In treating children with Autism practicing Pediatric physical therapy or Relationship Development Intervention (RDI), I see core difficulties in children with Autism as they try to manage the challenges of daily life. One is that they have difficulty negotiating a world of Multiple Demands/Roles/Goals.
Dr. Steve Gutstein, founder of RDI, says, "We are constantly shifting our roles and relationships and do it without conscious reflection most of the time. Faced with multiple goals and daily demands, we easily find ways to prioritize". Well, I agree with most of what he says...I'm not so sure about the "easily".
In my life these multiple demands appear on so many different levels. For example, last night when I get off work, I had to decide:
- Do I leave work now or stay and get some of this paperwork done? (You've got the essentials done. It's 7 pm. Get out of the office!)
- Do I have time to work out at the gym? (No, don't have time.)
- Do I go home first and find out what the DELL repair people said about my fried lap top or do I go ahead and price what a new lap top will cost? (Go ahead and price a new one, their original quote to fix the fried laptop was $500. Surely I can find a new one for almost that price.)
- How many stores should I get price quotes on? (Let's try 2. I can hit both of those on the way home and still make it home by 9 pm when the DELL repair office closes.)
- Do I go ahead and buy the one on sale with limited numbers in stock for $429? (No, I better wait until I hear DELL's final cost for repair and if they will consider it in warrantee.)
- My new artist housemate got paint on the floors, do I have time to go to Home Depot and find something to protect the floors tonight or risk having more paint splattered on my wood floors before buying something suitable? (Yes, take care of it tonight. I have time (and money) now that DELL says the work is under warrantee.)
- My housemate says Home Depot will have what I need, but this seems more like an Office Max kind of problem. I don't have time for both, which one should I go to? (Call Home Depot and ask before you waste a trip.)
- Now that I am back from Home Depot with flooring cover in hand, what do I have time to eat? I'm starved! (A can of soup is all you have time for. Fire up the Microwave.)
You can see how I have in just one evening multiple goals, demands, and roles to juggle... and this was the list of the main choices. Lots of smaller multiple demands were handled in between. These are challenges our kids with Autism struggle with (and me too many days). RDI helps build the precursors to these skills.
If I can help your child with Autism, give me a call. Amy Sturkey 704 332 4834 ext 114.
Some of the ideas we talk about in the "Managing Bullies" Class I teach at Child & Family Development in Charlotte, NC, are below.
1) Be clear about who owns (has) the problem. If it’s the bully, then make sure you don’t steal the problem from him or her.
2) If the bully verbally attacks you with name-calling, then help them feel better about themselves by encouraging them to “get it out”. Ask them “Anything else?” When they are finished, ask them, “Do you feel better now?”
3) Develop your own talents and abilities. Pursue your interests. Expand your horizons. The focus does not need to be on making friends, but on pursuing your interests and passions.
4) Remember, you don’t need friends (in some desperate and needy way). You are more likely to end up with friends if you are into self-improvement, talent development, cultivating your abilities, and expanding your horizons. Undoubtedly, you will not place any obvious barriers in the way of people who might want to approach you.
5) If physically attacked, block, yell for help, wrestle, or become dead weight as the need arises. Your goal is to survive. Do not use harmful force that could injure the attacker if at all possible. Seek immediate and effective assistance. Use verbal threats, if appropriate, to counter the attacker. Attempt to put the attacker in a potentially embarrassing spot that makes them think twice before proceeding.
I hope this helps you get an idea or two about some of the basic concepts we discuss and role-play in the managing bullies course. There are others. Practice is central for helping group members make the techniques a natural part of their skill set. Stephen Elliott, Ph.D., Licensed Psychologist
Well we all know that bullies don't feel good about themselves. One only has to think about how we feel when we are feeling very happy. We don't feel like spreading pain and suffering. We would be far more interested in everyone around us being happy.
So, what does one do when approached by a bully who wants to make us feel bad with words and name-calling? Answer: We help them feel better about themselves. When they call us a negative name, we respond with, "What else? Come on, get it out. What else?" We facilitate their catharsis! We take none of it personally. It's all about the bully and his or her problem with themselves. We ask the bully to get it all off their chest, to get it out. When they are done with spewing out their poison, we then sincerely ask, "Do you feel better now?" If so, we can be glad with them, and assist them in feeling even better.
