Teaching Social Skills to Kids with AS as Opposed to Blaming Them

Ben was in science class with his sixth-grade classmates. Stuart was seated next to Ben, and he was moving, moving, moving the container of seeds closer, closer, and closer to the edge of “STOP THAT”. Ben said to Stuart. Ben’s paraeducator asked Stuart to put the container back to its proper place. Done. Back to science, right? Wrong. “WHY DID YOU DO THAT STUART?” Stuart smiles at Ben. Ben then wonders to himself, “Why did he smile at me? Is he laughing at me?” “WHY DID YOU DO THAT STUART?” Stuart does not answer. “WHY DID YOU DO THAT STUART?” Then, Ben’s gone. Removed from the classroom because with each “WHY DID YOU DO THAT STUART?” his anger increased with his volume level.

Five minutes after this happens, I receive an email (because I am seeing Ben later that evening) from his well-intentioned case manager. Parts of the story were recounted — basically, Ben yelled again, Ben was removed again, Ben is in trouble again — and then the bottom line, “I had a STERN conversation with Ben. He KNOWS he can’t do it.” Again.

He’s “known” for a long time that yelling in class was “wrong”. If a stern lecture was the antidote, then, I guess we’d all have the cure to autism. This teacher is a well-trained professional whom I respect highly. We’ve developed a great system of communication in order to provide more comprehensive, targeted support for Ben. But, when I saw him tonight, I knew I had a foundation to lay. Yes, Ben lacks the coping strategies for managing his anger more appropriately and we could continue to provide him more deep breathing techniques, another “recovery spot”, a visual cue for how to request a break. These are all great ideas, but they are too late and miss the mark.

The issue is WHY Ben is getting mad. Well, Stuart broke a rule. You and I might realize that this rule isn’t a commandment, but Ben lacked that frame of reference. He wanted that rule enforced, and, even more basic than that, we had to discuss WHY people break rules. (That is not a simple conversation, by the way. Ben asked for a Top 3; my take was: to have fun, because they can, and because it makes them cool. Again, though, try explaining each of those!) Then, we had to build an internal assessment system in Ben’s head so that he could decide WHEN it mattered if a rule was broken. Does it hurt me? If so, do this. If not, do that.

Contrast this process with: Ben, stop yelling. I NEED THE ANSWER. Ben, stop yelling. I DON’T UNDERSTAND. Ben, let’s leave the classroom. I DIDN’T DO ANYTHING WRONG. Ben, you can’t do that. I KNOW THAT BUT I DON’T UNDERSTAND WHY HE BROKE THE RULE.

Why not address these social issues? Is it too hard? Yes, it’s a long, winding road. Does it take too long? Cynically, I say yes, when we want no disruptions in the general education classroom. But, clearly, NOT addressing these social issues is only producing more. So, ironically, it takes longer not to address these issues. Ultimately, though, in Ben’s situation, the support staff missed the forest for the trees, having no idea of what Ben didn’t know they focused on what Ben didn’t do.

“Tsk, tsk, Ben, don’t do it again” is an ill-fitting bandage to a systemic skill deficit in ASD.

 

Boys in Social Skills Group: “My Autism is Forever” versus “My Autism Used to Be”

Whenever a new member joins a group, we do what the kids call the NOOB game. In this game, they are given a set amount of time to figure out a fixed number (usually their age) of things they have in common. These commonalties cannot be what I call “no duhs” — they have hair, they are boys, they have feet, etc. Today, the boys eagerly requested the NUBE game with the addition of Vic.

The game usually begins with pizza, video games, ice cream, and Star Wars. Until today. “Do we all have diagnoses of Asperger’s, autism, or AD/HD or something like that?” asked Trevor. “Asperger’s”. “Bi-polar Disorder.” “Not me. I used to have autism, but not any more.” Trevor said, “Wait, dude, if you have autism, you have it forever.”

I can honestly say that this topic has never come up in group, which, now that I think about it, is somewhat surprising. Most days, no stone goes unturned. I was caught off-guard today and I know that I didn’t do the topic justice. In fact, we didn’t “do” the topic at all. Both boys were adamant that they were correct — Trevor that autism is forever, and John that he “used to”. They didn’t argue, rather they just shutdown. So, we moved on.

The question that remains for me: How do I reconcile this contradiction for Trevor and John and the others?

 

A Kid with Asperger’s Pays It Forward and I Smear My Mascara

I could not sleep last Thursday, February 17, 2011. I was awake until 4AM Friday morning, fretting, thinking, rethinking, analyzing, and regretting. I tried all of those cliched home remedies — warm milk (I’m not a fan of milk, so that was my level of desperation), melatonin (6mgs when I usually take 1mg), reading in low light, boring television, counting sheep, a deep breathing routine. Nothing. I hadn’t been that anxious about something in years.

