Quick Tidbits

I’ve been having my own form of writer’s block for the past few weeks. I can’t tell you how many blog posts I have started that now sit idle in the Drafts folder. I will get to them, I promise. In the meantime, I decided to give some practical tips that I’ve learned/been reminded of by some of my new clients. We can always use tips, right?

  • For some of my older clients on the spectrum, a lot of anxiety is reduced when they are given the whole picture or situation first. We tend to assume that they will not be able to process everything at once, but giving information in little pieces (especially if they are directions) can also make them anxious because they don’t know what’s next. What I’ve learned to do is to give the overview first, and then each step afterwards as we hit it. For example: “Okay, we’re going to make lemonade today. We’ll need lemons, water, and sugar so that we can mix them together.” Boom, I just summarized the entire recipe. After I did that, the client walked me through the process, asking when he needed clarification. While he is what would be considered “higher functioning,” he still needed the anxiety reduction.
  • Many kids love the feeling of independently doing and choosing for themselves. Even if it is not a true choice (say, choosing between your two choices), the illusion of choice can be a great asset. I try to give my clients choices whenever I can. Sometimes they bounce the ball back into my court for me to decide, but I offered them the choice, and that goes a long way.
  • To my fellow workers: it is really easy to assume that a parent is just being bossy, lazy, whatever trait you believe you’re seeing that week. Try to step into that parent’s shoes. Most of us get to go home at the end of our day. For those of us without kids, we go home to stillness (most of the time). For our clients’ parents, their challenges and triumphs continue long after we’ve gone home. It’s just a few hours a week for us…it’s 24/7 for them.
  • That being said, workers, know your boundaries. You have to take care of yourselves before you can take care of anyone else. Our clients can pick up when we’re tired, hungry, or just plain pissed about something…and the result is usually a less than stellar session. Parents, we go through a different kind of burnout. We are not just worrying about the well-being and future of your child; we often have several more families we have to put equal energy and time into (or dozens more if you’re a case manager). We’re not trying to be rude or mean if we hold our ground on session times or availability. We’re trying to make sure we can continue to be the best that we can be for all of our clients, including you.
  • Workers, think outside the box. Not just with your clients, but also in regards to your job/position in an organization/your own practice. What are your strengths? How can you use them for the betterment of your organization/practice? Are you doing things that others are not? If others are doing it, do you have a unique spin or voice to bring to the table? Is there something you see in your client that others don’t?
  • This one goes to everyone: have fun. I’m serious. I work mostly with kids, and I see so many instances of family and workers alike getting so wrapped up in the goals and the data that they forget that they are dealing with a kid. I celebrate when a client has a “kid moment.” In that moment, autism wasn’t some horrific veil hanging over their heads (according to everyone around them). Autism was a way to really feel the sunshine and the wind, to appreciate every color dancing across a bubble. Autism led to a laughing fit to end all laughing fits. I’m not trying to downplay the challenges of this type of neurodiversity. It is a tough road to tread, nearly impossible at times. What I am saying is to really be in the present when it comes to those moments where the child is just being a child. I dare say that maybe, just maybe, you may want to join them there.

The Bridge: Behaviors, Part 2

Last week, I talked about the more difficult behaviors that can sometimes pose a danger to autistic individuals and/or others. There is another category of behaviors that are pretty much a benchmark of what we consider to be autism, and those are the ones I want to address here.

In the autism world, these behaviors are often referred to as stimming behaviors. They can range from verbal (repeating words, making unusual sounds), to physical (rocking, jumping) and all points in-between.

Let’s go to a new client for a moment. His name is David. David is 7 years old, and his parents are a bit flustered at how he often waves his fingers in front of his face. He will do this for hours if they let him (which they really don’t want to), and they want it to stop because it is keeping him for getting through the school day. It also draws attention when they are out and about. He always seems to get very excited when he does this.

The reflex move, of course, is to just tell him to stop. If they are particularly frustrated, the parents may physically move his hands to his sides or threaten to take away his favorite toys (Legos). This only makes him frustrated, which leads to either a meltdown or David aggressively doing the behavior even more. The truth is, there is a very simple reason why David does this action.

