Social Skills for Kids

The Alert Program

The Alert Program for self regulation is a wonderful tool for kids (and adults) who struggle with managing their own level of attention. Throughout the day, kids are expected to adjust to the school schedule. They have to jump into the morning bright and attentive, while still sitting quietly and listening to the teacher, then move into socializing at recess, then sit right back down, up and down, all day long. And the demands don’t end with the school day. Kids today have homework, classes, practices and activities. The pace alone can make it hard for any kid to manage, and it’s especially difficult for those kids with ADHD. (A lot of kids on the autism spectrum fall into this category as well, even if they don’t have an official ADHD diagnosis.

The Alert Program was developed by Mary Sue Williams, OTR/L and Sherry Shellenberger, OTR/L to bring together ideas from sensory integration and present them in a way that’s concrete and easy for children to utilize. It was developed for kids, but has been adapted for teens and adults, and I find it useful for almost any age client.

You can learn more about the Alert program from their website, or the book “How Does Your Engine Run?” : A Leader’s Guide to the Alert Program for Self-Regulation.

Book Review: No More Meltdowns by Jed Baker, Ph.D.

No More Meltdowns by Jed Baker, Ph.D. is an excellent resource for parents trying to deal with their child’s out of control behavior, whether the kids have a diagnosis or not. This book is straightforward, with a simple step by step plan for dealing with tantrums and meltdowns. At the same time, there are plenty of detailed examples that show how to fit the simple plan to complex situations.

Certainly parenting is tougher when children have special needs, like an Autism Spectrum Disorder (ASD), Asperger’s or Attention Deficit (ADHD or ADD). And frequently these parents have to also deal with harsh judgment from the world every time their kids act up. Too often, parents are simply told to be firm, be consistent, take control, and their kids will behave. Well, what should parents do if they are firm and consistent, and it still doesn’t help? This book offers some solutions, and since the author has experience dealing with special needs kids, the ideas are realistic and practical for all families.

Baker acknowledges the basic rule of of child rearing, using consistent rewards and consequences. And that’s a good place for all parents to start. But he quickly moves beyond that to a four step plan of action for when this basic plan just doesn’t work. His model begins with accepting the child, then moves on to de-escalating a meltdown, understanding why the meltdowns are occurring in the first place and preventing future meltdowns.   

The real heart of the book is its detailed analysis to understand why meltdowns are occurring, and the techniques to set up a plan to prevent them in the future. Baker breaks down the different issues that might cause problems, then methodically explains how to change the triggers causing the tantrums, teaching the child skills to deal with the triggers, and how to set up a system of rewards and losses.

One thing I really appreciated in No More Meltdowns was the way that Baker exhibits respect and understanding of the children and parents in his examples. These aren’t presented as bad, out of control kids, with ineffective parents. Instead Baker acknowledges the difficulties of these tough situations and focuses on both short term crisis management and also long term skill building. This is a book I’ll be sure to recommend to my clients.

Book Review: Running on Ritalin, by Lawrence H. Diller, M. D.

Running on Ritalin is not just a book about ADHD or medications for children. Instead, it takes  a broader look at the issues involved in diagnosing, treating, and prescribing for our children. Although the book focuses on Ritalin and ADHD, much of the material is also applicable to other situations, such as those children with other diagnoses, such as autism, and those taking different medications.  Since Running on Ritalin (Bantam Books, New York) was published in 1998, it may be a bit dated as far as medicines and statistics, but the advice for parents and the general themes more than make up for this.

Dr. Diller is unusual in that he was not only trained as a Pediatrician, but also as a Family Therapist at the Mental Research Institute in Palo Alto, CA. Because of this unusual background, Dr. Diller is able to discuss treating his clients with both family therapy and medication. In his book, he takes a moderate, middle of the road stance, defining ADHD as stemming from both brain chemistry and environmental factors, such as school and parenting demands. The author looks into many of the factors involved, such as the impact of modern society and educational expectations, the strain on school resources from having so many children needing special services, the demands on parents, and the ethics of medicating children.

