Tuesday, March 31, 2009

Asperger’s, Autism, and Adult Women

For a long time, the autism media focus has been about young boys with Asperger’s and autism. But lately I’m noticing more of a focus on women with autism and Asperger’s. I’ve talked about women on the autism spectrum briefly, especially how tough it is to find information about how women and girls are impacted. Although the media stories or TV interviews may be poorly done, and the information can be misleading, I think this increasing media attention is a good thing because it can help bring down some of the stereotypes and raise awareness that autism and Asperger’s are not strictly about young males.
Glamour magazine, March 2009, ran a story “They’re Autistic - And They’re In Love” where they depicted Dave Hamrick and Lindsey Nebeker, who both have autism diagnoses. The story tends to play into the stereotypes, and doesn’t address much about the strengths that can come along with the diagnosis. But, it does tell about a positive relationship that seems to work for the couple. It also shows how adults can bypass all the limitations that medical professionals may predict about children. The article states that Hamrick’s parents were told he would never be able to work or live alone. Now he’s a college graduate who majored and works in meteorology.
America’s Next Top Model ran this season with a contestant, Heather Kuzmich, who says she was diagnosed with Asperger’s at age 15. I don’t watch this show, so I don’t have much to say about it. You can find a truly dreadful You Tube interview with Kuzmich. She’s does a good job on the interview, but the interviewer seems so uninformed and uncomfortable about the topic of Asperger’s, it’s a bit difficult to watch.
Finally, everybody has probably heard about Mary McDonnell on Grey's Anatomy as Dr. Virginia Dixon, a cardiac surgeon with Asperger's. I’ve only seen one episode of this character, but I got some idea of how the character was depicted.  It’s a shame that the portrayal is so broad and the character doesn’t seem to be coping as well as one would expect of a person who made it through medical school. Still, it does present the idea that Asperger’s and autism are a part of a spectrum and some individuals with Asperger’s are extremely successful professionally.
The media has a long way to go in showing all the aspects of the autism spectrum. These depictions of women are certainly flawed, but they do raise the visibility of women with the condition. They also start to present a more balanced picture, that autism is not a condition that affects only male children, and that some individuals with autism or Asperger’s can be very successful. I look forward to the day that the interviewers ask these successful individuals about how Asperger’s or autism contributed to their success.

Monday, March 30, 2009

School Organization Tips for Students with Asperger’s, Autism and ADHD

Organization can be a big problem for kids with Asperger’s, autism and ADHD. Executive functioning difficulties can be a factor in all of these diagnoses, making it difficult for children to plan, pay attention, organize details, and manage their time.
I sat down recently with Nancy Chin of Step By Step. Nancy Chin is the developer of the Step By Step program for academic coaching. Nancy works with school age children who are typically very bright, but still struggling in school. Many of her clients have diagnoses of Asperger’s, autism and ADHD. I asked Nancy for her tips on helping kids succeed in the classroom.
Nancy described how she often works with young students, those from kindergarten through third grade, directly in the classroom. After consulting with the parents and teachers, and observing her students in class, Nancy works to create detailed instructions for these children. Typically, she would start working only on one goal at a time, for example, dealing with transitions during the school day. With the student, she works to create a check list with all the steps necessary. She also explains that the routine will be the same everyday, something that these students may not realize.  An example might be: When the bell rings, put your books back on the shelf, put your pencils in your backpack and get in line with the other children, trying to be in the first half of the line. Although her students are very bright, executive functioning issues mean that it can be difficult for them to figure this out without instruction. She’s found that, too often, the teacher can misunderstand and view the child as being defiant or distracted, when actually they’re just unsure what to do next. Often, with younger students she’ll create a sticker chart, sometimes using tiny prizes to help reward successes.
Nancy said that her plan is to set the goals so that the students can be successful, and then to focus on the successes. She stressed that learning these skills can take time, and she likes to start working with children when they’re very young, when it can be easier for them to learn these new skills. Each small success can lead to success in other areas, for example successful transitioning from the playground gets the student to the classroom on time, which can then lead to more time for learning, and greater academic success.
After achieving this first goal, Nancy said they’ll move on to another, small goal, for example, completing classroom work. This doesn’t mean that the work is all correct, but just that the student is actually doing it. By setting small goals, and focusing on the successes, the student starts to feel successful, learns how to organize and plan, and often academic performance improves.
I think many children could benefit from an approach like this. It’s straightforward and simple, creates a visual plan, which is ideal for many individuals on the Autism Spectrum, and most importantly, allows the student to succeed.
Nancy and I also discussed her tips for organizing homework, which I’ll be talking about in a later post.

