DRUG ADDICTION COUNSELING, Part I

This posting is provided by Michael Mariano a Licensed Professional Counselor and a Licensed Clinical Alcohol and Drug Counselor. He has worked at First Hospital Wyoming Valley in Pennsylvania, Beth Israel Medical Center Methadone Maintenance Treatment Program in New York City, and is currently at Bergen Regional Medical Center in Northeast New Jersey.

Addiction can be loosely defined as a behavior that you cannot manage, is done impulsively, and results in major areas of your life becoming unmanageable. The longer and more often you use drugs and alcohol will make it increasingly more difficult to have a stable and healthy life.  

Most drugs are physically addicting (presence of physical withdrawals) while others are more psychologically addicting, such as cocaine and marijuana. No matter what the substance, recovery from addiction requires developing a recovery plan uniquely designed for you. Regardless of how you became addicted, there is a high probability it started with some form of physical, emotional, or spiritual pain. Other than that common core, there is no discrimination when it comes to addiction. I have treated those from all socio-economic backgrounds, races, ages, vocations, and educational levels.  

Addiction is a progressive disease that gets drastically worse before most sufferers seek treatment. It can start as innocently with having a drink after work to take the edge off a stressful day. Before you know it, whenever you feel stress you reach for a drink and develop a physical dependence. It can start from getting injured and receiving narcotic medication for pain. When the prescription runs out, you go through withdrawal symptoms and resort to buying them illicitly on the street.  

Street purchasing becomes expensive, and a “friend” tells you about heroin, how it is a fraction of the cost but with all the “bang.” The downward spiral begins into the pits of addiction, where many struggle and die before making it out alive. The facility where I work has lost over 30 patients in the last 5 years, mind you, this only accounts for those that we know of and only account for the ones that I have directly worked with. The number is much higher considering we lose over a 100 individuals a day to drugs and alcohol. Believe me when I say, we are dealing with a life and death issue that requires effective coping skills.

The more risk factors you have, the higher your risk for addiction. Here are some of the more common risk factors I have seen over the years: Lack of formal education, family history of drug and alcohol problems, poverty, lack of parental supervision, unstable parental relationships, sexual abuse when young (one of the strongest risks), and mental health issues. Three other clear warning signals are: using drugs at an early age, little social support from reliable friends and family, and a lack of available treatment programs and facilities. 

There are also protectors that can reduce and even cancel out the adverse effects of  risks. These are like a protective armor that shield and strengthen you. Examples would be: successful formal education, emotional support from a financially stable family, exposure to drug educational programs in school, engaging and healthy hobbies, social support from mentors and peers, self confidence, and presence of meaningful relationships. 

One of the hardest things about addiction is that it is almost impossible to treat if you don’t want the help. Finding that motivational kick is a highly individual matter, but again, many of the other entries in this book give you specific actions to take charge of your life. One thing is certain: the earlier you begin treatment, the better your prognosis for success.

 For many, the strongest motivator to seek help is the legal system. Unfortunately, that motivation usually lasts only as long as the legal issue itself. Fortunately there are other, more permanent strategies and I will discuss these in Part II.

 

IS ALEXA A BAD PARENT?

Eight-year old Susie is emailing Grandma about her birthday party and her presents from the neighborhood kids. Mom is nearby and she says, “Hey, Mommy. Could you please spell ‘neighbor’ for me?” Mom replies, “Sure, Honey, it’s n-e-i-g-h-b-o-r.” “Thank you, Mommy. I’m telling Grams about my birthday party.”

Nice, kid; even said “Please” when asking for the spelling. But let’s say Mom is in another part of the house. Susie is there in the family room, alone except for Alexa. “Ah!” Susie, thinks, “I can ask Alexa! Hey, you big zit loser, Alexa, how do you spell neighbor?” Alexa willingly accommodates: “Neighbor is spelled n-e-i-g-h-b-o-r.” “Thanks you big phony pimple face!” says Susie, laughing at her mastery of presidential language.

I recently saw an article in the newspaper bemoaning the “Alexification” of our kids. The idea is that Susie got an answer to her question, even though she posed it in a very crude, impolite way. In the language of Psychology, Alexa reinforced Susie’s nastiness, thus strengthening her tendency to be nasty when seeking information from others. Reinforce bad behavior and the bad behavior will be more likely to occur in the future. The conclusion: Alexa is a bad influence on our kids.

