Laying the foundations for self-awareness, and assuming the inevitable need for therapy.
It is very likely that my son will at some time in his life benefit from Cognitive Therapy (CT), therefore it seems logical to begin establishing the underlying principals now.
Rationalizing the practices of introducing the CT treatment model to an adult or an adolescent would require the use of different approaches. There is a need for some creativity when to introducing the idea to a younger child. Just as considering the client’s developmental levels and their diagnosis (DX) is important when relating the treatment model, the language and props used for a adolescent would be considerably different when helping a child of Kindergarten age.
Friedburg describes the first steps of introducing the CT model pointing out that a younger child may lack experience in articulating their emotional state, and recommends teaching children how to report their mood prior to beginning cognitive interventions. Once a range of emotions is easily identified, the work of rating intensity begins.
We began the process of identifying and labeling emotions in our family a before my son entered preschool. Once there, emotions were explored by use of positive modeling in class, a variety of books, and Second Step, a violence prevention curriculum. Second Step uses puppets to describe emotions such as “Glad, Mad, Sad and Scared’. And is very dependant on the skills of those who deliver the program. The puppets can be difficult for children on the Autism Spectrum to related to. My son related better to representations and descriptions of emotions in books such as “How are you peeling? Foods with moods”. We also found that using social stories or scripts to help both our children gain a better understanding of feelings. Recently we have started to relate a typical situation where one of us would display and identify a feeling, and narrate or interpret ‘in-the-moment’ event to explain what circumstance may produce feeling in each of us. For example-: “When mummy rushes around she might be worried and anxious about being late”. The ‘real-time’ example would be “I am getting worried about being late. Please get dressed so we can get ready to go because I am anxious about being late”.
My son can identify and label a variety of feelings and emotions and using the social stories or narrative interpretation can increase his emotional vocabulary. He learns well by associating one emotion to another in a context that he is failure with and I can introduce the concept of rating with the appropriateness of the words I use. For example, I combine ‘worried’ with ‘anxious’, but would avoid saying I ‘hate’ that TV show. At age 3 he struggled to get beyond ‘mad’ and ‘glad’. Now at the age of 5 he can identify excited, frustrated, mad, worried, scared, jealous, calm, sad, relaxed, disappointed, bored, upset, distracted and more. He can be extremely kind and thoughtful but a bit of a sore looser at times so we have begun to discuss those qualities and how when he behaves in a certain way it can effect how others feel. He is learning rapidly to identify and name his own emotions. He will spontaneously state how he feels, and how others’ actions made him feel, or how certain events made him feel. Sometime he seems to be confused and will make statements such as “Waiting ‘till my birthday will be just too boring!” I believe that “boring” is not the feeling that he is describing as his vocal tone suggests something more intense, so I reply. “Maybe boring is not quite what you mean. Perhaps you feel a little frustrated, or a bit impatient.” He replies that he is both frustrated and impatient. I say that I understand and we count the days until his birthday. I distract him with a discussion of what gifts he would like to receive.
Intensity teaching.
It seems more natural to combine recognizing feelings and emotions with some references to intensity. At this time, we have yet to establish a rating scale with more that 3 degrees. For example, yesterday my son was waiting for me to play “Go- Fish” with him. He had waited too long, and he came to protest. I asked “ When mommy takes too long at the computer, does that make you a little bit mad, are you very mad, or is it the end of the world (an idiom well used and accepted as an over statement) Of course he chose ‘the end of the world’. He had been waiting a very long time.
He is learning how to use his voice and his tone will change with intensity although he often uses impatient sounding voice. His use body language to enhance his communication is emerging and he is able to exaggerate his body movement in order to make is reason or justification more compelling. His ability to read others emotions seems to be improving but he frequently objects to any exaggerated body gestures that we use in an attempt to give him clues as to our emotional states. Because his sense of and control over his own body language is still emerging using ‘the body read’ to understand his responses to particular questions or circumstances may be difficult.