Monday, March 23, 2009

Asperger’s and Dating: Getting Started Later in Life

For many adults, dating and finding a romantic partner are important goals, and this is true for those with Asperger’s and autism as well as those without. But often, those on the autism spectrum may have gotten off to a slower start on dating. The high school social scene, when many neurotypical teens first start dating, can be horribly complex and not open to anyone who doesn’t fit into the popular crowd’s most narrow definition of acceptable behavior. High schoolers on the autism spectrum may be quirky, or dealing with bullies, or just not ready to enter into an activity that is so socially complex. Then, after high school, it can be even more difficult because it seems like the rest of the world is so much more experienced with dating. The older you get without dating, the tougher it may seem to get started. But, the good news is, if you’re wanting to start dating, it’s never too late to begin. Below are some tips for how to start dating, even if you’re no longer anywhere close to high school age.
Of course, the first step in starting to date is to find a date. This is actually probably easier than you might imagine. Remember, you’re looking for a date, not a spouse. So you can settle for a person you enjoy talking to or spending time with, this doesn’t have to be that perfect ‘one’ person. Consider expanding your ideal criteria. Maybe you envision yourself only involved with an extremely attractive, or brilliant, or successful individual. But, if you’re only setting up a date here, you can relax your standards. Many people whom you’d never consider marrying can be lot of fun to talk to on a date. Who knows, you may even change your standards.
Meeting people gets easier all the time. If you struggle in more unstructured settings, like bookstores and coffee shops, it’s fine to go to practical meeting places, things like speed dating or the internet. There, you can be assured that the people you’re meeting are looking to meet others. If you’re inexperienced with dating, it’s probably best to avoid asking out coworkers, neighbors or people you’ll continue to see a lot of after the date. Misread social cues can mean a long term awkwardness with people you have to interact with well after the date.
Of course, safety is key. It you’re an individual who struggles with reading social signals, assume that you might have difficulty in determining if situations are safe. Have your date in a public, well lit place, make sure you bring a phone and a friend knows where you are. Don’t give out your address or too many personal details. Plan in advance about how long the date will be, and then stick to that plan. You don’t want to get carried away with a charming stranger. Finally, and most important, trust your instincts. If something feels off, listen to yourself.
Your first dating experiences are bound to be somewhat awkward. Relax, this doesn’t have to be a lifelong romance. See if you can just think of this date as a way to get more experience with dating.   You don’t have to share your lack of dating experience with the person you’re chatting with, just keep it light. Talk about things you have in common, and try to learn general things about your date, things like where they’re from, what they like about the place they’re currently living, interesting hobbies. Also, plan on keeping it short. An afternoon coffee date is a lot less pressure than a full night of dinner and a movie. If it’s easier, consider setting your first date up as an activity, like touring a museum, taking a hike, visiting the beach. These activities can also take a lot of pressure off carrying on a lengthy conversation.
Finally, try to have fun! Dating can be the way to meet a spouse, or find the love of your life. But it can also be a pleasant way to interact with another person, and enjoy a Saturday afternoon.