This issue reminds me of a similar one that was hot back in the 1960s and ‘70s: Are children likely to imitate the violence they see on TV?  This was a big debate, folks, and Congress even got involved, holding hearings to hear from experts. The lawmakers were wrestling with whether they should pass legislation monitoring and controlling the level of violence on TV.

Not surprisingly, the debate stimulated all sorts of psychological research into the question. As the results filtered in some answers began to emerge to the question, “Is violence in the media causing aggressive behavior in children?”

Now any good critical-thinking educated Psychology major will know that the answer is not likely yes/no, black/white, either/or, but something a little more nuanced. As I always used to tell my students again and again, “The answer to most psychological questions is, ‘It depends!’”

OK, in the case of imitating TV violence, depends on what? Under what conditions is TV violence likely to encourage aggressive behavior in kids? The research showed two factors definitely playing a role: The degree to which a child sees depictions of violence on TV as real life, and the degree to which a child identifies (admires, wants to be like) with a violent character (typically the “bad guy”) on TV. Makes good sense, but it begs another question: “What makes a kid more likely to see TV as real, or more likely to identify with the bad guy?”

Not surprisingly, that question appears to be answered by kids’ home lives. The research shows that kids who imitate violence on TV have parents who are mostly cold, disengaged from their kids, and rejecting. “Can’t you see I’m busy, Danny? Go watch TV or something.” It certainly makes sense that a kid who has a non-supportive, frustrating, and anxiety-laden home life filled with criticism might turn to the more reassuring world of TV, especially shows that show violence as a real way to achieve goals.

The point is, we’re not going to take a random child, place him or her in front of a TV to watch violent shows, and turn that child into an aggressive bully (or worse!). There have to be other factors in the child’s life that “fit in” with the TV violence and make the child more vulnerable to seeing an aggressive world where lashing out at others is a real way to resolve problems.

I have a feeling the issue with Alexa is the same. If a child lives in a home with warm, supportive parents who are engaged in the child’s life, and who take an active role in teaching and guiding their child, that child will easily learn that human interaction has rules of courtesy and respect that are always to be followed.

So parents, don’t fret if you catch your child telling Alexa to go to hell. Always remember that Alexa, TV, social media, or crude and profane politicians do not alone have the power to turn your sons and daughters into callous, insensitive jerks. It is only with your help that these agents of current society can produce their evil effects. You must, therefore, fight them every step of the way by guiding, mentoring, teaching, and loving your children. Help them develop a social conscience and learn to act with dignity, grace, courtesy, and respect.

 

ARE YOU PSYCHOLOGIZED?

Last time I noted how some people become “psychologized” by our psychology-conscious society. By “psychologized” I mean wearing on your chest, like some sort of medal of valor, your stress, anxiety, conflicts, and any psychological diagnosis you may have received. The message to others is, “Hey, folks, treat me with care. I’m psychologically troubled.”

Over 41 years of teaching psychology in college I ran across this behavior more than a few times. I remember one first-year student taking Intro Psych who came up to me after the first class meeting of the semester. She said, “I need to get a tutor in this course. Having a copy of your lecture notes would also help me.”

Trying to show my surprise at her comment, I replied, “A tutor? We’ve only had one class! How do you know you will need a tutor?”

“I have borderline personality disorder,” she volunteered, “and my meds interfere with my studies. They gave me a lot of trouble in high school. College is going to be a lot harder on me.”

I sensed she was setting me up to enable her and, right or wrong, I wasn’t buying into it. I told her tutoring was premature but she could always register with the tutoring center. I also informed her that I did not use lecture notes. “Before class I write down one-word prompts or a phrase to direct me. It won’t be any help to you. Guess you’ll have to pay attention in class.”

She never repeated her requests and I don’t know if she ever got tutoring. She did, however, turn out to be a fairly good student, ending up with a B in the course. She withdrew from school after one semester, though. Too bad. With some guts she could have made great progress toward self-discovery.