Earlier that morning, I visited Christopher’s house. Well, I thought I was visiting Kim, Christopher’s mom. We were going to talk about Camp Confidence, a camp I started last year for kids with AS. When I arrived, I asked my customary question: “Do you want me to take off my shoes?” Kim laughed and said not to worry. Then, I looked up to see Christopher and his brother. “Why are you guys home?” I asked. Kim said, “It’s a special day off from school.” I joked, “If you guys keeping have special days off, you will be going to school well into June.” (We’ve had a lot of snow in Kansas City, which is akin to saying the North Pole has a lot of 80 degree days.) I was ushered into the dining room and, then, bam! camera in my face. You see (or you will see in the clip, please click here) that the special day off from school was for me.

All day and all night, I reviewed every answer to every question I was asked in my head.  In hindsight, I cringed at some of my responses. I downright groaned at others. I hoped and prayed for editing because I wanted Christopher and all of the clients I serve to be seen in the best light.  I realized  that light for me is not best when attached to the end of a television camera and shoved directly next to my face. But, I had this opportunity to speak for them, and, well, I laid in bed knowing I could have done better.

To watch that video, though, was perfect. I’m not the star, and I have never wanted to be. The light, you see, shines brightly for and on Christopher. He is a star, the star. I didn’t need to worry about what I said because he said it better. Better than I could ever have imagined.

I am simply proud, honored, and blessed to know him, his brother, and his family. Thank you, Christopher.

 

Aspergers and the Transition to Middle School: A Big Hiccup

Imagine with me for a moment that you’re fifth-grade student gearing up for the big, dreaded transition to middle school. You have the holy grail, though, a suit of armor if you will: Two friends. You play Pokemon with one, and Club Penguin with the other. You don’t talk about those things at school. You’ve learned the hard way that you’d get made fun of.

But, you just found out that your friends will go to Middle School A, but you won’t. You will transition to Middle School B because there are too many students at School A.

Or, there aren’t enough students at School B.

Or, your ED/BD classroom is only at School B.

So, what do you do? Or, rather, what do the adults in your life do? Do they fight for School A, or do they go to School B with the appropriate LRE?

 

First Impressions and ASD: Maybe We Should Get a Second Chance?

We all know the phrase, “You never get a second chance to make a first impression.” Each and every time a new member joins one of my social skills groups, we talk about first impressions and how behavior in both action and word impact how others think and feel about us. We talk about how first impressions are made automatically and immediately.

Unfortunately, I think these discussions have been a lot of hot air on my part.

A first impression is the outcome of:

• Reading facial expressions and body posture
• How someone talks – word selection, tone, fluency – as much as what this person actually says
• Assessing how this person is behaving around you and deciding if you want to be around someone who behaves in this manner
• Thinking about how this person would reflect upon you
• Looking at clothes, hairstyle, and other points of grooming to see if you believe they are up to your standard
• A reciprocal verbal and emotional exchange of thoughts and feelings

As I read this list, which is far from complete, I realize how many of these skills are so challenging for individuals with ASD. It leads to posit that perhaps individuals who are on the spectrum do not develop first impressions in the same way as neurotypicals. This is not to say that Aspies and auties fail to make first impressions, rather to suggest that other variables are at play.

For example, on Tuesday Darren joined a group of three boys his age. Mike’s behavior was in stark contrast with Darren’s as well as the two other boys in the room. Mike was nervous, excited, and happy to have a new member. He was tired from his school day and from a session with me individually to address some other issues he was having. Mike is more impulsive and less attentive than the other boys. When Darren asked the guys for help with a friend at school who is spreading rumors, Mike said, “I’d murder him in an online game.” Mike repeatedly used mild curse words, despite admonishing from George, who reminded Mike that Darren might not appreciate this language.

By most standards, Mike’s first impression on Darren was less than stellar, an idea I pointed out to Mike several times in a variety of ways. But, ultimately, the “impression” of the first impression was not my call. Darren’s opinion is what mattered, and Darren said, “He’s like my friend Sam at school.”

The complicating factor is that neurotypicals would not have made such a judgment. Neurotypical thinking and emoting is what has made the idea of a first impression so challenging, scrutinizing, and anxiety-producing. Aspies and auties seems to have a dual challenge:

1. The pressure to try to create a good first impression without some of the social skills to do so and the social-cognitive skills to actively process their behaviors in vivo
2. A different way of processing, assessing, and adjudicating others that can result in categorically different impressions of others

It seems that Aspies and auties have a second chance with each other, but not with NTs. Maybe we NTs could learn a few things.