That moderate, balanced view, backed up by published research, is really the strength of this book. As far as treatment, Diller recommends a multimodal treatment, which may include medication, individual and family counseling, and special educations services, as appropriate. He backs this recommendation up with both published studies, (Unfortunately there are not a lot of those out there.) and anecdotes from his own patient experiences. As a therapist myself, I know that my clients may need a variety of different approaches in order to function at their best level. As a scientist, I always appreciate when authors back up their statements with data and published studies.

Dr. Diller is also balanced in his viewpoint of the diagnosis. “... I feel a bond with those who want society to appreciate and adapt to the range of diversity in children’s personalities. On the other hand, I recognize that the ADD child must learn to cope with socially approved expectations and responses, and that this may sometimes require the use of medication. It seems to me critical to raise questions about a society where several million children are taking Ritalin. In everyday terms, however, children and families must adapt to social norms, while we work on broader levels to make room for all kinds of people with all kinds of strengths and weaknesses.” (p. 217)

There’s also an interesting chapter on special accommodations for those with disabilities, both in school and the workplace. This has always been a tough issue, and it only grows more so as our school budgets get stretched tighter in this economy.

In general, this book probably raises as many questions as it gives answers, but they’re important questions, questions we all need to be asking.

Sex Education for Kids and Teens with Autism and Asperger's: A Conversation with Sarah Attwood

Puberty and sex can be tough for any parents to discuss with their children, but it's important. And for kids, preteens, and teenagers with autism and Asperger's, sex education is vital. Kids on the autism spectrum may be less socially sophisticated than peers, but their physical development will progress regardless if they, or their parents, are ready to handle the changes. For your child's safety and happiness, parents need to put aside any reservations and start discussing sex!

Today, I'm talking with Sarah Attwood, the author of Making Sense of Sex: A Forthright Guide to Puberty, Sex and Relationships for People with Asperger's Syndrome. (Jessica Kingsley Publishers, 2008) Ms Attwood has been a sexuality educator in Australia for fifteen years, and has worked extensively with parents and their preteen and teenage children.

Patricia Robinson: Sarah, your book is different than other sex education books because it's specifically written to adolescents with Asperger's Syndrome. How is the information in your book tailored specifically to those on the autistic spectrum? What do you think are the special concerns and issues of teens with autism and Asperger's?

Sarah Attwood:You're quite right, Patricia, that young people on the autism spectrum are going to go through the changes of puberty in exactly the same way as all other people, and for this reason they need exactly the same information as everyone else. However, the nature of autism and Asperger's syndrome means that there are some specific issues which usually aren't addressed in regular puberty books, and that's why Jessica Kingsley asked me to write Making Sense of Sex.

Lots of regular puberty books use contemporary language - 'teen talk', if you like - and while this can be fun and amusing, it isn't always to everybody's taste, so I decided that it was more important to treat the subject with respect, and use a straightforward, factual tone (hopefully not too deadly serious, however!). I took into consideration that most people with ASD enjoy facts and appreciate being able to apply logic, so I have always explained 'why' as well as 'what'. An example of this is when I discuss hygiene (an issue for a lot of adolescents, whether or not they have ASD!). I explain EXACTLY what causes body odour, which bits of the body are affected most specifically, the reasons why it is important to wash regularly (health as well as social reasons), and exactly HOW to wash. I don't assume knowledge or make generalisations that can be misinterpreted. Because of the love of knowledge that most people with ASD have, I have provided plenty of facts. For example, the usual rule in sexuality education is to avoid giving young people any sort of hang-ups by giving facts and figures regarding penis size; it's standard practice to say something like 'Whatever size your penis is, is exactly right for you.' This isn't clear enough or reassuring enough for young people on the autism spectrum, however. So I have given specific measurements of both flaccid and erect penises (of fully grown men), and plenty of other reassuring facts about penises, so that there is no room for confusion or doubt.

I have also been careful throughout the book to use correct terminology, with a view to modelling this so that adolescents know how to talk about sex in a respectful way, and can make themselves understood. There is a whole chapter dedicated to the subject of sexual language (including slang), as young people with ASD so often miss out on what is current because they aren't included in teenage groups.

