Tuesday, October 18, 2011

International ADHD Awareness Week

This week is the official international ADHD Awareness week and I thought it might be appropriate to talk about the condition - especially since it's so common in children (and adults) with Asperger Syndrome. In fact, it's very common for people to be diagnosed with ADHD first.

ADHD stands for Attention Deficit Hyperactive Disorder and it goes hand in hand with another disorder which was once called ADD (Attention Deficit Disorder). These two disorders are now considered one, though it's quite common to distingish ADD as ADHD-I (ADHD - Inattentive).

Public Perception
If you don't have children with ADHD/ADD, you're probably imagining children who are literally bouncing off walls, throwing things and jumping across furniture. Like Aspergers, ADHD suffers greatly from stereotypes.

It's quite common for people to witness televised "extreme acts of ADHD" and blame it on the parents, red cordial, too much TV, poor discipline or any number of other things. Lots of people say that ADHD wasn't around when they were young. That children "behaved" and were harshly disciplined.

I beg to differ. ADHD was around years ago. ADHD is NOT about "extreme acts" it's about smaller everyday impulses. There have always been people who are easily distracted, impulsive or disorganised. It may not have been called ADHD in the past, perhaps they were simply "spirited" children but it was no different to the ADHD being diagnosed today.

Being Distractable
A person with ADHD may seem inattentive but the truth is that they are simply too easily distracted by their senses. A child with ADHD may find that other noises in the classroom constantly pull them off topic, that movement outside a window, or even within the classroom will constantly direct their gaze away from the board or that the smell of food in the classroom causes them to think about lunch rather than the topic at hand.

It's not all jumping around behaviour. Often it's just constant but little distractions which make it impossible to concentrate. These distractions can seriously impact the learning ability of the ADHD child.

Unlike the media portrayals, being impulsive isn't about walking up to people and hitting them. Most impulsive actions are far less visible. An impulsive child may start answering a question before it has been completely asked. In the classroom setting, this is simply annoying because it seems like an interruption but have you considered how this would affect a test?

In the classroom, the teacher can correct the child, "You didn't answer correctly because you didn't wait for the entire question". In an exam situation, the child is too busy answering the first part of the question to read the fine print. They might take three pages to answer a question that is supposed to be answered in 25 words. They may miss a vital part of the question or they may complete their test without knowing that there are more questions on the other side of the paper.

Children with ADHD already have enough issues in exams due to sensory issues and inattentiveness. Misreading questions makes it even more difficult. These are smart kids but even the best special exam considerations are simply not enough.

Of course, there are impulsive physcial actions too. A child may throw an object without taking the time to check that people aren't too closely grouped around them. They might chase a ball across a street without stopping to look both ways or they might snatch something off a friend without remembering to ask for it nicely. This isn't rudeness or deliberate endangerment, this is simply the ADHD child missing steps in a procedure.

Impulsitivty manifests at home too. It occurs when the child sits down to the table without having washed their hands. When they help to carry food to the table without being careful of spillage and when they are so eager to eat that they forget to use their knife and fork.

Being Disorganized
A child with ADHD will often live in either "the moment" or a "daydream". There's not a lot in between these states. They tend to react to things going on around them and they will often withdraw into their own thoughts. What they generally won't do is plan. Even when they do plan, their impusitivity prevents them from following a strict ordered list. They will rush out of a classroom, leaving their books still on the desk. It's not laziness, it's just steps in the procedure being missed.

They'll readily agree to go to an event but won't think to write down the date or the location. They won't consider potential clashes and chances are that if they do remember, they're going to be late. It all looks like complete disorganisation but really, it's just another way to look at impulsiveness.

Children don't grow out of ADHD. There are plenty of adults with the condition. Many of them have learned to use lists, plans and other methods to get by. Some are on medications (and some apparently swear by recreational drugs).

I'm not here to propose solutions. Today, I just want to sway a few opinions. Next time you hear about someone with ADHD, try to understand how difficult things that you take for granted are for them.

