Social Skills for All! (Kate Altman, M.S.)

Sometimes when I am trying to explain, teach, or role play a social skill or unwritten social rule to a person on the spectrum, I feel stumped.  Social skills and good social behavior can be challenging for all of us!  I consider myself relatively socially-savvy (you would hope so since I've spent a lot of time teaching social skills!), but I have certainly done the wrong thing or put my foot in my mouth on more than one occasion.

Interestingly, I've randomly come across some really nice articles intended for general audience that have great tips for mastering some social rules/etiquette.  This is one from Real Simple magazine about common phrases to avoid in conversation and what to say instead.  For example, they say that you should not tell someone they look tired, but instead should ask them, "Is everything okay?"  And this is a post on a lovely blog called Enjoying the Small Things by the mother of two children, one of whom has Down syndrome.  She breaks down what it means to be a good friend and suggests some ways to be a good friend, such as "really listen" and "remember little details".

Articles like these are helpful, and also a great reminder that we can all benefit from social skills education.

All Aboard! Trains and ASD (Kate Altman, M.S.)

Until I began working with children on the autism spectrum, I did not even know that my city's transit system, Septa, had its own museum.  As child after child told me about this museum through the years, I started to wonder what percentage of its visitors are on the spectrum.  Apparently, a great deal.

According to this New York Times article, children with ASDs' overwhelming interest NYC's New York Transit Museum have prompted the museum staff to create special programs for kids on the spectrum.  Their program, Subway Sleuths for 9- and 10-year-olds, has become so popular that the museum staff have decided to expand it starting in the fall.

Many children with ASD find transportation--particularly trains--fascinating and soothing.  Train, subway and bus schedules and maps are complicated and full of detail, but the trains/subways/buses themselves are (usually) predictable and reassuring.  In my experience, I have found that so many children on the spectrum have a special interest in trains that I often have to explain to people that many individuals with ASD have special interests OTHER than trains.

I think it is wonderful that a community organization like a city transit system is recognizing and embracing its impact on children on the spectrum.  Programs like the NY Transit Museum's excite and inspire kids with ASD, invite them to participate in the community, and build social skills and friendships.

What is your experience? Have you visited a transportation museum (or a museum dedicated to another special interest)?

ASD on TV...and in Books, Comics, Movies, etc. (Kate Altman, M.S.)

In working with children, adolescents, and young adults on the spectrum, I have often integrated representations of ASD in the media throughout the course of therapy.  I quickly found that young clients with ASD often enjoyed and appreciated the exercises.  We used pop culture and the media therapeutically in the following ways:

1.) Education.  When a person who is not a very young child is first diagnosed with an ASD, they may feel confused and overwhelmed by the diagnosis.  What does it mean to have an ASD?  How do people with ASD act?  What might my life be like?  I often direct clients who were recently diagnosed to explore ASD by reading books and poking around on the internet.  I especially like to point them to biographies about individuals on the spectrum, such as Stephen Shore, Temple Grandin, and John Elder Robison, and suggest they look for videos on YouTube made by "real life" people on the spectrum to get a feel for what ASDs are like and generally get the sense that they are not alone.

2.) Self-Esteem. I have asked groups of adolescents to look for books, comics, movies, and TV shows that feature characters who have (or may have) ASD who they think are cool.  They are often excited to discover characters with features like super powers, dry, witty humor, and, courage to whom they can relate and to make the realization that talented writers, directors and illustrators have interest in people on the spectrum.

3.) Self-Advocacy.  Reading about ASD self-advocates like Stephen Shore and Temple Grandin often inspires individuals on the spectrum to think about their own self-advocacy.  The reverse works as well: some of my clients take issue with portrayal of ASD in the media, such as the poorly-written, overly-stereotyped character of Dr. Dixon on NBC's Grey's Anatomy or the Braverman family who have a son with ASD on the NBC show Parenthood.  These portrayals anger some of my clients and help to inspire them to want to correct misrepresentations of ASD in the "neurotypical" community through self-advocacy.

4.) Humor.  Typically, young people on the spectrum spend a lot of time in therapy.  So I think it is important that some of that time actually be fun and enjoyable.  And humor helps build rapport between therapist and client as well as between group members in ASD therapy groups.  Characters like Abed on Community and Sheldon from The Big Bang Theory are clever and hilarious, and it is fun for individuals on the spectrum to see ASD characteristics portrayed in a positive and lighthearted manner.