Playing the “psychological-disorder card,” a definite symptom of “Psychologized Syndrome,” (nothing is really credible unless it’s called a “syndrome”!) is a form of wimpy avoidance. The message to others is, “Treat me gently; pad the corners of my world for me. I suffer a lot of psychological stress and am damaged goods. Don’t make me face the realities of life.”

You know what the big problem is when you work hard to avoid your stresses?  You are taking the first step down the road to depression. Let’s analyze that road a little more.

No doubt you have experienced your share of bad days. They’re no fun, and if you’re like most people you would prefer to avoid them altogether. Anxiety, guilt, anger, fear, frustration……..who wants to be confronted with those emotions? Better to get rid of them, right?

With that question in mind, settle back into a comfy chair or sofa and close your eyes. Now picture in your mind all the people and events that give you occasional stress and sometimes cause you to have a bad day. As you go along it’s OK to open your eyes to write them down on a piece of paper.

When you’re done check out your list and see who’s on it: Mom and dad, maybe? Spouse or partner? Kids? Siblings? Co-workers? Your boss? A BFF? The dog? Christmas? Anniversaries and birthdays? Computers? Smart phones? Vacations? Facebook? I bet if you took enough time your list would be quite long.

Next, rid yourself of all your stressful times, all those bad days, by imagining your life without any of those problem people and events in your life. The goal is to imagine a world where you avoid all your sources of stress. So close your eyes and start designing your relaxing new world by deleting all those stresses. “Wait a minute,” you protest, “you want me to get rid of my kids, my parents, even the dog? All those people I love. Give up my job and my friends? The dog? Are you kidding me? I’m going to end up with an empty world!”

Bingo! If you work really hard to avoid stress in your life, you will stop living! Stress is a vital of being alive and trying to eliminate it is a losing strategy. In fact, you’ll end up not only alone, but also lonely. You’ll suffer despair, helplessness, and hopelessness; your self-esteem and confidence will be in the toilet; your world will spin out of control and the directional sign on your next life path will be “Caution: Depression Ahead.”

Stress, challenges, obstacles, hard work, frustration, anger, anxiety, and a host of other things you prefer to avoid must not be avoided. Those bothersome emotions are a part of you; they are not alien invaders. To try and avoid them will compromise your very being. So rather than avoid them, attack them! Confront them, meet them head on, deal with them, and resolve them.

The task may sound easier than it is, but if you are willing to play by the rules, learning to confront the challenges in your life can become quite natural. And that’s what effective coping with the realities of life is all about: Devising a plan to confront the challenges of life and the emotions they arouse.

Your plan must include specific actions to take. Avoidance actions? No, not unless you have no control over the person or the situation, and in that case you must disengage and avoid. Directing personal empowerment at events over which you have no control is a waste of time and self-defeating. Focus on those things you can control: Your thoughts and your actions.

In carrying out your plan remember to live in the present, accept the stress in your life, learn from your failures, and keep in fighting shape with exercise and diet. Above all, remember that positive actions are more powerful than positive thoughts, so structure your plan around positive actions. Here are some examples:

*Stop apologizing to yourself or others for being emotional in certain situations.

*Channel your stress into productive activities like volunteering, joining a gym, taking a surprise family outing, having lunch with friends, or other enjoyable things.

*Keep a record of when you feel stressed and what you are doing at the time. You’ll be surprised at the positive consequences of doing so.

*Don’t focus on the stress you feel. Focus on positive actions you can take to confront your problem.

*Keep a precise record of when you perform bad habits like smoking, drinking, overeating, gambling, yelling, or any other behavior that causes you concern. Again, you will be surprised at the positive consequences.

*Rather than ask someone else to do something for you, do it yourself.

*Schedule stressful events at times when you expect relatively few demands on you.

*Schedule relaxing activities each day, even if only for a few minutes.

*Devote high-quality time to important aspects of your life, such as marriage, career, children, friendships and family.

*In confrontational situations, take slow, deep, steady breaths and concentrate on making calm but assertive comments.

*Admit to your weakness, but never be defined by them.

*Accept who you are and present that self to others.

*Monitor and modify your negative, self-defeating thoughts.

That last item is important. People often ask, “How do I control my thoughts? How do I stop thinking negative things, self-critical thoughts; how do I handle all those ideas that are downers and torment me?”

