Monday, July 27, 2009

ASDs and Video Games

Autism Asperger’s Digest Magazine is one of my favorite publications for all sorts of information. In the latest issue, July-August 2009, page 11, there’s an interesting little news brief about a video game making class.
So many of the kids and teens (and a few of the adults as well) with whom I work love video games. And many kids on the spectrum aspire to a career as a video game designer. As a therapist, I try to focus on my clients’ strengths and interests, and expand them if possible. This class could offer an opportunity to expand an interest beyond just playing the game to learning some new skills.
I’m not opposed to video games in moderation. Playing a video game can be a self soothing activity, or it can fill a crucial role as an emergency babysitter when the parents just have to cook dinner or finish the taxes. Certainly, for school age boys, video games are a part of the culture and they enable social connections and interactions to flow more smoothly.
Of course, becoming a game designer as a career is unlikely, but the skills involved are useful regardless. The organization also offers a Lego engineering class, another common interest. You can get more information on both at All About Learning.

Tuesday, July 21, 2009

Are You Struggling with Executive Functioning?

In my last blog post, I introduced the term executive functioning, and now I want to take the idea to a more practical level. Many of the kids I work with as a therapist struggle in the area of executive functioning, and they’ve frequently been diagnosed with specific deficits in this area. This might have been done at their school, by a psychologist or medical doctor, or at a learning center. Diagnosis can be a very helpful tool in setting up a plan to make up for any deficits, so every individual can function at the peak of their abilities.
But for adults with Autistic Spectrum Disorders (ASDs) like autism or Asperger’s, deficits in executive functioning are seldom diagnosed. Many of my adult clients don’t even have a formal ASD diagnosis, much less a specific analysis of their strengths and weaknesses. This isn’t because the deficits aren’t there, just because the diagnostic process is less rigorous and available to adults. So, if you’re an adult diagnosed or suspecting that you have an ASD, you might want to do some research into executive functioning as well.
A good place to start is by carefully defining any problems you might be having. A step by step, methodical approach can work wonders. And, by taking tiny steps, the problem, which was vague and huge, becomes more manageable and the solution intuitively obvious.
As an example, let’s look at a hypothetical engineer named Ed. Ed was never diagnosed with an ASD, but is pretty sure he fits the criteria for Asperger’s based on his problems with social interaction, unusual communication style, and strong interest in computer technology. Ed is very intelligent and has been quite successful professionally. More recently however, Ed has started to struggle with more work related problems and his boss never seems to be satisfied.
Imagine that you’re in a situation like Ed’s. How would you deal with this problem? The first step is to consider specifically what the boss has complained about. Replay the conversations in your head and list the issues if you can. Reread your performance reviews, or any other written comments you’ve gotten. Ask a trusted colleague for input. In Ed’s case, he realized that his boss has complained repeatedly because reports have not been completed on time, he’s missed numerous line item deadlines for his main project at work, and he’s often getting to work too late.
Clearly, all these issues fall under the category of deficits in time management. By redefining the problem from, “My boss hates me.” to, “I need the work on time management.” Ed can come up with specific, concrete solutions, and so can you.
What can you do if you’re dealing with a similar issue? Lots of things:

  1. Since people on the autism spectrum are frequently visual, lists, timelines and charts can be the best resource.

  2. Make a detailed list of the milestones in your work assignments.

  3. Figure out the order in which the steps need to be carried out, analyze how long they take, consider roadblocks and items that are out of your control.

  4. Factor in some cushion in case everything doesn’t run smoothly.

  5. Talk to your boss about his expectations and requirements for specific deadlines.

  6. List these items on a calendar and check it daily.

  7. It may help to create little checkboxes where you can physically mark your progress.

  8. If you’ve missed a deadline, deal with it immediately. Ignoring the problem does not make it go away.

And, most important, check back on this blog for more posts on managing executive functioning.

Monday, July 13, 2009

How Far Can Your Child Go?

