August 18, 2019

Sometimes School Issues Are Not Always Just About The Diagnosis

Hello Everyone,

      I hope you are having a pleasant, preferably un-hectic, last couple of weeks before the school year ramps back up.  Looks like were getting ready to put existing education plans back to work, while scrambling to schedule meetings with teachers and support staff so that our kids get the best deal they can in the classroom.  This month's post will, hopefully, be brief, and focus on the importance of not only focusing on the impact of the diagnosis on a child's performance in school, or other areas of life. I would like to say that understanding diagnoses are critical to helping kids get the best they can in school and do relate in many significant ways to behavior/academic challenges.  Much can be explained by the diagnosis and is a direct expression of it.  Accommodations are hugely important and need to be encouraged, not with-held or offered only after a kid has suffered shattering collapse of self in front of their peers in the classroom.  I agree that it is a necessity to evaluate behavior causes and outcomes and consider all options, however those are not the only pieces to explore.
      Kids with ADHD and other developmental diagnoses are, for many reasons, usually evaluated through the lens of their diagnoses, particularly how it impacts their ability to move through the school system.  Consequently, there is still a prevalence of the medical model of treatment where problems are seen and identified to be treated.  This is especially true regarding schools and other environments where kids with these diagnoses have to perform, whether it is academics, sports, music, etc.  The medical model approach gets used so much because it's easy.  Identify, diagnose, treat, evaluate outcomes.  Societal organizations such as schools, have to, by necessity, function like a machine in order to pass kids through their academic odyssey.  Any hiccups to the machine, such as challenges with learning or behavior, can be very disruptive in a classroom that has 30+ kids.  The machine, as we know, is strenuously overworked.  So of course the process of identify, diagnose and treat is a god-send for an over-taxed system.  However, there are some other aspects to this model, which often comes into use at the start of the school year, which ought not to be overlooked with respect to the impact of the well-intentioned focus on the kid with the diagnosis.
      I will be the first to admit, that I am guilty of getting into the identify, diagnose, and treat mindset, especially when a parent who is really distraught comes to me for help.  Who would not want to help?  That's what we do best and it's also very easy for us to launch into that find out what is wrong, tie it to a diagnosis, and come up with solutions.  I have to remember, especially about my own experiences with ADHD, that tying everything back to the diagnosis is not always helpful to the kid, but can often times perpetuate a sense of other-izing and tying their identity to their diagnosis.   A kid can have ADHD which makes it challenging to focus in class due to their "computer wiring".  That may be a reason that sets them apart from their peers.  The equally important reason to the kid is that the teacher sucks or they just don't like the subject.  That is what makes them like their peers and must be equally addressed if we are going to move beyond talking rhetoric about normalizing to putting it into practice.  The following is a personal example.
     I have had severe ADHD my entire life and am now completely un-repentant and living well without medication.  However, growing up, especially in my critical identity forming teen years, ADHD was a label I could not escape.  I had an IEP and accommodations, which were updated at regular meetings, which we are all very familiar with.  Teachers would come to the meetings and complain about my behavior or issues with my work, to which the resource staff and school psychologist would say it's because of ADHD!  I now appreciate, but certainly did not, at the time, their efforts at trying to offer some perspective for the teachers.  However, I began to really internalize that something was wrong with me because I had ADHD and that it was a bad condition that I lived with.  It's hard to love yourself when you are constantly at war with a part of you that you can't get rid of and is characterized as a bane of existence.  Could I not have school issues just because I was like everyone else?  Could I not fail or be given an equal chance at failure like everyone else?  Truth is that accommodations for myself and many others whom I have and do work with, while really helpful, often can contribute to a certain shame around failure.  We got "easy tools" and we still screwed it up! "Oh but you have a diagnosis".  So now I had tools that did not help me battle myself and I still failed!  That's really tough to deal with.
       I had one of the high school guys who I work with come in last week with his mother and father yelling at him because he still had not done his summer work.  I immediately went into "helpful mode" and started examining what were contributing factors such as attention, distraction, and so on.  I wanted to help.  The kid yelled at me "shut the  expletive deleted up!  Do you think that maybe I just don't want to do the work?  Why does it always have to be about me having autism?!"  True story.  That got me thinking really hard about myself and my own experiences.
      As a mental health professional, someone with ADHD and a new father recently diagnosed with medical student disorder by proxy, I completely understand where and why all the focus is on the diagnosis.  For myself and others, the challenges and difficulties are waaaaaaaay much more visible than the aspects of the self that are doing fine.  So what to do when dealing with someone you work with? 
First, I try to give myself some grace and acknowledge that when I start off with the diagnosis, it's coming from a good place. 
I also try to remind myself that just because I started out using the diagnosis lens does not mean I can't backtrack and start over. 
I then try to take a pause and reflect for a moment on my own experiences in the past dealing with such situations and try to come up with a reason not diagnosis related why I knew that I was having trouble or was not even aware might be diagnosis related.
(Please remember that as professionals with academic training and experience we have more of the objective knowledge about what might be causing difficulties.  Kids are much more concrete, subjective and experiential in their self-appraisals).
The next thing I would do is to then ask them about their own reasons and explore those with them first to get that alliance going again and to also put more of a focus on the positives about them and their own awareness.
So what have I found?  Kids with ADHD or other developmental diagnoses are too often aware of their shortcomings from a disability/challenge perspective as well as critical focus on their differences.  They want to be treated like all their peers, especially with respect to their opinions and behaviors, which are critical to their identity development.  So what does this mean?  A kid with ADHD does not have to have his diagnosis explain why he/she struggles in class.  He/she can, like the others, screw up, hate the teacher, not like the subject, and make poor decisions, just because they are a kid and do not have the development or life experience to do otherwise or cope with it in a more mature manner.  Believe it or not, a kid with autism can be a psychopath because they genuinely are a psychopath and not because they have autism.  I know...I worked with one for two years in child welfare.  Anyway, my point is that those of us with developmental diagnoses have challenges at school that can be explained and treated in many ways that are related to our diagnoses.  We can also have challenges in the classroom because we are also people and just very well may be exercising our own, and not well thought out (because that's something we who are impulsive or struggle to organize our thoughts and feelings to send a message) views about a class or assignment as we continue to figure out how to sort out who we are as a whole person.  Whether we are professionals or parents, we must remember this.

