Don't forget, the Temple Grandin movie is premiering on February 6, 2010 on HBO! Most of my readers are familiar with Temple Grandin, PhD, perhaps the most well known autistic person in America, as well as the designer of almost half the cattle handling equipment in North America. Dr. Grandin is inspiring because of her clear presentation and writing style, as well as the way she’s learned to adapt the strengths of her diagnosis to accomplish things she probably wouldn’t have been able to if she weren’t autistic. Dr. Grandin remains a free thinker, an individual who lives a life that is meaningful for her, and expands our own vision (whether autistic or neurotypical) of what a successful life can be.
Our society so frequently presents one way of succeeding in the world, with a fixed idea on success, relationships and how we should behave. Dr. Grandin is an example to all of us on how success can really be defined by the individual. Although she writes about learning social skills and has adapted to a neurotypical world in some ways, at the same time she remains true to herself, defining her own needs and wishes with regard to career and relationship. I always enjoy Dr. Grandin's writing, and I'm looking forward to this movie.
Mirror neurons, structures in the brain that fire not just when performing an activity, but also when watching another perform that same activity, are being researched by neuroscientists around the world. What is of interest here regarding mirror neurons is the theory that differences in the mirror neuron system may account for some of the symptoms seen in Asperger’s and autism.
Many of my clients on the autism spectrum are very interested in learning about the technical and medical issues surrounding their diagnosis. I’m always excited when I find good, straightforward information on these topics. Rather than attempt to re-explain what the researchers already have explained in clear and understandable terms, I’m going to just direct interested readers to these links.
For a basic discussion of mirror neurons, go to TED, and listen to VS Ramachandran’s The neurons that shaped civilization. Ramachandran doesn’t discuss autism in this brief talk, but his 2006 article in Scientific American, Broken Mirrors: a theory of autism with LM Oberman. discusses autism in depth. Finally, if you’re still looking for more, Nova has a presentation online about how mirror neurons work.
The Only Boy in the World: A Father Explores the Mysteries of Autism, by Michael Blastland (2006) is a fascinating, philosophical, and honest account of raising a child with severe autism. The book, unlike so many others, isn’t about treatments or the day to day struggles of raising a special needs child as much as it’s a look at theories and ideas behind autism, illustrated and brought to life through one small boy, Blastland’s then 10 year old son, Joe.
This book is not a feel-good inspiring story of hope and triumph. Blastland can be quite pessimistic about his son’s prospects. There are a few promising signs of progress presented, such as an expanded list of foods Joe will eat and some progress in reducing aggression. But, Joe is severely impacted and struggles throughout the book. However, the author is clearly a caring father, who loves his son and wants to do what’s best for him. He presents scenes of embarrassment and near disaster, such as when Joe hits a toddler, as well as times when Joe is joyful in his own experiences. Throughout the book, the author examines some of his own difficult decisions, such as his mixed feelings about the decision to send his son away to live at a school.
Frequently, this book feels almost philosophical in tone, moving well beyond autism into ideas that impact all of us as humans. For example, most well informed parents of an autistic child have read articles on ideas such as Theory of Mind. But in this book, Blastland takes the theory beyond science into experience. Using examples from Joe’s life, the author looks with compassion at different experiences with Joe, and analyzes just what might be going on inside his son. Certainly, none of us can truly know another’s interior experience, and when communication is severely limited, as in Joe’s case, his father can only make guesses. But Blastland is consistently and sometimes painfully honest about his own thoughts, as well as what he’s guessing about what’s going on for his child. Blastland then pulls in other ideas from his own extensive reading.
This book shares the joys and pains of raising a severely disabled child, brings the theories behind autism to life, and in a much broader way, raises questions about what makes us all human
Asperger’s, Sex, and Sensory Issues
Asperger’s and sex is the phrase most frequently searched for on this blog. I’ve written a bit on the topic of Asperger's, autism and sex, as well as posted an interview with a Bay Area sex therapist. But I suspect there’s a large group of current and potential readers looking for more information. I think a lot of readers want dating information, but even more are interested in help specifically about sexual relationships. Unfortunately, there’s not a lot published on the topic.
One issue of concern to many adults with Asperger’s and autism is Sensory Processing Disorder, also called Sensory Integration Dysfunction or sensory or tactile defensiveness. And of course, sensory problems could easily impact sexual matters.