Lets try not to be so judgmental.

Thursday, October 13, 2011

Special Needs Family Life

This is a "best of the best post. Check the link: SOS Best of the Best Edition 11: Family Life from 15th October for more posts on this topic by other authors.

Normally I tend to keep my family life quite separate from my general aspergers posts. No, I'm not fussed about privacy, it's all there on a different blog (see:http://gbollard.blogspot.com). I just do my best to to shield my readers from the boredom of my daily life.

This month's BOB topic however is "family life" and I guess this is one of the hardest posts I've had to write. How do I make it sound interesting?

You see, apart from unexpected change, our lives are pretty much the same as everyone else's. We've got things down to a routine.

It wasn't always like this. We had years of terrible struggle until we developed all of the rules. As parents, we've gotten very good at predicting events and distractions.

For example; We can now look at food with the eyes of my eldest son and know that the texture will set him off. We're prepared. Sometimes we'll give him an alternative and sometimes we'll simply give him a smaller portion, carefully selected to avoid triggering his texture sensitivities.

We can anticipate the problems that change will create and begin warning and preparing well before the event. If classes at school are going to be largely disrupted or if there's a large unstructured and loosely supervised event occuring (like a swimming carnival), then we can simply keep the kids at home that day.

Then there's disappointment. We've learned to deal with it. Instead of shamfacedly saying, "oh well, you got an E in writing... at least it wasn't an F", we dismiss the reports and concentrate on effort rather than performance. Our kids are trying and that's all that matters. We say; "did you do your best? Well done then. Good effort".

Then there's worry about the future. It used to be part of our lives but now we're all Hakuna Matata (thanks Timon and Pumbaa). Our aim is simply happiness.

We've learned to not only accept the weird but to openly embrace it. Sure, we still have some crazy moments, like when Kaelan (10) whipped out his camera at customs and started taking photos of the officials, or when Tristan (7) booked a wedding for himself online. We still have our meltdowns, our car fights and crazy misinterpretations.

We've learned to live with those weird moments - and to celebrate them.

Every family has those things though.

So, our home life is sweet now - at least until the next meltdown, holiday or unscheduled event.

Tuesday, October 11, 2011

Less Confrontational Strategies for Approaching Children with Asperger's Syndrome during a Meltdown Event

In my last post, I looked at less confrontational strategies to approach children with Asperger's syndrome under normal conditions. In this post, I want to look at how it's done during a meltdown.

A Brief Look at Meltdowns
I'll begin by defining a meltdown. Meltdowns are generally violent and loud events which look very much like temper tantrums with one very obvious distinction. Meltdowns are "out of control" events. The aspie is not using the meltdown as a means of getting what they want - in fact, they want the meltdown to stop more than you do.

Of course, not all meltdowns actually are violent but all have the capacity to be violent. An aspie in a meltdown state is not responsible for their actions.

For this reason, it's important for young aspies to learn their triggers and how to avoid them.

To Approach or Not to Approach
The first question that you need to ask yourself is; is it dangerous for you, for others or for the aspie?

If the situation isn't dangerous, then don't walk into it unless you're very confident that you can provide the exact kind of support that the aspie needs. During a meltdown event, no support is much better than the "wrong kind" of support.

Different ways to Attract Attention
The techniques which work for one aspie won't necessarily work for another. Many children respond well to a calm voice repeating something like "it's alright". In fact, most people with aspergers seem to respond best to "the calm voice" but as I found out during one incident, it's not for everyone.

If your technique isn't working - and particularly if it seems to be irritating the aspie then stop. Some children respond better to a stern voice or even a snap of the fingers. It's important to discuss control techniques with the parents to find out what works best for a particular child.

What not to do
Don't become part of the meltdown. The child may be using violence, shouting and abusive language but you should not. For the most part, the aspie isn't in control of the situation but you, the adult, should be.