How to show a 5-year-old that feelings, thoughts, behavior, and health are all connected and all happening within environment.
I showed my son a picture of four gears and asked him what would happen to all the gears if we moved just one of them. “They all move.” He stated immediately.
A person’s acceptance of the principles that CT is based upon is critical for the success of the treatment and relating to their special interest can help the process. What better visual representation to use for a child who fixates on turning wheels that interlocking gears. Each of the four gears has removable and replaceable labels that are written or visual representations of feelings, thoughts, behaviors, and physiology or health. The gear model will work for my son. His passion for inanimate objects and the stimulation he receives when he is control is intense. My daughter may be happier with the balloon model, and another child I know would love to see 4 stunt kites all connected.
It might be challenging to for both my children to accept that they have varying degrees of control over what each individual gear or balloon represents. The use of social stories and appropriately selected picture story-books can help to promote the idea that we all have some influence over our thoughts, but no control of our feelings. They may struggle more with the fact that we all can learn to control our behavior and yet our reaction to the events in any one circumstances are part of whom we are. Currently I would say of my children that they have little way of separating their behavior from their emotional state and may not understand their own physiology or why they react in certain ways. It is often the behavior that they are ether reprimanded or praised for and little attention is given to the cognitive elements. Perhaps an earlier introduction of CT in their daily learning would promote an advanced level of maturity and an overall better outcome. I predict that for my son the ability to understand and control his thoughts and behavior will make a huge difference to him, and I hope that we can set him on an earlier path of discovery. A thought record may work well for him, as currently the way we modify and implement social stories is equivalent to a thought record without the word ‘sometimes’. Although there is no directive in the thought record, there is an objective in the treatment environment that thought records are completed within, and therefore there is a desired positive outcome.
In the absence of a formal treatment environment, I use our numerous games of ‘Go Fish’ and ‘Uno’ to create an episode of treatment. My son focuses on the game and I ask him about events of the day and what when through his mind. He asks me to stop talking and play the game. I create an event by challenging his play, or deviating from his interpretation of the rules. He responds predictably and gets a little mad at me. We identify his feelings and agree upon a rating. We investigate what worked, and what didn’t work. Generally, what works is sticking to the rules of the game or playing a different game. We decide that what does not work would be when someone refuses to play anymore, or becomes very mad at loosing. I judge just how much of the ‘Family Therapy’ he can tolerate and we get on with the game. He normally wins.
Sunday, March 11, 2007
'Family Therapy’
Executive Function, Central Coherence and Theory of Mind. A trickle of information.
My five year-old son and I often talk about his school day while we drive to collect his sister. During one of these conversations, I asked him how he felt about something that happened in school that day. He said, “I can’t tell you”. “Why not?” I asked. He replied “Because I am not at school now”.
During another exchange, I asked my son how Mrs. B felt about something, and he replied, “I don’t know because I am not with her”.
I attempt to rationalize his reposes and think about his strengths and challenges to help me determine the brain activity that might explain his answers.
While global and contextual possessing may be one in the same function, they are both considered functions of central coherence that promote the generalization of skills, thoughts and understanding and therefore offer plausible expatiation as to why individuals with ASD have difficulty with context.
I would say that my son is developing his generalization skills. He happily recognizes his friends and teachers out of school, and he is able to adapt and generalizes skills from one place to another, interchanging activities, and across disciplines. I am considering that he might not wish to discuss school time activity because he has made the transition from school to the journey and either cannot or is reluctant to “put his mind back into school”, and that he thinks the school ends when leaves. This may also explain why getting him to attend to homework is such a challenge.
On the contrary, occasionally he tries to replicate the school environment at home, and will often act out school activities and pretend to be the teacher.
In order to help him further generalize, and support his central coherence and executive function we should attempt to re frame the learning process. While he has been successfully encouraged to attend school by use of a simple social story, “We go to school to learn, play and make friends, so that when we grow up we can have choices and be happy.” The story could easily be adapted to promote the concept that learning takes place all of the time, and in different environments.
