March 11, 2020

A Picker's Perspective On Self-Picking Behavior During The Corona Virus Pandemic

Hello Everyone,

      I hope you are all well and staying safe.  This month's post is intended as a follow-on from my previous post about how to fidget and 'get away with it", albeit with a twist to reflect the growing concern around the corona virus.  Quite understandably, there have been numerous articles with suggestions about how to limit being vulnerable to acquiring the illness, not to mention the hundreds about being a vector for the disease.  Many of these articles have a focus on limiting touching parts of the body, particularly the face, which are quite reasonable and valid.  While I fully support, and actively encourage these practices, as an inveterate self-picker, it is my hope that this month's post will provide A SELF-PICKER's PERSPECTIVE and bring some attention to some of the more significant challenges likely faced by self-pickers in their efforts to adapt their behavior to the demands of the times.   I also hope it will help increase empathy around this particularly physical fidgeting behavior.

      Before getting into suggestions for how to work with picking instead of against it, it may be helpful to explain it in "everyman" words.  Quite simply picking is a physical action where the hands are used to grab onto an object and by applying force in the opposite direction (pulling, tugging, rending, tearing, etc.) seek to remove the object from what it is attached to.  A self-picker, such as myself is someone who picks at their skin, hair, nose, or other part of the body.  Self-picking is considered to be a fidgeting behavior because of its repetitive motion and use during times of assumed discomfort.

      Historically, self-picking has been viewed as a very observable and destructive behavior with no foreseeable goal except futile repetition.  The idea of using one's hands to destroy their skin or hair has historically been viewed as aberrant ie. socially inappropriate to the point where those who picked at themselves were stereotyped as "spazzers" or having some form of severe mental defect.  While, self-picking may seem random and pointlessly repetitive, there are many reasons why we pick and even more so, why WE HAVE DELIBERATELY CHOSEN TO PICK, instead of utilizing other behavior alternatives.  You may end up being surprised at the complexity behind our behaviors

Why I and other self-pickers pick: NOTHING BETTER, EASY, QUICK, UNCONSCIOUS, A GREAT OUTLET, REWARDING, CONTROL

NOTHING BETTER-The vast majority of us self-pickers DO NOT PICK BECAUSE WE ENJOY PICKING AT OURSELVES.  We often do not believe we have suitable alternatives to picking; in fact most of us have relied on self-picking since a very young age.  We made the association early on between self-picking and relief from any number of symptoms that it was quickly reinforced.  I pick because it meets my sensory and mental/emotional regulatory needs during high stress/high energy times.  Self-picking has happened to be the most effective tool I have historically had available throughout my younger life, especially since behavior alternatives did not provide the necessary wrap-around relief to meet my different needs. 
Just like when behavior plans don't work, picking alternatives are most effective when they provide a way to get the same rewards while also meeting a goal.  Often times the alternatives to picking and fidgeting do not provide all the components of relief we get by engaging in self-picking.  For many of us, I myself included, self-picking ended up being the replacement behavior for more visibly obvious behaviors such as hitting, tantruming, making noises, random movements, etc. that often resulted in our shaming because of their social inappropriateness.  In a way you might say that a big (not all) aspect of self-picking, in all its ferocity, is a result of being driven to conceal what was the most effective way to release emotion.

IT IS EASY-first, foremost, and so far not acknowledged in any of the articles about encouraging less frequent face/body touching.  Self-picking does not require multiple steps to engage in as would be involved in reaching for a stress ball or other object.  We are our own source of relief, self-contained Swiss Army Knife of self-soothing.

IT IS QUICK-Many self-pickers struggle with impulsivity, often times because we also have some other diagnosis associated with picking behaviors such as severe ADHD, anxiety, and/or depression.  Our impulsivity is not only rewarded with a quick solution, but it gets reinforced, especially when we get such quick relief for the symptoms we are seeking to alleviate by picking.  This is especially true for us who perceive blemishes or "aberrant parts" that feed into illusions of control, when we perceive we have none, and need to be removed.

UNCONSCIOUS-I am usually not aware I am picking until I either hit some form of physical resistance or I happen to see myself picking.  Picking has been so ingrained into my brain that, even though I have effective alternatives now, I go to it first out of habit.

REWARDING (NOT NECESSARILY POSITIVE)-Self-picking provides sensory stimulation to many parts of the body, particularly to the parts doing the picking and those being picked.  Picking can be ruminative (repetitive) and as such not only the physical input we are receiving through our skin, but the repetition of the behavior creates a consistent and controllable flow of sensory input.  Also, it is a quick way to distract oneself or avoid negative emotions.  Self-picking is a repetitive cycle.

