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 28, 2010
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.
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 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.
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
• 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.
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.
Wednesday, April 28, 2010
Speed Reading and Study Skills Classes and Too Much Homework
A few local notes of interest to those here in the San Francisco Bay Area’s East Bay. California State University, East Bay is offering a variety of reading skills, reading comprehension, study skills and speed reading classes this summer in Danville and Walnut Creek. These classes include programs for ages 4 up through adults and college students. For more information, call them at (800) 979-9151.
Some of my regular readers may be aware of my concern about the vast quantity and poor quality of homework that fills our children’s time, not to mention the tremendous pressure kids are under these days. For a moving and thought provoking look at this topic, please make an effort to see the locally produced documentary Race to Nowhere. The film will be shown in Danville, California, on June 1st, 2010 at Monte Vista High. For information, and other screening times and locations, visit the Race to Nowhere website.
Friday, April 23, 2010
Anger Management and Asperger’s, Part III: Allowing Anger
Anger can be a scary emotion, and many people try to suppress it. Kids may think they’re not allowed to get angry, parents may not want their kids to show their anger, and adults may think anger is, somehow, wrong. The reality is that anger is a part of being human. Anger allows us to feel the injustice of situations, it helps us set healthy boundaries, and it can provide the power to make great changes.
Most small children start expressing anger when they don’t get something that they want. That’s still true of older kids and adults, but as children develop, they also will get angry when they perceive a situation as unfair. Our innate sense of justice gets triggered, especially when we’re the ones being mistreated.
The goal in anger management is not to get rid of or suppress anger, it’s to allow the emotion in a healthy and even a useful way. I often ask clients, “How are you allowed to express anger?” Frequently, the question is answered with a puzzled silence or, “But, I’m not allowed to get angry.” My suggestion, to everyone trying to manage anger, is to think in advance about what’s allowed.
Parents should discuss anger with their kids, during a calm time. What are the family rules about anger? Some families forbid the use of certain words, name-calling, breaking things, throwing things. Other families are more liberal. Whatever your family’s rules, there has to be some allowed form of anger expression. And remember, siblings get mad at each other. That doesn’t mean they hate each other, or that they will not get along in the future.
For adults, just acknowledging your own anger may make you feel better. Writing in a journal, or writing (not mailing!) a letter can get the thoughts out of your head. Physical activity, like running or dancing, may help use that energy up. Others feel better if they put their emotions into creative activities. Music can be either expressive or soothing. Focusing on change may make anger easier to manage, whether it’s starting a neighborhood watch, or thinking about what you can control in your marriage.
It’s important to pay attention to how the emotion of anger feels, physically in your body. So many people tend to be head oriented, they forget about the body. And, the body is where emotions live. Being more body focused can help you manage your feelings and move on.
For more on this topic, be sure to check out my earlier blog posts on anger management. Anger Management and Asperger's, Part I: Understanding Anger and Anger Management and Asperger's, Part II The Feeling of Anger.
Most small children start expressing anger when they don’t get something that they want. That’s still true of older kids and adults, but as children develop, they also will get angry when they perceive a situation as unfair. Our innate sense of justice gets triggered, especially when we’re the ones being mistreated.
The goal in anger management is not to get rid of or suppress anger, it’s to allow the emotion in a healthy and even a useful way. I often ask clients, “How are you allowed to express anger?” Frequently, the question is answered with a puzzled silence or, “But, I’m not allowed to get angry.” My suggestion, to everyone trying to manage anger, is to think in advance about what’s allowed.
Parents should discuss anger with their kids, during a calm time. What are the family rules about anger? Some families forbid the use of certain words, name-calling, breaking things, throwing things. Other families are more liberal. Whatever your family’s rules, there has to be some allowed form of anger expression. And remember, siblings get mad at each other. That doesn’t mean they hate each other, or that they will not get along in the future.
For adults, just acknowledging your own anger may make you feel better. Writing in a journal, or writing (not mailing!) a letter can get the thoughts out of your head. Physical activity, like running or dancing, may help use that energy up. Others feel better if they put their emotions into creative activities. Music can be either expressive or soothing. Focusing on change may make anger easier to manage, whether it’s starting a neighborhood watch, or thinking about what you can control in your marriage.
It’s important to pay attention to how the emotion of anger feels, physically in your body. So many people tend to be head oriented, they forget about the body. And, the body is where emotions live. Being more body focused can help you manage your feelings and move on.
For more on this topic, be sure to check out my earlier blog posts on anger management. Anger Management and Asperger's, Part I: Understanding Anger and Anger Management and Asperger's, Part II The Feeling of Anger.
Monday, April 19, 2010
Online Screening for Adult ADHD, Asperger’s, or Autism
Frequently, I get calls from adults thinking that they have ADD, ADHD, attention deficit, autism, Asperger’s, or some combination of these symptoms. Usually, they’ve never been formally diagnosed with anything, but they’ve researched online and they’re pretty sure about the pattern that fits them. So the question is: How good are online screening tools?
To start, how does a professional diagnose autism, Asperger’s, ADHD in adults? There is no easy blood test or brain scan to make these diagnoses. Generally, a professional will look at the patient’s history, especially problems and symptoms, administer some screening tests, and then use their clinical judgment to come up with a diagnosis. Unfortunately, the most frequently used screening measures are designed for children, so working with adults requires some adaptation. Clearly, testing is a bit more involved than just the online screening tests individuals take.
What about confidentiality? Many individuals are concerned about a diagnosis going on their record, getting back to their employer, or some other worry. This shouldn’t keep you from working with a professional. Before you see any professional, ask about confidentiality. Specifically, discuss how you’ll be paying for treatment, and what kind of confidentiality insurance plans or employee assistance programs offer.
What about online screening tests? For some people a doctor’s appointment may be too expensive, or intimidating, or complicated. Other people want to be informed before they talk to a professional, so online screening is a place to start. Taking an online screening test is not a bad starting point in understanding yourself, although it doesn’t substitute for professional help.
When looking for a screening tool, it’s probably best to go to larger organizations rather than individual’s websites. Often, the best known and most popular measures are not available online, and professionals have to purchase them, so although they may be well written and well researched, you’re not going to find them online. Also, I don’t like measures that merely repeat back a symptom list from the DSM. The DSM is written for professionals, and the symptoms may be tough to interpret without training and experience dealing with a large group of individuals having those symptoms. You can also find excellent self report measures in books. Again, look for the credentials of the author writing the book, or a forward by a well known professional.
A good general rule: books and websites written by individuals diagnosed with an issue can be interesting and informative, but they’re not the best way to diagnose yourself. Books written by actors, politicians or playboy bunnies may be enthusiastic, but they are not the best sources of science. Get professional information from professionals.
Some examples? For depression and anxiety, David Burns has written excellent books with self assessments in them. For ADHD, you can find self measures on both the CHADD and ADDA websites. For Autism and Asperger’s, check out Simon Baron-Cohen’s book or website. For alcoholism questions, The National Institute on Alcohol Abuse and Alcoholism has a clinician guide with questions.
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