Recently, I posted a blog review of the book Too Loud, Too Bright, Too Fast, Too Tight: What to Do If You Are Sensory Defensive in an Overstimulating World, by Sharon Heller, Ph.D. (2002, Harper-Collins). The book covers many topics, but it also has some information specifically on the impact of sensory defensiveness on sex.
Sensory integration is not an area where I have any training, but if you’re interested in learning more on this topic, check out the book for some specifics, or talk to an Licensed Occupational Therapist who works with adults.
There are so many treatment options for children on the autism spectrum, it can be really confusing for parents. Different programs may sound like the same thing, other programs have trademarks, or they’re proprietary, or they’ve been developed in one location and not available elsewhere.
What’s the difference? Is there one best treatment? Can differentprograms be used together? In the end, it all comes down to one question: how do you figure out the best treatment for your own child?
In the interest of sorting this out, I try to provide specific information when I can find an expert who is really knowledgeable about a specific treatment program. For example, you can see an earlier interview on DIR/Floortime. One option that you may have heard of is P.L.A.Y. Project®. Today I’m taking to Joanne Finn, a Licensed Educational Psychologist, who also provides private services as a home consultant for families of children with an autism spectrum disorder through the P.L.A.Y Project®.
Joanne, Can you explain the P.L.A.Y. Project®?
P.L.A.Y Project® was started by Dr. Rick Solomon, a developmental pediatrician, who wanted to develop an affordable, family-friendly and effective early intervention program for children with autism spectrum disorders ages 18 months to seven years. P.L.A.Y Project is an international program with home consultants serving families in 27 states and 3 countries outside of the U.S. The program focuses on helping parents to help their children build emotional connections and engage in meaningful relationships.
As a school psychologist, I became interested in finding more ways to support parents who really wanted to help their children at home. A friend introduced me to DIR®/Floortime™ and I was excited to find the P.L.A.Y. Project model of home consultation. I recently became a licensed provider for P.L.A.Y. and I am so happy to be able to provide this to parents. What I really love about being a PLAY home consultant is working with parents. Children spend more time with their parents than all of their teachers and therapists combined. So parents are really the best ones to help their child learn to connect.
P.L.A.Y Project uses the DIR®/Floortime™ model of Dr. Stanley Greenspan, a nationally respected child psychiatrist. DIR stands for developmental, individual-differences, and relationship-based. This means that parent-and-child interactions are highly valued and respected. A child’s emotional development depends so much on the intimate connection between a baby and parents – from early smiles and coos, to looks and gestures, verbal language, and ideas about how the world works. For a child with autism these connections can be disrupted because of the child’s challenging neurological disorder. As a home consultant I carefully analyze a child’s unique individual differences to determine the best play activities, methods and techniques to help relationship happen. And it does happen! Dr. Solomon’s initial pilot study of 70 children with autism demonstrated that 65% of the children in the P.L.A.Y. Project made good to excellent progress.
P.L.A.Y. Project has recently been awarded a $1.85 million grant from the National Institutes of Mental Health to conduct a three-year study of the model.
P.L.A.Y. Project is one type of DIR/Floortime service delivery model. Floortime therapy can be delivered many different ways - through a school program like Creekside, during OT or speech therapy, through private play therapy by a psychologist, through clinic or home consultation. P.L.A.Y. Project consists of a specific structure to provide DIR/Floortime through home consultation. Aspects specific to P.L.A.Y.include use of the PLAY Project Workshop DVD for an initial introduction, a 3-hour home visit once or twice monthly, the use of video and video feedback reports as part of the coaching. PLAY project home consultants must be trained in DIR/Floortime techniques by PLAY Project trainers and must work with a licensed PLAY Project agency. (I am my own licensed agency). Home consultants are also strongly encouraged to participate in ICDL DIR/Floortime Institute certificate program.
P.L.A.Y Project format looks like this: As a home consultant, I make one or two home visits per month for a 3 hour block of time. During that time I observe parent and child during play sessions and during their daily routine. I offer coaching and support to the parents, and as the child builds trust I model play techniques for the parents. With permission, I also videotape some of the play.