What are your thoughts about ASD in the media and pop culture?  Do you find it inspiring? Entertaining? Offensive? A combination of all three?

Post-Partum Depression (Kate Altman, M.S.)

As I mentioned in a previous post, I started attending a New Moms Support Group when my daughter was born.  I remember at one of these meetings, one of the mom's, "Cathy," started to tear up as she announced to the group, "The doctor officially diagnosed me with PPD.  I'm going to see a counselor and take medication to see if that helps.  It was so great to have what I've been feeling acknowledged as more than just 'the baby blues' and I'm hoping that treatment will really help." My heart ached for Cathy as the tears rolled down her cheeks and she clutched her beautiful son.  She looked so desperately sad and lonely.

Post-partum depression affects 1 in 7 women, according to this piece that aired on NPR yesterday. PPD is distinguished from the "baby blues", which are much more common and typically occur within the first few days or weeks of birth (but are also significant and ought to be taken seriously by a mother's support system).  PPD includes serious depression symptoms (severe mood swings, loss of appetite, insomnia, overwhelming fatigue), possibly suicidal thoughts or even attempts, difficulty bonding with the baby, and oftentimes, obsessional thoughts and fears about harming self or the baby.  Rarely, some women can even develop postpartum psychosis along with PPD, which may include hallucinations and/or delusions.

Many women suffering from PPD or even a significant case of the baby blues feel guilt or shame because they think they "should" be nothing but overjoyed with their new child...particularly with a "planned" pregnancy and healthy baby.  This guilt or shame can prohibit women from seeking support and treatment.  However, treatment--including counseling from a therapist specializing in postpartum issues (such as Alternative Choices, actually), joining a support or therapy group, and possibly medication--is crucial to both the health of the mother and the baby.  In general, I can't stress to parents enough the importance of self care in order to take good care of our children.

As Cathy spoke to the group that day about her struggles with PPD and her search for treatment, I remember feeling not only a sense of compassion for her, but also pride.  I felt proud of this mother who was brave enough to not only seek treatment, but also to openly share her story with other mothers. Now--after several months of treatment--she is much happier and her son is flourishing.

The Window (Liz McGarry)

Ever since I became interested in a career involving autism I imagined myself working with very young children. I know that early intervention is one of the best ways to promote healthy development in children with autism, so working with one and two-year-olds always seemed like my only option. Or so I thought…

Everything changed last semester. I will never forget the first day of my internship at the Manville School in Boston, MA. I sat in the back of the class of middle-schoolers with autism, quietly observing and taking it all in. Three teachers circled the room, helping their small group of eight boys to remain quiet and focused. I noticed one boy, Alan,* was having the most difficulty paying attention. A teacher handed him tickets when he sat quietly in his desk, and took them away when he started laughing loudly or interrupting the class with his favorite lines from SpongeBob. (I later learned that enough tickets earned Alan a coveted prize—an old set of car keys.)

During health class, the head teacher was leading a lesson about the brain. She asked the class, “What part of our body helps us to think?” It was hard for me to tell if the boys didn’t know the answer or simply weren’t paying attention, but they all stared back at her blankly. After a brief pause, all eyes were on Alan as his hand shot straight into the air. “Yes, Alan?” the teacher asked. “Brain cells,” he replied flatly, “Brain cells help us to think.”

Out of nowhere, a chorus of shouts and cheers echoed throughout the room. The noise came so suddenly I nearly jumped out of my seat. All three teachers jumped up and down, wildly dancing around the room shouting, “Alan! You did it! We’re so proud of you. Great job!” Alan’s expression shifted from bored indifference to a wide grin as he realized the sudden celebration was in his honor. At fifteen years old, this was the first time Alan ever raised his hand to answer a question.

After that first day at Manville, watching three teachers help Alan celebrate such a significant accomplishment, I knew that my original ideas about helping children with autism were totally inaccurate. I think a lot of people share the same perception that I did—that early intervention is not just the best, but the only opportunity to help children with autism learn and grow. Now I know that is far from true.

A lot of people have this idea that there is some sort of invisible “window” of time when it is possible to help children with autism. After about age five or six the “window” closes, and any further therapy or other efforts are useless. I think we need to take this idea of a “window” and throw it out the window. Early intervention is extremely important, but there is no age when a child shuts off and can no longer improve. I am now opening myself up to more experiences working with older children and teens on the spectrum, because I’ve realized that it is never too late to impact the lives of people with autism.

*I changed this name for the post.