July 9, 2019

Use Your Special Interest to Understand Your Thinking!

Hello Everyone,

      I hope you are all well and are having a lovely summer.  There will be two posts this month to make up for not having one in June.  In this post, we will be exploring how you, whether a therapist, parent, care provider, or someone else, can help your child with autism spectrum disorder (ASD), and other developmental diagnoses not considered intellectual in nature, understand how their thoughts work by connecting them with their special interest as a METAPHOR.  The second post will cover special considerations for those populations.  Using your child's special interest as a metaphor for understanding thinking is not hard at all.  It can actually be quite fun and only requires your attention, empathy, and as much of an imagination as possible  to come up with ways to visualize the invisible concept of thoughts and how they affect feelings and behavior.
     Using your child's special interest to connect with them to not only help them understand how they think serves many useful purposes in addition to facilitating your child's progress in mastering their challenges beyond the therapy office.  When you connect with your child around their special interest you are sending critical non-verbal messages of unconditional acceptance and acknowledgement of their existence and values as a unique individual.  Using a special interest in a metaphorical sense also has the additional benefit of generating empathy, the ability to truly understand things from their point of view.  Rapport, or the positive connection between individuals that serves as the building blocks for a relationship, is also improved when you use another individual's special interest to help them understand a concept because it demonstrates that you can make a meaningful emotional connection with them.  Lastly, using a special interest helps them understand themselves and be more accepting of themselves and also more compassionate regarding their feelings and thoughts behind the observed behavior.  They are then truly able to see beyond their behavior and visualize themselves as more than just a product of action.

    So why is using a special interest to connect so important for teaching someone with ASD how to understand their thinking?  Here's why (there are many more besides these):
 Attention: Individuals with ASD have shorter attention spans for many reasons beyond the scope of this post.  This can be greatly exacerbated if learning materials are too complex or considered to be irrelevant to the individual, or considered threatening (such as with perfectionism if the individual struggles with some form of comprehension).  These individuals have been shown to be able to pay greater attention when concepts are related to their special interest.
Abstraction: Individuals with ASD have significant challenges understanding abstract concepts, especially those involving other people such as around thoughts, feelings, or any "invisible concept" like social norms and beliefs and values.  They have a significantly harder time generalizing abstract concepts to others.
Concrete thinking: Due to challenges with abstract thinking, the processes of complex thinking can be very stressful and limiting.  They are also more likely to view abstract concepts very narrowly from a self-centered lens, as well and not be able to conceptualize abstract concepts of wider consequences or the options presented by choices.  Consequently, they are more likely to view others and their actions in terms of themselves and how they think, often unconsciously
Perseveration: Individuals with ASD can become hyper-focused on certain topics such as special interests or if they believe their views on their actions are being criticized by others or not respected.
Connectivity and relevance: As an extension of the above, many times individuals with ASD struggle to understand how thoughts, feelings, behaviors, that affect others will affect them or why it is important to understand the mechanisms behind them.  Basically, "why should I care?"  Remember, it is not because of a lack of empathy, but more around an inability to connect abstract concepts to each other.
Generalization and Consistency: For learning to accept and cope with your thoughts, there needs to be consistency, which means practice outside of the therapy session, and generalization, which means taking the concept being taught in session and applying it to the outside, everyday world.  Since you are likely not a therapist, using a special interest as a metaphor can help you continue that education and practice beyond the therapy office.

    OK, so how do you connect with your child using their special interest to help them practice their negative thinking skills beyond the therapy office?  The biggest points to remember are affinity, creativity, and flexibilityAffinity means being able to conjure up a connection between seemingly unrelated concepts or topics in a natural and genuine way.  Creativity is your best friend in addition to having knowledge of what your child is working on in therapy sessions so you can use what you have identified in the child's special interest that can be connected to the work in the therapy session.  You need flexibility to be able to change your metaphor as needed based on how your child responds.  You are THE EXPERT on them so if your attempt is too complex or not specific enough (remember that these guys often are highly interested in a sub-topic within a sub-topic of a broad topic) make sure you read up so you can make that connection.  Let's look at some examples below from some of my clients and concepts they were struggling to understand.