 

Fact or Fiction: James Durbin and Asperger’s?

Tonight, Jesse, a nineteen-year-old client with AS, asked me to watch James Durbin. By now, I’m sure you have heard of him. The twenty-one-year-old unemployed singer on American Idol who has a small child and a supportive girlfriend. I hadn’t heard of James Durbin, nor had the four other guys in the group, all with AS. So, we viewed this clip:

Watching the clip was easy. James Durbin is an excellent singer, more likable and less polarizing than Adam Lambert. He has a story that AI loves — no job, big dreams, complications. For James, these complications are even diagnostic: Tourette’s and Asperger’s. But, watching was only the first part of what Jesse wanted.

“I don’t think he has AS, Jeanne. I think he is working that situation for the show. What do you think?” That’s where the hard part came in. So, I asked the guys to make a case for why he might not have AS; here were their arguments:

“Um, I don’t know many Aspies who frequent bars. Especially at that age. I mean, he’s barely legal.” (James might be breaking a rule, an Aspie no-no.)

“I have Tourette’s. The stress of singing would make me start ticking.”

“Yeah, well, I have Asperger’s. The thought of being around that many people would make me more than nervous.”

“I thought Aspie’s don’t make good eye contact. He just looked his son in the face.”

“That much crap in my hair would make me freak out.”

“His clothes look itchy.”

“I didn’t look at the camera when I was in pictures.”

“I don’t call it AUS-pergers.”

Then, I asked the guys why he would “lie”?

“I don’t lie.”

“I don’t know.”

“To get on tv.”

“To get on tv.”

“To take advantage of the situation.”

I ask you, my reader: What do you think?

 

The Fascinating Way Aspies Problem-Solve

When did you learn that sometimes the whole gets punished for the actions of few? Did it make sense to you? Or did it incense, confuse, and call you to action?

Christopher came into group today ready to charge into battle, literally and figuratively. His school’s principal had issued the following “fiat”: The “green equipment” on his school’s playground was a no-fly zone. Sixth-grade students were caught engaging in inappropriate touching in the slide tunnel. Christopher, a fifth grader and the rest of his school, were now banned from this play area because teachers could not reliably supervise this area. Christopher wished the sixth-grade students had “never taken a breath”. He could not for the life of him figure out why everyone was banned, not just the traitors. Nor could he figure out why those kids would do THAT in the first place. Plus, Christopher argued, the tongue-lashing for the sixth-graders was enough to teach the lesson for everyone.

Christopher’s plan: A formal protest. With signs, and marching, and shouting, and refusals. Everyone has that right, right? The back-up plan: Storm the equipment during recess and sit-on (not sit-in!) until the principal allowed the students to play on the equipment again.

There was SO much to discuss about this issue — consequences, social outcomes, why the group was punished in the first place, etc. — but we spent most of time problem-solving. One of the boys, who is historically prone to ideas that are impossible and tangential, started off with that a classic pie-in-the-sky idea. Christopher became upset, holding back tears by turning and looking out the window. Shane and I addressed the effects of his far-fetched ideas, when Shane had “another” idea. He always does. I watched Christopher tense, warned Shane about how tenuous our situation was, and made a leap of faith.

“Paint the ‘green equipment’ blue and the other equipment ‘green’.”

Shane’s solution completely broke the ice that had frozen Christopher’s brain. We laughed so hard we shed joyous tears and began an amazing brainstorming session. Christopher had decided to play “near” the equipment, rather taking it apart to play “with” the equipment (another Shane classic) when he shouted: “I know what to do! I’ll bring my football from home and we can play catch.”

We decided that we’d get our paint brushes ready as a back-up.

 

Recess: Rest and Relax, Asperger Style

What’s your favorite part of your school day?

A NT girl typically says, “Lunch,” a time for chatting and gossiping with a side of eating. A NT boy usually says, “Recess,” when tag, football, four-square, and kickball abound. Ask one of my clients, let’s say a boy with Asperger’s, and that is not typically an automatic answer. Does that surprise you? Does that sound like you?

The traditional idea of recess as “freedom” from the watchful eyes of teachers, “freedom” to conspire, compete, and converse with friends, and “freedom” to do an activity of your choosing is constructed upon the foundation of socialization as inherently comforting, calming, facile, and rejuvenating. In this construct, recess is a break from a boring, sedentary day to do what you want to do when you want to do it. You just happen to be perfectly happy with your choices because they fit your “needs”: running, jumping, climbing, and talking.