Today is Valentines Day – but the treats from friends and all the parties are postponed due to the heavy snow. I monitor my children as they play at home. My son is agitated and shouts at his sister “Valentines day is tomorrow!” I have to intervene before he gets too upset. She’s correct” I say, “ It is just that your Valentines Day party is postponed until tomorrow. He accepts this explanation, but attempts to justify his behavior and says, “Yes. It’s just that Valentines Party Day is tomorrow”
I evaluate the components that account for his behavior.
His lack of understanding could be due to simply not knowing that Valentines Day is always on the 14th of February. He could have confused it with holidays like Thanksgiving or Presidents Day for example, as these are specific ‘days’ rather than special ‘dates’. When his teacher, anticipating the snow day, told him the Valentines Day party would be tomorrow, he thought that the day was moved. This could be typically developmentally appropriate or be an indication of weak central coherence in one with a diagnosis of PDD NOS.
The elevation of his tone and escalation of his anger is, I believe due to his deficits in executive function. Sensory wise he may already be in a heightened ‘fight or flight’ mode as the snow day is a departure from his regular schedule and his is therefore more likely to over react, but his inability to inhibit and rationalize his behavior and reactions all can be associated with the function of the limbic system.
His attempts to justify his behavior are motivated by his need for control. He reluctantly accepts my ruling, and quickly rethinks his argument which indicates that the parts of his executive function that manages other cognitive processes, such as planning, working memory and retrieval, are present and developing.
Currently we are working hard on the skill of persuasion. Ensuring that my son knows that he has to be successful at persuasion if he is to get what he wants helps to support his weak central coherence by giving him the big picture. We model what persuasion is and I allow myself to be persuaded in areas where I know both my children are motivated, and can be successful. At the same time my son is reminded of the presence of others thoughts and examines his own theory of mind in the process.
Recently my son and I had a disagreement surrounding being kind and thoughtful to others.
It was a neighbor’s birthday, and my son knows the little girl and they seem to like each other. I wanted to deliver a birthday card. My son did not. I described how people bringing gifts and cards would make the girl feel happy and that it was good to show people that we care about them. He accepted that receiving gifts and cards on his birthday made him feel good, yet he stated that he would not go reasoning that he not want to go to her party.
The discussion ended with an ultimatum.
The situation was aggravated by the departure from his regular routine, and later I realized that he had planned his activities and knew what he wanted to do when we arrived home. My rationale of how his actions could affect how others feel had little impact as I did not successfully related to the big picture, supporting his central coherence and the ‘social story’ was delivered as a directive rather than in preparation.
In attempting to relate his reasoning, our discussion and the outcome to both our brain functions, I may prevent any reoccurrences. Ultimatums are not productive and go against the principals of collaborative imperialism and guided discovery. I did not enquire as to what he wanted to do when we got home, He did not tell me when wanted to do something else that he had already planned in his mind. I did not prepare him properly or gain his buy-in. We both lacked a developed sense of Theory of Mind.
When the time came for the visit, once more I asked him to come with me to deliver the card.
He was delighted to do so, and the visit went well.
With hindsignht, I can see that the incident became a power struggle.
This is an emerging issue, enhanced by my sons need for predictability and control, supported by our choice behavioral management strategy, and could be a typical developmental phase.
I prepare to re visit the power struggle issue, employing a new social story. The story will be something he and I write together and will follow the “The Macdonald Way” (Our family mission) He may not clearly understand that his is challenging me for control, and I have to find way to illustrate and reinforce the expectations that we have as a family. The next time a similar situation arises, I will help him understand that it is OK for him to get mad and challenge me. I will discuss with him the many choices that he does have control over, but that ultimately it is my job to keep him safe, help him understand, and grow up to be the best he can be.
My five year-old son and I often talk about his school day while we drive to collect his sister. During one of these conversations, I asked him how he felt about something that happened in school that day. He said, “I can’t tell you”. “Why not?” I asked. He replied “Because I am not at school now”.
