Tuesday, July 26, 2011

Subtle Social Skills (Kate Altman, M.S.)

When treating children and even adults on the autism spectrum, one of the core areas of treatment comprises social skills training.  Many--if not most--children with ASDs spend at least some time in a social skills group or class (either in school or outside of school) and much of individual therapy focuses on social skills development and education as well.

What are social skills?  "Social skills" applies to such a broad array of behaviors, knowledge, language, rituals and graces that evolve with time, age, and culture.  Teaching social skills to young children often looks similar to a course on etiquette (say "please and thank you"; allow for personal space, etc.).  However, when children with ASDs become adolescents and adults, they must contend with and fit into a much more nuanced and complex social world.  Learning and using social skills can be much more challenging--and even more crucial to happy and healthy social functioning.  After all, an adorable 5 year-old can more easily get away with not following social norms than a 25 year-old who most probably expect "should know better".  

Social skills are not just about behaving a certain way in order to fit in to society, they are also about understanding and connecting with other people in order to make meaningful relationships.  In my research with young adults on the spectrum, I asked them a lot about how they learned to use good social skills to build relationships.  One important issue that came up repeatedly was the issue of trust in new friendships.  Trying to figure out how to know if you can trust another person is challenging, especially in a new relationship...and it is a social skill.  When I asked one young woman how she knows she can trust a new friend, she described using a simple rule she had figure out for herself: a good clue that indicates someone is probably trustworthy is if they confide some piece of important information in you first.  She described realizing she could trust a new friend in college when that friend called to tell her that her grandmother had passed away.  

I thought that the young woman's revelation was simple, yet brilliant, as good social skills rules and clues often are.  For a good book on the unwritten social rules, click here. And for information on social skills-based therapies in the Philadelphia area, contact Alternative Choices.

Monday, July 25, 2011

Autism and Empathy (Liz McGarry)

After discovering the truth about the “80% divorce rate” a few weeks ago, I’ve been wondering what other autism myths might be out there. Dr. Ariel suggested I look into the commonly held belief that people with autism are incapable of empathy. This was a topic I hadn’t really thought too much about, so, naturally, I headed to the Internet to educate myself.

My initial results weren’t exactly what I expected. I was pretty surprised to find papers by Simon Baron-Cohen, one of the most prominent leaders in autism research, claiming the exact opposite of what I set out to prove; namely, that people with autism exhibit less empathy than typically developing individuals. However, after some serious digging, I came to realize that Baron-Cohen’s definition of empathy is very different than my own. When I think of empathy, I think of compassion. The ability to care about someone other than yourself. Even from my own limited experience with autistic individuals, I know without a doubt that people with autism are able to form meaningful relationships and care about others. So what is Baron-Cohen talking about?

What I have come to understand is that there are two different kinds of empathy: Cognitive and Emotional (or Affective). Research, like this study from Haifa, Israel, shows that these two types of empathy are independent of each other, and even use different parts of the brain. Here is a basic description of each:

Cognitive Empathy (Relative Weakness in Autism): The kind of empathy that Baron-Cohen usually refers to as a relative weakness in autism is known as cognitive empathy. This is the ability to take another person’s perspective and ‘get inside their head’. This term has nothing to do with care or compassion—it simply refers to the ability to “infer what someone else is thinking or feeling”.

Emotional Empathy (NOT a Weakness in Autism): On the other hand, affective or emotional empathy is closer to my original understanding of the word. Emotional empathy is “the drive to respond with an appropriate emotion to someone else's mental states.” Research shows many people with autism are capable of this kind of empathy, and are fully able to form compassionate, meaningful relationships. A study published in the Journal of Autism and Developmental Disorders in 2008 showed “while individuals with AS are impaired in cognitive empathy, they do not differ from controls in emotional empathy,” (Dziobek et.al).

