If your child has ASD, autism or Aspergers you most likely wonder what is the most useful, powerful and successful treatment for him or her? How can you help your child meet their potential? Simply, what is the most effective Aspergers treatment and help for aspergers? Many parents of aspergers children worry that their child will never be able to develop strong friendships let alone a human-romantic relationships that could eventually lead to marriage and children and a full life. Relationships during childhood, who you have as friends and how well you get along and attach, as Dr., John Gottman has pointed out, are the #1 factor in determining outcome later in life. They correlate to employment success, to later relational success and even to life span. People who related better in the 4th grade earn more money, are happier and live longer. It's more important that academic grades, prizes in science or awards in sports.
So can your child with Asperger's do well in relationships? The truth is, it is possible, but it takes a lot of work, the right advice, access to the right information and treatment interventions. Which ones work best? Regretfully, the answer is "it depends." What we do know is there are treatments know to work, and those for which there is no scientific support.
Here are the top 4 methods of aspergers treatment:
1. Applied Behavioural Analysis
2. Floor Time
3. Speech Therapy
4. Social-Cognitive Therapy (training in theory of mind)
Notice "social skills" isn't in this list. We are always teaching social skills, but there is a difference between a lack of social skill knowledge and the social-cognitive deficits children and adults with Asperger's suffer from. (I recently posted two great videos that explain "theory of mind" and urge you to watch those. Understanding the difference between a social skills deficit and a deficit in theory of mind is critical for successful treatment for you or your child. And many schools and therapists don't understand the difference.
At different times your child my need one or all of these treatment interventions. They each have their place at the appropriate developmental time, and can be adapted to use at different developmental moments. Heres a little more detail on each:
1. Applied behavioural analysis (ABA)
ABA is a method of teaching that involves breaking tasks into small, discrete 'teachable' steps. At each step appropriate behaviours are reinforced. ABA selects developmentally appropriate behaviours as teaching targets. These can range from maintaining eye contact to complex responses such as social interaction. The child is given enough support to ensure success, which is then positively reinforced by consequences that are reinforcing for that child. Gradually the amount of support and reinforcement is reduced.
Early intervention programmes for children with autism and Asperger's have the potential to produce positive changes in development and consequently reduce the need for later interventions. Therefore in many ABA programmes parents are trained to become the primary therapists and their children receive one-to-one tuition in their own homes. There is evidence that intervening in a child's development in this way can help children with autism to be more successful in mainstream schools (Keenan et al., 2000). Often parents want to avoid this step, especially if their child is a little most socially developed, verbal etc. DON'T AVOID ABA! ABA training is necessary for you as a parent to understand the basics of behavioural interventions. Exposing your child to good, competently taught ABA prepares them with tools you can use later to teach new skills. It's a tool best learned young, and then used again and again.
ABA is not everything, however, and for some schools and intervention programs it seems to be. There are other, more complex skills that cannot be taught through ABA. But ABA is the foundation of your future work.
2. Floor Time
Here is one description of ABA I really like, "During floor time, your child will stretch his imagination and logical understanding of the world as he stages make-believe games and locks horns with you over rules. He'll use gestures and words to express his needs and to explore a broad range of emotions, from exhilaration to anger. He will also hone his physical skills as his muscles strengthen and grow." Yes, floor time means getting down on the floor and MODELLING appropriate make believe games, using your imagination, and exposing your child to the idea of "sharing the floor" with another person. It's the environment you use to generalize behavioural skills you have taught. Later Floor Time can be thought of as becoming Social Cognitive Therapy I mention below in 4. Floor time has not been shown to change "autistic" behaviours (self stimulation etc.) but it has been shown to improve the quality of the relationship between the child and parent. I expect research will show it does the same with the child and therapist, teacher, teacher aide and so on. Some positive play time involving the reciprocal interactions between the child and adult needs to be part of any program. And it needs to be fun, reinforcing and relaxing!
3. Speech Therapy
Speech Therapy may help their child with communication difficulties. The difficulties are not in how the child speaks or pronounces words, but rather in how the child perceives the meaning of other people's speech. A speech therapist focuses on issues of social reciprocity, understanding the second level of communication in speech. Often this is more about what is not said than what is said. In speech therapy I would expect a child to learn to understand how what he or she says effects others. And in addition, a speech therapist is able to measure our overall progress in terms of "pragmatic language and help with simple speech difficulties that make communication, already difficult, even more difficult. Every child with Asperger's should be seen by a speech pathologist.
4. Social Cognitive Therapy
The I-LAUGH Model of Social Cognition developed by Michelle Garcia Winner is a framework of social cognition designed to explain the multiple skills and concepts that we must process and react to in order to succeed at social interaction and personal problem solving. Each of these elements of social cognition affects not only our ability to make and keep friends, but also our ability to process complex information in the classroom and the workplace. The I-LAUGH Model is evidence-based in that each aspect of it has been researched and defined as a trait of persons with social relatedness issues. A brief summary of the I-LAUGH framework from her web page is below. You can find out more about here work at her website at www.socialthinking.com:
I = Initiation of Communication (Kranz & McClannahan, 1993)
Initiation of communication is the ability to use one’s language skills to establish social relations and to seek assistance or information from others. Many students with autism spectrum disorders have significant problems initiating communication in stressful situations or when information is not easily understood. Language retrieval is difficult in anything other than calm, secure situations. Even within the higher functioning population with autism spectrum disorders, the student’s ability to talk about a favourite topic of interest can exist in sharp contrast to how that student communicates when needing help or when attempting to gain social entry into peer groups. Yet, these two skills – asking for help and understanding how to join a group for functional or personal interaction - are paramount for any student’s future success.
L= Listening With Eyes and Brain (Mundy & Crowson, 1997; Kunce and Mesibov, 1998; Jones & Carr, 2004)
Many persons with autism spectrum disorders and other social cognitive deficits have difficulty with auditory comprehension. From a social perspective, listening requires more than just taking in auditory information. It also requires the person to integrate information seen with that which is heard, to understand the full meaning of the message being conveyed, or to make an educated guess about what is being said when one cannot clearly understand it. For example, classroom teachers expect students to “listen with their eyes” when they point to information that is part of the instruction. They also indicate to whom they are speaking in a class, not by calling the student’s name but instead by looking at the student or moving closer. Students repeatedly relate to their peers through nonverbal cues, ranging from rolled eyes to signal boredom, to raised eyebrows to indicate questioning, to gazing at a particular item to direct a peer’s attention. Clearly to “listen with one’s eyes” requires students to have mastered the concept of joint attention – a skill that seems to effortlessly develop by the time a child is 12 months to 15 months old in neurotypical children, but may be missing from the social repertoire of the student with autism spectrum disorders, ADHD and similar challenges. Instruction in this essential and fundamental function of social interaction begins with teaching students that eyes share social information. Not all students understand this concept, nor do they grasp that listening requires full attention to both verbal and nonverbal cues. It can then expand to teaching students to relate to each other’s thoughts through play and other activities of social relatedness, followed by extending the student’s realm to attending to and processing increasingly complex cues that help students “listen with their whole bodies.”