A 21 year-old man who is really interested in the manufacturing of different tanks in a war economy.

Therapy Concept: Changing negative thinking to positive thinking
Special Interest: The manufacturing of tanks
Affinity: Tank production requires specific machine tools to make different components of a                               functional tank.  Manufacture of different tank models require different machine tools
Metaphor: When we change our thinking from negative to positive it's as if our brain were a tank manufacturing center, which has been producing one model of tank and has just received an order to make a new model of tank.  A process begins of "re-tooling" the machines so they can be adapted to making the new tank.  Our brains have to "retool" their thinking process to change from negative to positive thinking and "manufacture" a new model of thought.

A 12 year-old boy who loves Adam Sandler movies

Therapy Concept: What happens when we allow negative thoughts to take over
Special Interest: Adam Sandler movies
Affinity: Adam Sandler's nemesis in Happy Gilmore, Shooter McGavin, gets in to Happy's "happy place" and ruins his calm focus during the golf tournament
Metaphor: When we are experiencing positive or calm thoughts we are focused and able to function smoothly.  However, when we allow negative thoughts, or worries, or anxious thoughts in, we are letting Shooter McGavin into our minds and he is doing the same thing to us that he did when he got into Happy Gilmore's "Happy Place" by getting him all distracted and unable to focus and stay calm and controlled.

A 38 year-old man who is really interested in children's toys, particularly ones that make sounds

Therapy Concept: How triggers can lead to cascades of anxious automatic thoughts.
Special Interest: Children's toys that make sounds
Affinity: Jack-in-the-box
Metaphor: When the Jack's crank starts turning it is like what happens when we experience a trigger for our anxiety.  As the crank turns faster and faster and the music plays, it's like what happens when we experience rapid anxious thoughts in quick order.  When the song stops and the Jack pops out, it's like what happens when we can no longer handle the anxiety and we experience a meltdown.

A 9 year-old girl who loves commercials and wants to be an ad executive

Therapy Concept: Negative/unhelpful thoughts are easier to manage when we acknowledge them and accept them without trying to fight them away
Special Interest: Commercials in different media formats
Affinity: Commercials have different formats and styles designed to send messages about their products to different groups of buyers.
Metaphor: Negative thoughts are like annoying, loud car commercials.  They both have a message that may be trying to be helpful but is doing a really bad job of sending their message.  A negative thought may be trying to say "hey be careful" and a bad car commercial might be saying "we can help you get a car if you need one" but when we focus on their negative qualities, we are just getting more dis-regulated and are not making the message go away by combatting it.

A 19 year-old woman who is specifically interested in different types of frosted cookies

Therapy Concept: Understanding different cognitive distortions that she uses
Special Interest: Frosted cookies
Affinity: Many cognitive distortions can be illustrated with different cookie making techniques and types of cookies.
Metaphor: Our cognitive distortions can be seen in terms of cookies and how we make them.  For example a black-white cookie can be used to illustrate black and white thinking; it's one or the other for the color of the cookie and only positive or negative for the thinking.  When we sift or filter flour for baking, we are re moving any impurities.  However, when we filter our thoughts we are keeping the impurities, the bad thoughts or details, and keep those instead of the ingredient we really want, the positives.

Lastly, a 22 year-old man who hyper-focused on The Force in Star Wars

Therapy Concept: We have the power to stay regulated and in control
Special Interest: The Force
Affinity: Using calming and deep breathing exercises is very similar to the Force training Luke Skywalker uses in Yoda's home where he has to balance the rocks by focusing his attention.
Metaphor: You can use the Force too by practicing meditation and focus as well as by taking your time when you are doing a task to really pay attention to the steps that need to be done so you do them correctly.  You have time and you can stay calm.

Parents and Professional Note!!! Many obvious objects and processes from the real world are applicable as metaphors for thinking such as computers and telephones to illustrate how the brain sends messages via thoughts and feelings.  Aspects of movies such as Star Wars are excellent for using as parallels to therapy concepts; "the force" used by Luke Skywalker and Yoda as a metaphor for mindfulness.  However, you need to remember that a special interest in Autism is usually very specific and involves a great deal of acquired knowledge on technical details on some subcomponent of a topic.  Even for those with ASD who are interested in fantasy subjects, such as Star Wars, the focus is usually more on technical and easily quantifiable concrete details of characters and their stories.  Just using a superficial knowledge of a special interest will not work for you; once you know your child's special interest find out their certain specialized area of focus within that topic and learn about it.  If you don't you risk your credibility as a caring listener and as an authority figure.  When you do take time to learn the details, you will be more successful at creating a more effective metaphor that teaches the cognitive concept and grabs their attention.
      Remember you are THE EXPERT on your child so use your own creative examples!  Remember to be compassionate to yourself as well when trying this out and also remember to give yourself a big hug for trying this out-of-the-box idea.  Best of Luck!