How about this? Perform positive, constructive actions that bring you a sense of satisfaction and empowerment. Then you can think about those actions during the day. Not only will you be teaching yourself to think positively, but you will also get a sense of fulfillment, peace, and competence. You’ll feel good about yourself, with the added benefit of being less stressed out! And you get to keep the dog!

 

TOO MUCH PSYCHOLOGY!

Recently I noticed a newspaper piece dealing with the importance of college internships. The writer noted that these opportunities not only give a student a good feel for the demands and skills involved in a particular vocation, but also provide valuable experience that will look good on the resume’ when searching for that first job. In fact, the article made me remember an occasion years ago when one of our senior psychology majors came to see me about three weeks into her internship working one-on-one with an autistic child.

“How’s it going?” I asked. She replied, “Well, I’m going to see this thing through the end of the semester because the parents really appreciate it when I’m at their home to help out. But one thing for sure, I’ll never look for a job working with autistic kids! It’s not for me. I thought this was what I wanted to do, but now I see that reading about it in a book just doesn’t show the stress and frustration involved. What an eye-opener!”

We chatted some more and we both agreed that even though it was going to be a challenge to stick it out, this was already a very successful internship because of what she had learned about this line of work.

But let me get back to the newspaper article because I’m not blogging about internships. The news writer gave an example of a student who was doing an internship in computer science during the spring semester of her junior year in college. Thanks to the internship the student discovered that she was more of a people-person and didn’t find the CS work fulfilling.

The writer commented: “Imagine the emotional stress of having to find a new career path one year shy of getting your college degree.”

Oh, for heaven’s sake, stop it with the emotional stress garbage! Why does every unexpected event, every challenge to one’s plans, every conflict, every OMG intrusion into one’s world have to be psychologically debilitating? Dozens of times in my classes over the years I called this phenomenon the “psychologizing” of society, and cautioned my students that every personal issue is not necessarily a psychological crisis. Emotional stress my derriere!

I can’t begin to remember how many times a student came to me in the junior year and said, “I’ve decided to change my career plans. I always thought I wanted to be a psychologist, but now I don’t!”

Never once did I reply, “I’ll give the Counseling Center a call so you can deal with the stress and anxiety you must be feeling!” In fact, such a thought never even occurred to me in 41 years of college teaching. Never! My reaction was always along the lines of, “Cool! You’re learning about yourself! That’s what college is all about.”

I remember one particular case that was kind of extreme. A second-semester junior came into my office late in the spring and said, “We have to change my schedule for next fall. I’ll keep Senior Seminar so I can finish my psyc major, but after taking this Principles of Management course this semester I’ve decided I want to apply for an MBA degree after graduation, not a Masters in psyc.” Naturally I reflexively reached for the phone to call the Counseling Center  (JUST KIDDING! LOL!)

I said, “Good for you! Shows you’ve been doing some good thinking lately. The first thing I want you to do is go to the Chair of Bus Ad in the business school and get an advisor in that department. Find out what courses you need at a minimum to be considered a serious candidate for an MBA program, and what ones will be offered next year, including over the summer. I have no idea what they would be so find out at the source. Then get back to me and we’ll work with your business advisor on changing your schedule for the fall and even look ahead to the spring. A summer course may be needed. I agree about keeping Senior Seminar. That’s the last course you need to complete the psych major.”

The student ended up taking two business courses over the summer at a community college near his home. Over the course of his senior year he took 9 business courses, plus psychology senior seminar. Spring of his senior year he applied to three MBA programs and was invited to interview at all three schools.

The interviews went well because, as the he told me, “Once it was determined that I had the business course prerequisites, all the interviewers wanted to talk about was my psych major! They asked me what psyc courses I saw as most relevant to the business world, what did I see as the role of psychology in business, all sorts of stuff like that, just like you said they would. Good thing I was prepared because I really had some good answers, at least I think and hope I did!”

I guess he did because all three MBA programs accepted him. I don’t know how things worked out in the long run because he didn’t keep in touch. Still, to me the lesson is clear: When the best-laid plans suddenly and unexpectedly go off track, your life is hardly over. Emotional stress? Don’t buy into that psychologizing message. Use your resources to adapt to the challenge of change.