A = Abstract and Inferential Language/Communication (Minshew, Goldstein, Muenz & Payton, 1992)
Most of the language we use is not intended for literal interpretation. Our communication is peppered with idioms, metaphors, sarcasm and inferences. Societies around the world bestow awards to writers, and even comedians, who are most creative with language. Each generation of teens creates its own slang; kids who follow along are in; those who don’t, are often out. Advertising and other forms of mass media follow these cues. The abstract and inferential component of communication is huge and constantly in flux. It is a mistake to assume that our students with social thinking deficits understand our society’s non-literal use of language. In fact, most of them don’t! Literal interpretation of language is a hallmark characteristic of individuals with ASD. Yet, as educators and parents, we either miss this impairment entirely – thinking our smart kids must understand our nuanced communication - or we address it in the briefest of ways, with instruction dedicated only to explaining idioms, irony and metaphors as part of English class.
U = Understanding Perspective (Baron-Cohen & Jolliffe, 1997; Baron-Cohen, 2000)
To understand the differing perspectives of others requires that one’s Theory of Mind (perspective taking) work quickly and efficiently. Most neurotypical students acquire a solid foundation in ToM between the ages of 4 to 6 years old. Perspective taking is not one thing, it represents many things happening all at once meaning it is a synergistic and dynamic process.
G=Gestalt Processing/Getting the Big Picture (Shah & Frith, 1993; Fullerton, Stratton, Coyne & Gray, 1996)
Information is conveyed through concepts, not just facts. When involved in conversation, the participants intuitively determine the underlying concept being discussed. When reading a book of literature, the purpose is to follow the overall meaning (concept) rather than just collect a series of facts. Conceptual processing is a key component to understanding social and academic information. Difficulty developing organizational strategies cannot be isolated from conceptual processing. Students with conceptual processing challenges often have difficulties with written expression, organizational skills, time management and being overly tangential in their social relations. (All of these concepts require us to stay focused on a central theme or main idea and to keep our writing, discussions or planning focused to this central point. Many of our folks struggle with this, over-focusing on details and not focusing in the concept (an intuitive skills for neurotypicals).
H= Humor and Human Relatedness (Gutstein, 2001; Greenspan, & Wieder, 2003; Prizant, Wetherby, Rubin, Laurent & Rydell, 2006)
Most individuals with autism spectrum disorders, Asperger’s and similar challenges have good senses of humour, but they feel anxious since they miss many of the subtle cues that help them understand how to participate successfully with others. It is important for educators and parents to work compassionately and with humour to help minimize the anxiety these children are experiencing. At the same time, many of our clients use humour inappropriately; direct lessons about this topic are needed and relevant.
Human relatedness - the ability to bond emotionally with others - is at the heart of human social relationships and the fuller development of empathy and emotional regulation. Teaching students how to relate and respond to other people’s emotions as well as their own, while also helping them feel the enjoyment that arises through mutual sharing, is critical to the development of all other aspects of social development.
Michelle Winner's "Social Thinking" approach may sound overwhelming, but it is in reality simply, fun and reinforcing for children. She has numerous books, workbooks, videos and other resources for use at home and in the school. One of my favourite is a book called "Superflex," a book for kids/students that teachers about the way the mind of a person with Asperger's works, and steps you can take to overcome many of the problems this brings. She demonstrates this through an exciting and funny set of stories involving super-heros battling super villains like "RockBrain," an evil doer who keeps you from using your brain in a flexible manner. If you have a teen, or are an adult with Aspergers, you'll understand and like this story.
This is a lot to think about, and most parents need to find someone to guide them through this maze of techniques, programs and new language. Often I see parents jump at quick and easy answers that make promises based upon "testimonials" of others. These include the use of "brain tuning," "hearing training," ""sound tuning," biofeedback or neuro-therapy and many miracle diets and supplements. None of these have any scientific basis, and many plainly don't make sense. These four treatment methods should be the foundation of your plan. They are supported by research, used in most schools and intervention programs, and are accepted by the professional community. If you insist on "testimonials" I can even say, although I am reluctant, that these are the programs most highly recommended by parents.
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My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other social-cognitive deficits and learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.
Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.
Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com
Showing posts with label Port Coquitlam. Show all posts
Showing posts with label Port Coquitlam. Show all posts
Tuesday, December 28, 2010
Saturday, December 4, 2010
MRI Test Shows Diagnostic Promise for Autism - in Pediatrics, Autism from MedPage Today
Medical News: MRI Test Shows Diagnostic Promise for Autism - in Pediatrics, Autism from MedPage Today\
Does this new research mean we can get a quick, easy and absolute diagnosis of Autism from a simple MRI scan? No, regretfully not, although that's how the mainstream press presents it. MRI scans of the brain in this research protocol focused on two specific regions in the temporal lobe was able to diagnose high-functioning autism with 94% sensitivity in a preliminary evaluation. There are, however some serious limitations with this study included the small sample size, lack of a comparator group with developmental disorders other than autism, and use of highly selected features for evaluation. These limitations mean that we don't know if this type of scan can or ever will (although ever is a long time) tell us if a child has autism, a language disability or other disorder. So far, and for the near future, the scan can't tell these different disorders apart, and that's why we use more complex tests for autism such as the ADOS (Autism Diagnostic Observation Scale) and the ADI-R (Autism Diagnostic Interview0-Revised). These remain, and most likely will remain, the standard for assessment here in British Columbia.
Autism, like many other social and learning disorders present on a scale, and it is necessary for the treating clinician to understand the unique way the disorder presents itself. Two children with identical brain scans may, I would expect, present very differently in terms of behaviours and immediate intervention needs because the disorder interacts with their temperament, other co-morbid issues (such as sensory sensitivities), environmental factors such as parenting skills/temperament/siblings and developmental experiences. Add on to this factors relating to the larger social environments such as schools. An MRI, blood or urine test may be helpful, and may very well become necessary for diagnosis or government funding in some locations, but a good clinical interview, observation in multiple settings, history taking and appropriate "hands-on" diagnostic assessment are still the foundation for building a good treatment and intervention plan.