Don't turn the aspie into a spectacle. As I mentioned before, the child in a meltdown state isn't putting this on. They're" out of control" and they really want the meltdown to end. It's very much like being a helpless observer in someone else's body. They're going to feel bad enough about the situation after the crisis without you drawing extra attention to it by pointing, laughing or taking photos/video.

Don't attempt to lecture or accuse during the meltdown. The aspie isn't in control and won't be able to process information. Save any recriminations and discussion until the meltdown is over.

What to do
  • Make the situation safe
    Take a good look at the meltdown and the objects/people around. Look for anything which is unsafe, such as glass objects, dangerous things which could be thrown or used as a weapon and move them safely out of reach. If others are in harms way try to get them to maintain a safe distance and if you have extra supervision, have that supervisor clear them from the area.

    Watchers, particularly youth watchers can often contribute to a meltdown by teasing and laughing. You'll also be helping the aspie to keep their friends if you can isolate them in times of crisis.

  • Remove the trigger
    Although meltdowns usually serve a longer term and less visible "feeling", there is usually a trigger for a given situation. Sometimes this will be something simple, like building blocks and sometimes it will be a person. If it is possible to remove the trigger safely, then do so. If the trigger is a person, then remove the person from the room or at least out of reach/sight of the aspie.

    Sometimes it will be better if the aspie is escorted away from the trigger. If that's the case, you'll need to entice them rather than attempting to drag them.

  • Attempt to get the aspie into a stationary position
    If the aspie is moving about they're far more likely to cause harm to themselves, others or objects. If you can get them stationary, you'll be more able to control the situation.

    There will be times when you do need to chase them to intercept, such as when they're heading towards a busy road. In general, however, you should allow the aspie to separate from a situation provided that they stop a short distance away. One of the cardinal mistakes that police make with aspies is chasing them or restraining them unnecessarily.

    Often, if you sit down, the aspie can also be convinced to sit down - albeit, some distance away.

  • Desensitize the Environment
    It should come as no surprise that meltdowns occur more frequently in noisy, overcrowded environments. Don't forget that aspies have a lot of sensory issues. If you can reduce these by turning off any background music, bright lights, sound etc, then it will often reduce the intensity of the meltdown.

  • Co-habit but don't touch
    If it's safe to do so, you might want to sit near the aspie who has had a meltdown. Your presence may be enough to calm them down. Note however that if you're wearing strong scents, you could pose a sensory issue. Most importantly however, don't touch. You can tell the aspie that if they want a hug, they can have one but don't initiate. Touch is a very critical sense and during a meltdown, those senses are already on overload.

  • Forgive and Move On
    When the aspie has calmed down enough to participate again, please don't hound them with recriminations. You'll want to discuss the incident but give them time to get over it and process what has happened before demanding apologies.

  • Be a Mentor
    When the aspie has calmed down, discuss with them how they felt and what they could do better next time. Ask them what they think they need, what made them feel better and what made them more angry.

    We need our young aspies to learn how to deal with meltdowns, and how to recognize and avoid their triggers. After all, there's a big difference between a child's meltdown and an adult one.

    You might even like to practice some scenarios and develop some code words so that the aspie can leave the room safely before a situation explodes and without their classmates noticing.

    Your advice as a mentor will make a huge difference.

For more information on meltdowns, you might want to read some of my earlier posts on the subject;

Thursday, October 6, 2011

Less Confrontational Strategies for Approaching Children with Aspergers Syndrome

For many people, particularly teachers, the first real experience with Asperger's syndrome comes as part of an intervention in a "situation". After all, aside from odd mannerisms and odd comments, many children with aspergers can appear quiet and non-participative - this can easily be mistaken for shyness.

The real problems begin to surface when an extraordinary event, such as a meltdown or shutdown occurs. Even if no such event occurs, a simple friendly intervention from a teacher can sometimes result in a unexpectedly nasty response.

When such events do occur, they can "sour" the relationship between teacher and child - and sometimes between the parents and school too.

