Sunday, May 30, 2010

The Sensory Impact on Eating

Sensory issues are common amongst children on the autistic spectrum and one of the most obvious places is in the mouth. Some children need extra sensation there while others have a very low tolerance.

Either way, it causes problems.

The Need for Extra Sensation
My youngest son was always putting objects into his mouth as a baby. In fact, it's something that he still does most of the time now, aged six. It wasn't just food that interested him, it was wallpaper - which he ate at night from the walls nearest his cot. It was toys and stones and bits of fluff too. My wife used to have to watch him closely all the time becuase he'd often start choking and have to be rescued. The sensory needs were so overwhelming though that no sooner had he spat out the object he was choking on then he would start eating it all over again.

On the first Christmas we had after he could sit up, we had to unplug the lights on the Christmas tree because he kept trying to mouth them. Later on, after I discovered a christmas light bulb in his nappy (yes, it had made it all the way through) we moved the tree entirely out of reach.

Our pediatrician wasn't much help either. He first suggested that children with low iron sometimes suck rocks and other objects to get the vitamins and minerals they need. We tested our son but his iron levels were fine. When we complained to the pediatrician about our son eating lead pencils, he simply said smiling, "he probably just wanted to put lead in his pencil". I think that was when we realised that we needed to change pediatricians.

These days, we recognize it as a sensory need and tolerate it accordingly. I say tolerate instead of "approve" because he still does a huge amount of damage to clothing and furniture with those teeth. There are sensory tools that you can get for kids to chew on but somehow we always figured that he'd prefer to seek out his own sensations.

One thing's for sure, the need for extra sensation is at least partially to blame for my son's huge appetite.


Too Much Sensation
Then there's the other side of the coin. Over-sensitive mouth tissue. This has always been a problem that I have, and it seems that my eldest son suffers from it as well.

Just the sensation of my tongue on the top of my mouth can sometimes have me itching or trying to calm down my mouth for hours. When I'm sick, an inflamed throat or an ulcer feels gigantic and has great impact because I can't stand for it to come in contact with other parts of my mouth.

The biggest impact however is in the region of food. I do have some taste issues; for example, I can't handle carrots too well and I seriously can't even look at sultanas. The thing is, that I think these issues didn't start out as taste problems. I think they started life as sensory issues.

These days, I'm grown up and I can eat carrots provided that none (or at least minimal) chewing is done. It's not so much that chewing releases the flavour but rather that it brings my mouth in contact with the texture of carrot. I can also clearly remember that my first issues with sultanas began as texture issues.

When my eldest son was just a baby, it was quite common for the feeder (usually my wife) to be covered in muck (spat out food). She used to get quite mad about it and feel that my son was mocking her. Of course, back then we didn't know about autism and we had no idea that it was texture issues.

Today, my son still eats very little. I'm not worried. I was nicknamed "sparrow" by my best friend's mother because I ate almost nothing. I survived. There were always things I could eat, eventually.

Again, there are things you can do to get around the problem, one of the most obvious being to change the texture. Try orange juice instead of oranges. Try teaching your child to use a knife to cut corn kernels from a cob instead of biting them off (I have texture issues with the cob but not with the corn). Try using a blender to puree foods, try freezing them. Try anything and everything...

...but don't panic.

As far as I know, no child has ever starved themselves to death - or even into a state of illness, for texture reasons when food was readily available. As I used to say to my wife when our son wouldn't eat. It takes about 25 days for a child to starve themselves to death - call me on day 20 if he still hasn't eaten anything.

Tuesday, May 18, 2010

So... Your Child has Aspergers - Part 2

"Congratulations! Your child has Aspergers!"

I'll often say this to parents and the blank/astonished looks that I receive make it clear that they just can't see the good in the label.

There are many worse conditions that your child can have. People with aspergers can have rich and fulfilling lives. They can get married, they can become successful business people and they can have loving and supporting families.

The main keys to the condition are;
  • Early Intervention
  • Supportive and Understanding Parents, friends and partners

Early Intervention
There's a lot more to early intervention than just detection. In fact, if you're going to stick with detection only, then you might as well, not bother getting a diagnosis.