Many people with autism have difficulty understanding and predicting people’s emotions. This seems to be an accepted fact. I have learned, however, that this does not mean they are incapable of caring about others. When they do understand what others are feeling, autistic individuals are capable of just as much compassion (“emotional empathy”) as everyone else.

Click here for a video of Dr. Naseef, Dr. Stephen Shore, and Dr. Dan Gottlieb discussing autism and emotions.


Dziobek, Isabel, Kimberley Rogers, Stefan Fleck, Markus Bahnemann, Hauke R. Heekeren, Oliver T. Wolf, and Antonio Convit. "Dissociation of Cognitive and Emotional Empathy in Adults with Asperger Syndrome Using the Multifaceted Empathy Test (MET)." Journal of Autism and Developmental Disorders 38.3 (2008): 464-73. Print.

Shamay-Tsoory, S. G., J. Aharon-Peretz, and D. Perry. "Two Systems for Empathy: a Double Dissociation between Emotional and Cognitive Empathy in Inferior Frontal Gyrus versus Ventromedial Prefrontal Lesions." Brain 132.3 (2009): 617-27. Print.

Thursday, July 14, 2011

Boys are taught that you are a sissy if you cry… by Robert Naseef, Ph.D.

Times are changing but most men have still been raised to hold in their emotions or risk ridicule.        On Thursday, July 7, I had the privilege of moderating a panel on fatherhood at the 42nd annual Autism Society Conference.  The panel was made up of fathers with the courage to open up along with autistic self-advocates, and service providers. 

As the fathers opened up, men and women listened intently.  I shared how hard I had tried to change my son, Tariq, now 31.  In the end, it was he who changed me, made me a father and the man I needed to be.
Charles Jones shared his sadness and confusion about the diagnosis, his love for his son, Malik, and his joy in Malik’s progress.  Charles is determined to make a difference in raising awareness about the needs of fathers.  His voice came through with passion in the teaser for his documentary in production—“Autistic Like Me.” (http://www.youtube.com/user/AutisticLikeMe)
Ven Squenzia is the father of a young woman with autism and the president of the Florida Chapter of the Autism Society (http://www.autismsocietyofflorida.com/).  Ven cannot imagine who he would be today if his daughter, Amy, did not have autism.  He is a tireless advocate for families with countless friends and acquaintances in the autism community.  He read a poem by his daughter expressing her love.
Dr. Stephen Shore, non-verbal until 4, has fond remembrances of his father.  Today he is professor of special education at Adelphi University and travels the world building autism awareness.  He credits both parents for believing in him.  His father’s beard felt like needles and created what Stephen refers to as a sensory violation.  Stephen did wish that his father had gotten more involved with his special interests in his youth.  His web home is http://www.autismasperger.net/    
Alex Plank was diagnosed with Asperger’s at 9.  He is the creator of www.wrongplanet.net, a social networking site for people with Asperger’s with over 52,000 members.  Alex shared some of his social struggles growing up with a funny stories and good humor.  Like many young men on the spectrum I know, he wished his father had been more helpful to him in terms of how to begin dating.
Craig Gibson spoke as a triple agent.  He himself grew up with a learning disability and openly shared how he was mercilessly bullied and how he relates to fathers’ worries about their children.  He also has a son with a speech delay, and he has served as the lead evaluator for a preschool program for children with special needs.  Craig blogs regularly at www.autismspot.com and www.sensoryspot.com.
Dr. Diane Adreon has an adult son with autism and over 30 years experience working with children and adults with autism at CARD, the Center for Autism and Related Disabilities in Miami (http://www.umcard.org/).  She talked about the important leadership roles played by fathers in the autism community of South Florida.  These men were open and comfortable speaking to her.
Speaking on behalf of the panel, I expressed gratitude for the opportunity for our voices to be heard.  When fathers open up, everyone benefits.  We will continue to express the vulnerable feelings, as we encourage others to do the same to further the needs of children and families.    

Talking to Parents of Kids with Autism (Kate Altman, M.S.)

