The Bridge: Siblings

In working with child and teen clients, I have seen other professionals address the subject of siblings in one of two ways: inclusion or exclusion.

Thankfully, most of the time there is some degree of inclusion. Siblings are an intricate part of the everyday life of a child, and when the child is on the spectrum, brothers and sisters can take on a much more important role.

In most of my experiences (but not all), the siblings have been neurotypical. They are having a host of emotions regarding their autistic brother or sister: they are at times protective, sometimes jealous (because of the attention their sibling gets), often a bit confused as to how they can help, but almost always coming from a place of love.

For workers and professionals, they can present a challenge. The siblings often want to be involved in some way, particularly if the therapy is a play-based approach like I tend to use. They see the “cool” things I’m doing with their sibling, and naturally they want to be a part of it.¬†Completely cutting the sibling out of the play (or worse, telling them that I’m only there for the client) can have negative results; the sibling may start acting out or “sabotaging” the session. Of course, if they have too much freedom, they could undercut whatever the worker is trying to do.

Here are some of the things I have done to incorporate the siblings into the sessions in a constructive way:

  • Sometimes, they just want to play with the “new” toys (if a worker brings toys) . With one family, I started giving the older brother his “own” toy/play station at the start of the session. This greatly minimized his tendency to snatch toys from my client.
  • Doing activities that all of the siblings (and ideally all of the family members) can participate in equally. Active games like ball games (kicking/rolling back and forth), art activities (fine motor skills treasure troves!), and board games (turn-taking, social interaction) are great ways to have fun, work on skills, and involve everyone.
  • Enlisting the siblings to help their autistic brothers and sisters. I honestly believe that kids want to be loved, accepted, and praised, and this is a great way to fold that in. I have seen parents do this really well, and in a variety of ways. The easiest way is having the sibling model some behavior or routine that they would like the autistic child or teen to pick up on. The praise they receive for their help does a lot to raise the self-esteem of both siblings.
  • Cooking can be a great activity, especially if any or all of the kids/teens show an interest in doing so. Interventionists have created some great cooking sessions where they have made everything from sandwiches to stews with the family. Make sure to use safety first!

I always try to talk to the siblings in some context, even if it is just a check-in while writing up my note or setting up. They often feel left out when their neurodiverse siblings have special friends coming in to work with just them. Looking at it from the neurotypical sibling’s viewpoint, I can see why they would feel isolated in that sense. I also make a point to commend the parents who have fine tuned the delicate art of giving all of the kids quality time, because it is by no means an easy feat. I encourage my fellow professionals to do the same. ūüôā

 

Meet Julia

julia-muppet-sesame-street

I first heard about Julia, a new Muppet on Sesame Street, over a year ago. She was part of an online autism awareness campaign that Sesame Street launched. I remember that while she was pretty well-received, there was a concern that she may be¬†too¬†“high-functioning” (Can we please think up another way of saying this, by the way?). Julia is now set to make her first appearance on the TV show.

From what I’m gathering in the article from CBS News, Julia as she is appearing on the actual show may be a bit more towards the middle of the spectrum (if such a guideline exists). One character cannot possibly capture the entire autism spectrum, but I do commend Sesame Street for not only introducing an autistic character, but for also consulting with a family ¬†in the process.

Newest “Sesame Street” Muppet has autism: Meet Julia

Today article about Julia

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…

When Play Goes Away

This article is not exactly autism-related, but it speaks to the consequences of the decline of play at the preschool level and how this is affecting sensory processing in young children. Definitely worth a read.

The Decline of Play in Preschoolers

Note: I will be getting back to The Bridge series shortly. My “day job” has a slew of reports due this week, so my brain is a little fried. If I don’t get it out this week, I definitely will first thing next week!

The Bridge: 3,2,1…Contact!

Last week, we met our new client and collected as much information as we could on them. Among the data that we gathered was the fact that they LOVE toy trains. So, guess what I brought to the next session?

Peter likes to line up the toy trains, and then rearrange the order. He gets very excited whenever he does this. Rather than deter him from the activity (which is sometimes the first instinct), I decide to take a different approach.

First, I do not give Peter all of the trains that I have. I keep at least three of them. When he starts lining his trains up, I start to do the same and match his enthusiasm. In fact, I may actually get more into the trains, though not enough to disorient him. While doing this, I don’t immediately interact with him. This is only the second session, and as a newcomer I do not have that privilege just yet.

Then, it happens.

Peter pauses and makes brief eye contact with me…but it’s longer than any time previous. He then goes right back to his trains. My immediate response is: “Peter, you looked at me!” in a quiet but enthused tone. With this I achieve two things: I acknowledge his communication attempt, and I indicate that I am happy with this action. After that, I go right back to my trains as well.

One of the biggest problems I see here from Interventionists and Specialists is a lack of patience and a need to perform. This is especially true if a parent/caretaker if observing the session. It’s normal to feel this way, to feel nervous about how the entire family is viewing you, your actions, and your expertise. It is important, however, to remember why you are there, and to trust your intuition. When reviewing video with workers after their session, or in feedback meetings following sessions, the workers often¬†knew¬†what they should have been doing, but became intimidated by what they¬†thought¬†the family wanted them to do. If you feel this happening to you, don’t be afraid to have a conversation with the family about what the expectations are. Are there certain therapeutic approaches that they prefer? How willing are they to try other possibilities? If the client is verbal, you can also ask them. I have had treatment plan meetings where the clients (in my case, autistic preteens) had a say in their goals and their progress.

Back to Peter. More than likely, I will not push him much further beyond eye contact on the second session. I will also make a point to explain my method to the parents so that everyone is on the same page. That will save you a lot of confusion down the road: lay a plan out to the family, and review what you worked on at the end of the session before you leave.

Goal of session two: Acknowledgement/contact

Next week, we’ll look at how to build on that “blink and you’ll miss it” eye contact.

PS- The title is an 80’s reference. Can my 80’s Babies guess what I’m referring to? ūüôā

ASD Nest Program

Nice article from NPR about New York City’s ASD Nest program, which aims at taking autistic kids from kindergarten through high school with the goal of getting them into college. I have seen similar ideas floated through schools elsewhere, but this program is probably the most consistent I’ve seen since it carries individuals through various schools. ¬†There are also links to other pieces as well.

NYC’s ASD Nest program

 

“Get Over It”

Yes, I’m going to talk about what just happened in America tonight.

As my friends and I on Facebook started feeling the slow, horrible feeling of someone punching us all collectively in the gut, a young white man (who says he didn’t vote for Trump or Clinton but someone else) jumped into one of the conversations.

He essentially said that we (the minorities) were “overreacting” and need to get over it.

Naturally, he got verbally destroyed.

Despite this, though, there was still more pain than anger. The pain that, even now, there are those who didn’t even vote for Trump who STILL cannot empathize with those of us who have been insulted or ridiculed by the man who is now President-elect. I thought about my clients more than anything, and they run the gamut: some of them are minorities and autistic, others white but severely delayed, and others female but strongly dependent on the Affordable Care Act in order to get medical services and equipment. If Trump and his surrogates keep to their words, all of my clients are about to be negatively impacted.

So no, I cannot afford to just “get over it.” Never mind me as a black female who has also benefited from the ACA…my clients, the¬†kids,¬†are now at risk. They are all under the age of three, and they are all about to learn just how much this country doesn’t care about them.

I will not just “get over it.” Too many are depending on me to continue to support and fight for them. They are the next generation of Americans (and yes, they are all Americans); they deserve a shot at a hopeful future. I will continue to do my best to ensure that they get that.