For a start, there's information dissemination. You can't keep the diagnosis to yourself. You're going to have to tell people. A lot of parents balk at this on the grounds that they feel their child will be victimized by the system, by their teachers or by their peers. If anything, the opposite is true. If your child behaves "out of the ordinary" and no satisfactory reasons for their behavior are given, then there is no defense from the actions of their school (for example being expelled for taking something literally) and no special accommodations are made. Similarly, children without a known condition will find themselves with less teacher protection from bullies.

The absolute best therapy of all is "early intervention" and this means that you really need to make the diagnosis known. You'll be surprised how often teachers guess the problems before you tell them and how often they reveal themselves to be experienced in special needs and aspergers.

You should find out if your child's teachers know about aspergers and if they've taught children with aspergers before. If not, it's a good idea to print off some material for them to read. If your child has different teachers every year, then you should consider giving them an introductory letter each year. A letter which points out not only information about aspergers but also information about your child's particular likes and dislikes, strengths and weaknesses.

Once the teachers are aware of the diagnosis, they'll probably engage you in the IEP process. IEP stands for Individualized Education Program. The IEP is a legally supported method of customising your child's classroom activities to address their particular weaknesses. It needs to be taken very seriously and both parents need to attend IEP meetings. You need to be prepared and you need to be focussed on moving your child forward rather than complaining about past mistakes the school may have made.

You'll find some useful IEP information on this blog; Click on Series Articles and look for "The Individualized Education Plan (IEP) for School Children with Aspergers".

The IEP is nothing to be scared of and it's instrumental in getting your child the right support. Don't let the school take the lead in the IEP because they usually have a lot of special needs children and what works for one child doesn't necessarily work for another. Keep the IEP meeting strongly focussed on your child - put the I back into IEP.

As well as the IEP, you'll probably want to get your child into various other forms of therapy such as speech therapy and occupational therapy. Be careful about engaging too many forms of therapy at once because your child can be overwhelmed and all of them produce a degree of "homework". It becomes quite expensive too.

Even if your child has well developed speech, speech therapy is a good starting place for getting rid of that characteristic "robotic tone" that aspies are famous for. You can use speech therapy to get your child to develop a richer and more emotional voice. Acting lessons are a good substitute for speech therapy in older children.

Occupational therapy is a must for children with aspergers. Children with aspergers often suffer from "low muscle tone". This doesn't mean that they can't develop muscles - and even if they become very muscular adults, it doesn't disappear as a condition. Low muscle tone manifests in a number of different ways many of which result in greater flexibility but less control over limbs and other moving parts.

It's common for exercises in balance and co-ordination to be big part of occupational therapy for aspies. You'll see these sorts of exercises as; swinging, climbing monkey-bars, skipping with rope, balancing on a rope bridge and catching and kicking a ball. In fact, taking your child to the park regularly will go a long way towards satisfying their occupational therapy needs.

Low muscle tone isn't restricted to limbs however and your child may demonstrate low muscle tone in the most bizarre places. The muscles of eye for instance may make it difficult for them to focus on the blackboard for long periods of time or to switch between the far and near focus of blackboard and paper. It may be very difficult for them to copy anything from the board. Your occupational therapist may request "following a pencil" exercises to correct this.

Then there is the problem of pencil grip. Low muscle tone can cause severe aches in the hand and you may find that your child is quite reluctant to write. Low muscle tone can manifest later in life as overuse injuries, so the more work you can do in this area, the better.


Being Supportive and Understanding
I know that I "harped on" quite a bit about acceptance in my last post. It's because it's such a significant problem. I've talked a bit about support already, covering topics like advocacy and support services but sometimes it's easier to understand what's needed by looking at the negatives - what not to do.

One of the first things that parents do when they "accept" that their child is different is lash out angrily. It's ok to be angry. It's hard to watch all of those plans you made in your pre-parenthood days collapse into reality. You may feel victimized but you'd be surprised how different things will be one day. One day you'll realize that those plans you made were never realistic and that your child's label had nothing to do with their collapse.

In the coming days, you'll find plenty of things to feel angry about. One of the worst of these is other parents with "perfect children" who simply can't understand your situation. If you're in a mother's group like this, then get out now! Find some parents with similar issues to your own. There are plenty of aspergers support groups around both online and in real locations.

You need to find parents who have accepted their children's diagnosis and who aren't afraid to talk about how things really are. You'll also find that although the grass always seems greener on the other side, it quite often isn't. Those parents with perfect children either have other issues or simply don't discuss their problems openly.