.....................................................................................
My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.
Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.
Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com
Does this new research mean we can get a quick, easy and absolute diagnosis of Autism from a simple MRI scan? No, regretfully not, although that's how the mainstream press presents it. MRI scans of the brain in this research protocol focused on two specific regions in the temporal lobe was able to diagnose high-functioning autism with 94% sensitivity in a preliminary evaluation. There are, however some serious limitations with this study included the small sample size, lack of a comparator group with developmental disorders other than autism, and use of highly selected features for evaluation. These limitations mean that we don't know if this type of scan can or ever will (although ever is a long time) tell us if a child has autism, a language disability or other disorder. So far, and for the near future, the scan can't tell these different disorders apart, and that's why we use more complex tests for autism such as the ADOS (Autism Diagnostic Observation Scale) and the ADI-R (Autism Diagnostic Interview0-Revised). These remain, and most likely will remain, the standard for assessment here in British Columbia.
Autism, like many other social and learning disorders present on a scale, and it is necessary for the treating clinician to understand the unique way the disorder presents itself. Two children with identical brain scans may, I would expect, present very differently in terms of behaviours and immediate intervention needs because the disorder interacts with their temperament, other co-morbid issues (such as sensory sensitivities), environmental factors such as parenting skills/temperament/siblings and developmental experiences. Add on to this factors relating to the larger social environments such as schools. An MRI, blood or urine test may be helpful, and may very well become necessary for diagnosis or government funding in some locations, but a good clinical interview, observation in multiple settings, history taking and appropriate "hands-on" diagnostic assessment are still the foundation for building a good treatment and intervention plan.
.....................................................................................
My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.
Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.
Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com
Tuesday, November 30, 2010
Medical News: Groups Assail Vision Therapy as Remedy for Learning Disabilities - in Pediatrics, General Pediatrics from MedPage Today
Link to the original article: Medical News: Groups Assail Vision Therapy as Remedy for Learning Disabilities - in Pediatrics, General Pediatrics from MedPage Today
I don't like to cross post, and Google hates it when I do, but this is an excellent article on "vision therapy," a form of therapy that many of my clients come to me and ask about. Here's what the medical professionals have to say:
"Behavioral vision therapy, eye exercises, and colored lenses have no role in treatment of dyslexia and other learning disabilities, according to the American Academy of Pediatrics. The academy came down hard on these "scientifically unsupported" alternative treatments in a joint statement with the American Academy of Ophthalmology and other vision organizations. Because learning disabilities are difficult to treat and have long-term consequences for education and socioeconomic achievement, unproven therapies have become highly visible, Sheryl Handler, MD, of the AAO, and colleagues wrote in the August issue of Pediatrics. "Ineffective, controversial methods of treatment such as vision therapy may give parents and teachers a false sense of security that a child's learning difficulties are being addressed, may waste family and/or school resources, and may delay proper instruction or remediation," they cautioned.
I'm not too sure there really is much more to say than that. Read the article, watch the video. The world is full of people telling parents of children with autism, Aspergers, ADHD and related learning disabilities they should spend thousands of dollars on medical treatment that fixes their child. Often, rather than research, we see many many parent testimonials. I've heard them from parents in my office. Vision therapy CURED my child. While that was going on there was a change in classroom teacher, a new support teacher tried a new methods, the child matured and a medication was tried. But the providers of these services stressed how without them nothing would have changed. Do not rely on testimonials. Talk to your doctor. Make science based choices.
This web page/blog is NOT meant as medical advice. NEVER get your medical advice from a blog, or from the internet. If you find something, press print. Take it to your medical doctor and ask what he or she thinks. Go to someone who has the training and experience to help you make good medical and educational choices.
..........................................
My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.
Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.
Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com
I don't like to cross post, and Google hates it when I do, but this is an excellent article on "vision therapy," a form of therapy that many of my clients come to me and ask about. Here's what the medical professionals have to say:
"Behavioral vision therapy, eye exercises, and colored lenses have no role in treatment of dyslexia and other learning disabilities, according to the American Academy of Pediatrics. The academy came down hard on these "scientifically unsupported" alternative treatments in a joint statement with the American Academy of Ophthalmology and other vision organizations. Because learning disabilities are difficult to treat and have long-term consequences for education and socioeconomic achievement, unproven therapies have become highly visible, Sheryl Handler, MD, of the AAO, and colleagues wrote in the August issue of Pediatrics. "Ineffective, controversial methods of treatment such as vision therapy may give parents and teachers a false sense of security that a child's learning difficulties are being addressed, may waste family and/or school resources, and may delay proper instruction or remediation," they cautioned.
I'm not too sure there really is much more to say than that. Read the article, watch the video. The world is full of people telling parents of children with autism, Aspergers, ADHD and related learning disabilities they should spend thousands of dollars on medical treatment that fixes their child. Often, rather than research, we see many many parent testimonials. I've heard them from parents in my office. Vision therapy CURED my child. While that was going on there was a change in classroom teacher, a new support teacher tried a new methods, the child matured and a medication was tried. But the providers of these services stressed how without them nothing would have changed. Do not rely on testimonials. Talk to your doctor. Make science based choices.
This web page/blog is NOT meant as medical advice. NEVER get your medical advice from a blog, or from the internet. If you find something, press print. Take it to your medical doctor and ask what he or she thinks. Go to someone who has the training and experience to help you make good medical and educational choices.
..........................................
My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.
Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.
Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com
Thursday, September 23, 2010
What services are available to my child with autism or Aspergers in BC schools?
I am often asked this very simple question by parents of children who come in for assessments of autism and Aspergers. And the answer is: It depends.
It depends on your specific school district, it depends on the funding the school has in total (your child's funding is often put in a big pot by the school district and divided up between several different children with special education needs...yes, it's hard to believe but in many districts this is true), and finally, it depends upon the training and availability of staff.
For the next few posts I'm going to try and walk you through this process as best I can. We will start with information about getting your child services at all. That means having him or her "designated" with a "code." And from their I will talk about what you should expect, and what you might actually get.
The process begins with a diagnosis. Depending upon your child's age he (I will be using he from now on to make this simpler to understand, although I know girls are OFTEN overlooked in this process) needs to diagnosed by an appropriately registered and trained professional. This can be done for free through several provincial services, however there is a waiting list. You start with a referral from your medical doctor. Usually the referral is to your regional autism program, and your MD should know how to do that. Start on this process early, as there is a significant wait and early treatment is important.