For help with child or adolescent misbehavior or parenting issues, call one of our child psychologists or family therapists for a consultation. Best wishes, Stephen Elliott, Ph.D., Family Therapist, Child and Family Development, Charlotte, NC
Social groups are normal, and they are usually healthy and positive when individuals are gathering to focus on talent development, a common interest, to achieve a reasonable goal or to help a worthy cause.
However, social groups can become a problem when the emphasis within the group, or how they present themselves to others, becomes more about “superiority” or “specialness” than it is hard work, talent development, or a worthy cause to benefit others. These groups are sometimes referred to as "cliques". In cliques, group members are encouraged to feel or think of themselves as “special” just because they are a “member” of that group, while those who are not in the group are viewed as not special, or less special, simply because they are not members of the group. Bullies are often spawned out of such cliques. It is noteworthy to understand that social cliques and individual bullies are similar in that they are after the same goal, the goal of subjectively experiencing a feeling of superiority over others. They don’t seem aware that they are overcompensating for feelings of inferiority by swinging past the balance towards the other extreme in their pursuit of the superiority feelings they think they need. They completely miss the insight (first attributed to Alfred Adler in the early 1900's) that inferiority and superiority are heads and tails of the same coin. Adler was the first to speak of the inferiority complex and the superiority complex.
It's a great idea to join one or more healthy social groups. Join a common interest group or a talent development group for the right reasons – because of genuine interest in the topic or activity. Work as a team to develop your individual or group talents or achieve an altruistic goal as a group.
Let’s realize that superiority groups, composed of people who think in terms of inferiority for non-members and superiority for members, are best avoided.
Specifically, what can we do if exposed to so many choices (both groups and cliques) as in a school setting?
- Realize we don’t need a clique. We do need positive social groups. With a decent self-esteem, we don’t need what cliques as groups are trying to offer. Equality as a person is fine with us.
- Don’t pay cliques, clique members, or bullies much attention. Attention is what they crave. It feeds their inflated need for superiority over others.
- Get a life! Join a common interest, talent development, altruistic goal-achieving, or worthy cause group. Enjoy being an equal! Enjoy it fully! For help with child or adolescent adjustment issues or parenting issues, call on a child psychologist or family therapist for a consultation. Best wishes, Stephen Elliott, Ph.D., Family Therapist, Child and Family Development, Charlotte, NC
After students finish the first few days of school, the newness wears off, and the hard work begins. The following are a few ideas to keep the days running smoothly.
- Put in place a routine for the week. Children need expectations that are clearly defined and consistently followed. Establish set times for a snack, homework, play break, chores, and outside activities. Help children to begin transitioning from one thing to the next in order to avoid meltdowns. Make a picture chart to serve as a visual reminder.
- Healthy habits should be an important part of every day. Allow children to help plan nutritious meals. Within categories of fruits and vegetables, give kids a chance to pick out at least one or two of their choice. Writing out menus allows parents to shop ahead of time, and children will know what is coming. This advance planning reduces chaos at mealtimes. Don’t forget to get involved in family exercise time for 20-25 minutes a day.
- Set up a homework station in a special location. Your children can then have a quiet place to study and keep all of their materials in one area. Children with learning disabilities, dyslexia, attention deficit disorders, and autism spectrum disorders rely on this type of structure to accomplish tasks. Use praise and rewards to celebrate successful work completion.
- Before bedtime, arrange everything that you will need in the morning. This includes clothes, shoes, notes, assignments, and lunches. End the panic of the early morning rush!
Martha Knight, M. Ed., is an Educational Specialist at Child and Family Development in Charlotte.
As a Relationship Development Intervention (RDI) Consultant and a Pediatric Physical Therapist here in Charlotte, NC, I've had to learn a great deal about Autism Treatment. I try to learn all the time. I read books and attend autism chats on the RDIos (the online community available for people on the RDI path), but one of my favorites is listening to lectures on itunes or U-tube. It is free and keeps me up to date. You might want to consider it. I listen while on the treadmill or on long drives out of town.