The blame game can also be quite harmful. It's one thing to identify which parent or which family line the aspergers comes from (because it is a genetic condition) but it's not ok to lay blame. Nobody is responsible for your child's condition and getting into blame or "if only..." territory doesn't help anyone. Of course, if you manage to identify the source, you may well find some family "heroes" who can help your child in matters of self-esteem and understanding.

Then there's the knee-jerk reaction of "curing". There is no cure. You'll find all kinds of information on the internet about miracle cures but none of them work and some, such as chelation and stem-cell therapy are downright dangerous.

That's not to suggest that you shouldn't try anything. There's evidence both in favor of, and against dietary changes, such as the gluten and casein free diets (see: http://www.autism-help.org/intervention-casein-gluten-free.htm). If a "safe" behavior modifier brings results, then use it. Just don't expect a cure.

Medications will also be offered along the way. Obviously nobody is keen to try out medications on their children but even so, caution is advised. Medications tend to have both positive and negative effects and a doctor's recommendation should not be relied upon as sufficient reason for you to put your child on a medication program. You need to be informed. You need to research the medication and learn its side-effects and you need to feel confident that you'll be able to spot the negatives if and when they arise.

The internet is a great place to start for information about medication because there's a lot of forums where people discuss the various effects and the wikipedia pages for various drugs are very informative. You need to be aware of the various biases out there. Some people and some organisations (such as the Church of Scientology) tend to be very anti-medication. Some of their documentation needs to be treated with caution. Similarly, documentation from pharmaceutical companies and certain active groups may favor medication without considering the full side-effects. The choice must be weighed and considered - and it must be your own.

One thing to be particularly aware of is that there is NO drug which is effective against Aspergers. None at all.

The drugs are effective against co-conditions only.

Co-conditions
I guess this leads us neatly into co-conditions...

Aspergers doesn't like travelling alone. There are usually co-conditions of one form or another. In fact, many children get diagnosed with the co-conditions long before an aspergers diagnosis is arrived at.

Sometimes a co-condition is present and sometimes aspergers itself simply "looks" like the co-condition. I've written a lot about co-conditions in the past and often the symptoms of the co-conditions are far worse than those of aspergers. There is really no reason why an aspie with no co-conditions cannot function as well, if not better than, any neurotypical (normal) person. Of course, I've never actually met an aspie with no co-conditions, so a big part of dealing with your child's condition will be learning what their co-conditions are and how they affect them.

To properly support your child, you'll need to be knowledgeable about more than just aspergers. You'll need to isolate and understand the co-conditions too.


Self Esteem
Given that the worst aspects of aspergers tend to be social, it's well worth your time providing your child with extra-curricular activities which preferably have no connection with school. If your child is good at sport then get them into a team. If sports isn't their thing, a common problem for aspies due to their low muscle tone, then get them into another type of activity.

There are all kinds of activities and clubs which are less focussed on teams but still provide social outlets. These include reading, acting and chess clubs and one-on-one sports, such as Karate, Sailing and ten pin bowling. Scouts or guides are particularly good choices as they provide a lot of variety and often cater specifically for special needs children.

The main aim of these external activities is to surround your child with additional (backup) friends in case issues begin at school. It also helps to develop life-skills, provides social practice and depending on the activity, increases your chance of making contact with other parents and children with aspergers or similar conditions.

One of the keys to building self-esteem in your aspergers children is to find good role models for them. It's generally recommended that you ensure that your children are aware of their diagnosis and what it means. It's also best to tell them at a very young age so that they have plenty of time to get used to the labels before they begin to have any social impact. Teenagers have enough self-image issues of their own, so it's best to tell children in their first 12 years of life.

Once your children know about their condition, you should try to find successful relatives who have risen above the limitations of the label. Since Aspergers is genetic, it shouldn't be too difficult to find others in your family who share traits. Hopefully, they'll be confident and successful.

It's also good to have the names of some famous figures who can be paraded out every now and then. A good book for this is "Different Like Me: My Book of Autism Heroes". You may be very surprised at some of the names which crop up in connection with aspergers.


Getting Over It
I've seen a lot of surveys of people with aspergers and talked to a lot more aspies directly. In most cases, the aspie wouldn't change their condition if given a chance. It doesn't "define" them in terms of putting boundaries on them but it does influence and bond with, their personalities.