All parents want their child to succeed, personally and professionally. But, if your child is diagnosed with a disorder or syndrome, like ADHD, Asperger's or an autism spectrum disorder, it can be tough to adjust your expectations as a parent. On the one side, your don't want to place unrealistic, potentially damaging goals onto your child. For example, we can all see that not every little dancer is cut out to be a prima ballerina and it would be cruel and pointless to push every kid in the local dance class to train to be a professional. But, on the other side of the expectation equation, it can really be damaging to your child if you give up all your parental hopes and dreams. Too often, I've seen parents come back from their child's diagnosis sessions having heard all about the limitations of Asperger's or ADHD or whatever the diagnosis is, without having a balanced picture of strengths. In the end, I don't think any child achieves great things without someone, usually a parent, believing in him or her. No diagnosis should make a parent lose hope.
So, how do you figure out what's realistic for your child? It's best done in three simple steps.
1) Trust Parental Intuition
You know your child better than any professional can. You've seen your child grow up, and you have a good idea of his or her strengths and weaknesses. To improve the power of that intuition, get educated about your child's diagnosis. Just be careful, because there's a lot of misinformation on the internet. Find sources you can trust and avoid anything that takes a strong "black or white" tone, because that's (usually) wrong. Then, if a professional tells you something that doesn't seem to fit your child, consider getting a second opinion.
2) Take It Step By Step
It's not necessary or even possible to plan your child's entire future. Even before the diagnosis, you weren't able to do that. With any child, it's best to aim for progress, and give up worrying about what the end point will be. Set small, concrete goals and look for ongoing improvement.
3) Pay Attention to Your Child
If your goals are too intense, or your expectations too high, your child will probably let you know. But the signs might be subtle, so you need to pay attention. If your child seems overly nervous, depressed, withdrawn or volatile, consider what might be going on. Are your goals and expectations putting your child under too much pressure? Consider easing up for a while and see if things improve.
As an example, many parents are told that their child with an autism spectrum disorder will not have "good relationships" as an adult. It's okay to question that statement based on what you know about your child specifically. Start with the knowledge that many people on the autism spectrum are happily married, or parents, or in other satisfying relationships. Factor in what you've seen for your child. Has your child been able to get very close to a teacher, friend or family member? That's evidence that the professional opinion may be too limiting.
Then go to the second step and aim to improve your child interpersonal skills. Don't worry about the end goal of what your child will achieve as an adult. Just try to improve current social skills, looking for small progress in things like relating, coping with emotions and being thoughtful.
For step three, see how your child is reacting. Almost everyone loves to achieve and succeed, as long as the pressure isn't too intense. Enjoy the successes and the progress along the way, and don't worry too much about the end point.
The final point to remember is that for many kids, progress comes slowly, but things do keep improving. In Engaging Autism, by Stanley Greenspan, M.D. (De Capo Lifelong Books, 2006), there is an excellent chapter on  working with older children, teens and adults, subtitled "A Lifetime of Learning".  Greenspan, best known for his development of the DIR/Floortime approach, argues that it's important to "overcome the myth that children reach a developmental plateau beyond which improvement can only be minimal. In fact, during the teenage and adult years, the brain and nervous system are still developing."  (p. 212) Give your child lots of time to fail, to try again, and to succeed.

Tuesday, July 7, 2009

Executive Functioning and Autistic Spectrum Disorders

How can you solve the problems you’re having at work or in your relationships? One solution might be to consider the concept of executive functioning.
Executive functioning is a term that comes up frequently in discussions of the characteristics of autism, Autistic Spectrum Disorders (ASDs) and Asperger’s Syndrome. In general, many individuals with an ASD struggle with specific deficits in executive functioning as well. I don’t want to go into the details of measurement of executive functions or review the research on correlations between autism or Asperger’s and executive functioning in this posting, but I do want to introduce the basics.
A good definition of “executive function” can be found in Simon Baron-Cohen’s The Essential Difference (Basic Books, 2003, p. 176). Baron-Cohen defines executive function as “shorthand for the control centers of the brain that allow not just planning but also attention-switching and the inhibition of impulsive action.”
Tony Attwood discusses executive functioning in The Complete Guide to Asperger’s Syndrome (Jessica Kingsley Publishers, 2007, p. 234) and lists “organizational and planning abilities, working memory, inhibition and impulse control, self reflection and self-monitoring, time management and prioritizing, understanding complex or abstract concepts, using new strategies.” Other researchers may classify executive functions differently, but the general concept is the same.
The research on the correlation of executive functioning deficits and autism or Asperger’s can get very complex, due to the difference of ability levels along the autism spectrum, as well as the many measures of specific types of executive functions. It’s not surprising that different studies measuring executive function in individuals with autism get different results. What is clear is that individuals, both those with autism and neurotypicals, can vary in their abilities in each of the different executive functions.
What’s probably of more immediate value to those with ASDs, is to individually consider the specific executive functions as Attwood lists them. For individuals who are struggling professionally or in relationships, this can be helpful as a first step in problem solving.
Check back on this blog over the next few weeks. Further posts will give some examples and specific suggestions for managing problems with executive functioning.