One of the concepts I've learned that I really like is an acronym for remembering the core deficits in people with Autism. Dr. Steve Gutstein from RDIconnect.com talks about how important Dynamic intelligence is. It "allows us to successfully solve complicated problems, prioritize multiple demands, carry on meaningful relationships, and achieve long term goals. Jobs, friendships, marriages and most aspects of daily life are primarily 'dynamic' in nature, although each has static elements that must be mastered. Almost all human communication and interaction occurs during dynamic encounters, they are the things that make us who we are today."* The MESSIER acronym lists the skills needed to negotiate our very complex worlds. It is as follows:
Multiple
Ever-changing
Simultaneous
Surprising
Imperfect
Emotional
Relative
On future posts, I'll discuss each one of the above challenges in more detail.
*Quotes and concepts taken from the Messier brochure available from RDIconnect.com
The late Michael White, author of Narrative Means to Therapeutic Ends, would frequently say to his clients that "You're not the problem, the problem is the problem". He insisted on the principle that mental health and/or behavioral problems not be defined as permanent fixed entities in the person's infrastructure. He preferred to construct the narrative of the problem as one where the understanding and meaning of the problem could be readily tampered with or countered. He didn't find it useful or helpful to locate the problem within the person as if it was a permanent part of them like their lungs or stomach. By contrast when an expert or authority figure says to a young person, "You have problem x (fill in the x with a label from the diagnostic manual of mental disorders)", the problem becomes like a thing the person has within their very structure. White strongly challenged this framing of the problem.
The truth is that I have been undeniably influenced by Michael White. Yes, I have, and I am sure glad its true. I would most certainly want to explore with my client's those times when the problem was not allowed to "have it's way with them". I like using language that externalizes the problem. This helps the client position themselves to fight against the problem by making purposive choices that are incompatible with the problem. The person becomes postured to win against the problem if they so choose, to out-trick it, and to potentially put the problem in its place. In therapy sessions, I have seen first-hand, and repeatedly, the power that comes to a young person when they are defined as competent and capable of out-maneuvering the problem. They are defined as being one step away from effecting a victory over the problem. They begin to mount a counter strategy to defeat the demands the problem makes on them. They are inspired and ready for battle. They are encouraged to rebel against the problem and to use their anger to defeat the problem. After all, the problem wasn't a part of them to start with. For help with child or adolescent misbehavior or parenting issues, call one of our child psychologists or family therapists for a consultation. Best wishes, Stephen Elliott, Ph.D., Family Therapist, Child and Family Development, Charlotte, NC
I am pleased to announce that Joy Granetz, Ph.D. is joining the Child and Family Development team on August 30.
Dr. Granetz received her Ph.D. in Psychology from George Mason University and is a North Carolina licensed psychologist. She has over twelve years of extensive experience in neuropsychological testing with a special focus in working with children and adolescents with learning disorders, attention related problems, and head injury. Dr. Granetz also provides therapy for children and adolescents with emotional and/or behavioral difficulties.
During her training, Dr. Granetz worked at the National Institutes of Health in the Cognitive Neuroscience Section administering neuropsychological tests. During a two year internship, she worked at the Defense and Veterans Brain Injury Center of Walter Reed Army Medical Center, where she performed neuropsychological assessments. In addition, she has published research on the neuropsychological effects of brain injury and learning disorders.
Prior to joining the Child and Family Development team, Dr. Granetz worked in a pediatric group practice in Northern Virginia for ten years. Dr. Granetz will be based at our South Charlotte clinic.
In addition to our assessment and treatment services, we plan to expand our scope to include neuropsychological testing.
The speech therapy team at Child and Family Development welcomes Carolyn Curry, M.A., CCC-SLP on August 30.
Ms. Curry graduated from Fairfield University and completed her Master's in Communication Arts at Hofstra University in 1998. She has over twelve years of clinical experience in both the school and private practice settings. In addition, she was a teacher of children with autism spectrum disorder and an applied behavior analysis (ABA) consultant.
