'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.