It makes him feel good.

There used to be a notion that these behaviors were a sort of torture for the client, and that the therapist/interventionist was “freeing” them from it by stopping the behavior by force (physically, verbally, or otherwise). Now that more and more autistic adults are speaking up, we are learning (or at least I hope we are learning) that the stimming behaviors are actually relieving the so-called “torture.” The difficult part for our clients is navigating an overstimulating, often unpredictable world. In my work, these behaviors signal that the client is trying to calm and steady themselves in the best way for them. When I see them, I want to find out why the behavior is happening. Either something in the environment has shifted, or there has been a build-up of uncomfortableness for the client.

Or, you know what? Maybe they just felt like being happy in that moment.

Much like the previous entry, a bit of detective work can go a long way. After doing some data collection, we discovered that the finger waving would often increase just before going somewhere that involved being in a crowd. We gave him a fiber optic wand as a possible sensory replacement, which he loved. The family also started giving him plenty of warning as to when they were going to go out. We even went a step further and created mini social stories about frequent places they visited (complete with pictures from those places). While David still waves his fingers sometimes (especially when excited), it has decreased along with his anxiety. We didn’t stop the behavior because it was “wrong,” we adjusted it and the environment so that the anxiety that causes the behavior would decrease.

To put it more simply: if someone bites their nails, forcing them to stop will just make them either do it more in secret, or lead to them switching to another tic. Uncover the source of the emotion behind the action first.

Finally, I wanted to share a blog post from another blog that I follow. The author touched on this very subject, and it is a great way to hear about stimming behavior from an autistic adult.

Oh the Ways We Love to Stim

Next week: About The Siblings…

The Interview/Rejection

I’ve seen some great videos come out of the National Autistic Society in the UK about the autism experience. I really wish that the US organizations would take a similar approach, but hopefully we’ll get there. I want to hear from some of you: do you think that this video captures some aspects of adult autism? Is there anything that is different in your personal experience? I would love to use it in an upcoming training, but I wanted to see what others thought first.

 

My Thoughts on ABA

I just realized that I have never given my personal viewpoint on the current poster child of autism therapy, Applied Behavior Analysis. I think this is mostly because I know that I have strong feelings about the subject, and because I was usually surrounded by proponents of ABA and didn’t want to rock the boat. Now removed from it for about a year, I can talk about it more freely and without the anxiety the environment gave me. Please understand that this is my personal opinion, grown from my personal experiences in the ABA field.

I worked at an ABA-centered organization for a few years, so my thoughts do not come from a lack of exposure. The organization actually started out with a different model (and one of my preferred models), the Early Start Denver Model. Then, as Kaiser became more involved due to funding, the organization started to shift gears quickly. I gave it a chance, I really did. I listened to its proponents (some of which are/were friends of mine), got trained in several aspects of ABA, and created treatment plans based on it.

And I eventually hated every second of it.

Okay, hate is a strong word. Let’s see…each day that I worked there took a tiny piece of my soul away. Yikes, that sounded worse. It was true for me, though. Let me break down the reasons why I tried and eventually decided ABA was not for me or most of my clients:

