "hope" for her beloved son. I wasn't sure what she really meant. Sure there was hope, I responded, curious why she was so concerned. The tears of relief flowed as I used one of my favorite lines: "I'm not going to lose sleep about you or your son this weekend." I did not predict horrible things in the life of her son. (As if we have crystal balls through which we can predict all coming events!)
Mom quickly came to understand the dilemma she created in transferring anxiety "down the generational line" from her father to her to her son. The solution was pretty straightforward, as mom now admits. The first thing mom agreed to do was to check her own anxiety at the door. Family therapy theory discusses pushing the dysfunction "up" the generational ladder. She, not her father was the parent of this boy. She knows kids need to learn how to swim, bike etc. despite her father's trauma with his nephew. But how to reverse the tide? The answer was a simple behavioral intervention - understanding what was "reinforcing" to her son.
She said she'd tried lots of rewards to motivate him to participate in activities about which she had been giving big mixed messages. She signed him up for swim lessons, and he, in perfect form, cried about swimming. He had a bike, but was afraid to learn to ride it. Motivations? Stickers failed. Food (often a dangerous reinforcement, but not universally) was not a first choice as her son was already large for his age. So I asked him - what would HE like to get if he participated in the upcoming swim lessons He drew a blank. It's better if kids of almost any age come up with their own reinforcement when trying to get them to participate in something. This was about developing or increasing a new behavior, not inhibiting a "maladaptive" behavior. But when a child is a bit on the shy side, I'll toss out some of the tried and true options.
So I went fishing - it didn't take long. Stickers were out, TV and video games were appropriately limited by mom, so I was hesitant to go there. Food? Nope. Going to the pool is a great reinforcement for some kids, but not this one, not yet. Extra "play dates" with peers can be a good draw, but this boy has a record of being a bit shy. How about staying up a bit late after participating in the swim lesson? His eyes lit up. Bingo.
Mom was game, and in 2 weeks the report was perfect. He not only had participated in the swim lesson but was now swimming on his own, head in the water and on those days he did so, mom or dad stayed up with him an extra half hour - an easy accommodation during summer break. The reinforcement combined two most powerful reinforcers: staying up late, a sign of maturity, growth and responsibility, and parent attention during that extra half hour. Parents were aware that they needed to begin to wean the "reinforcement" pretty quickly which they had spontaneously begun to do - once he was swimming. We discussed that "reinforcements" are establishing an economic model. Now as my son the economist will tell you, I know diddly about economics. But I know enough to know that parents are the rulers of economics with children. Reinforcements can be established, changed or cancelled, as the situation demanded. These parents understood that there is no need to waste a working reinforcement when a behavioral goal (swimming) is established. Save it for other goals. Mom continues to be aware that the anxiety specter loomed, but was working hard at keeping her goal on the child's needs, not her father's anxiety. That'll be a work in progress that we can address as needed.
Mom's still nervous about her dad's anxiety, but is giving a strong signal to her son of what is of real value. The bike's next. The shyness? Who knows where that will end up? Mom? She got a sticker and her son didn't even want one.
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