Don’t get me wrong. Over the years I had many students who suffered genuine crises in their lives, events that understandably gave them a lot of stress. They needed help getting through those times, and some ended up dropping out of college. I’m not talking about those types of cases. What I’m irritated about is students (and newspaper writers) who take the slightest mishap and turn it into a psychological crisis. And you know why it happens?……Because it’s stylish to “play the psychology card.” Society not only allows this card to be played, but also encourages young people to make the stress, anxiety excuse.

Recently I was talking to a retiree about this and he gave me his story: “My first-semester midterm gpa was 1.3. Good start, huh? Sure I was in the wrong major and a little overwhelmed, but I was also spending a lot of time in the student center shooting pool instead of studying more and going to the tutoring center. Final first-semester gpa? How about 1.7? But you know what? Never did anyone, no friend, no parent, no teacher, no advisor…….no one ever said to me, ‘You should go to the Counseling Center.’

“But a wise teacher said to me before I left for semester break: ‘Why don’t you drop one of those D courses for next semester, maybe Chemistry, and substitute something totally different.” Over the holidays one of my parents casually mentioned one day, ‘You could try sociology. I really liked that in college.’

“What the hell, first thing I did when I returned to campus was see a Dean and drop Chemistry and pick up…………you guessed it, Intro to Sociology. Played less pool, too. Ended up with a C in sociology and a second-semester gpa of 2.7. Also decided that I wanted to take more sociology!” (He ended up as a social worker and eventually Director of a county child-care agency.)

Here’s the thing, folks. No matter what the issue, effective coping does not mean wearing a badge saying “anxiety sufferer” on your chest and seeking professional help. If you’re psychologized see what you can do to deal with your stress. Empower yourself and go into attack mode! Confront the stress and take charge of your life. More on that next time.

 

 

 

CHILDREN WITH AUTISM, PART IV

This post, fourth and last in a series, is courtesy of Dr. David Jenkins, Sr., a Licensed Specialist in School Psychology and Lead for Psychological Services at Lubbock, TX. Dr. Jenkins has provided psychological services to school districts in Lubbock, Texas and surrounding school districts for over 25 years and has served on the Texas Education Agency statewide networks for autism and behavior.

Working With Your School System

A confusing issue for many parents is that there is a difference between getting a diagnosis of autism outside of the school setting, and how it is diagnosed within the school setting.  Medical doctors, Psychologists and other professionals who evaluate children outside of the public school setting use criteria in the fifth edition of the Diagnostic and Statistical Manual (DSM V) to ‘diagnose’ the presence of Autism. Public schools, on the other hand, use Special Education Law with specifically defined disabilities.  Unfortunately, the two sets of guidelines may not match exactly, and this disconnect can cause confusion for parents. Both sets of guidelines, however, do have two major commonalities:

Children with autism have significant communication deficits, both verbal (the words we use and how we use them) and nonverbal (facial expressions and gestures we use when we communicate).

Children with autism show significant deficits in social interaction skills.

Parents should have their child evaluated by their local school district because it is in this setting that educational strategies must be put into place. The school system will generally have qualified professionals who are most familiar with in-school Special Education programs, plus they know how the educational system works. That familiarity is important, and is why many school districts may want to do their own evaluation, even when parents have already had a private evaluation from a professional, or have a medical diagnosis from their family physician.

When having your child evaluated for autism by school professionals, you need to be aware of the need for a comprehensive strategy. Make sure you are dealing with qualified professionals who have specialized training in autism.

Professional titles you should look for include School Psychologists, Speech and Language Pathologists, Occupational Therapists, and the Special Education teachers themselves. Others might include Educational Diagnosticians and Physical Therapists. All should be willing to partner with you, the parent. The professionals should be knowledgeable about Special Education laws and the specific programs provided by the public schools in your district.

The evaluation process should include gathering as much information as possible, from as many different sources as possible (those who know the child the best), and in as many different ways as possible.  In addition to structured interviews and standardized rating scales, parents, teachers, child care workers and others who know the student should be included in the process. The child should also be observed in a variety of environments that might include the home, a child care center, a community site, and a public school classroom.