Without aspergers, people wouldn't be "themselves". With good support, your children will grow up to be an independent, happy and successful people who take pride in their individuality.

It feels like a rough beginning now but it won't be long before you can honestly say that you're proud of your aspie child.

Monday, May 17, 2010

So... Your Child has Aspergers - Part 1

I received an email from a concerned parent who was struggling with her child's new label and I wrote a reply. Afterwards, when I re-read the reply, I thought that it might be a good thing to share with other parents who are in the same situation. So, names and places changed to protect the innocent, plus a whole lot more detail added, here it is;

The Aspergers diagnosis is always frightening and overwhelming for parents but you are not alone. There are lots of parents out there in the same boat and lot of very successful "aspies" out there too.

Your child will not be "defined" by their label. It won't describe them fully and it won't necessarily limit what they can do. All people with aspergers show considerable variation from one trait to another and the mix is always unique. More importantly though, your child is, and always will be, an individual.

First Steps - Acceptance
The first thing that you need to do with the label is to accept it. It's only a word. Your child may struggle with various forms of acceptance for their entire life so it's important that their parents at least accept them for who they are.

Accepting the label does not mean accepting all of the conditions, criteria and symptoms of the Aspergers. Your child will always be different and no child fits every part of the diagnostic criteria. Your child will also change as they get older, some difficulties and traits will get better and some will get worse. The label you're accepting is truly only a shorthand way of referencing your child's condition. It's a way of quickly giving your child's teachers, helpers and supporters a head start in understanding your child and providing the right level of care.

You need to accept that your child has aspergers. Accept that it's not like a broken arm which can be fixed - your child has the condition for life. This word is going to be very important to your child's future and only by accepting it can you gain access to appropriate support services.

One of the most obvious signs that a parent hasn't fully accepted aspergers is their statement that their child has "mild aspergers". Don't try to downplay things. Accept your child and their label for what they are and the set about dealing with them.


Understanding the Impact of Aspergers
There is no such thing as "mild aspergers". Aspergers is a difference of structure. There is no "mild". It is either present or absent.

The mild vs severe concepts come into play when looking at how aspergers affects a child's ability to go about their daily lives. There are a lot of environmental and parental factors at play here.

Environmental factors have significant impact on the degree to which a child with aspergers is affected by their label. For example; A child who has aspergers and lives in a big city is probably much more likely to experience difficult social and sensory issues than one who lives on a farm.

Of course, while this is certainly true in the early years of life, it's also true to suggest that children who live in places with greater environmental stimuli will find themselves adjusting to the stimuli. They will eventually be more resistant to the challenges that a busy and social city presents than their country cousins.

I'm not suggesting that you change your lifestyle or move house. Simply that you be mindful of the amount of stimuli that your child receives from the environment and try to reduce it, particularly during moments of stress. You should not try to remove such stimuli entirely though as your child needs to experience it in order to grow and adjust to their surroundings.

There are parental factors to consider too with the most obvious ones being overprotective or being overly negative (violent or critical). I know of parents who don't allow their children out of the house and who don't allow them to attend school simply because they are trying to protect their child from other children. Home-schooling is a very effective tool but it needs to be done for the right reason. A child with aspergers cannot learn social skills if they aren't exposed to social situations outside of the family home.

Similarly, negative parenting techniques can be very damaging for the aspergers child. I'm not talking about beatings, though obviously such behaviour is harmful. I'm talking about day-to-day negativity. Statements like "oh, you're useless" or "you'll never make any friends if you keep doing that...". We all lose our cool with our children from time to time but we really have to watch what we say. Aspergers children generally have more a more fragile self image than neurotypical children.

There are lots of other parental issues though and lack of acceptance is certainly up there with the worst of them. Your child will always be your child, regardless of the label. If you deny your child the label, you will find that you're also denying your child access to early intervention services that they desperately need.


Parenting a Child with Aspergers
There are some things that your aspergers child will need from you more than neurotypical children. Your aspergers child needs your love and acceptance. They need to feel confident of your protection and that they can tell you about anything that is bothering them without fear of criticism. Sometimes it's hard to hold back on criticism when your child makes what seems to you to be an obvious wrong choice - unfortunately, you have to "hold your tongue" at these times.

While a lot of what your child says will be "garbage", you'll find that interspersed between discussions on the detailed mechanics of various star wars vehicles and other discussions of the special interest, your child will provide you with profound insights. You'll have to listen though and be ready to jump on seemingly throwaway lines to get the full conversation.