Between visits I analyze the videotape to better understand the child’s strengths and needs. And I provide additional input in the form of a Video Review report. The parent receives the report and the video between visits to help them continue their learning and to help train others such as grandparents, friends and other caregivers.
Most of my current families are using P.L.A.Y Project to supplement their child’s half-day school program or ABA home therapy. P.L.A.Y. Project and ABA are complementary and have different strategic directions. DIR/Floortime is distinctive from ABA as it emphasizes following a child’s interests and preferences rather than therapist initiated activities. DIR/Floortime emphasizes emotion to create engagement and connection rather than primarily focusing on building skills. And PLAY Project’s main focus is integrating parents into the therapy.
Joanne, thanks for explaining the details of this program. East Bay parents in Northern California can contact Joanne Finn directly through her website, and those in other locations can check out the P.L.A.Y Project website to find a local provider.
For adults on the autism spectrum, including those with Asperger’s, sensory issues can be a major problem. Clothing textures are irritating, foods taste and feel unpleasant, lights may be glaring and noises and odors overwhelming. These issues can be a major contributor to problems with social interactions and managing work environments.
Often, children diagnosed with autism spectrum disorders (ASDs) like Asperger’s, autism, or PDD-NOS, as well as those with ADHD are under the care of a medical doctor who recommends Occupational Therapy as a part of treatment. OT can be invaluable in helping these children manage sensory problems. Unfortunately, many adults on the autism spectrum were not diagnosed as children, and only figure out their issues when they self diagnose as adults. Learning about autism and Asperger’s can help many adults adapt to their own deficits and start to utilize their strengths more effectively. Frequently, looking at sensory integration and sensory defensiveness can add immeasurably to the quality of life for adults with ASDs as well.
There are several good books on sensory integration and sensory processing, but generally they concentrate on children’s issues. Too Loud, Too Bright, Too Fast, Too Tight: What to Do If You Are Sensory Defensive in an Overstimulating World, by Sharon Heller, Ph.D. (2002, Harper-Collins) is an excellent guide that's written more for adults.The beginning of the book explains sensory processing and details the many ways that sensory defensiveness can manifest itself in different individuals. Heller focuses on the different senses and how each sense can individually vary for different people. While some people are tormented by tactile sensations, others struggle with smells and tastes. The most useful section of the book called “Your Sensory Diet” lists dozens of activities and lifestyle changes that individuals can make to improve their sensory experiences. Appendix B lists the many ways in which different individuals may react to sensory issues. I think a lot of people, both on the spectrum and neurotypical, will recognize themselves in some of these areas.
While many adults may (and should) decide to see a specialist, such as an Occupational Therapist, to get treatment for sensory issues, this book is both a useful introduction to sensory processing, and a reference book packed with ideas to get the problem under control.
Girls and the Media
Girls with Asperger’s and autism seem to be more involved with TV, movies and the whole celebrity culture than neurotypical girls. For these girls, the restricted interests that are a part of the autism spectrum often fall into the realm of pop culture and celebrities. Add in the facts that these girls aren’t connecting as well with their peers, and often struggle athletically, and the result is that teen and tween girls on the spectrum can spend all their free time watching favorite TV shows, reading about celebrities and Googling them on the internet.
One big concern about this is that the messages the media send to young girls are anything but positive. Pressures about image and consumerism are rampant. Girls may feel they can’t measure up. It’s not surprising because the media images are not just unrealistic, but often completely false.
There are some fascinating sites online that show just how invalid media ideals can be. Check them out with your own daughter, and have a conversation about what the media is presenting as beautiful. Jamie Lee Curtis started the whole discussion years ago, by allowing photographers to document her appearance before and after a team of experts polished up her appearance. Dove has a great campaign including a fascinating video called Evolution, showing how makeup and Photoshop transform an attractive, but normal, young woman into a billboard image. There are other sites that show some of the worst offenders of modified images from magazine covers.
You can't change what your daughter finds fascinating, but paying attention and connecting over her interests can make a positive difference in your relationship and her self esteem.
Patricia Robinson MFT
I'm a licensed therapist in Danville, California and a coach for Asperger's and ADHD nationwide. I work with individuals of all ages who have special needs, like Autism Spectrum Disorders, ADD, ADHD, and the family members and partners of special needs individuals.