She will based at our Midtown clinic as a full-time pediatric speech therapist.
Welcome Carolyn, we are glad you are here!
It has been a busy week for Stephen Elliott, child psychologist at Child and Family Development.
He has been interviewed by two Charlotte news crews for segments about helping children prepare to go back to school.
His messages emphasized consistency and positivity for both the child and parent. View the segments by clicking on these links:
http://www.foxcharlotte.com/rising/100977359.html
http://charlotte.news14.com/content/local_news/charlotte/629362/back-to-school-prep-includes-getting-necessary-vaccines
Earlier this summer, Child and Family Development was featured in Charlotte Parent magazine and website.
The article, titled "Exceptional Children, Exceptional Care" describes our multi-disciplinary pediatric therapy services, including traditional evaluation and intervention as well as many specialty groups and services.
See it for yourself at
www.charlotteparent.com!
Jessica Sapel, MPT joins the Child and Family Development team on August 23.
She graduated from Quinnipiac University in 2003 with a Bachelor’s degree in Health Sciences, summa cum laude, and received a Master’s of Physical Therapy, with distinction from Quinnipiac University in 2005. She has worked with children in the home health, out patient, and school settings in Connecticut and North Carolina. Her clinical specialties include gait training, kinesiotaping, adaptive equipment, orthotics, weight training, and working with medically fragile children. Jessica enjoys working with children with a variety of diagnoses, including torticollis, cerebral palsy, hydrocephalus, down Syndrome, spina bifida, premature birth/very low birth weight, and genetic conditions. She is based at our South Charlotte office.
Welcome Jessica!
Is your child ready for the social challenges of school? With all of our normal emphasis on academic preparedness as the school year approaches, our child's social learning and its importance can often be overlooked. For most children who are considered "neurotypical", social learning/thinking is innate and begins from birth. Social thinking, which was a term coined by Michelle Garcia Winner (speech-language pathologist), is a type of intelligence that is essential to learning about concepts and integrating learned information across settings- including academic, social, home, and community.
For our students who have difficulties learning, understanding, and/or applying socially relevant information, school presents with challenges beyond the traditionally thought-of "social time"- friends, lunchroom, and recess time. They can also experience frustration in academics, particularly in reading comprehension and written expression. Also, as social dynamics become more complex through elementary, middle, and high school grades, these students struggle more and more to interpret social nuances of their peers and to "keep up".
Our students with social thinking and learning difficulties often present with diagnoses such as High Functioning Autism, Asperger Syndrome, PDD-NOS, Non-Verbal Learning Disability, and Attention Deficit Hyperactivity Disorder.
Child and Family Development offers Social Thinking
® groups led by Elaine Byrd. These groups focus on teaching students how to recognize their own and others’ social minds, navigate their behaviors in a social world, and successfully adapt to people and situations. Please visit the C&FD website or contact me at (704) 541-9080 x213 for more information!
When teachers have good self-esteem and adequate amounts of self-love, they are able to engage in effective teamwork with their fellow teachers. Effective teamwork allows the teachers to be more effective with the children and it ripples down to help the children develop self-esteem themselves. Solid teamwork allows the teachers to have more power and influence in the classroom and it subtracts power from the students in a good way. We have all seen students who are intoxicated with power. In these cases there are hierarchical reversals where students are telling the adults what they will be doing. Effective executive functioning is absent. When this happens the self-esteems of both the students and the teachers will plummet. All parties will feel discouraged.