Children under 6 need to be assessed by a "team" including a medical doctor, speech pathologist and usually a psychologist. Children over six need only one professional, either a medical doctor or psychologist. Whoever does this needs to use two important assessment tools. These are the ADOS (Autism Diagnostic Observation System) and the ADI-R (Autism Diagnostic Interview-Revised. YThey may use additional tools, but the MUST use these, and they need to have appropriate training and experience using these. These assessment take a few hours to complete. In addition to these tools/tests the team or individual professional needs to do other investigations as well in order to rule out other possible causes of your child's behaviour of concern. This includes a cognitive test (intelligence), an academic assessment (usually the WIAT or WRAT-4) and speech/language assessments (sometimes the Test of Pragmatic Language or a similar test). Finally, you will need to complete some form of behaviour evaluation such as the ABAS. There may be other tools/tests used, but these are the basics. Depending on the age of your child and the complexity of the assessment the cost can run from $1,800 to $2,400 or higher. It usually takes three, four or five sessions to complete the assessment.
IF the assessment leads to a diagnosis of autism or Asperger's Disorder (the final diagnosis is not made by the numbers and scores but by the professional's overall judgement of your child) you will need to complete an application for funding from the Ministry of Children and Family Development if you are seeking provincial funding. You can click here and download a brochure from the ministry that takes you through all these steps. I would download this in any case.
After the assessment is complete you should get funding form completed by the professional, and he or she will attached a written report that goes with the application. You should also get a report to take to your school. Your report needs to clearly state your child's diagnosis.
The Ministry issues above are unrelated to school services and funding, they are totally separate issues and should not be confused.
Now take a copy of your report and a cover letter requesting that the school's Committee on Special Education or Support Team (different names are used in different district) evaluate your child for coding. Coding is a process where the School Based Support Team, usually, meet and determine what is going to happen about coding and what services your child will get. You should request that you be informed of ALL MEETINGS at which your child is discussed, and make sure you are asked to attend. Do this in writing even if you already know you work and can't attend these meetings. Insist on your right to be informed and attend.
I would give a copy of the report to the school based team or principal, and bring a copy to your school district's Support Services or Special Education department. Get a dated note that says they have received this, or send an email and ask for acknowledgement that it has been received. This things get lost, overlooked and forgotten, don't let that happen!
You should not be asked to attend a Support Meeting where your child is "coded," that is, given a special education designation, (for Autism the coding is G) and at that meeting an IEP or Individual Education Plan should be written. This plan looks at your child's needs and should say how they will be addressed, and how they will measure the effectiveness of their interventions (not how your child is doing!). If there are significant behaviour problems you should also request a Functional Behaviour Analysis take place by someone trained to do it and a formal Positive Behaviour Support Plan be written from that. In later posts I will go into detail about what those look like and what you should expect.
What next? Your child should be getting INDIVIDUALIZED services to help with their deficits and needs. This should include, at the least, someone supervising your child's program who has training and experience in the field of autism. The most appropriate person would be his or her teacher. The province provides training for teachers through workshops during teacher training days, and through certificate programs at POPARD, the Provincial Outreach Program for Autism and Related Disorders. Someone woking with your child should have attended these workshops - at a minimum.
When a child is "coded" for autism the school district receives money to help support that child. This is not enough money to do the job so school districts need to take those funds and combine them to create staff positions that are then shared by several children. Yes, some children with more severe behaviour problems get more staff time. You can be aware of this, monitor it, and make sure your child is getting the support they need, but also be sensitive to the fact that there is not enough funding to do what needs to be done, and districts are doing the best they can. You can make sure that funds for children with an autism coding isn't moved over to deal with children with other coding that didn't get enough funds. This does happen.
Once your child is found eligible for autism services in school you should ask to meet with the schools autism team, or with the staff member in charge of students with autism. Often there is a staff member assigned to work as a partner with the Provincial Outreach Program for Autism and Related Disorders (POPARD). This person usually has the title of "POPARD District Partner." Find this person and immediately request a consultation from the POPARD consultant. Always put your request in writing, and send a copy to the Director of Support Services or Special Services in the district.
The POPARD consultant can come to the school, review your child's case, do an observation of your child in the classroom and then meet with the staff and present a written support plan. Often they also come to the school and provide direct training to staff, as well as observation and consultation. Each school district has a specific number of hours of POPARD consultation time, it gets used fast, and there is never enough, so get on this early! If all the time that is allotted by Ministry funding is already use remember, school districts can pay for extra time, consultation and training! These are excellent professionals, highly trained with years of experience. You can find out more about POPARD by clicking here and going to their site. They have an abundance of information and videos demonstrating the services and techniques you should be seeing in your child's class.
So to review: to obtain services for your child with autism or Asperger's Disorder in British Columbia you first need to have your child diagnosed. This can be done either through a referral from your family doctor to an appropriate provincial program (such as Children's hospital) or through a private practitioner if you don't want to wait or simply want to use your own professional. The ministry website for information on this process can be found above. Next, you bring your assessment and diagnostic letter to the school and request a meeting to discuss "coding" for your child. The school should code your child, write an IEP and if necessary a behaviour plan. Finally, you should check to see that the staff working with your child are properly trained and receive appropriate supervision and consultation. Try to get your school's POPARD consultant involved.
In the next few weeks I will discuss the IEP process, writing behaviour plans, and where to go for help with curriculum. I hope this has been helpful.
For information about my private practice you may go to my website at www.relatedminds.com and look for autism services. You can also find out more about my services for children, adolescents and adults with autism or Asperger's Disorder at my PsychologyToday website or my BCAMFT/AAMFT website.
It depends on your specific school district, it depends on the funding the school has in total (your child's funding is often put in a big pot by the school district and divided up between several different children with special education needs...yes, it's hard to believe but in many districts this is true), and finally, it depends upon the training and availability of staff.
For the next few posts I'm going to try and walk you through this process as best I can. We will start with information about getting your child services at all. That means having him or her "designated" with a "code." And from their I will talk about what you should expect, and what you might actually get.
The process begins with a diagnosis. Depending upon your child's age he (I will be using he from now on to make this simpler to understand, although I know girls are OFTEN overlooked in this process) needs to diagnosed by an appropriately registered and trained professional. This can be done for free through several provincial services, however there is a waiting list. You start with a referral from your medical doctor. Usually the referral is to your regional autism program, and your MD should know how to do that. Start on this process early, as there is a significant wait and early treatment is important.