During another exchange, I asked my son how Mrs. B felt about something, and he replied, “I don’t know because I am not with her”.
I attempt to rationalize his reposes and think about his strengths and challenges to help me determine the brain activity that might explain his answers.
While global and contextual possessing may be one in the same function, they are both considered functions of central coherence that promote the generalization of skills, thoughts and understanding and therefore offer plausible expatiation as to why individuals with ASD have difficulty with context.
I would say that my son is developing his generalization skills. He happily recognizes his friends and teachers out of school, and he is able to adapt and generalizes skills from one place to another, interchanging activities, and across disciplines. I am considering that he might not wish to discuss school time activity because he has made the transition from school to the journey and either cannot or is reluctant to “put his mind back into school”, and that he thinks the school ends when leaves. This may also explain why getting him to attend to homework is such a challenge.
On the contrary, occasionally he tries to replicate the school environment at home, and will often act out school activities and pretend to be the teacher.
In order to help him further generalize, and support his central coherence and executive function we should attempt to re frame the learning process. While he has been successfully encouraged to attend school by use of a simple social story, “We go to school to learn, play and make friends, so that when we grow up we can have choices and be happy.” The story could easily be adapted to promote the concept that learning takes place all of the time, and in different environments.
Today is Valentines Day – but the treats from friends and all the parties are postponed due to the heavy snow. I monitor my children as they play at home. My son is agitated and shouts at his sister “Valentines day is tomorrow!” I have to intervene before he gets too upset. She’s correct” I say, “ It is just that your Valentines Day party is postponed until tomorrow. He accepts this explanation, but attempts to justify his behavior and says, “Yes. It’s just that Valentines Party Day is tomorrow”
I evaluate the components that account for his behavior.
His lack of understanding could be due to simply not knowing that Valentines Day is always on the 14th of February. He could have confused it with holidays like Thanksgiving or Presidents Day for example, as these are specific ‘days’ rather than special ‘dates’. When his teacher, anticipating the snow day, told him the Valentines Day party would be tomorrow, he thought that the day was moved. This could be typically developmentally appropriate or be an indication of weak central coherence in one with a diagnosis of PDD NOS.
The elevation of his tone and escalation of his anger is, I believe due to his deficits in executive function. Sensory wise he may already be in a heightened ‘fight or flight’ mode as the snow day is a departure from his regular schedule and his is therefore more likely to over react, but his inability to inhibit and rationalize his behavior and reactions all can be associated with the function of the limbic system.
His attempts to justify his behavior are motivated by his need for control. He reluctantly accepts my ruling, and quickly rethinks his argument which indicates that the parts of his executive function that manages other cognitive processes, such as planning, working memory and retrieval, are present and developing.
Currently we are working hard on the skill of persuasion. Ensuring that my son knows that he has to be successful at persuasion if he is to get what he wants helps to support his weak central coherence by giving him the big picture. We model what persuasion is and I allow myself to be persuaded in areas where I know both my children are motivated, and can be successful. At the same time my son is reminded of the presence of others thoughts and examines his own theory of mind in the process.
Recently my son and I had a disagreement surrounding being kind and thoughtful to others.
It was a neighbor’s birthday, and my son knows the little girl and they seem to like each other. I wanted to deliver a birthday card. My son did not. I described how people bringing gifts and cards would make the girl feel happy and that it was good to show people that we care about them. He accepted that receiving gifts and cards on his birthday made him feel good, yet he stated that he would not go reasoning that he not want to go to her party.
The discussion ended with an ultimatum.
The situation was aggravated by the departure from his regular routine, and later I realized that he had planned his activities and knew what he wanted to do when we arrived home. My rationale of how his actions could affect how others feel had little impact as I did not successfully related to the big picture, supporting his central coherence and the ‘social story’ was delivered as a directive rather than in preparation.
