Friday, May 28, 2010

Interesting Psychotherapy Blog

I recently stumbled upon a blog called Psychotherapy Brown Bag, Discussing the Science of Clinical Psychology. This isn’t a site about only autism, but about an array of mental disorder diagnoses, and many different psychotherapeutic treatments. It’s a useful site for those looking for in- depth and detailed science, because the information is presented in a straightforward, easy to read manner, and the facts are referenced. Some more technical terms and ideas, such as “meta-analysis” are discussed at length. But most important for non-professionals looking to understand the science of mental health treatment, it’s a very good example of a well written scientific site, with authors clearly identified, facts clearly referenced and a general lack of hype and hyperbole. Check it out and see if it's worth adding to your regular reading.

Friday, May 21, 2010

Emotion and Feeling

Managing emotions is a challenge for many individuals, young or old, whether neurotypical or somewhere on the autism spectrum. Everyone’s struggles are a bit different, with some people veering toward worry and anxiety, others tending to sadness or depression and still others prone to anger. A great deal of my work as a therapist is in helping people manage their troubling emotions, whatever emotions they happen to be.

When working with emotions, it’s helpful to pay attention to the feelings of the body, the actual somatic sensations. Many individuals are more comfortable staying in their heads, intellectualizing and reasoning, rather than physically feeling. If you’re intellectual, pride yourself on your academic achievements or thinking strengths, this could apply to you. If you struggle with overwhelming sensory issues, or physical activities like athletics, then it’s not surprising if you also avoid the more bodily experiences of emotions.

The best way to manage feelings is to actually feel them. Try it now. Stop talking, stop doing anything, try to quiet that conversation in your head. Take a breath, and feel what’s going on in your body.

Monday, May 10, 2010

Special Needs Trusts: Local East Bay Event

Setting up a special needs trust for your child is a complex situation requiring expert advice. I am not that expert! However, I did hear about an upcoming event, and since I’m not affiliated with this group, I’m pulling directly from the flier they sent me. 

The event takes place on June 9, 2010, from 6:30 to 8:30 PM, to be held at Fremont Bank’s Bankers Building, 7611 Niles Blvd., Fremont, CA 94536. Topics to be discussed include:

• The Benefits of a Special Needs Trust

• What assets can be used to fund the Trust

• Choosing the right Trustee

• How California’s Budget Crisis will affect our Special Needs

The speaker for this event, Stephen Dale, received his law degree in 1982 and teaches courses on special needs trusts and trust administration to the public, financial professionals and other attorneys.  He is a national member of the “Special Needs Alliance” of attorneys and has written several publications related to special needs planning.

For more information on this presentation, call (800) 504-4721.

Friday, May 7, 2010

Should We Teach Children Scripted Responses?

There are several opinions about teaching children with special needs to use scripted social skills. For kids who struggle with reading and sending social messages, such as those with Asperger’s Disorder, Autistic Spectrum Disorders including Nonverbal Learning Disorder (NLD), as well as Attention Deficit Hyperactivity Disorder (ADD or ADHD), figuring out subtle messages can be much too challenging. A set of scripted, simple rules and guidelines may be useful in getting a general plan of action. (An example of a scripted response might be, “Say hello when you walk up to one person, but not when you enter the classroom.”) At the same time, trying to memorize and apply dozens of social rules can be overwhelming. It may even backfire because a person attempting to apply specific rules while in the midst of a confusing situation is not going to be able to focus on reading what’s going on. As is usually the case, I think the optimal answer lies somewhere in the middle.

Ideally, parents, teachers and therapists should be helping children figure out how to read social cues and how to naturally respond to them. This may accomplished in a completely organic way, with a parent getting a “hello” back from an engaged baby. In more difficult situations, trained adults can be working deliberately to engage the child and get a natural response. This is similar to techniques that might be used in Dr. Stanley Greenspan’s DIR® and Floortime™ model.

Setting up frequent playdates gives the child the opportunity to interact frequently with peers and may be a way to give practice in reading and responding to social cues in a natural and unscripted manner. This can be tricky because kids who are socially skilled are probably not going to adapt their interactions to be less subtle or more engaging in order to interact with a child who is struggling. Too often the socially skilled children will just stop playing with, or worse, start teasing or excluding the less skilled children. 

Playdates with two or more children who are all struggling socially may be the best choice for allowing friendships to develop and social skills to grow. This situation is not without its challenges. Some degree of adult involvement may be necessary in order to ease the relationship. For example, initiating a playdate may be the most challenging step. Teachers and parents may have to help set up the initial connection. While the children are playing, it may be necessary to have an adult present to help all the children interact smoothly. Because all the children may struggle to both read and send signals, the interactions can be difficult for everyone. When all goes well, the children can develop truly deep and important friendships that move beyond the more formal playdate setting. In addition, the skills are learned in a realistic way, so the problems with generalizing lessons to a different setting don’t occur.

When more natural interactions with adults and peers are not effective, then formal, scripted skills may be helpful. I view these scripts and rules as a way to ease into more ordinary, real-life interactions. An example of this might be a teacher prompting a shy child on how to approach a classmate, so they can sit together for lunch. Here, the most productive interactions will occur when the kids are eating and talking together without the teacher, but the more formal rules will help the child get to that point.

This example really illustrates the ideal situation. Allow the child to have as many natural and rewarding interactions with others, both children and adults, as possible. Use more formal social skills training to ensure that these natural interactions can take place and that they run smoothly. Take the time to analyze and understand the subtleties, and more important, set up a plan to make the interactions more productive next time.