This is a nice essay in the Washington Post by a mother of a child with autism on what people should say (or not say) when a parent tells them their child has autism.

The author laments that when she tells someone her child has autism, they often respond by minimizing the condition or its symptoms (like saying, "Oh all kids get fixated on inanimate objects! That's just normal.") or else are overly apologetic (thus overlooking all of her child's great qualities).  She also writes that her greatest pet peeve is when people offer suggestions or advice ("I heard on TV that gluten-free diets can cure autism.  You should try that!").

Whenever we hear that someone is facing a complexity or challenge, coming up with the right thing to say can be difficult.  Responding to the news that someone has a child with autism can be especially difficult; as the author points out, you don't want to minimize the challenges autism provides but you also want to bear in mind that this is still an adored, special and wonderful child.  When someone is grieving a clear loss or death, it can actually be easier to figure out what to say to that person.  But when a parent has learned that their child has autism, it is likely that they will grieve and experience great sadness, but they also still love and adore their child as much as ever and feel great joy about having that child in their lives.

So what to do?  I like the author's advice about asking questions.  Ask the parent, "how do YOU feel about your child's diagnosis?"  You can even admit you are not sure what to say.  And, best of all, simply ask the parent about his or her child: what is she like?  What are his interests? What do you like to do together?  And--if the parent is a friend--let them know you are always there to listen and offer support.

What do you think?  What have been your experiences as a parent or a person on the spectrum with disclosure to others?

Monday, July 4, 2011

Collaborative Problem Solving (Kate Altman, M.S.)

The other day I was with a friend and her four-year-old daughter.  The little girl, Jane, started to get bored and whined that she wanted her mom to play with her.  Her mom said she would when she was finished talking.  Exasperated, Jane began to whine more.  Her mom said, "Jane, if you stop whining and let me finish my conversation I will play with you.  But if you continue to whine I will not play with you.  It is your choice.  What do you choose?"  Jane took a deep sigh, but begrudgingly muttered, "I'll stop whining."  And she did, and was rewarded with some playtime with her mom, as promised.

Witnessing this exchange led me to reflect on my work as a behavioral therapist with children and their parents.  None of the children with whom I worked--whose diagnoses included ASD, ADHD, and developmental delays--would have benefited from the approach that worked so well with Jane.  Many did not have the language or comprehension capacity necessary for detailed verbal instructions, nor the ability to self-regulate, or other executive functioning abilities required to reason through the benefits of changing a behavior to earn a reward.  Therefore, the traditional rewards/consequences approaches to discipline often did not work, at least at first.

Instead, I often used Ross W. Greene's (he is the author of the parenting book, The Explosive Child) method called Collaborative Problem Solving.  Essentially, he posits that parents of children with executive functioning problems (such as the difficulties with self-regulation, problem-solving, and verbal reasoning seen in children with diagnoses like ASD, ADHD, and developmental delays) must teach their children executive functioning on the road to discipline.  He says parents must at first "be their child's frontal lobe."  To do this, Dr. Greene suggests implementing his "Plan B" approach, in which the parent first conveys empathy to the child ("I know, you really really want that ice cream right now") and gathers information about the problem, then the parent explains his or her problem with the situation ("You see, I'm concerned because I know if you eat ice cream now, you won't eat your dinner and you need to eat your dinner to be healthy and strong."), and then the parent invites the child to brainstorm with him or her ways to solve the problem.  The approach works because the genuine empathy diffuses the child's anger and frustration, and the brainstorming empowers the child and also helps him or her to exercise the problem-solving muscle.  So the child curbs his or her behaviors and also practices using executive functioning skills that he or she is lacking.

Parents are sometimes skeptical of this approach because it seems "too soft", and it is certainly not for everyone.  But when done right, I've seen Collaborative Problem Solving used very effectively with very challenging kids.  To read more about it, go here.

Have you tried it? What do you think of this method?