There are some social issues surrounding puberty that can be veritable minefields for young people with ASD, and which are often not included in any detail in regular puberty books - namely, the rules that surround sexual behaviour (especially public vs. private behaviour, body parts, places and language); friendships; coping with teasing, bullying and peer pressure; and handling strong emotions (a particularly important issue for people on the autism spectrum). So I have included whole chapters on these subjects, with some specific guidelines, laid out in dot point format for easy reference.  All young people need someone they can turn to when they have questions or anxieties, and research shows that most youngsters would love to be able to talk to their parents about sexual issues. Many don't, however, often due to their parents' discomfort with the topic, instead turning to their friends for information (or misinformation). Adolescents on the autism spectrum may not be able to turn to a group of friends, so it is absolutely vital that parents and carers fulfil the role of mentor. There is no place for squeamishness or embarrassment - parents and carers MUST educate themselves and be there for their child. Throughout the book I make reference to the young person's social mentor, and give many pointers as to the role this person may take in terms of providing reassurance and guidance, giving accurate information, and helping with friendship skills and emotion management.

At the end of the book, I provide quite an extensive list of resources, both for parents and for the young people themselves. Some of these are specific to people on the autism spectrum and some are mainstream but still very relevant.

The book is illustrated with diagrams and cartoons to provide both detailed information (anatomical drawings etc.) and fun ways of viewing some of the points made in the different chapters. I hope these illustrations make the book more accessible and reader-friendly.

Patricia Robinson: Thanks for your comments!

Book Review: Asperger’s and Girls

Asperger’s and autism are diagnosed much more frequently in boys than girls. But that doesn’t mean there aren’t many girls and women dealing with autism and Asperger's. The book Asperger’s and Girls (2006, Future Horizons) addresses the female part of the spectrum.

The book is compiled of chapters written by different individuals on different topics, such as education, puberty, dating, marriage and relationships. All the authors are either well known experts, such as Tony Attwood or Temple Grandin, lesser known authors, or individuals with their own or family connections to the autism spectrum. Although the quality of the writing varies, the tone of the book is positive and much of the material is useful.

For this review, I want to focus on one chapter, "Girl to Girl: Advice on Friendship, Bullying, and Fitting In", written by Lisa Iland. At the time of publication, Iland was a college student who’d gotten interested in this topic because of her interactions with her brother, who is on the autistic spectrum. In this rapidly changing world, it can be tough for parents to really understand what high school is like, so a younger person’s insights can be especially useful. Although the chapter is aimed at teenage girls, much of it can be useful for boys as well.

Iland covers ideas such as personal style, social hierarchies, and levels of friendships. Although it’s already getting out of date, there’s information on popular social conversation topics, like TV shows and music. (Lots of girls on the spectrum may avoid pop culture, often to their parents relief. Still, it’s hard to join in the conversation if you haven’t read the book or seen the movie that everyone’s talking about. I think it more effective when parents read the book or see the movie also, then have a conversation with their daughter about their concerns.)

The chapter includes lots of examples and step-by-step instructions on starting a conversation, making new friends, and dealing with bullies. Why don’t you check it out and see if it might be helpful for your child?

Twilight, Girls and Asperger's

What does a teenage girl's vampire movie have to do with Asperger's, autism, and social skills? Plenty! Nobody who works with girls, neurotypical or those on the autism spectrum, can avoid it: Twilight is everywhere. The four book series, by Stephenie Meyer, is currently ranked 2,3,4,and 5 on the Amazon bestseller list. The movie, which opened November 21, was the top ranked movie in the US and is currently in 3rd place.  Certainly, a lot of the interest is drawing from neurotypical girls. At the same time, this story may be especially appealing for girls with Asperger's.

Autism and Asperger's are disproportionally diagnosed in males. Most of the autism literature looks at a male behavior patterns, and only recently has there been much written about the specific traits and behaviors of girls on the Autistic Spectrum. Social skills difficulties can be especially difficult for girls, because their peer interactions are governed by such complex rules, and social expectations are much higher for them. Many school aged girls with Asperger's and autism suffer for years from excruciating feelings of loneliness, being different and left out, and not fitting in.