July 6, 2019

Ue Your Special Interest to Understand Your Thinking Errors! Children With Intellectual Disabilities

Hello Everyone,

      I hope you are all well and are having a lovely summer.  There will be two posts this month to make up for not having one in June.  In this post, we will be exploring how you, whether a therapist, parent, care provider, or someone else, can help your child with special needs understand how their thoughts work by connecting them with their special interest.  Doing so is not hard at all.  It can actually be quite fun as you can get as creative as you want when coming up with ways to visualize the invisible concept of thoughts and how they affect feelings and behavior.  This second post is the follow-up to the previous post on using special interests to explain thinking errors and the concept of thoughts to children and individuals with ASD and other developmental diagnoses.  Here, we will be looking at implications for using special interests to connect with people with intellectual disabilities. 
      It is critical to distinguish between ASD and other developmental diagnoses such as learning disabilities and intellectual disabilities.  Individuals with the former have challenges around accurately processing and interpreting information due to differently mis-firing brain mechanisms.  However they do not have a reduced capacity for short-term memory.  Their cognitive functioning is not limited, rather how they go about accurate knowledge formation is more convoluted and not organized.  Limited short-term memory is characteristic for intellectual disabilities, for reasons, we shall see below, and results in lower cognitive functioning, ie. the ability to make knowledge from meaning and accurately understand information being received.

Special Considerations: Using your child's special interest as a metaphor for understanding their thoughts and thinking errors is definitely useful for many different developmental diagnoses.  However, using metaphor without use of visual aids that depict each concept in gory detail, is not recommended for individuals with Down Syndrome and other intellectual disabilities.  There are several reasons for this mainly around short term memory and processing skills.

Short Term Memory is critical because it is the receptacle for all information coming into our minds that gets processed into knowledge and cognition ie. the ability to think and use information accurately and competently.  Short term memory is divided into separate areas for processing verbal and visual information.  Children and individuals with Down Syndrome and other developmental diagnoses have a reduced capacity for storing information in their short term memory.  Consequently, they have lower cognitive functioning since their ability to retain information and correctly process what they are capable of holding onto is incomplete.

Processing is how our brains take short term memory information and make meaning so that we can have knowledge to use to navigate our world.  The two types of processing most relevant here are verbal and visual processing.Children and individuals with Down Syndrome and other developmental diagnoses have fundamentally strong gaps between their verbal processing and visual processing skills. 
        Verbal processing as affected by limited capacity of their verbal short term memory makes it very difficult for those individuals to take information and turn it into complete meaning.  The more complex the topic and concept, the greater difficulty around taking in and processing information accurately.  An individual will have a much more difficult time understanding a metaphor about thinking even if it is directly on target with their special interest because of the verbal complexity of the explanation and lack of imagery to make it more concrete and more understandable.  Here's why...
         Visual Processing is for reasons not fully understood, much stronger in individuals with Down Syndrome and other developmental diagnoses.  One hypothesis is that what is missing in areas of verbal processing capacity is being compensated for in visual short term memory.  This does not mean that the individual no longer has an intellectual disability.  Rather, they are able to retain more information in a visual context and can make more complete meaning if pictures to illustrate concepts are provided.

So what can you as the caregiver do?  Here are a couple of ideas in case you want to try using a metaphorical example.

Simplicity: Even if you know your child with an intellectual disability understands a great deal about his special interest, do not assume that they understand the concept of thought or how it works.  Also, remember that due to processing issues in visual and verbal memory, keeping it simple will help them retain and make correct meaning of more of the information.  Consider using one concrete example from their special interest and connect it to one concrete concept.

Relevance: Special interests are usually not consistent within a topic.  Many times the special interest will be hyper-focused one a specific sub-topic within the overall topic.  Find out what their primary interest is and then focus in on that to find the appropriate and most effective visuals to help your metaphor.

Visuals: Use relevant visuals to illustrate the concept you are trying to teach.  Only use visuals for what you can visually and verbally explain yourself!  Again, simplicity!

Verbal: The fewer words the better and they need to be super specific.  If you cannot explain the concept using the special interest metaphor you have chosen to yourself in simple language, then they will not understand it either.

Patience and Self-Compassion: Using your child's special interest to connect with them around how they think is a great way of building empathy and compassion for them.  Remember that you can only do your best and that you may have to try again and again to understand how they view their thinking challenges, as they are aware of them,  so you in turn can understand and connect.

June 10, 2019

NEW!!!! Young Mens' Social Group

Hello Everyone,

I hope you are all doing well.  I wanted to put out a copy of the flyer for Potomac Community Resources' upcoming Young Mens' Social Group.  This is a group for young men aged 14-18 who have been diagnosed with high functioning autism spectrum disorders.  We are offering this group as a practical supplement for young men to practice the social skills they are learning in their social skills groups and at school.  We will be covering many different topics including special interests and life challenges of being a young man with high functioning autism.  Please feel free to contact me with any questions and feel free to spread the word.  If your son is interested, he is welcome to come by himself or bring a friend.  Thank you for reading and I hope you all have a lovely June!