Children under 6 need to be assessed by a "team" including a medical doctor, speech pathologist and usually a psychologist. Children over six need only one professional, either a medical doctor or psychologist. Whoever does this needs to use two important assessment tools. These are the ADOS (Autism Diagnostic Observation System) and the ADI-R (Autism Diagnostic Interview-Revised. YThey may use additional tools, but the MUST use these, and they need to have appropriate training and experience using these. These assessment take a few hours to complete. In addition to these tools/tests the team or individual professional needs to do other investigations as well in order to rule out other possible causes of your child's behaviour of concern. This includes a cognitive test (intelligence), an academic assessment (usually the WIAT or WRAT-4) and speech/language assessments (sometimes the Test of Pragmatic Language or a similar test). Finally, you will need to complete some form of behaviour evaluation such as the ABAS. There may be other tools/tests used, but these are the basics. Depending on the age of your child and the complexity of the assessment the cost can run from $1,800 to $2,400 or higher. It usually takes three, four or five sessions to complete the assessment.
IF the assessment leads to a diagnosis of autism or Asperger's Disorder (the final diagnosis is not made by the numbers and scores but by the professional's overall judgement of your child) you will need to complete an application for funding from the Ministry of Children and Family Development if you are seeking provincial funding. You can click here and download a brochure from the ministry that takes you through all these steps. I would download this in any case.
After the assessment is complete you should get funding form completed by the professional, and he or she will attached a written report that goes with the application. You should also get a report to take to your school. Your report needs to clearly state your child's diagnosis.
The Ministry issues above are unrelated to school services and funding, they are totally separate issues and should not be confused.
Now take a copy of your report and a cover letter requesting that the school's Committee on Special Education or Support Team (different names are used in different district) evaluate your child for coding. Coding is a process where the School Based Support Team, usually, meet and determine what is going to happen about coding and what services your child will get. You should request that you be informed of ALL MEETINGS at which your child is discussed, and make sure you are asked to attend. Do this in writing even if you already know you work and can't attend these meetings. Insist on your right to be informed and attend.
I would give a copy of the report to the school based team or principal, and bring a copy to your school district's Support Services or Special Education department. Get a dated note that says they have received this, or send an email and ask for acknowledgement that it has been received. This things get lost, overlooked and forgotten, don't let that happen!
You should not be asked to attend a Support Meeting where your child is "coded," that is, given a special education designation, (for Autism the coding is G) and at that meeting an IEP or Individual Education Plan should be written. This plan looks at your child's needs and should say how they will be addressed, and how they will measure the effectiveness of their interventions (not how your child is doing!). If there are significant behaviour problems you should also request a Functional Behaviour Analysis take place by someone trained to do it and a formal Positive Behaviour Support Plan be written from that. In later posts I will go into detail about what those look like and what you should expect.
What next? Your child should be getting INDIVIDUALIZED services to help with their deficits and needs. This should include, at the least, someone supervising your child's program who has training and experience in the field of autism. The most appropriate person would be his or her teacher. The province provides training for teachers through workshops during teacher training days, and through certificate programs at POPARD, the Provincial Outreach Program for Autism and Related Disorders. Someone woking with your child should have attended these workshops - at a minimum.
When a child is "coded" for autism the school district receives money to help support that child. This is not enough money to do the job so school districts need to take those funds and combine them to create staff positions that are then shared by several children. Yes, some children with more severe behaviour problems get more staff time. You can be aware of this, monitor it, and make sure your child is getting the support they need, but also be sensitive to the fact that there is not enough funding to do what needs to be done, and districts are doing the best they can. You can make sure that funds for children with an autism coding isn't moved over to deal with children with other coding that didn't get enough funds. This does happen.
Once your child is found eligible for autism services in school you should ask to meet with the schools autism team, or with the staff member in charge of students with autism. Often there is a staff member assigned to work as a partner with the Provincial Outreach Program for Autism and Related Disorders (POPARD). This person usually has the title of "POPARD District Partner." Find this person and immediately request a consultation from the POPARD consultant. Always put your request in writing, and send a copy to the Director of Support Services or Special Services in the district.
The POPARD consultant can come to the school, review your child's case, do an observation of your child in the classroom and then meet with the staff and present a written support plan. Often they also come to the school and provide direct training to staff, as well as observation and consultation. Each school district has a specific number of hours of POPARD consultation time, it gets used fast, and there is never enough, so get on this early! If all the time that is allotted by Ministry funding is already use remember, school districts can pay for extra time, consultation and training! These are excellent professionals, highly trained with years of experience. You can find out more about POPARD by clicking here and going to their site. They have an abundance of information and videos demonstrating the services and techniques you should be seeing in your child's class.
So to review: to obtain services for your child with autism or Asperger's Disorder in British Columbia you first need to have your child diagnosed. This can be done either through a referral from your family doctor to an appropriate provincial program (such as Children's hospital) or through a private practitioner if you don't want to wait or simply want to use your own professional. The ministry website for information on this process can be found above. Next, you bring your assessment and diagnostic letter to the school and request a meeting to discuss "coding" for your child. The school should code your child, write an IEP and if necessary a behaviour plan. Finally, you should check to see that the staff working with your child are properly trained and receive appropriate supervision and consultation. Try to get your school's POPARD consultant involved.
In the next few weeks I will discuss the IEP process, writing behaviour plans, and where to go for help with curriculum. I hope this has been helpful.
For information about my private practice you may go to my website at www.relatedminds.com and look for autism services. You can also find out more about my services for children, adolescents and adults with autism or Asperger's Disorder at my PsychologyToday website or my BCAMFT/AAMFT website.
Monday, July 19, 2010
Does it make sense to use Time Out with children with Asperger's?
Another parent comes by with tales of woe from attempting to use "Time-Out" to change behaviour. Well, this doesn't surprise me at all. Time Out is a very difficult procedure, and it really isn't designed to do what most people expect: get a new behaviour started. It is especially difficult to use with children with ADHD, autism, Asperger's and other disorders that have a high percentage of problems with executive function.
Time Out is designed to reduce the frequency of a behaviour by reducing the reinforcement it gets. If a behaviour isn't reinforced, eventually it will fade away. The problem with this is that often times we don't do Time Out well, and because we argue, occasionally give in, and sometimes the child simply wins or gets other reinforcement (like attention) Time Out is very hard to do. This is especially true with children with attention deficit hyperactivity disorder, autism or those kids we think of having paediatric bipolar disorder. Even if we do it wrong one time out of five, we are providing what we call "intermittent reinforcement" and the child will become even more difficult to change. Intermittent reinforcement is what keeps people going back to gamble, in spite of the fact they only win occasionally. Face it, if you've watched "Super Nanny" you know she uses Time Out a lot, calling it the "naughty circle." And in every episode she needs to return and retrain the parents.