Lines like "my tablet tasted funny today" or "that boy wasn't a good friend" should never be ignored. Follow them up because these are clues that something out of the ordinary has happened.

Children with aspergers don't always read the social signs around them. They miss non-verbal cues and they don't always react in the proper way to people and events. You need to be part of their lives and to be included in conversations about their day in order to help them understand why things are wrong and how they are supposed to react. These are learning experiences and should be treated as such. The best teaching methods do not involve anger, shouting or punishment.

Your child needs you to become their advocate. Don't hide the fact that your child has got aspergers from professionals who need to know. Teachers and activities co-ordinators, scout leaders for instance, need to know these things. You'll be surprised how many professionals will book themselves on a course or pick up a book to learn more about your child. What they don't know, they can't accomodate for.

There's a lot more to advocacy though. I'm not suggesting that you need to start a blog or carry a placard but you do need to make sure that the right messages are being sent. There's a lot of misinformation out there about aspergers such as;

  • They don't have emotions
  • Sociopaths and Psychopaths often have aspergers
  • They only think of themselves
  • It can be cured by chelation, brain surgery, special dieting or proper parenting.
  • It's impossible for them to be in a relationship or get married
  • Aspies always have children with aspergers
  • They can't live independently
  • Only males get aspergers
  • Aspergers doesn't exist, it's just an excuse
  • They are all geniuses
  • They all do morally reprehensible things
  • They cannot lie
  • None of them can make eye contact
These are all myths.

There's a few good mythbusting articles out there including one from Boston.com and one from Health Mad.

A good advocate will protect their children from false information about their condition by ensuring that their teachers and supporters always have access to good sources.

Next Time
I've added a lot more to this article than I originally intended, so I've decided to split it into two. Next time I'll look at blame-laying, IEPs, miracle cures and self esteem.

Thursday, May 6, 2010

A Recent Experiment with Eye Contact

As discussed a few posts back, I've been doing a lot of cub scout leader training recently. It's been very interesting because it has taught me a lot about myself. In this post I want to discuss a recent experiment with eye contact.


Overcoming the Eye Contact Behavioural Issues
I don't have a particular problem with eye contact compared to my aspie peers. This is because most people assume that I am giving good eye contact and don't hassle me about it. In truth, although I don't give good eye contact, I give great "lip contact", though probably not the kind you're thinking of.

Being deaf has taught me to stare at people's lips when they talk as an aid to lip-reading. Since most people simply assume that I'm looking at their eyes when they're talking I haven't been subject to the constant corrections that other aspies have to suffer.

Of course, it has its downsides too. Every now and then, someone will realise that I'm not looking directly into their eyes but am looking a little bit lower. Females particularly tend to become unnerved by this and will slap a hand to the top of their clothing (as if they're worried that I'm talking to their breasts).

When that happens, It's embarrassing for me and for them. Even worse, their sudden hand movements distract me so that I do end up looking there. If they could just wear sensible clothing we could concentrate on the exchange of information rather than "wardrobe malfunctions". At work, I'm always wearing a tie, so it isn't an issue for me (not that I have anything to look at anyway).


The "Test" from the Inside
Being a part-physical and part academic course, scout leadership includes a lot of bonding, team-building and psychological exercises. I groaned inwardly when we were told to select a partner for an eye-contact exercise. We had the option to refuse but I'm always keen to experiment and learn new things about myself. This seemed to be a good opportunity.

I can't remember the last time I deliberately tried to look someone in the eye but I suspect that it was when I was a child.

We stood opposite our partners and when told to start began starring into each other's eyes. I immediately felt nauseated. It was like a howling wind was screaming in my mind and I felt like I was being peeled away layer by layer. I ended up having to look away several times and although I felt calmer when I did, I still felt extremely uncomfortable knowing that those eyes were waiting for me to look back.

Finally, after what seemed an eternity, our leader told us to stop. I broke contact immediately and was surprised to find her standing right next to me.


The "Test" from the Outside
Our leadder talked generally about how our body language changed during the experiment and she mentioned mine in particular. She said that she'd sensed something was wrong with me and had moved over to me because she was worried that I might collapse. She said that I had jolted backwards and was doing things with my hands. Fisting and spreading my fingers, obviously a stim which I'd subconsciously started.