The Twilight series connects to those left out and different feelings, and it provides a fantasy of a romantic hero and an eternal connection. Just what lots of girls with Asperger's may be looking for.

For starters, Bella is a fantasy teen heroine for any girl who’s struggling with fitting in. She’s the new girl at her tiny school, one where everyone else has been together since kindergarten. She describes herself as pale, non-athletic, and soft. Much of the story involves Bella tripping, falling, and humiliating herself in P.E. And when she describes her personality, it’s, “I didn’t relate well to people my age. Maybe the truth was that I didn’t relate well to people, period.... Sometimes I wondered if I was seeing the same things through my eyes that the rest of the world was seeing through theirs. Maybe there was a glitch in my brain.” (p. 10) Somehow, in spite of this description, Bella easily makes friends in her new school, breezes through academics, and manages to get the boy of her dreams.

Edward, her love interest, can represent all the popular, athletic, handsome, yet out of reach boys at any school. At the same time, he too is that outsider, not even human, yet somehow above the crowd rather than excluded from it.  Bella describes him as “devastatingly, inhumanly beautiful.” He may be officially 17, but he has a maturity not matched by the awkward other boys at the school. Edward is confident, impossibly strong and capable, and completely uninterested in the girls in the school. Except Bella, whom he can’t resist.

Their relationship is intense and forbidden, and it continually balances the themes of danger and safety. Edward is bossy and volatile, while at the same time protective and strong. The relationship revolves around their sexual energy, yet the two can barely touch. The couple bickers continually throughout the book, Edward repeatedly warns Bella that he’s dangerous to her, but she isn’t afraid. Throughout the book, Edward instinctively uses his magnetic good looks and velvety voice with woman, but he doesn’t even notice their attraction. It’s only about Bella. Is it any wonder that this story line appeals to young girls who long for a safe connection?

What does this mean for parents? This story may very well develop into one of those special interests your daughter has. Some parents may object to the intensity of this interest, or the dysfunctionality of the relationship. Certainly, fantasy is no substitute for real experiences, but your daughter may not be experiencing much real connection in own life. The Twilight story can become a safe way to experience and practice feeling of social connection, even if it’s not a realistic setting. Experienced emotions can help individuals with Asperger’s generalize learning, so an identification with Bella may allow your teen to grow emotionally.

If your daughter loves this story, why not go to see the movie with her or read the book yourself? It’s the perfect opportunity to glimpse her world a bit, to see and experience from her perspective. Think about all the ways your daughter may feel like Bella, awkward, alone, not fitting in. Connect the grey and rainy town of Forks with her experiences of preteen and teenage years. Remember your own school experiences, maybe times you felt left out, different, or chosen and special. Twilight isn’t a deep, psychological drama, but it’s a simple story that may help you understand and feel more connected to your daughter, and a way your daughter may be able to experience her own connectedness.

An Inside Look at Asperger's

Look Me In The Eye: My Life With Asperger’s, by John Elder Robison, is an insightful and fun book for parents of kids on the autism spectrum, as well as older teens. It’s also an easy way for others, such as teachers, caregivers and extended family members, to connect with and understand the unique ways that people on the spectrum may be thinking. The author does a great job of relating the events of his life from an observer’s perspective, while explaining his internal thought process at the same time. Many parents already understand how their kids are thinking, but it can be difficult for others with less familiarity with the autism spectrum.

The author first achieved a small amount of fame when his brother, Augusten Burroughs, wrote about him in his own book, Running With Scissors. Burroughs then encouraged Robison to write his own memoir about growing up with undiagnosed Asperger’s. The result is Look Me In The Eye. Look Me In the Eye is that great combination of funny and entertaining, while giving the reader a close up viewpoint about what it was like to grow up feeling different, misunderstood and like a misfit. Robison writes about his childhood and adult life, and he’s introspective and forthcoming about what was going on for him as he tried to figure out how to make friends, follow social rules and use his impressive intellectual gifts.