Monday, March 16, 2009

Support Services for Individuals with Developmental Disabilities: Transition Faire

Alameda County Public Health Department is hosting their Transition Information Faire for individuals with developmental disabilities on March 28, 2009 at the College of Alameda. This is an opportunity for any individual to learn about services from agencies that help individuals manage issues such as housing, employment, and self advocacy. Although the Faire is aimed primarily at young adults transitioning out of the school system, I’m told that many of these services are appropriate for older individuals, who are welcome to attend as well. The March 13, 2009 registration deadline has passed, but I’ve been told that  registrants can still apply.

Negotiating the maze of support services for disabled individuals can be an overwhelming task. It can require searching the internet, making numerous phone calls, waiting for responses and meticulous record keeping. Unfortunately, for individuals with Asperger’s, autism and other developmental disabilities, those who really need the services, these organizational skills may be especially difficult to manage. Events like this, with real people available to talk directly to the people they work with, can make it much easier to figure out the system.

You can access the brochure with information at the Alameda County Public Health Department website. (It’s under: Major Events and Activities: 2009 Transition Faire March 28, 2009 - School Registration Form.

Friday, March 13, 2009

More on DIR®/Floortime™: A Conversation

Many parents are interested in using the DIR®/Floortime™ model with their children on the autism spectrum. One of the benefits of this treatment is that parents can be trained and work directly with their children. Today I'm talking with Lynette DiLuzio, MS, CCC-SLP, and a DIR Certificate Candidate - Level III. Lynette is also the director of The Creekside School in San Jose, a small private school for students, age 5 to 9, with autism.
Patricia Robinson: Lynette, can you explain a bit about DIR®/Floortime™ and your experience with it?
Lynette DiLuzio: As a speech-language pathologist, I came to Floortime as a young clinician.  It seemed simple and very natural to me -- follow the child's lead, be playful, try to get the child to connect.  The more I practiced it and the more I studied Floortime I realized just how intricate and holistic the method truly is.  It was kind of like starting at the bottom of a pyramid and working to climb all the way to the top.  But once I got there, there was an inverted pyramid and I had a lot more climbing to do!!  Thank goodness the journey has always been fun!
Floortime is one element of the larger model -- DIR, which stands for the Developmental, Individual difference, Relationship-based Model.  Similarly, DTT is one element of ABA - to make a comparison.  As a DIR Clinician, I am able to assess both the child AND the family's needs within the model.  DIR helps me know how to use my skills as a speech-language pathologist to meet a child's needs in all areas (with help of the family and other specialists on the team) while helping the child integrate skills and reach their highest potential socially, emotionally, physically, and academically.  I can do this using Floortime as well as any other method that can benefit that particular child's specific need (which can borrow and/or include anything from TEACCH methods, behavioral intervention, visual supports, sensory integration, technology, etc.).  All of that happens within the constructs of the family unit through relationships.
Patricia Robinson: Lynette, can you share some of your experiences with using DIR®/Floortime™ with your students?
Lynette DiLuzio: I'd love to!  One recent event was with an 8 year old boy with whom I've been working since he was 3.  This guy is non-verbal and struggles with significant dysregulation and motor issues.  Over the last several years, he has learned strategies that help him self-regulate though he often depends on the adults around him to give him the input he needs.  He uses a combination of PECS, some words, and phrases he has memorized from books and songs to communicate.  We were in class participating in a sensory/art activity and he was becoming dysregulated, which for him used to lead to aggressive episodes.  We were able to stay connected using Floortime around the activity in which we were involved because I provided the deep pressure/sensory input he needed at that moment.  As the activity got harder, I anticipated we would have to give up on finishing the activity.  At this point, he reached into his PECS books and requested "walk" - typical reaction, so I thought.  He had another idea -- he got his backpack (which is weighted so when he goes for a walk it often gives him the needed support to stay regulated), put it on, took me by the hand, and went back to the activity!  I was so proud of him!!
Another instance was with a 6 year-old boy.  He is also non-verbal and has motor processing issues that really prevent him from using his body in ways that he wants to.  He came into class pretty low arousal -- for him meaning that he wasn't looking at anyone, didn't acknowledge people in the room, and simply entered and sat on a bench looking at something out of the corner of his eye. I was coaching our Occupational Therapist during this session. She was able to address his low arousal by getting on his level (physically) and wooing him in with her high affect.  She began giving him a horsey ride around the classroom.  As he was brought up to a higher arousal level, she would move further away from him.  He began using gestures and vocalizations to call her back and request another horsey ride.  She, using high affect and simplified language, would ask "Oh, you want another horsey ride?"  He began to nod in reply as a "yes".  This was a first!!  Throughout the session through the use of Floortime, she was able to keep him well-regulated while increasing the demand on his communication.  He was having so much fun he began using all kinds of gestures, vocalizations, and even some words.