ILLUSION OF CONTROL-As a self-picker, with severe ADHD and social anxiety to boot, being out of control whether by anxiety or some other external situation outside of my control very dis-regulating, which itself can be extremely uncomfortable physically, emotionally, and mentally.  With picking I can control the speed, intensity, pressure, movements, and the physical sensations that come from picking.
Many of us also pick at ourselves when we are very anxious as a means of trying to control the disruptive anxiety that is coursing through us.  We may also engage in self-picking behaviors as an unconscious way of projecting our lack of control onto our physical selves to give the illusion that we have some control by how we interact with our bodies-picking and depression go hand in hand.

So what would self-picker me like for you to know when working with me and other self-pickers?  What do we want you to know about what's going on for us even though there is a pandemic being spread by transferring germs through touch?

DO NOT SHAME US! Self-picking may be largely unconscious but it is a behavior that most of us would not choose to have if we had other viable alternatives that actually worked.  Do not draw attention to our self-picking as if we are commenting a selfish crime fully knowing about how the corona virus is spread.  Again, many of us self-pick because we have been shamed into it from a very young age. 
With respect to getting us to become more "mindful" of our self-picking, paying attention to how many times we touch ourselves can serve the negative purpose of reinforcing that we are doing something wrong and that we have really weak self-control.  Not to mention the way negative terms like "impulsivity" and "lack of awareness" get roped into such self-examinations, there is the increased likelihood of identifying the behavior as "bad", and therefore a negative reflection on us.

CHANGE IS HARD!  It's all well and good to take into account how often we might touch ourselves, but actually doing something about it is extremely difficult.  Remember that self-pickers have had a life-time of learning that picking serves many purposes and meets many different needs.  It is impossible to simply decide that many years (in my case 34) can simply be pushed aside and overridden by adopting new techniques.  We need compassion and patience.  Even one less incident of picking on a less than consistent basis would be a victory, especially in the beginning, for a behavior that is as entrenched as it is.

PRIMARY NEEDS MUST BE MET FIRST!  When I get dis-regulated, whether by anxiety, or some other stressor, particularly those of a sensory nature, my first focus is going to be on getting myself back to center.  That does not mean that I have no regard for others or how my actions affect them.  Simply put, I am going to respond first to what is easiest and quickest to fix before going to the more complex stuff.  I am not capable of engaging higher level thought processes about cause and effect if my more basic biological needs are not met. 

PLEASE BE PATIENT!  The corona virus pandemic is very new to us and likely as anxiety/fear provoking for us as it is for you.  That will likely contribute to our becoming more dis-regulated and needing to utilize our self-picking as a regulating tool until we have found something that works as well and is more appropriate.  We are not self-picking to be willful or send a "screw you" message, despite what you might think after having told us a bunch of times to stop picking.  Remember we're being asked to change a particularly deep-seated behavior on short notice.

ALLOW US OUR FRUSTRATION!  We do want to comply.  We do not want to be targets for other peoples' negative reaction or bullied.  However, while we are working on changing the behavior and finding a replacement, we will get frustrated!  Allow us to experience it and share that experience.  You can rest assured that we will put ourselves under tremendous pressure to avoid further threats of shame.  We also want to be respectful and succeed despite the guaranteed numerous failures we will encounter along the way.  Those failures will contribute all the more to our own negative self-assessment; for those of us who already struggle with negative self-concept (which self-picking can be a strong indicator) these failures will be internalized and likely weaponized against ourselves.

REPLACEMENT ALTERNATIVES MUST MEET NEEDS!  As noted above the reasons why I pick are many and serve many important purposes simply beyond being an anxiety reducing behavior.  Replacement behaviors for self-picking need to be easy, quick to access, and capable of meeting not only extra energy needs, but sensory ones as well as emotional/mental needs.  For many of us, the underlying quilt of co-existing challenges requires us to utilize more than mindful meditation or another fidget.

Thank you for taking the time to read this post.  I hope it provides some insight into what goes on behind the scenes for a self-picker and what we need in order to be able to make changes.  Please check back soon for my next post, which will focus on self-picker identified behavior alternatives for picking behavior! 

February 3, 2020

Understanding Face Expressions Is Hard: Featuring Darth Vader!