One interesting chapter is early in the book, where Robison discusses his earliest friendships. It’s heartbreaking to see the problems he has in connecting with other children in spite of his well meaning, friendly advances. Robison clearly points out his own limited way of thinking, for example, he couldn’t conceive of the fact that there might be more than one way to play in the dirt. His preschool attempts to make a friend are rejected when he can’t pick up on the cues his companion is sending, something many parents are all too familiar with in watching their own children.

Robison also discusses how he makes some slight behavioral changes after learning of his diagnosis. He worked on making more eye contact, followed more neurotypical rules for conversation, and made more small talk. His result was that he suddenly made a lot more friends and was included in social functions. At the same time, Robison doesn’t give up his quirky personality. He’s unusual and brilliant, and seems to succeed professionally and personally because of that. Maybe that’s the best part of this book. While taking a clear and honest look at the problems the autism spectrum may bring, the gifts of autism are even more apparent.

Recommended Books for Asperger's, Autism, ADHD and Parenting

Please check out the new list on the side of my blog! I’ve added some favorite books on the topics of Asperger’s, Autism, ADHD, other special needs, and parenting in general. These are all books which I’ve read and enjoyed, that I think will be helpful to parents, and they’re books I recommend to my clients.

Parents of kids with special needs seem to be some of the most well read, well educated parents out there. I think in part it’s because the answer aren’t clear. No one has all the answers about what causes ADHD or Autistic Spectrum Disorders. No one knows the best treatments and what will help any particular child. But there are some answers out there. Researchers, therapists,  doctors, parents, teens, and kids, are all writing about their knowledge, experiences and what’s worked for them.

I’d love to hear from you. What books did you find most useful? What books do you recommend to other parents? Is there something in one of these books that you didn’t find to be helpful? If you comment here, I’ll try to leave your recommended books in the comments sections. If I read it and find it helpful, I’ll add it to the recommended list. Thanks for your comments!

Book Review: ADHD & Me, by Blake E. S. Taylor

ADHD & Me, written by Blake E. S. Taylor (2007, New Harbinger Publications, Oakland, CA) is a memoir about growing up with Attention Deficit Hyperactivity Disorder. The author, currently a student at UC Berkeley, has a charming and very real voice throughout the book. Sometimes the book reads almost like a high school science report, which I think makes it more accessible for young readers. I recommend this book as something parents can read to help understand their own child with a diagnosis of ADD or ADHD. More than a book for parents though, I think it’s a great read for kids trying to deal with their own diagnosis.

Because the book breaks down into chapters dealing with different issues, such as “being disorganized” or “being unpopular” it can be useful for kids dealing with all sorts of social, home, or school problems, whether it’s due to ADHD, autism and ASDs, Asperger’s syndrome, or non-diagnosed issues with executive functioning or reading social cues. For each chapter, the author begins by presenting an illustration from his own life, showing how the specific issue impacted him. He then moves into his own analysis of why this issue comes up. Each chapter ends with the author’s suggested solutions for how to deal with the issue. Because the author just recently graduated from high school, his ideas may be more realistic than those of adults who were in school years ago.

For children and their parents who are feeling mistreated by a world that doesn’t always accept those who are different, this book could be a great support. The author comes right out and discusses the ideas of being treated unfairly by peers in chapters such as “being bullied” and “being isolated” while at the same time looking at his own contribution to the problems. He’s also direct about discussing the negative attitudes he’s encountered from adults, in chapters such as “being discriminated against” and “being blamed”. There are empowering ideas here for kids who are struggling with the realities of dealing with both peers and adults.

The best part of the book is the final two chapters, “taking control” and “being gifted”.  In ADHD, as with any difference, there are strengths as well as difficulties. Too often children, parents, and teachers are focused on the issues and their solutions, and the gifts and advantages that come with that difference are overlooked. The author lists all the ways in which his ADHD diagnosis can be a benefit, such as creativity and high energy. Seeing this list in a published book may be just what a child needs to be able to take a fresh look at his or her own diagnosis.