Recovery is a long process of "walking on eggshells" for which most teachers don't have the time or patience,

In this post. I want to look at some of the ways that you can modify your approach to children with aspergers syndrome to reduce those ill effects. I'll be concentrating on an approach under normal conditions, perhaps to encourage participation in an activity. I'll look at approaching an aspie in a meltdown condition in a later post.

Body Language
Before approaching a child with aspergers, take a moment to study their body language. It's true that children with aspergers have a great deal of difficulty expressing themselves non-vebally but in general, their body language can still be read. Most of what you've probably heard about the difficulties of non-verbal aspergers language deals with facial expression. Those bits are true. You can't be sure that the facial expression of an aspergers person is really communicating their feelings.

For example, if the person is grimacing, it doesn't necessarily mean that they're in pain - or frightened. It could mean that they're thinking about something entirely outside the situation, that they're stimming or that they're actually happy. Tears and anger however can usually be trusted to be correct.

Take a careful look at how the child is sitting or standing and watch how they react as you draw nearer. Try to look at things other than their face. For example, are they holding a wall, bannister or some other part of furniture? Are they attempting to withdraw into it? Perhaps they're even hiding under a table. These are clear signs that a normal "front-on" approach will end in disaster.

Approach Carefully
Instead of approaching them front-on, try to approach them gently from the side. If they're under a table or sitting at a desk, it's a great approach to sit beside them - not opposite them. This significantly reduces the issues of eye contact. If possible, reduce yourself to their height to avoid being confrontational.

Don't touch!
Don't sit too close. Aspies usually like their space and especially, don't like a light touch. I had a counseller once ask me if it was ok to touch me on the arm. It was nice to be asked first but I felt like I needed to say "yes". Touch to us usually doesn't convey reassurance. It often simply increases the irritation of tactile stimulii. If you're touching the aspie, chances are, you're doing it for your own benefit/reassurance rather than the aspie.

Converse Carefully
As a general rule, many people with aspergers aren't too concerned with small talk, so there's not a great deal of benefit to be gained from saying "hello" because you're obviously already there and hello is implied by the fact that you just sat down next to them. Of course, if you feel that you need to teach the basics of small-talk or manners, then a couple of conversation starters can be used. Just don't expect a major response.

Many people with aspergers have quite stilted conversation. They may not handle high-speed talk even though they often talk fast themselves. They may also take longer to reply than neurotypicals because they want to think about your question and their answers. As most kids "how long have you been sitting here" and they'll say a "a while". Ask an aspie and they're likely to calculate the time.

Don't rush them. People with aspergers aren't stupid and there's no need to talk super slowly. Just enunciate well and try not to rely on variations in tone so much as content. Be direct too. While people with aspergers have little difficulty understanding metaphors and "sayings", they won't necessarily know when you're using them. If you tell them that you're "going to see a man about a dog", they're going to assume that you're going to a pet shop. Say what you mean and you'll be understood.

Direct Questions are Attacks
If you're approaching a person with aspergers syndrome and they seem agitated, don't sit next to them and start hammering them with questions such as; "Why aren't you playing the game with the other kids?". Try a more oblique approach first. For example, sit down and say; "That looks like a cool game that the kids are playing doesn't it?". The response you get might clue you in to what the problem is; for example, "It looks fun but it's very noisy".

Be Sensitive.
Aspies often have high sensitivity to noise, smell, light and other environmental factors. It isn't fair to force a child with such sensitivities to join in an activity which ignites those senses. If you can find a way to reduce these sensitivities, then great. If not, just accept the situation and wait for a less sensory moment to include the aspie child. Perhaps you can speak to the parents about the sensitivity. For example, if they are sensitive to noise, they may want to try cancelling headphones or perhaps you can find quieter ways to engage the child.

Of course, the reasons for non-participation will vary and it's difficult to decide when the child is simply being lazy or wilful versus an actual sensory issue. The only clue is continued conversation.

If your initial comments don't provide you with an answer, slowly direct the questioning towards the activity without being accusatory. As the child warms to you, you'll find that the information they provide becomes more relevant and useful.

Next time I'll look at ways to approach a child in a meltdown state.