In attempting to relate his reasoning, our discussion and the outcome to both our brain functions, I may prevent any reoccurrences. Ultimatums are not productive and go against the principals of collaborative imperialism and guided discovery. I did not enquire as to what he wanted to do when we got home, He did not tell me when wanted to do something else that he had already planned in his mind. I did not prepare him properly or gain his buy-in. We both lacked a developed sense of Theory of Mind.
When the time came for the visit, once more I asked him to come with me to deliver the card.
He was delighted to do so, and the visit went well.
With hindsignht, I can see that the incident became a power struggle.
This is an emerging issue, enhanced by my sons need for predictability and control, supported by our choice behavioral management strategy, and could be a typical developmental phase.
I prepare to re visit the power struggle issue, employing a new social story. The story will be something he and I write together and will follow the “The Macdonald Way” (Our family mission) He may not clearly understand that his is challenging me for control, and I have to find way to illustrate and reinforce the expectations that we have as a family. The next time a similar situation arises, I will help him understand that it is OK for him to get mad and challenge me. I will discuss with him the many choices that he does have control over, but that ultimately it is my job to keep him safe, help him understand, and grow up to be the best he can be.
Last months assignment
“Why label?”
The week started with an article in New Scientist Tech “When sociable computing meets autism”
The researchers were interested by a film created by Amanda Baggs’s “In My Language”.
While reading the article, I began to feel uncomfortable. If scientists could invent a “mind reading tool” to help individuals with Autism to understand emotions, “then everyone will know what I’m thinking!” I said it aloud, Homer Simpson-style.
Luckily, I can’t stay on one topic for long, so I visited Antioch First Class to see what’s up for next weekend. Amanda Baggs is one of the people we can research for a brainstorm session during our first class with Stephen Shaw. I am delighted as the first time I ‘met’ Amanda she was a major contributor to autistics.org The real voice of Autism one of the many websites added to ‘my favorites’ when we first realized our child was on the Autism spectrum. The site was refreshing but sometimes shocking suggesting that other Autism websites and organizations we built by neuro-typical people who were ignorant of Autism and that their assumptions were insulting to those on the spectrum. It was the first site to make me think about how we as a family perceive Autism and how we frame it at home, in school and in our community. We thought we needed to make a positive introduction of Autism to our then 2 and ½ -year-old son who was diagnosed with Pervasive Developmental Disorder Non Otherwise Specified (PDD NOS), but we were not sure how. Did he need to know? When should we tell him? What should we say?
I had read books by Luke Jackson a young author with Asperger’s Syndrome from the UK. Luke compels parents to tell their children what “the thing” is as soon as they can. Others in the fields of therapy and research working with children on the spectrum, describe seeing a huge weight removed once they understand that the difficulties and differences that they experience have a name, and that there are other people like them.
Amanda defers to Jane Meyerding for her explanation of “why label?”. Jane describes her acceptance of the Asperger’s label “If I could understand my life for the first time only by understanding how my brain was different from the majority of brains, how much did I really have in common with all those neuro-typicals (NTs) out there, compared to whom I'd been judged inadequate so many times.”
As our family navigated our son’s early intervention process, we accepted the labels as signposts. The signposts told us which way to go. Rather than categorizing, or stereotyping behaviors and personality, the explanations of our son’s Autism also helped his sister, his peers, our friends and extended family. All of who now have experience of one person’s Autism to include in their understanding of the diagnosis. We chose to tell our son (and our daughter) about how we understood his Autism, and how others may understand it too. As our son grows, we hope he will find the explanations, labels and signposts helpful. We hope he will not be limited or undermined by the diagnosis and others perception of his ‘disorder’ Each day our soon-to-be six- year-old son shares more of his Autism with us, and as we build a better understanding, we make the least dangerous assumptions possible.
In her video Amanda states, “This is not a freak show.” And raising awareness and creating positive perceptions and changing society’s negative viewpoint can be a painful and slow process, so we take time to introduce people to Autism and we ‘show off’ our son as proud parents do. And every day he reminds us that he is truly an individual with Autism, and not “an Autistic’.