May 9, 2019

The Social Plan Part Two: Rejection

Hello Everyone,

I hope you are all having a happy May.  This month's post focuses on what you and your child can do to stay positive when your friends are not able to hang out with you.  There are many reasons why your friends may not be able to commit to a hang-out plan.  Most of those reasons have nothing to do with your friends thinking you are a loser (honestly).  Sometimes they will just not to hang out; even more rarely your friend does not think of you as a friend and does not want to hang out for that reason.  That last reason is very, very uncommon.  Yet, if that is the reason why your friend does not want to hang out, well then, they are not your friend.  Unfortunately, you will rarely know the reasons behind why your friend is not able to hang-out with you.  It's not worth the stress or effort of trying to understand why.  Here are some ideas for what you can do with that mental and emotional energy instead, which will be much more helpful for you and your confidence.

April 23, 2019

The Hang Out Plan: Making Plans With Friends

Hello Everyone,

I hope you all are having a lovely April.  I am sorry for the delay of this month's post!  This month, we will be exploring how to take the next step in the friendship (or relationship process), where we move our social encounters with friends from places like school or work into our daily lives.  The handout covers how to not only make a plan to contact friends to "hang out", but how to put that plan into action.  Included are additional tips for parents as well as for readers on how to remain flexible in a social transaction that does not follow a script.  I hope you find the suggestions useful, and as always, please use, share, and comment!  Your input helps me make these better.  Please remember that this handout is protected by copyright and may not be reproduced for any purposes other than personal use.  Thank you!

March 16, 2019

Trauma Bomb Rapid Response Part Two: Balms and Salves

Hello Again Everyone,

      Thank you for stopping by again to read part two of the post on what you and your loved ones can do to provide rapid response help to your child in the immediate aftermath of a sexual abuse disclosure.   

      With damage control in mind, let's look back in history to explore what served as rapid response treatment for deep, devastating wounds, at a time when more sophisticated medical treatment was unavailable.  In ancient times, balms and salves, usually made from plant extracts, were quick remedies to help ease pain for the victim while the care teams were being assembled to get more effective treatment.  Today balms and salves still exist to help provide comfort for wounds while waiting for emergency care.  While we are not looking at traditional balms and salves as a curative for the blast of the sexual abuse trauma bomb, the concept can be hugely effective when adapted to providing your child with emotional and psychological relief from trauma of sexual abuse disclosure.  However, before we administer our balms and salves to our children, we need to stay away from BAD behavior that can happen when we are first told of the abuse.  If we as parents do not watch out for BAD behavior, then we run the risk of making the wounds of sexual abuse much worse through our crushing of the victim's remaining hope for help. We erode what remains of their self-value as a person that they connected with as a motivation to take action for themselves by getting help.  So what is BAD behavior?

BLAME: Do not blame the child for revealing their abuse to you or immediately seek someone else out to blame for the abuse.  Doing so is only destabilizing and does not provide any comfort to the child in the moment.  Blaming the child can be devastating to their remaining sense of self and contribute to deeper senses of being responsible for allowing their abuse to happen.
ANGER: Anger is a wonderful and natural emotion, however at such an emotionally volatile time as this, displaying anger can be very destabilizing to the child and to your ability to stay present and focused on providing comfort.  You are allowed to be angry and rightfully so, but be very careful how you let it out around your child.
DISMISS AND DOWNPLAY:  it's very natural to try and avoid horrible events by making them seem like they are less than what they are.  It's a very effective way at managing negative thoughts and emotions.  It's also a very effective way to guarantee that your child feels even more crushed by not being listened to or taken seriously.  By being dismissive of the trauma, you are being dismissive of the child's worth as an individual with a right to care and safety.

      When we engage in BAD behavior, we are reinforcing shame, guilt, fear and doubt.  These feelings are the tag team from heck with respect to helping the child who has been abused not only be willing to engage in the healing process but to feel safe that they have support and care to do so.  Your balms and salves will be no more effective than putting a bandaid over a severed limb unless you can engage your compassion, love, and understanding for what your child has endured when they detonate the trauma bomb.  
      So who gets balms and salves anyway?  Well, you both do!  Your child needs you to give rapid response balm treatment and you need to have a salve for yourself so you can provide care for your traumatic experience of having to learn of your child's sexual abuse.

Believe: Your child is telling you the truth no matter how horrific the trauma may sound.  Believing is the most crucial piece of the trauma recovery process.  Believing your child establishes you as their protector and ally.
Allow: Allow your child to tell you whatever they need to tell you, while being mindful of your emotional and psychological reaction.  Doing so sends a message of safety and promise that they can trust you to be there through the whole trauma process.
Love: Assure your child of your unconditional love and how much you value them.  Doing so is critical to your child's ability to seeing themselves as not being a worthless or less of a person.  Loving your child will help them re-establish love for themselves as they have a purpose to challenge self-loathing.
Make space: This is a hard one, but really important.  Your child may not be ready to tell you everything about the abuse; they may not be able to depending on the depth of the trauma and how they have held it up to now.  Give your child space to work on how they want to approach disclosing further information about the trauma.  Give your child space to work on their own reactions while you remain available to them with your love.
Safety and Stability:  Make sure your child is safe and not accessible to the perpetrator.  Be available to help your child cope with their disclosure and its accompanying reactions.  Doing so helps build a secure base to begin the healing process.