But eventually things do improve, and that's often because other behaviour techniques are being used that work better for ADHD, autism and bipolar disorder. These include setting up a family visual schedule, which helps reduce anxiety and depersonalizes the parent-child interactions, and there is always a positive reinforcement system (sometimes a token system) being used.
Whatever the inappropriate and unwanted behaviour is, somehow it works for the child. Somehow it is reinforcing. It may not have been at first, but sooner or later something about the behaviour and the response to it is reinforcing. Otherwise the behaviour would have stopped. It's our job to find out what is reinforcing the behaviour, what its "function" is, and teach our children new, more appropriate and functional "replacement behaviours." Behaviours that serve the same function as the original one, but are appropriate. We call this behaviour the FERB or Functionally Equivalent Replacement Behaviour. Every behaviour plan worth it's salt has a FERB. The replacement behaviour is taught, reinforced, and at the same time the inappropriate behaviour is ignored (as much as humanly possible ....we aren't all Super Nanny!). In this way we are teaching a new skill, and ignoring something we want to go away. We also make environmental changes to decrease the need to engage in the inappropriate behaviour (that's the purpose of that visual family schedule).
Notice, we are ignoring, and teaching, but what are we not doing? We aren't punishing. It isn't really a "naughty circle." It's a Time Out space where what your doing doesn't get reinforcement. Punishment is seldom an important component of successful parenting!
A really good book to learn interaction techniques to deal with children who have frequent and excessive temper tantrums is Dr. Ross Green's "The Explosive Child." It teaches you the skill and philosophy behind providing positive behaviour support to your child rather than trying to use punishment, which, you may have noticed, might stop a particular behaviour, but fails in one big way: It doesn't teach new skills!
For more information about child and adolescent parenting you can visit my web page at www.relatedminds.com, or www.adhdhelp.ca or my Psychology Today Website. You can also call my office at 778.998-7975 to make an appointment for a consultation.
Time Out is designed to reduce the frequency of a behaviour by reducing the reinforcement it gets. If a behaviour isn't reinforced, eventually it will fade away. The problem with this is that often times we don't do Time Out well, and because we argue, occasionally give in, and sometimes the child simply wins or gets other reinforcement (like attention) Time Out is very hard to do. This is especially true with children with attention deficit hyperactivity disorder, autism or those kids we think of having paediatric bipolar disorder. Even if we do it wrong one time out of five, we are providing what we call "intermittent reinforcement" and the child will become even more difficult to change. Intermittent reinforcement is what keeps people going back to gamble, in spite of the fact they only win occasionally. Face it, if you've watched "Super Nanny" you know she uses Time Out a lot, calling it the "naughty circle." And in every episode she needs to return and retrain the parents.
But eventually things do improve, and that's often because other behaviour techniques are being used that work better for ADHD, autism and bipolar disorder. These include setting up a family visual schedule, which helps reduce anxiety and depersonalizes the parent-child interactions, and there is always a positive reinforcement system (sometimes a token system) being used.
Whatever the inappropriate and unwanted behaviour is, somehow it works for the child. Somehow it is reinforcing. It may not have been at first, but sooner or later something about the behaviour and the response to it is reinforcing. Otherwise the behaviour would have stopped. It's our job to find out what is reinforcing the behaviour, what its "function" is, and teach our children new, more appropriate and functional "replacement behaviours." Behaviours that serve the same function as the original one, but are appropriate. We call this behaviour the FERB or Functionally Equivalent Replacement Behaviour. Every behaviour plan worth it's salt has a FERB. The replacement behaviour is taught, reinforced, and at the same time the inappropriate behaviour is ignored (as much as humanly possible ....we aren't all Super Nanny!). In this way we are teaching a new skill, and ignoring something we want to go away. We also make environmental changes to decrease the need to engage in the inappropriate behaviour (that's the purpose of that visual family schedule).
Notice, we are ignoring, and teaching, but what are we not doing? We aren't punishing. It isn't really a "naughty circle." It's a Time Out space where what your doing doesn't get reinforcement. Punishment is seldom an important component of successful parenting!
A really good book to learn interaction techniques to deal with children who have frequent and excessive temper tantrums is Dr. Ross Green's "The Explosive Child." It teaches you the skill and philosophy behind providing positive behaviour support to your child rather than trying to use punishment, which, you may have noticed, might stop a particular behaviour, but fails in one big way: It doesn't teach new skills!
For more information about child and adolescent parenting you can visit my web page at www.relatedminds.com, or www.adhdhelp.ca or my Psychology Today Website. You can also call my office at 778.998-7975 to make an appointment for a consultation.
Monday, June 14, 2010
Dealing with Angry, Aggressive and Explosive Children
I just posted this on my ADHD blog and realized it may very well apply to some children with Asperger's or higher functioning ASD. This article refers to a technique called Collaborative Problem Solving that can be used in conjunction with some of the techniques you would find in Michelle Garcia Winner's book "Thinking About You Thinking About Me." This technique is really about supporting children with executive disorders and may be of interest. Here it is:
There are a number of children who parents, siblings, schools and friends have a difficult time dealing with because of their apparent mood swings, what appears to be angry attitude towards others and often explosive, angry and sometimes aggressive response to requests or instructions.
Sometimes these children are diagnosed with a mood disorder (paediatric bipolar disorder, mood disorder NOS), sometimes with ODD (oppositional defiant disorder) and often with related neurological disorders which might be referred to as NVLD (non-verbal language disorder), high functioning autism, Asperger’s disorder or even a sensory disorder.
Treatment interventions range from simple behavioural programs using reinforcement schedules to the use of visual cues and prompts and medication. While one of the main interventions I teach in my office is a simple 8 part behaviour management program based upon the book Your Defiant Child by Dr. Russell Barkley. However, with certain children there is more to the problem than can be fixed with behavioural interventions in the home. This is especially true because for behavioural interventions to work they must be done in an environment we can control, and finally, besides changing an inappropriate behaviour and replacing it with a new appropriate one, there is often a much more complex task we need to teach- problem solving.
With these children we often use the work of Dr. Ross Green and his “Collaborative Problem Solving” approach. To teach this technique we strongly recommend parents read the book The Explosive Child (available on my web site, go to the home page and click “books recommended by Dr. Roche). We also suggest parents watch the video Parenting the Explosive Child and then practice the skills taught for several weeks under the support and supervision of a trained clinician.