Patricia Robinson
: Do you have any suggestions for how parents can keep progressing with their Floortime experience at home?
Lynette DiLuzio: Many parents often try to fit in eight 20-minute sessions a day.  These can be incorporated throughout the regular course of your time at home.  It's important for parents to remember that Floortime is anytime - when you're putting away the groceries, giving your child a bath, sorting the laundry.  Also, there is no "bad" Floortime...there is only better Floortime.  The most successful Floortime parents are those who remember to take a break, refresh, and ensure they are taken care of so they can be fully charged to play!
Patricia Robinson: How can parents learn more about DIR®/Floortime™? Where can they find trained experts to work with their families? How much parent training is necessary for parents to start using this approach?
Lynette DiLuzio: Parents can find DIR trained and certified practitioners by visiting www.icdl.com and clicking the "Find DIR Professionals" link.  Parents can learn more about Floortime by clicking the "DIR/Floortime Model" or "Getting Started" links on the same site.  There is also information regarding the online courses available through the ICDL as well as area trainings.  We just had our first parent training event at The Creekside School on February 28th.  We will be scheduling more trainings and conducting parent training groups in the near future.  Please visit our website at www.creeksideschool.org and click the "Events" page.
Parents are always the best expert when it comes to their own children.  That is all the training they need to get started.  Don't be afraid to be silly, get messy, and have a good time.  The rest can be learned through practice with the support of the rest of the team, by reading one of the resources (also listed on the ICDL website), attending a conference, or contacting a Floortime practitioner.
Patricia Robinson: Thanks for the information, Lynette!