Research links-:
http://www.newscientisttech.com/article/mg19325917.100-when-sociable-computing-meets-autism.html Accessed 2.19.2007
http://www.youtube.com/results?search_query=Amanda+Baggs&search=Search Accessed 2.24.2007
http://amanda.autistics.org/ Accessed 2.19.2007
http://www.autistics.org/ Accessed 2.19. 2007
http://www.inlv.demon.nl/subm-brain.jane.eng.html Accessed 2.10.7007
http://www.jacquijackson.com/books/freaksgeeks.html Accessed 2.20.2007
The week started with an article in New Scientist Tech “When sociable computing meets autism”
The researchers were interested by a film created by Amanda Baggs’s “In My Language”.
While reading the article, I began to feel uncomfortable. If scientists could invent a “mind reading tool” to help individuals with Autism to understand emotions, “then everyone will know what I’m thinking!” I said it aloud, Homer Simpson-style.
Luckily, I can’t stay on one topic for long, so I visited Antioch First Class to see what’s up for next weekend. Amanda Baggs is one of the people we can research for a brainstorm session during our first class with Stephen Shaw. I am delighted as the first time I ‘met’ Amanda she was a major contributor to autistics.org The real voice of Autism one of the many websites added to ‘my favorites’ when we first realized our child was on the Autism spectrum. The site was refreshing but sometimes shocking suggesting that other Autism websites and organizations we built by neuro-typical people who were ignorant of Autism and that their assumptions were insulting to those on the spectrum. It was the first site to make me think about how we as a family perceive Autism and how we frame it at home, in school and in our community. We thought we needed to make a positive introduction of Autism to our then 2 and ½ -year-old son who was diagnosed with Pervasive Developmental Disorder Non Otherwise Specified (PDD NOS), but we were not sure how. Did he need to know? When should we tell him? What should we say?
I had read books by Luke Jackson a young author with Asperger’s Syndrome from the UK. Luke compels parents to tell their children what “the thing” is as soon as they can. Others in the fields of therapy and research working with children on the spectrum, describe seeing a huge weight removed once they understand that the difficulties and differences that they experience have a name, and that there are other people like them.
Amanda defers to Jane Meyerding for her explanation of “why label?”. Jane describes her acceptance of the Asperger’s label “If I could understand my life for the first time only by understanding how my brain was different from the majority of brains, how much did I really have in common with all those neuro-typicals (NTs) out there, compared to whom I'd been judged inadequate so many times.”
As our family navigated our son’s early intervention process, we accepted the labels as signposts. The signposts told us which way to go. Rather than categorizing, or stereotyping behaviors and personality, the explanations of our son’s Autism also helped his sister, his peers, our friends and extended family. All of who now have experience of one person’s Autism to include in their understanding of the diagnosis. We chose to tell our son (and our daughter) about how we understood his Autism, and how others may understand it too. As our son grows, we hope he will find the explanations, labels and signposts helpful. We hope he will not be limited or undermined by the diagnosis and others perception of his ‘disorder’ Each day our soon-to-be six- year-old son shares more of his Autism with us, and as we build a better understanding, we make the least dangerous assumptions possible.
In her video Amanda states, “This is not a freak show.” And raising awareness and creating positive perceptions and changing society’s negative viewpoint can be a painful and slow process, so we take time to introduce people to Autism and we ‘show off’ our son as proud parents do. And every day he reminds us that he is truly an individual with Autism, and not “an Autistic’.
Research links-:
http://www.newscientisttech.com/article/mg19325917.100-when-sociable-computing-meets-autism.html Accessed 2.19.2007
http://www.youtube.com/results?search_query=Amanda+Baggs&search=Search Accessed 2.24.2007
http://amanda.autistics.org/ Accessed 2.19.2007
http://www.autistics.org/ Accessed 2.19. 2007
http://www.inlv.demon.nl/subm-brain.jane.eng.html Accessed 2.10.7007
http://www.jacquijackson.com/books/freaksgeeks.html Accessed 2.20.2007
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