The good news is that many teachers are able to give themselves good advice and cooperate as team players. This is at the core of self-esteem, giving ourselves loving and encouraging self-instruction and direction. To watch these teachers in action is to watch an artistic choreography. The teachers dovetail their teaching, leading, and helping of the children with their corrective, re-directing, and supervisory roles like two well reheased dancers. They enforce the rules consistently without yelling and screaming (which would result in them losing their power if they got pulled into that). These well-functioning teachers are supportive of each other and it's obvious to anyone who watches them in action. So, teacher self-esteem produces effective teamwork which in turn becomes positive self-esteem for the students. For help with child or adolescent misbehavior or parenting issues, call one of our child psychologists or family therapists for a consultation. Best wishes, Stephen Elliott, Ph.D., Family Therapist, Child and Family Development, Charlotte, NC
Here's something I have learned and it took me a good while to learn it. It sure takes awhile to learn that people just really don't like to be criticized or blamed. Children feel discouraged by it. So, what's the option? The option is to encourage others by seeing the good while minimizing or overlooking their faults. This doesn't mean we are stuck with the Pollyannaish option of utilizing strictly positive thinking. Complaints stated as preferences, yearnings, or wishes can still be launched. But adding a critical personal attack dimension definitely needs to be eliminated.
Criticism can also be de-personalized. I really liked the way my karate teacher handled it when a student would make the same mistake several times in a row. The teacher would address the entire group of students as if they had all done it wrong. He would teach the group how to do it correctly, thereby sending the individual a message without making it personal. No one really knew who he was personally correcting, but we all knew he was not singling anyone out to embarrass them. It seemed to help the entire group while no one seemed to feel personally attacked. For help with child or adolescent misbehavior or parenting issues, call one of our child psychologists or family therapists for a consultation. Best wishes, Stephen Elliott, Ph.D., Family Therapist, Child and Family Development, Charlotte, NC
Some students have difficulty remembering what they have learned. As they progress in school, there are greater demands for efficient information storage and retrieval. Struggles with memory can create increased frustration as these children are required to process larger amounts of material. The following are a few tips to aid memory:
· Break down a long study guide into smaller parts that are learned over the course of a week rather than in one night.
· Use multi-sensory instruction. Pair words on a flashcard with picture cues. Have the child act out the concept or make a model. This approach will help to engage various senses and build multiple pathways for that information in the brain.
· Always tie new concepts to something that the child already knows.
· Use chunking to group bits of information that are similar. This strategy helps with organization of new material.
· Provide multiple opportunities for practice and review. Repetition aids recall.
· Offer frequent encouragement and praise for the child’s accomplishments.
If your child has had longstanding difficulty with memory tasks and exhibits other academic struggles, you should consider a consultation with a professional. As an Educational Specialist at Child and Family Development in Charlotte, I work with a team of clinicians in providing consultation and comprehensive evaluation. We work with children who have learning disabilities, dyslexia, attention deficit disorders, and autism spectrum disorders.
Help…I am ready to medically treat my child’s ADHD. What do I tell the doctor?
Assuming you have had a Comprehensive Psychological and Educational Evaluation* to rule out other contributing interferences, the most important first step is to work with an experienced physician whom you trust and who is knowledgeable about ADHD. Your doctor will recognize how hard this decision has been for you and will understand that considering a medication approach is an emotional hurdle that is not easy for a parent to jump.
Your doctor will know how to reassure you, provide you with good information, and talk to you about how the process of selecting a treatment approach that addresses your child’s ADHD symptoms.
Your doctor will want to know about ADHD symptoms and will ask what behaviors interfere with your child’s daily functioning such as:
- How your child’s ADHD manifests in the classroom?
- Is your child impulsive, hyperactive or just squirmy and restless?
- What do the teachers tell you about how your child’s ADHD behaviors interfere with classroom performance? Specifically talk about as work completion, forgetfulness of homework, listening to and following of directions, and whether the ADHD symptoms interfere with peer interactions? Improvement in concrete behaviors such as these can help the doctor judge the effectiveness of the ADHD medicine.
- What ADHD behaviors are causing disruption in the home? Are ADHD symptoms such as forgetfulness, poor follow through with the rules and routines of the household, argumentativeness, poor tolerance to frustration, anxiety or sadness diminish your child’s happy home life?
- Be ready to talk about your child’s many positive qualities that you do not want to see altered by ADHD medicine.