Wednesday, March 4, 2009

Making Friends: Tips for Lunchtime Socializing

Sitting in the cafeteria at the lunch table is a classic school experience - and the time your child may feel most isolated and alone. For kids who struggle with social skills, like those with Asperger’s, autism and ADHD, lunch period can be one of the worst in the day. But, if your child can manage to make a few changes, lunchtime can be a time for fun and friendship. This is a perfect area where parents can coach their child to social success.
Timing is Everything:
Kids on the autism spectrum or ADHD can be struggling with the executive functioning aspects of getting to lunch - things like packing up the backpack and finding the lunch box, or navigating the hallways to get to the lunch room. Or, they may race from the classroom without talking to anyone. This might mean that your child is the first to arrive in an empty lunchroom, or the last one to walk in, when all the seats are full.
The goal is to get to the lunch room somewhere in the middle of the crowd. If your child is the first into the room, he’s faced with empty tables, where he has to sit down alone, and then somehow draw others to him. Kids who have close friends have enough “social power” to pull others to their table. But, it would be unusual for other kids to sit down with kids who are struggling socially. There’s nothing worse than sitting all alone.
It can be tempting for your child to dawdle on the way to the lunch room. The problem is that when the dawdler arrives, the tables might be packed. Your child may have no place to sit down, or be forced to sit with younger kids, older kids, or, even worse, mean kids. Better to get there a few minutes earlier, and have a bit of control over the table mates.
Lunch Lines Provide Social Structure:
The chaotic, unstructured quality of the lunchroom is one of its toughest aspects. Waiting in the cafeteria line is a bit easier. Just a few kids are standing near your child, and they are pretty much stuck there. This is your child’s chance to strike up a conversation. The topic is easy - what’s for lunch, what happened in class, what’s coming up that afternoon.
Fit In With Food:
Pay attention to what the other kids are eating. Usually, there are two separate lines, for kids who buy and kids who bring, maybe a separate line to buy drinks. Figure out if your child is the only one buying or bringing. This sets him or her apart from the other kids and makes it tougher to stick with the crowd. Even for kids bringing a special diet, it may be worthwhile for them to stand in line with the others to pick up fruit or a beverage.
Looking for a Table:
Once your child is ready to sit down, it’s time to scan for friends, acquaintances, or classmates. The goal here is to find the kids your child knows best and see if they’re open to table mates. Explain the social rankings of schools to your child. It’s never a good idea for socially struggling kids to try to sit at the popular table. Even if they’re not rejected, they’ve committed a social error and are open to all sorts of later problems.
You should coach your child on the basics of looking busy, not standing desperate and alone. Brainstorm ideas like checking out the salad bar, putting on a jacket, filling a water bottle. These little activities give your child a chance to scan the room while looking busy, and to wait for a more social spot to open up.
An Escape Plan
For some kids, lunchtime is torture and no amount of planning and scheming improve things. It’s perfectly reasonable for parents to request a different plan rather than have a child suffer for an hour every day. The office, a teacher’s room, or the library can all offer a safe refuge. It’s important to keep trying, and socializing is learned through repeated efforts. At the same time, if things aren’t going well, maybe your child just needs a break from the effort for a few weeks. 

Monday, March 2, 2009

Interview Tips for Adults with Asperger’s: It’s an Interview, Not a Therapy Session

I just read an interesting, entertaining list of 10 Way to Ruin a Job Interview, written by Liz Ryan. The article lists simple “don’ts, like: don’t grovel, don’t share too much.  At first the list may seem ridiculous. Does anyone really need to be told not to swear in an interview? But then I started remembering interviews I conducted when I was working as an engineer. So often, interview candidates did the very things on this list. And Liz Ryan is right, they made a bad first impression.
I think many of these “don’ts” fall into the category of “Don’t be too relaxed or too open.” Job interviews are stressful. Your interviewer is most likely a well meaning, kind individual, who wants to put you at ease, and wants to like you. That’s great, and if it helps you to relax and make your best impression, the interview will be that much better for both of you. But, don’t mistake an interview for what it is not. This is not a friendly chat, and it certainly isn’t a therapy session. Just because someone is open and cordial does not mean the interview rules have changed.
I remember many interview candidates sharing way too much. I’d ask why they were looking for a new position and I’d get an endless list of the things their boss did wrong and the company did wrong. Remember, the person interviewing you does not know you. Your future employer wants a capable individual who will be easy to work with. They have no way of knowing if your crazy boss is really crazy, or if the problem was with you. Don’t give your future employer any reason to question your ability to be a team player.
I also remember desperate job candidates. They’d tell me things like how hard they were working to find a job and how little success they were having. A comment like that would make me question why no one else wanted to hire this candidate. Are you more likely to walk into the deserted restaurant or the busy one? The busy one, of course! If you tell your interviewer that no one wants to hire you, you look like the empty restaurant.
Another way interview candidates shared too much was in telling me that they weren’t that interested in the job. Things like, they’d take the job as an emergency measure, but they really were looking for a job two levels up. Hiring and training a new employee is expensive and a lot of work. Nobody wants to go through that just to have the new hire be unhappy. If you can’t be enthusiastic, fake it, and if you can’t fake it, don’t bother interviewing.
If you’re looking for a new job, you’re probably feeling a great deal of stress, and that’s OK. Just share that stress with an appropriate person, like your friend, or a family member, or your therapist. Not your interviewer.