What is the Collaborative Problem Solving approach? Dr. Green thinks that challenging children have often been poorly understood. All to often their challenging and difficult behaviour is seen as willful and goal oriented. (In spite of the fact it rarely gets them to their goal.) In other words the explosive and angry behaviour is seen as a means to getting attention and coercing people to give in to their demands. In fact, based upon research by Dr. Green and others, the basis of their difficult and explosive behaviour can best be seen as a learning disability or developmental delay in the executive functions of the brain that support flexibility in thinking and frustration tolerance. When the situation calls for the cognitive skills that are part of mental flexivbility (seeing things from the perspective of others) or handling frustration, they have difficulty. They may appear to be choosing to be non-compliant and explosive, but they are making that choice no more than the child who acts out in reading class when the work becomes too hard due to a reading disability. Dr. Green compares the typical view of these acting out children: “Children do well if they want to,” with the collaborative problem solving approach’s philosophy of, “Children do well if they can.”
How do these children get this way? Is it poor parenting? There are a number of different factors that leads to this lack of appropriate developmental skills. For some it is a developmental issue. For others it might be a combination of neurological (hard wiring) and neurobiological (chemical) issues. Dr. Green has identified five major areas of deficit that may be at the heart of the problems:1. Executive Function Skills; 2. Language Skills; 3. Emotional Regulation Skills; 4. Social Skills; 5. Cognitive Flexibility Skills. Luckily we have simple and effective ways to evaluate and determine where the child’s weaknesses as well as strength are. This can help us make intervention choices on a day to day basis that begin to address skill deficits rather than just make life more quiet and peaceful temporarily.
That’s a nice philosophy, but how do you make changes in my families day? The approach Dr. Green and others have developed (actually this is a rather old idea, you can find it in the treatment interventions of the Teaching Family Model at Boy’s Town) is called the Collaborative Problem Solving Approach (CPS). There are three major goals to this approach: 1. Allow adults to pursue expectations; 2. Teach lacking thinking / cognitive skills, and; 3. Reduce meltdowns and angry outbursts.
We do this by first understanding what are called the pathways (skills deficits) that underly the explosive behaviour; decide which plan will be used to handle any specific problem or situation (There are three plans, A,B,C); and then executing some form of plan B to teach the lacking skills. Plan be is the teaching of collaborative problem solving. Teaching your child how to work out a conflict with another person, whether it is another child, adult, teacher or you. Using this plan B is a way to support your child’s lack of executive control. Making up for and supporting your child with a structured interaction that naturally leads to solving problems. What’s in your mind and mouth are the phrases, “Let’s work it out,” and “We worked it out.”
How does this interaction style help control anger and meltdowns? The plan consists of three steps. First: Empathy and reassurance, then we define the problem, and next there is what is called the invitation. (This process is similar to other interventions taught for working with aggressive individuals such as CPI, the Boy’s Town Teaching Family Interaction, most mediation training, the approach to parenting found in Dr. John Gottman’s book Bringing up Emotionally Intelligent Children and many others. Green, however, has made it simple and emphasized the philosophy behind this positive support approach.)
Empathy is communicated through reflective listening and letting the child know that “you heard them.” This may sound simple, but we need practice, practice and more practice. This helps the child calm down, and ensures them that their issues are “on the table” and being heard. In a very specific order we ask what is going on with the child, let them know they have been heard, get them to tell us more (this is where language deficits might come in) and give them reassurance (Green says, “I’m not saying no....”)
We then clearly define the problem and invite the child to use problem solving skills to solve our mutual problem. All through the process you are teaching and modelling skills that address the child’s deficits as defined in the pathways assessment. This is a process that takes practice, can often use feedback, and honestly doesn’t guarantee there will be no more blowouts. But it does reduce the risk of them, it increases the chances you will have a pleasant and successful interaction with a usually angrey and easily frustrated child, and it will, over time, teach you child the executive problem solving skills they need to be not just compliant with your commands and requests, but able to negotiate and collaboratively problem solve with others out in the real world.
How long does this process take? And who comes to therapy? It’s my kid who needs therapy, not me. Honestly, while in my practice I see your child for an initial evaluation, and then may see them a few more times throughout the process, the most effective and successful way to treat children with anger problems of this magnitude is through education those who they interact with during the majority of their day. This usually means parent meetings and sometimes training and consultation with schools. It’s hard to give a length of time or number of sessions that you can expect. What I can say is that I have divided the process into eight parts, and each week we review some of Green’s work, usually watch and discuss Dr. Gottman’s video or book on emotionally intelligent children and review the basics of parenting skills found in Dr. Barkley’s program. Eight weeks is the usual length of family treatment. We then often meet a month later for a check up and then as needed. (Even Super Nanny comes back to visit!) I’m afraid that many people expect children can see a therapist in their office and play therapy or other interventions will make a dramatic change. There isn’t really any scientifically based proof that this kind of therapy is effective. Your best changes for significant positive change involves everyone, and we need to remember it’s about your relationship with your child.
Final Word Finally, I want to remind you that there are other techniques and interventions that are effective and may be used in conjunction with collaborative problem solving, and sometimes are more appropriate. These include using visual supports, teaching anxiety reduction skills, using cognitive behaviour therapy through a structured child focused program like “The Incredible Five Point Scale” and positive behavioural supports. Often school is a critical area where we need to intervene. This might include an assessment aimed at “coding” to obtain school based support, conducting a functional behaviour analysis (FBA) and developing a positive behaviour support plan and the possibility of medical interventions. Whenever there are serious behavioural concerns you should start by visiting your medical doctor for a full check up.

Therapy and counselling may involve just your child, your child and parents, the entire family constellation or in some cases consultation with schools and other agencies. Each case is unique and after our initial consultation and evaluation we will develop a plan together.
For more information on services I provide to children, adolescents and adults with ASD or Aspergs please visit my web site at either www.relatedminds.com or www.socialcognitivetherapy.com
There are a number of children who parents, siblings, schools and friends have a difficult time dealing with because of their apparent mood swings, what appears to be angry attitude towards others and often explosive, angry and sometimes aggressive response to requests or instructions.
Sometimes these children are diagnosed with a mood disorder (paediatric bipolar disorder, mood disorder NOS), sometimes with ODD (oppositional defiant disorder) and often with related neurological disorders which might be referred to as NVLD (non-verbal language disorder), high functioning autism, Asperger’s disorder or even a sensory disorder.