What happens if you need something else from recess? You need solace, silence, and solitary moments. Recess is a break from a stressful day, with directions, rules, and interactions that always feel elusive and never static. Homework has begun to pile up, and there is only more coming. Noises, taps and touches, and distractions have overwhelmed. If you can just get to that tree, that track, that walkway, the slide, then you can refuel. You can cope by pacing, by processing the morning, or by planning for your after-school activities. You begin to think about that Lego set you are building and how you are only a few hundred pieces from being able to fly Darth Vader’s ship along side — “Tommy! Why don’t you play with Lucas and Evan?” 

Lucas and Evan bully me. Lucas and Evan don’t play the way I want to. Lucas and Evan won’t let me be Darth Vader. Lucas and Evan make fun of me because I can’t catch the ball. Lucas and Evan get too close to me. Lucas and Evan shout in my ear. Lucas and Evan smell like Lunchables’ plastic. Lucas and Evan talk really fast. Lucas and Evan have never watched Star Wars. Lucas and Evan think Star Wars is stupid. Lucas and Evan call me retarded.

“I don’t want to.”

“But, Tommy, you are always alone at recess, talking to yourself and pacing. Don’t you want to have fun? It makes me feel bad to see you all alone.” So, our well-intented teacher attempts to convince our Aspie to flex his social muscles. After all, this is what kids do at recess, and we want our Aspie to fit that mold. Otherwise they aren’t learning, they aren’t working on their IEP goals (pragmatic language), and they look even more different.

These muscles, if flexed (involuntarily or otherwise), limp back into the classroom for the remainder of a long day. You ran a half marathon in the morning and had the other half in the afternoon but, somehow without you knowing, the course was lengthed just for you. So, you start your second 13.1 with 26.2 logged already.

Imagine giving a spelling test on the playground. A pop quiz during lunch. Teaching social studies from the slide or the basketball court. I don’t imagine it would go over well. It would cause dread and anxiety before AND after recess. Failing to consider the emotional needs of our Aspies results in the same.

This picture need not always evoke sadness.

 

A General Education Classroom is NOT the Setting for Survivor, Asperger’s Island

In 2008, a general education teacher  brought Alex, then five years old, to the front of the classroom at Morningside Elementary School in Port St. Lucie, Florida. He had just returned from a visit to the principal’s office when Ms. Portillo put Alex in front of the tribal counsel — Alex’s fellow five-year-olds. These kindergartners were asked to vote on whether Alex should remain in class. Alex was voted off the island, I mean classroom.

Yesterday, Alex’s mother was awarded $350,000 by the school district. After a one-year unpaid leave, St. Lucie’s own Jeff Probst has returned to teaching. Alex still has Asperger’s Disorder (sarcasm intended, as I know AS is a life-long disorder).

$350,000 is apparently the price tag for:

• Humiliation of a child (and family)
• A quick “fix” to behavior problems (Puts the costs of ABA in perspective!)
• A real-life lesson in intolerance
• Publicity for the extent to which a school district is untrained
• A year off in the world of a teacher

I, for one, would like the school district to do a matching-funds option to pay for some ASD training. Actually, I’d do it for the cost of my flight. Southwest.com tells me that’s about $200.

 

Namenda and Aricept: Not a Cure for Autism, but a Start

Doctors, parents, and researchers always seem to be looking for “it”: The cure to autism. While science seems to be years away from such a discovery, scientists have tapped into drugs intended to treat Alzheimer’s disease as a possible catalyst for brain activity in individuals with autism. Their out-of-the-box thinking has been rewarded with some positive, though tentative, results.

Dr. Randall Kavalier, a psychiatrist in private practice in West Des Moines, Iowa, prescribes Namenda to children who have autism or who suffer from brain injuries. Namenda, the brand name of memantine, is the first in a class of Alzheimer’s disease medications that blocks NMDA glutamate receptors. Dr. Kavalier states that Namenda clears up the interference among signals to nerves in the brain. Dr. Kavalier said that while elderly brains have long finished developing, children’s brains are still being molded. He said that, in many cases, after children swallow a few pills, “They light up. I mean, they turn on.”

Dr. Kavalier is not the first to experiment with memantine. Last summer, researchers at The Ohio State University’s Nisonger Center also used a drug normally prescribed for Alzheimer’s patients to determine if it will improve the communication skills of children with autism with positive results.

In 2001, Michael Chez, M.D., a child neurologist and assistant professor of neurology at Rush Medical School in Chicago published a study about the positive effects of Aricept (donepezil) on the language production in mild to moderately affected children with autism.

Have you tried this medication? Would you try it?