Stay focused and calm: While it is essential that you have time to process your own reactions to the disclosure of trauma, right now during rapid response your efforts need to be focused on providing safety and compassion for your child. This is where you can start applying BALMS to your child.  Take some deep breaths and allow yourself to have time to think through your responses so they are measured and cproject a sense of control over the situation.  How would you want someone to help you?
Assure: Remind your child that they are safe and that they are still loved even after disclosing the abuse.  Provide comfort and remind them that you will help them through the recovery process.
Locate love and support: Your child's trauma is also your trauma.  You cannot be expected to help your child alone.  Doing so will lead to burn out for you and greater difficulty for your child if you do not have your own support network to help you with your experience.
Validate your experience: All thoughts and feelings are real and relevant.  You will likely experience a wide range of emotional responses so let yourself experience them as being real and alright to have.  Your own support network is critical.
Empower: You are now tasked with beginning the damage control and clean-up process following the explosion of the trauma bomb.  Remember that you are resilient and have been trusted with helping your child achieve mastery over their traumatic experience.  While difficult you and your child are already taking charge and working toward recovery by remaining grounded and focusing on emotional and psychological stability.

Balms and salves are excellent for rapid response trauma care but they are not only useful for the immediate aftermath of the explosion.  As you go through later steps of the explosion damage response and future healing process, you will need to keep your balms and salves handy for everyone as a source of relief to the ongoing pain.  Thank you for reading and I hope that you go into action remembering that you are strong and you are precious to your child.  They need you more than ever.  You can do this!

March 15, 2019

Trauma Bomb Rapid Response Part One: The child's revelation of sexual abuse

Hello Everyone,

      I hope you are all well.  There has been a recent resurgence in focus on child sexual abuse and its impacts not only on the victims but on their family and support systems as a whole.  With recent documentaries, exposes, and interviews with alleged celebrity perpetrators, many parents are finding new fears not only around protecting their children from being the victims of such trauma but also around how to do damage control when they find out that their child has been a victim.  In response to numerous parent questions and concerns, this month's post will take a look at some tools that parents (or any loved ones) can use at the time abuse has been disclosed to provide some anchorage in the new storm of chaos.
Image result for castle bravo test       A child's disclosure of sexually abused trauma has the emotional and psychological impact of nuclear explosion on the whole family system.  Just like a nuclear explosion, the disclosure of the abuse represents the initial detonation of a trauma bomb on what we can say is the village of a previously an intact family.  The subsequent shockwaves following the detonation represent the devastation of farther ranging impacts on the family as a whole as well as its component individuals.  The effects of disclosure on individuals in the family are called fallout and, just like the aftermath of a nuclear explosion,  can linger for years and can continue to deliver poison that weakens recovery efforts or in some cases contribute to their complete failure.  A disclosure of sexual abuse does not come with the aid of an air raid siren or with other advanced warning in many circumstances.  While there are warning signs of sexual abuse , in many cases there is no knowledge that it is even occurring, which makes the power of the initial blast so much more devastating.  It is outside the scope of this post to go into detail about all of the different emotional and psychological aspects giving power to the trauma bomb, however it is critical to note that they are many, conflicting, and totally overwhelming.  When a child reveals abuse to the parent, that explosion is immediately absorbed by the parent, which sets off their own chain reaction of thoughts and emotional trauma.  This chain reaction continues as it spreads from family member to family member and throughout the extended support system, hence the shockwave effect.
      Before we look into our suggestions for emergency response, I want to take a moment to make several points very clear.  Taking them to heart may be very difficult, but you, the parent or loved one, need to make the effort for yourself and your child. 
      First, you may have an overwhelming surge of guilt that you did not protect your child or that you had no idea they were being abused.  Experience that emotion but do not get caught in it because you will invariably collapse inward on yourself at the expense of being able to help your child.  Please remember that perpetrators of sexual abuse are very good at not getting caught and it often only gets revealed after the abuse has been going on for a long time.  Since you are not a super hero with powers of seeing what is not visible, you cannot be expected to know.
      Second, it is unreasonable to expect that your child has been purposely withholding information from you about the abuse or that they are trying to gain some kind of attention by revealing abuse to you.  For us children who have been abused, whether we reveal early into the abuse, or many years later, it is completely dependent on how we have been scarred by the abuse.  For many of us, we have been threatened or coerced into silence.  For others, we have been groomed to believe that the abuse is alright and normal.  For others, there is fear that we will not be believed if we tell our loved ones, or that we might be responsible for destruction of the family.  Many of us, when encountered with the shocking fact that the abuse is either not ok or has been so damaging to our bio-psycho-social-spiritual-sexual self, withdraw into numbness or experience profound shame and try to bury the horror.  We do not reveal sexual abuse with the goal of hurting you.  If we could we would make it our responsibility to take on your trauma from hearing our revelation; we experience tremendous guilt as a result, which often contributes to why we won't tell you.
      Third, you as the parent, may have expectations for how your child reacts to their own disclosure.  You may also have expectations for yourself for how you will react to the detonation.  Consider SUSPENDING YOUR DISBELIEF.  A child who has been abused is experiencing a huge range of thoughts and feelings all conflicting with each other and uncontainable when pushed too far.  You may not get an emotional reaction you are expecting.  for example, one child I worked with experienced disclosure of their trauma as a happy event because they felt a sense of freedom from the terror they had endured.  Another displayed no emotion at all.  as recipients of this information you may not know how to react either, yet however you do, know that it is real and valid, and must be held in some control when you are being told about the abuse.
      Fourth, the shockwaves of the abuse will spread to other members of the family, especially if a member is the perpetrator.  Know that further damage control and crisis intervention will be needed.  Family alliances, structure, supports, strengths, functioning, and identity of the family as cohesive unit all get destroyed by the detonation of the sexual abuse trauma bomb.  Trust gets destroyed and relationships can be irreparably damaged. 
      However, you as parents, are resilient and that quality is critical to have not just at the time of disclosure but as you help everyone heal and rebuild the family village.  You will need this resilience and an ability to tap into your deepest strength as a caregiver to provide the necessary damage control and lay the groundwork for your child's recover, which will be discussed in the next post.