Treatment interventions range from simple behavioural programs using reinforcement schedules to the use of visual cues and prompts and medication. While one of the main interventions I teach in my office is a simple 8 part behaviour management program based upon the book Your Defiant Child by Dr. Russell Barkley. However, with certain children there is more to the problem than can be fixed with behavioural interventions in the home. This is especially true because for behavioural interventions to work they must be done in an environment we can control, and finally, besides changing an inappropriate behaviour and replacing it with a new appropriate one, there is often a much more complex task we need to teach- problem solving.
With these children we often use the work of Dr. Ross Green and his “Collaborative Problem Solving” approach. To teach this technique we strongly recommend parents read the book The Explosive Child (available on my web site, go to the home page and click “books recommended by Dr. Roche). We also suggest parents watch the video Parenting the Explosive Child and then practice the skills taught for several weeks under the support and supervision of a trained clinician.
What is the Collaborative Problem Solving approach? Dr. Green thinks that challenging children have often been poorly understood. All to often their challenging and difficult behaviour is seen as willful and goal oriented. (In spite of the fact it rarely gets them to their goal.) In other words the explosive and angry behaviour is seen as a means to getting attention and coercing people to give in to their demands. In fact, based upon research by Dr. Green and others, the basis of their difficult and explosive behaviour can best be seen as a learning disability or developmental delay in the executive functions of the brain that support flexibility in thinking and frustration tolerance. When the situation calls for the cognitive skills that are part of mental flexivbility (seeing things from the perspective of others) or handling frustration, they have difficulty. They may appear to be choosing to be non-compliant and explosive, but they are making that choice no more than the child who acts out in reading class when the work becomes too hard due to a reading disability. Dr. Green compares the typical view of these acting out children: “Children do well if they want to,” with the collaborative problem solving approach’s philosophy of, “Children do well if they can.”
How do these children get this way? Is it poor parenting? There are a number of different factors that leads to this lack of appropriate developmental skills. For some it is a developmental issue. For others it might be a combination of neurological (hard wiring) and neurobiological (chemical) issues. Dr. Green has identified five major areas of deficit that may be at the heart of the problems:1. Executive Function Skills; 2. Language Skills; 3. Emotional Regulation Skills; 4. Social Skills; 5. Cognitive Flexibility Skills. Luckily we have simple and effective ways to evaluate and determine where the child’s weaknesses as well as strength are. This can help us make intervention choices on a day to day basis that begin to address skill deficits rather than just make life more quiet and peaceful temporarily.
That’s a nice philosophy, but how do you make changes in my families day? The approach Dr. Green and others have developed (actually this is a rather old idea, you can find it in the treatment interventions of the Teaching Family Model at Boy’s Town) is called the Collaborative Problem Solving Approach (CPS). There are three major goals to this approach: 1. Allow adults to pursue expectations; 2. Teach lacking thinking / cognitive skills, and; 3. Reduce meltdowns and angry outbursts.
We do this by first understanding what are called the pathways (skills deficits) that underly the explosive behaviour; decide which plan will be used to handle any specific problem or situation (There are three plans, A,B,C); and then executing some form of plan B to teach the lacking skills. Plan be is the teaching of collaborative problem solving. Teaching your child how to work out a conflict with another person, whether it is another child, adult, teacher or you. Using this plan B is a way to support your child’s lack of executive control. Making up for and supporting your child with a structured interaction that naturally leads to solving problems. What’s in your mind and mouth are the phrases, “Let’s work it out,” and “We worked it out.”
How does this interaction style help control anger and meltdowns? The plan consists of three steps. First: Empathy and reassurance, then we define the problem, and next there is what is called the invitation. (This process is similar to other interventions taught for working with aggressive individuals such as CPI, the Boy’s Town Teaching Family Interaction, most mediation training, the approach to parenting found in Dr. John Gottman’s book Bringing up Emotionally Intelligent Children and many others. Green, however, has made it simple and emphasized the philosophy behind this positive support approach.)
Empathy is communicated through reflective listening and letting the child know that “you heard them.” This may sound simple, but we need practice, practice and more practice. This helps the child calm down, and ensures them that their issues are “on the table” and being heard. In a very specific order we ask what is going on with the child, let them know they have been heard, get them to tell us more (this is where language deficits might come in) and give them reassurance (Green says, “I’m not saying no....”)
We then clearly define the problem and invite the child to use problem solving skills to solve our mutual problem. All through the process you are teaching and modelling skills that address the child’s deficits as defined in the pathways assessment. This is a process that takes practice, can often use feedback, and honestly doesn’t guarantee there will be no more blowouts. But it does reduce the risk of them, it increases the chances you will have a pleasant and successful interaction with a usually angrey and easily frustrated child, and it will, over time, teach you child the executive problem solving skills they need to be not just compliant with your commands and requests, but able to negotiate and collaboratively problem solve with others out in the real world.
How long does this process take? And who comes to therapy? It’s my kid who needs therapy, not me. Honestly, while in my practice I see your child for an initial evaluation, and then may see them a few more times throughout the process, the most effective and successful way to treat children with anger problems of this magnitude is through education those who they interact with during the majority of their day. This usually means parent meetings and sometimes training and consultation with schools. It’s hard to give a length of time or number of sessions that you can expect. What I can say is that I have divided the process into eight parts, and each week we review some of Green’s work, usually watch and discuss Dr. Gottman’s video or book on emotionally intelligent children and review the basics of parenting skills found in Dr. Barkley’s program. Eight weeks is the usual length of family treatment. We then often meet a month later for a check up and then as needed. (Even Super Nanny comes back to visit!) I’m afraid that many people expect children can see a therapist in their office and play therapy or other interventions will make a dramatic change. There isn’t really any scientifically based proof that this kind of therapy is effective. Your best changes for significant positive change involves everyone, and we need to remember it’s about your relationship with your child.
Final Word Finally, I want to remind you that there are other techniques and interventions that are effective and may be used in conjunction with collaborative problem solving, and sometimes are more appropriate. These include using visual supports, teaching anxiety reduction skills, using cognitive behaviour therapy through a structured child focused program like “The Incredible Five Point Scale” and positive behavioural supports. Often school is a critical area where we need to intervene. This might include an assessment aimed at “coding” to obtain school based support, conducting a functional behaviour analysis (FBA) and developing a positive behaviour support plan and the possibility of medical interventions. Whenever there are serious behavioural concerns you should start by visiting your medical doctor for a full check up.

Therapy and counselling may involve just your child, your child and parents, the entire family constellation or in some cases consultation with schools and other agencies. Each case is unique and after our initial consultation and evaluation we will develop a plan together.
For more information on services I provide to children, adolescents and adults with ASD or Aspergs please visit my web site at either www.relatedminds.com or www.socialcognitivetherapy.com
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