Hello Everyone,

    I hope you are well.  I wanted to a quick post in response to a challenge, one of the kids I work with, told me about in our last session: accurate interpretation of emotions based on facial expression.  I asked him what he thought was so difficult and he did not respond except to show me a picture of a birthday card, which said "Darth Vader's Emotions".  He then went on to explain that one of the biggest struggles he faces as a young man with autism is being able to understand others' emotions based on their facial expression.  Darth Vader, he said, is how he experiences attempts to understand visual signals, noting that to him the face looks largely the same and provides as much information as an unchanging mask.  The picture of Darth Vader was very simple and only contained a couple of emotions, along with no further information about what they meant.  To be fair, this was a greeting card, yet the client's connection was very clear.  Together we decided to create an expanded identification guide for emotions based on how he experienced them for sharing with his family and team of supporters.
      When you are looking at the "Darth Vader Facial Emotions Recognition Chart", I would like to encourage you to take a moment and consider what it must be like to be taught about, and expected to use, appropriate and congruent facial affect; to be taught and expected to do without being able to rely on yourself to interpret the correct result.  Also, please pay attention to the fact that there are a greater number of emotions identified (ones picked by the client according to their importance to him) and there are no definitions of what they mean, no definitions of situations where they can be encountered, and no definitions of nuance.  How would you define these emotions to someone who does not connect to them like we do?
 

January 16, 2020

Fidget Fun Without Getting Unwanted Attention

Hello Everyone,

      I hope you all are having a positive January and a great start to your new year.  I am what you would call an intense fidgeter; I have been that way my entire life.  For me, fidgeting was the first basic tool I learned to try and help me manage my severe social anxiety and ADHD.  Despite being harmless, fidgeting presented a number of important social and academic challenges.  Attention and focus was  much harder when I fidgeted, especially when I was in a class I did not like or when I was bored.  When I was in school, or anywhere, we did not have access to putties, slimes, spinners, squishes and so on so fidgeting usualy took the form of what was easy and quickly available: skin, clothes, hair, pencils, paper...These were all highly visible and more often than not resulted in unwanted attention in the form of a reprimand or unwanted attention from peers and adults.  Often the result was teasing, shame, and humiliation; when I was in school kids who fidgeted were considered weird or "SPEDs" and "spazzers" because of the constant, sometimes erratic movement.  A lack of information on their part did not help, especially when seeing a kid destroying a piece of paper for no obvious reason.
      It took me years to figure out how to meet my fidgeting needs, which I learned later in life was based on a more basic and critical need: internal calm.  Fidgeting helped me get that internal calm so I could be more mentally available to learn skills to manage ADHD and anxiety. For many kids like myself, and regardless of diagnosis(es), fidgeting is a behavior that is not worth fighting, but working with because it's easy and meets the most important basic need of internal calm.  FIDGETING CAN BE SUCCESSFULLY BLENDED WITH FOCUS.  Fidgeting does not need to be embarrassing or a source of mockery, yet it needs to be done plan-fully and intelligently.  This month's post is all based on my learned experience of fidgets and how to fidget without getting negative attention, whether it's from a parent, teacher, or other kid(s).

Please note that this post focuses on addressing the physical actions of fidgeting.  There will be another post about fidgeting and sensory challenges, including how to incorporate fidgeting into a sensory diet.

Why fidget?  The reasons why kids fidget are innumerable and beyond the scope of this post, yet they all share a similar underpinning: the basic need to achieve a state of equilibrium, a state of internal calm.

What does fidgeting mean? To fidget means to move parts of the body in any way not associated with movement considered necessary to functions needing to be performed at the time it occurs.  For example, rubbing fingers together while using a chrome book to take class notes, would be considered fidgeting.

Who fidgets?  Anyone and everyone.  Fidgeters are more often found in kids with developmental diagnoses where fidgeting serves a purpose of maintaining a sensory as well as cognitive organizational purpose.  Many kids with anxiety, PTSD, ADHD or who are just active fidget as a way to release pent up energy that causes distress.

Why do fidgeters get in trouble more often? Why are they more noticed?  Kids who fidget often get more unwanted attention from peers and adults because they are not subtle about it, meaning that their fidgeting behavior is highly visible.  The nature of fidgets being used, such as spinners, slimes, squishes, and putties, are not easy to conceal and are not at their most effective unless there is ample space to use them.  Doing so draws peers attention as more interesting, which will also get the attention of adults.  Fidgeters also tend to get more distracted by their fidgets, especially when they are engaged in an unpleasant task that contributes to their internal calm being messed up, an example being a kid who hates math, is not good at it, and fears failure, may be more likely to fidget as a way to manage the anxiety and avoid facing the work.