I told her that I had aspergers (I hadn't written it on the forms, so nobody knew) and I was surprised to find that I had trouble getting the words out. I was a bit out of breath. I think I'd been supressing my breathing during the experiment. Worse though, my heart was still racing and I was shaking like a leaf. It didn't seem to be getting any better.

Fortunately, our leader announced lunch immediately and I think I almost bowled people over in my haste to get out of the room. I ran down to the lunch room, quickly grabbed a plate and sat at an empty table as far away from the occupied tables as I could. It took my colleagues quite a while to fill up the tables around me and I was just beginning to stop shaking when the seats around me started to fill. There were a few people around me who obviously wanted to talk but somehow, I'm not quite sure how, I must have been giving off strange vibes because they stayed fairly silent for a few minutes longer.

Eventually I calmed down enough to be able to speak.


Things to take note of
It was an interesting test but it's not one that I'm inclined to repeat. I wasn't expecting the intensity of my own reaction and I wasn't expecting that full-fledged eye contact would be so painful. That's what happens when you go about your daily business for years not having to do it.

I'm one of the most well adjusted aspies around (IMHO). I like to think that Aspergers doesn't impact me as much as my colleagues. It's probably true but it's still scary to think that eye contact can so quickly reduce me from a competent business person to a gibbering wreak.

The most important point that I want to make here is... before you start encouraging (or forcing) your child to make eye contact, spare a thought for what it might be doing to them. Try asking them to look at mouths or chins instead.

Sunday, May 2, 2010

FTF: Post 4 "All Showers Lead to Australia" by Hartley Steiner

May's first things first article is by Hartley Steiner.

Since the entire "First things First" series is Hartley's brainchild, I was really looking forward to reading her entry. It doesn't disappoint.

You can read it here...

All Showers Lead to Australia
Hartley Steiner is the author of; This is Gabriel Making Sense of School, A Book About Sensory Processing Disorder. She is also a contributing writer at Grown In My Heart (www.growninmyheart.com). Hartley's eldest son Gabriel struggles with Sensory Processing Disorder, High Functioning Autism, Bipolar and Learning Disabilities. She is a sensational writer-mom and I'd encourage everyone to follow her blog "Hartley's life with three Boys" at http://www.hartleysboys.com/.


My thoughts (don't read these until you've read the article).
This article touched a raw nerve for me. It's not that I don't take care of my own needs - I do. Sort of. Every day is mostly the same for me. I get up, shower, go to work (before the kids are awake). I work long hours and don't have a huge amount of social contact at work (I actually like it that way). I come home late and have a short while to eat dinner and be bombarded with the kids babble before they go to bed. Then I talk to my wife and watch a DVD.

There are variations, weekends particularly, and scout nights but generally my life is the same every day. To a certain extent, I'm stuck in a rut. Right now, taking care of my own needs tends to mean that I read books on the bus or that I go shopping and buy DVDs to cheer myself up. I used to say to my wife that I only buy DVDs when I'm feeling depressed. The fact that I have 2,328 says a lot about my feelings.

My wife is in a similar, dare I say worse(?) rut. Her days involve much more child support because she somehow has to get them ready for school in the mornings - and help them with their homework in the afternoons. She also doesn't have the luxury(?) of going to work where she can hold adult conversations.

It's funny but like Hartley's husband, I'll occasionally throw a lifeline out to my wife. I'll offer her the chance to go out without the kids or suggest that we do something different. I'm always surprised that it's rarely taken up. It looks like something she'd want to do. It's tempting, but somehow her responsibility to the family always ends up being put first.

The thing is; my kids have set weekday routines and set weekend routines (they both have tutoring on the weekend too). We're stuck in such a rut just caring for our kids that we've neglected ourselves.

I'm not saying that I'd like to go on holidays - though, of course it would be great. It's much simpler than that. I've got friends who I never see anymore because I'm too caught up in the here and now with my family to think about anything else. I'd love to just go out and have dinner with them more than twice a year.

Then there's the health issues. Last year was a difficult one for us. Both my wife and I had big issues. In my case, I was hospitalized with a heart issue. A lot of the problems stem from us not taking care of ourselves. We're just too busy.

Hartley's suggestions are great ones. Start with the little things, like showers and work upwards from there. Reclaim your life. You can have life and family too.