You will want to ask about:
1. Side effects of the ADHD medication such as appetite or sleep interferences.
2. Ask your doctor how you will know the ADHD medicine is “working”.
3. Provide your doctor with all outside evaluations and documentations.
4. Ask what side effects would indicate that the ADHD medicine needs adjustment or is not effective.
5. Do not be alarmed if the first trial is not the right medicine. Every child with ADHD responds differently. Often times securing the right treatment for ADHD may seem like trial and error. That is when trust in your doctor becomes important.
* Psychologists and Educational Specialists at Child & Family Development are experienced in the evaluation and behavioral management of ADHD symptoms
How can a child be an excellent student or outstanding citizen in one setting (like school) and a holy terror in another (like in the home)? The answer lies in our understanding of the self. The self is like a multi-faceted diamond. With many facets, a given social context will elicit just a certain number of these facets while another social context will call forth completely different aspects of the self, other facets of the person. The self can be thought of as a 1000 card deck of playing cards. A given relationship will tend to draw out 50 of these cards and put them into play over and over again. In school one set of 50 cards may be called out and become a pattern there. At home 30 of these fifty are put back in the deck and a different 30 are drawn out. Each setting has the potential to call forth different aspects of the self. Yet, each setting tends to limit the self to the usual facets shown in that setting. The patterns can become overly predictable and the patterns can become rigid and stuck.
When a child misbehaves in one setting, but not in another, no diagnosis should be made other than an adjustment issue in the setting where misbehavior is repeatedly occurring. If there was a condition or mental disorder it would prevail across all settings. If the child is well behaved in at least one setting, the parts of the self being shown there are accessible and can be shared in other settings. The right set of motivators and interactions can be discovered and put into play. One can learn a lot by studying the setting where good things are happening. The adults in the two settings may need to communicate with each other. They can put their heads together and figure out a winning strategy to break up the 'stuckness' of the discrepancies. Calling forth a child's competencies can occur in more than one setting if it's occurring in at least one setting already. For help with child or adolescent misbehavior or parenting issues, call one of our child psychologists or family therapists for a consultation. Best wishes, Stephen Elliott, Ph.D., Family Therapist, Child and Family Development, Charlotte, NC
It's not uncommon for a child to act out terribly at home, and yet be a perfect angel at school. Parents and professionals alike may be perplexed and want to discuss the confusion and inconsistency with you.
In general a good rule of thumb is this: if the child is acting up in only one setting, then it's fairly safe to say there is something going on in that setting that explains why the child is acting up there. The solution is likely to rest with the environment rather than attempting to correct something inherrent within the child. For example, the child may be struggling with the inconsistencies and unpredictability in the environment. In this case, a solution strategy of increased structure and predictablity would make the most sense.
A child psychologist or experienced therapist may be able to help you figure out how to make the needed changes in the setting where the misbehavior is occuring. By learning what's going on in the settings where the problems are not occuring, you can gain clues that may help you find an efficient solution. The solution should be fairly easy to see if you look in the right places . If our team of psychologists can assist you, please give us a call. Best wishes, Stephen Elliott, Ph.D., Child and Adolescent Psychologist.
You’ve made the big shopping trip to buy school supplies for your children. Now think about yourself! There are three important things that parents can stock up to make the new school year run smoothly.
- Preparation…The start of school can be difficult both for children and for parents alike. By transitioning to the school routine one to two weeks ahead of time, you and your children will have time to work out any kinks and gradually adjust to the changes that will take place. Have a family meeting to discuss goals and expectations for the new school year. Ask your children be a part of the planning process, and record your decisions so that they can be posted for the whole family to see on an ongoing basis.
- Open Mind…As a parent, be open to a new learning experience. The fall offers a fresh start. Welcome the changes that a new teacher brings and show your interest in ongoing communication. After the first few weeks of school, arrange a meeting to discuss the ways that you and the teacher can work as a team.
- Perseverance…Remain attuned to your child’s learning and persist in finding answers to any questions that you may have. Particularly if your child has had longstanding struggles in school, pursue further consultation. As an Educational Specialist at Child and Family Development in Charlotte, I help parents address these issues. I enjoy working with students who have learning disabilities, dyslexia, Attention Deficit Disorder, and autism spectrum disorders.
Enjoy the end of the summer and get ready to make the new school year POP!
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