February 11, 2019

Unhappy Valentine's Day? It Does Not Have Be That Way, Even If You Are Single!

Hello everyone,

      I hope you are all well.  Valentine's Day is coming up, and since February does not have much else to offer in terms of holidays ripe for mass consumerism, whether it is ads on the radio, television, or huge card and balloon stands, you can bet that you are going to be bombarded by constant reminders that you had best remember to celebrate your relationship with that special someone, or else...
      While the weeks leading up to Valentine's Day  come full of reminders to celebrate our love and special relationships with gifts, for many of us, Valentine's Day and the time leading up to it brings the reminders of being single and lonely.  (Please see my post for December about coping with loneliness during the holidays for a more detailed discussion of causes of loneliness and its impacts on sense of self and quality of life.)  For many of us, hearing ads saying to show your love with expensive jewelry, or rose bouquets, or deals for couples, serve as harsh reminders that we are not in an relationship.  Often times, although not explicitly stated, the message "show off your romance for the world to see!" or "show everyone your love" is sent through such advertising at this time of year.  It is also considered socially and culturally acceptable to engage in more public displays of affection as well.  Please note that I am in no way trying to suggest that people need to feel guilty for showing their affection for their partner, in fact quite the opposite!  Merely, I am aiming to draw attention to a very visual source of distress and frustration for our loved ones who are single and struggling to enter into a loving, romantic relationship.
      With the ever increasing presence of social media and instant status updates, various social media platforms are ever the source of further reminders of someone's single status.  Being confronted with images or videos of friends, loved ones, or even strangers seemingly engaged in a happy romance, can be quite distressing.  It's not uncommon at all for singles, male or female or transgender, to quickly involute and turn in on themselves to try and find answers to why they are single.  For many with poor self-acceptance, being reminded of being single is the same as being reminded of being a loser.  In a world where social media is there to show social popularity and, especially, fitting in, the very real images that we are not part of highlight this social goal with brutal clarity.
      For example, I remember as a kid, before social media (to date myself), that it was very easy to forget about other students in class and being popular when not in school, because let's face it, my mind was not developed enough to really engage in or care that much about what other kids were doing or who they were hanging out with.  Come a holiday like Valentine's Day, every student had to give the other students a Valentine, no question.  It was really easy to get caught up in the hype and feel like you were the most accepted student in the class and that everyone was your friend because you got a Valentine from everyone.  In basic concrete thinking a Valentine was given to show care and friendship; therefore getting one from every student naturally meant they were a friend.  For me, Valentines were the equivalent of "likes" for the 90's.
      Now let's fast forward to today where we grow up and, of course, learn that giving a Valentine is a social nicety but does not mean you are friends at all.  With social media use being used by kids who are younger and younger, this message is being made all the more clear, especially when their peers are posting pictures of all the fun stuff they are doing with other peers when they are not invited.  "But I got a Valentine from them!  Why did they leave me out!  I thought we were friends!"  What confusion and frustration!  What disbelief!  And what a rough way to come to the conclusion (however wrong but since we are being conditioned to view likes, number of comments, friend requests, and physical items like cards or candy as true measures of friendship and worth) that I do not fit in and do not have anyone who cares about me.
      For the older kids and adults, giving classroom Valentines has transitioned to what we see/hear in the ads and what we see people posting about romantic trips or dinner dates.  Again, these reinforce the concept that romantic relationships are socially important and special.  The consumerist aspect further adds a frustrating layer of commodification and an association of wealth with quality of relationship.
      These points noted above, are especially difficult for young people with disabilities and developmental diagnoses.  In essence, the exposure is setting a goal that is largely unattainable, at least according to the images being conveyed via advertising.  If anything, this time of year is for many with such diagnoses, extremely difficult because it highlights people who are "normal" as the only ones able to be successful achieving a goal which is a huge challenge for many with developmental diagnoses: social acceptance and inclusion.  As we continue to learn more about how the minds of individuals with developmental diagnoses work, we are learning that they desire inclusion and acceptance with mainstream society.  Having difficulty with social skills and other challenges adds layers of further difficulty, which gets compounded by the lack of societal understanding of these diagnoses and how they exactly impact the lives of those with them.  We are still very much in a society that views people who do not fit societal images of normality as being "other".  When these views are reinforced with all the reminders of what sets the "other" apart from the normal, especially when linked to subjective emotions like love and naturally normal desires for love and companionship (as in advertising or social media) it is very common for these natural needs to become seen as unattainable.  For individuals who so want to be accepted like everyone else, having a developmental diagnosis and the knowledge of its limitations and challenges on being able to achieve the socially defined goals of acceptance, greatly contributes to the presence of self-hate and shame.  That said, it does not have to be this way, whether for someone with a developmental diagnoses or any other child or adult who "does not fit in".
     Here is a helpful (hopefully) handout with some ideas on how YOU can take the power of determining whether you have worth and are worthy of having a romantic relationship, away from the consumerists and turn this time of year from one of exclusion to one of inclusion.  Best of luck, YOU deserve it!