  1. The obsession with fixing what isn’t broken. This is the basis of nearly every issue I have with ABA in general. I have never heard so many references to fixing someone as I have in that field. It is problem-focused almost to an extreme in some cases, and much of my training was solution-focused. That led to an instant clashing of values. I don’t believe autistic people are broken, they just have a different experience with the world.
  2. The therapist/interventionist/analyst is the expert. Um…no. A former boss of mine (who was deep in the rabbit hole of ABA) actually said of our clients’ families, “They’ll listen to us…we’re the experts.” Before I could stop myself, I blurted, “No, we’re not. The client is actually the first expert of themselves, then the parents are a very close second…we’re around third.” That boss and I butted heads from then on. Yes, I’ve studied a lot about autism, and I’ve had many autistic clients. Guess what, though? “If you’ve met one autistic person…you’ve met one autistic person.” In other words, we aren’t experts at all. Guides, maybe. Advisors, perhaps. Experts on autism? Not even close.
  3. Disregard/dismissal of any other approach. I may not be a fan of ABA, but I still respect it as a discipline and a psychological approach (even though quite a few of its supporters don’t want it associated with psychology because I guess psychology isn’t considered a true science…as I sit here with my two science degrees in psychology and counseling). Sadly, the other approaches, some of which I have seen work very well with clients, were met with almost mocking ridicule during my ABA experience. The often-repeated reason was that ABA is “evidence-based” and basically everyone else isn’t. This is a sad catch-22 to me: no funding is given to other approaches to give them an evidence base, and more is going to ABA because it is evidence-based. Good luck getting off that carousel right now. Also, the testimonies I see arising from the adult autistic community suggest that the psychological harm being done by some of the execution of ABA is real, and those voices are largely being ignored by the ABA community (at least to me).
  4. It simply does not fit me or my beliefs with regards to autism. Again, this is all my opinion, based on my experiences with the ABA approach. I don’t agree with the approach in general, and that’s fine. We can agree to disagree. What bothers me is the absolute takeover of ABA (along with “cure seeking”) in the autism world. Actually, it scares me. I have never seen such a monopoly occur in a field (except maybe Apple and the iPod), and when monopolies occur, innovation can be stifled. I have seen colleagues with amazing ideas get shot down repeatedly in ABA-centered organizations, their insights rendered mute. Then these same organizations wonder why they can’t keep solid employees.

Look at it this way: say you need to see a therapist. You got to your HMO doctor to ask for a referral, and they’re happy to give you a list. You notice that everyone on the list is a psychoanalyst. You say, “Um, this is great and all, but I really wanted a cognitive-behavioral therapist.” The doctor replies, “Nope, this is all we have.” You go to your insurance company, and get the same response. You have to choose a psychoanalyst because that is all that is offered. Your chances of getting anything out of those sessions just dropped significantly before you even walked through the door because you didn’t get to choose for yourself. Welcome to the current state of the autism treatment world.

This is what led to my difficult decision to work on the fringe of the field, so to speak. My work is now more developmental in nature, and with a much younger client base. My methods of building trust and a relationship first and foremost, of making the sessions fun and engaging, and involving the family whenever I can have not changed. I am much more happy here. Again, I am not to the point of chanting “down with ABA” (at least not yet); I think all of the different approaches can work in harmony.  However, there needs to be some additional educating to some of ABA’s followers on working with the autistic population, and other approaches need the opportunity to shine again without being shunned by the majority. Yes, ABA is now the majority approach. The ABA field can no longer use the “we’re the underdog” excuse.

No, you’re not. You’re the monopoly now.

Seeking Help

First, I’m fine. The emerging online conversation amongst black men (and men in general) about being able to admit when they need help inspired this post (See #yougoodman on Twitter).

I’m one of those stubborn people who really hates asking for help. I like figuring things out on my own, solving problems, and above all, maintaining my inner dialogue that I have *most* of my life figured out. Asking for help tends to dim that dialogue.

The truth of the matter is, we all need help at some point.

We are taught to think that asking for help is a sign of weakness, of defeat. You couldn’t handle it on your own, so clearly something’s wrong with you. It is one of the main reasons why depression and anxiety run rampant in American culture. Society is very demanding on the human psyche, but no one wants to publicly admit that.

Maybe it’s not depression. Maybe you’re just going through a hard time. That stubbornness will tell you that you can’t ask for help because it will imply that (again) something’s wrong with you, or that you clearly made some bad choices and had this coming to you. By seeking help, however, you are admitting that you want to do better. You want to be better, and you are willing to do what it takes to achieve that.

Yes, your ego may get bruised a bit at first, but by learning to actively seek help you are becoming a more complete you. Maybe you need help with a project from someone more experienced. You can now add that person’s knowledge to your own. If you had a financial hiccup, I am willing to bet that you will more than likely examine ways to not make those same choices. If you feel overwhelmed, seeking professional help will give you tools to address that stress going forward. You have everything to gain.

Those of us in the helping fields made this our life paths for a reason. There are people who live to literally see you do well. Don’t be afraid to seek us out, and don’t be afraid to seek out those right in front of you for help, either.

In the long run, you’ll be glad that you did.