SMART FIDGETING IS MINDFUL FIDGETING!!  When fidgeting, it is really important to remember that when you fidget with parts of your body (picking, shaking, flicking, rubbing, shaking, etc), clothes, large objects, you will get attention.  People who fidget have more success avoiding unwanted attention when they fidget with items that are easy to access, small, and can be kept out of sight of others.  Large items such as spinners, squishes, putties and the like, can be easily replaced by less noticeable items that can serve the same purpose just as effectively while also meeting other critical needs such as sensory regulation.

What else do I do to fidget mindfully?
Replace larger items and body movements with smaller items and movements.
Pick items that are of little to no financial or sentimental value.
You want to use items that can easily be replaced because you will lose them and break them.
Pick items that will fit into confined areas that you can fidget with out of sight of peers and adults.
The best place is in an easy-to-reach-pocket.
You are trying not to be noticed so keep the items in the pocket and feel them with your hand, keeping it in the pocket while you feel the objects.
Use your hand to explore the objects by moving them around with your fingers slowly and gently so you can experience their sensory offerings.
KEEP THE ITEMS CONCEALED!!!  Choosing items that are boring and lack interesting visuals can help.
Pick quiet items; making noise will attract attention.
Pick a number of different items that can meet your sensory as well as fidgeting intensity needs.  These do not need to cost anything and most of them can be found in your home.  Here are a few suggestions!

popsicle stick-firm and provides some texture while being thin and easily concealable
cotton ball-soft with some give that facilitates smooth circular rubbing motions; can take pressure and return to shape
large bean-smooth and hard while providing a unique shape
smooth pebble-more durable with a bean, providing firmness and texture
marble-round and very easy to move with fingers; not the best for firm pressure; excellent for rolling
rock-can provide many different textures, shapes, and durability for intense rubbing or moving
bottle cap-combines shape, different textures, small size, and durability all in one; center great for pushing and heavy rubbing while maintaining shape
coin-convenient to get, small, takes up little space and combines textures, firmness, and broad surfaces for rubbing, pushing, and moving around in hands
small pom pom-soft and excellent for squeezes or rubbing
single lego block-serves same purposes as bottle caps and rocks with high durability for intense fidgeters
paperclip-combines unique shape with firmness that is also flexible and can bend under pressure; excellent for intense outputs of physical force whilst bending
textured cloth-excellent for rubbing, stroking, picking, as well as a container for other fidgets; can wrap other fidgets in cloth for additional sensory stimulation; can also fill with pom-poms for quick stress balls
sandpaper-rough texture for under stimulated individuals, very compact and excellent for seekers of intense tactile response especially when scratched
eraser-excellent alternative for pickers; provides firmness and resistance yet will give under stronger pressure and strongly replicates sensation created by sudden loss of resistance when picking motion is completed and fingers are no longer in contact with object being picked
chapstick container-multipurpose for a range of different fidgeting needs; removable parts, smooth surfaces for strong and rubbing; easy to move around; can be small and compact

Can you think of others?  I bet you can!

Thank you for reading my post!  I hope it was helpful and gave you some ideas.  Please come back for my next post when we will focus more on the sensory side of fidgeting.

November 13, 2019

The ABC's of Dating and Relationships

Hello Everyone,

I hope you all are having a very happy November and are getting ready for the holidays.  This is the first post I have done in several months as I have been working on a new project with a focus group consisting of young adults with Autism and other developmental diagnoses.  I am really excited to share the first part of our project called "THE ABC's OF DATING AND RELATIONSHIPS".  We took each letter of the alphabet and assigned a different concept, tool, or observation about the whole process of dating to it based on the first letter.  We then brainstormed several "facts" about each of the identified concepts that the participants wished they had known, but did not, before starting out on their own dating journey.
Starting with this first round of advice on dating and finding relationships, by young people with developmental diagnoses for other young people with developmental diagnoses, we are hoping to expand on the range of topics, concepts, tools, and challenges that are faced by everyone looking to date, but are more challenging for those who live with developmental diagnoses.  We have included a "teaser" about texting etiquette called "textiquette" (copyrighted 11-02-2019) of one potential format.  Eventually, we are hoping to create a "living and evolving" resource that can serve as a handbook on dating and relationships, but with a focus toward addressing the unique challenges faced by this particular community.  We hope you find our initial effort as fun and informative as it was for us to create.  Thank you!

(Please note that the following document is trademarked and copyrighted for the purposes of protecting and honoring the group member's intellectual property.  This document may not be re-duplicated or disseminated in any way without express permission from myself and the group members)















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.