December 13, 2018

Alone for the Holidays: Helping Your Young Adult Cope With Being Single During the Holidays

Hello Everyone,

      I trust you are all well and enjoying the holiday season.  This time of year can be a source of great joy and happiness for many, especially when spent with family, loved, ones or a significant other.  For others, however, this time of year can represent a time of great loneliness.  While getting together with others to celebrate can be great fun, such gatherings can serve as very painful reminders to those who desire a romantic relationship, but do not have one, of their isolation.  These reminders can often have disproportionately intense emotional and psychological impacts on those with developmental diagnoses.  Indeed, being reminded of not having someone special to celebrate the holidays with contributes in no small part to increases in depression and melancholy.  Sadly this post does not permit an in-depth rehashing of the reasons contributing to their distress, so please refer to my previous post on rejection to get the science behind the the reaction.
      Without fail, every year, once the holiday season begins, I encounter many young men, who are despondent over their single status.  I also receive many more concerned requests for help for parents who are equally worried, as well as frustrated, about helping their young man cope with the intensity of their psycho-socio-sexual tempest.  Why frustrated?  Why upset?  Even, why angry?  Why do parents experience these reactions to their young man's pain?  Well, for those wondering why a parent would react this way, it is VERY understandable.  Dealing with an individual with a developmental diagnoses often involves huge efforts helping that person manage emotional and psychological dis-regulation.  Once the individual has identified that source of angst, they very often will perseverate and get "stuck" on the issue as they try to cope with the distress, often by trying to figure it out.  When an answer is found, especially one that does not make sense to them or does not meet with their agreement, the perseveration can intensify.
      As parents know, it can be extremely trying to get the person to shift to a different topic or just let it go.  Many times loved ones do not have the endurance to continue the struggle and become frustrated, angry, etc.  It is very common that this time of year especially generates frustration for loved ones because of the triggering nature socio-cultural expectations of our holiday culture.  Being faced repeatedly with not having a relationship, when you have never had one, or have endured a break-up, is likely to trigger a resurgence of thoughts and emotions that may have not been dealt with for a long time.  I have worked with numerous parents around their frustration and anger over seeing all the work they have done with their young man, or the work the young man has done in therapy on their own, seem to disappear to be replaced by those perseverative,  life disrupting triggers that brought them into therapy to begin with.  I have to say, it is also a very discouraging time for me sometimes to see similar situations occur, especially when I have seen a guy make so much progress, only to seemingly fall apart when he sees all of his siblings with their significant other at the once-a-year family holiday get-together.  Such an occurrence can be massively difficult for loved ones to cope with, not just their own frustration, but to be available to their young man to help him re-visit his source of socially fueled torment.  So, enough blah blah blah from me...what can we do to stay sane managing our reactions to processing a topic that we have dealt with more times we can count (while trying not to pull our hair out), while also helping them cope with their reactions?
      Here is a helpful (hopefully) handout to give YOU a hand out figuring what to do.  Maybe, you may also find it helpful for other situations as well, even if they are not related to dating and relationships.  Either way, I would like to wish you the very best of luck and leave you with this gentle reminder that, even without professional training, YOU ARE THE EXPERT on your young man.  Have a blessed Holiday season!

November 13, 2018

"Textiquette" Texting Etiquette for You and Me

Hello Everyone,

I hope you are all well and getting ready for the holiday season.  I have been approached by numerous families of kids with special needs with concerns about using texting as a means of communication during the holidays, especially for communicating with family and friends who they may not get to see in-person.  In response, I have created a fact sheet for parents and other caregivers to use as a guide for helping their child master this skill appropriately and safely.  Please remember that texting etiquette is a set of social skills just the same as "in-real-life" social skills and is much more useful when practiced regularly.  I hope you find this helpful and happy Thanksgiving!

Please feel free to use this resource as you wish, however note that it is protected under copyright and trademark laws.  Please feel free to get in touch with me if you have any questions about using this resource in other capacities besides those for which it is intended.  Thank you!

October 15, 2018

2018 Montgomery County Transitioning Youth-Dating and Relationship Handouts

Hello Everyone,

Thank you for attending the 2018 Montgomery County Transitioning Youth Resource Fair!  The vendors were really great this year and so was attendance.  I am posting my presentation handouts as requested so please feel free to use them any way you want.  Please know that these handouts, and CREEPDAR, are registered trademarks of JMR Counseling LLC. and may not be reproduced for any purposes other than personal use.  Thank you for your cooperation and I hope you find them useful!