A professional evaluation within the school system may recommend Special Education programs for your child. To access Special Education programs you must first have the child complete the evaluation process to determine if a disability is present and, if so, what that disability is. There are 13 disabilities defined in federal Special Education law, and autism is one of them.

Before formal evaluation can begin, as parent or guardian you must provide your informed consent. This material should include a description of what will be done, who will be involved, and how it will be done. It is important that you review this information carefully and know precisely what will be taking place during the evaluation process.

Once the evaluation is completed, you should expect to meet with the evaluation team to discuss if any disabilities were found. The team should consist of you, the Administrator of the process, a Special Education teacher, a General Education teacher, and any additional professionals who were involved. You must play an active role in this meeting and ask questions freely. Always remember, you are dealing with your child’s future and your peace of mind.

If the professional evaluators tell you that a disability is present, they next should provide you with any recommendations they have with respect to the need for specialized instruction, support, and services for your child. Remember, being identified as having a disability does not automatically mean that your child will need Special Education services. If such services are recommended, however, once again you will have to give your consent to have your child placed in Special Education services.

Finally, the team will design a plan specifically to meet the needs of your child. The plan will be thoroughly explained to you and you must make sure you completely understand all the features.

As the plan is implemented, you should expect future team meetings to assess your child’s progress and discuss if any modifications in the plan are needed. Such a meeting must be held at least annually, although depending on circumstances more frequent meetings may be appropriate.

A Final Note: What Happened to Asperger’s?

In the profession of psychology, there is no longer something call Asperger’s Disorder. Even though research about Asperger’s is almost as old as that of autism, it was not a separate diagnosis until 1994 when the DSM was revised. Asperger’s was felt to be either something different than autism or the mildest, least severe form of autism.

The newest revision of the DSM (DSM-V) does not include Asperger’s. What is new in DSM-V is Social (Pragmatic) Communication Disorder. The primary features of SCD are difficulty with the use of social language and communication skills, adapting speech to the situation (such as home vs. school), and being able to make non-literal interpretations of written and spoken words.

 

CHILDREN WITH AUTISM, PART III

This post, the third in a series, is courtesy of Dr. David Jenkins, Sr., a Licensed Specialist in School Psychology and Lead for Psychological Services at Lubbock, TX. Dr. Jenkins has provided psychological services to school districts in Lubbock, Texas and surrounding school districts for over 25 years and has served on the Texas Education Agency statewide networks for autism and behavior.

Identifying a Child as Autistic

How do you know if your child might have Autism? Perhaps the most striking behavioral symptom of the condition involves verbal communication problems. When they occur on a regular basis you should be concerned and investigate further. Keeping in mind the continuum we have described in my previous posts, these language deficits can take a variety of forms. The child may:

Never use spoken language to communicate.

Sound like a parrot, simply repeating everything that is heard.

Repeat your question instead of answering it, or repeat songs they have heard or portions of movies they like.

Use odd word choices when they communicate. I pointed out earlier how one child at Thanksgiving talked about getting to “hack” the turkey.

Talk and talk and talk about favorite topics and interests but never ask you a question about it.

Be able to read but not understand the material.

Say unusual things like, “He likes ice cream,” instead of “I like ice cream.”

Be able to carry on a conversation.

Some additional warning indications, although not definitive signs of autism, should nevertheless raise a red flag in your head. These include things like the following:

The child is not talking by 2 years of age. Or, your child has begun using words and then around 18-24 months stops using those same words.

You notice inattentive behavior on a regular basis and think your child might have a hearing problem.

You find yourself wondering why your child rarely makes eye contact with you.

You wish your child would be more interactive with you and others, such as playing peek-a-boo or smiling back at you.

You notice your child regularly prefers to be off alone, even at his or her birthday party or at other family gatherings.

Your child seems to have exaggerated sensitivities to certain sensory experiences, such as lights or sounds.

You notice on a regular basis that your child has difficulty adjusting to change, such as a new routine. The child definitely prefers sameness and predictability, and repetitious behaviors occur frequently.

To some degree, all children can display any of the above characteristics at any point in time. Generally you hardly notice them. When they are extreme, frequent, and predictable, however, they catch your attention. It is at this point you may want to investigate further. Also keep in mind that any of the above could be indications of something other than autism. The child might have a language deficit. A condition like fetal alcohol syndrome, due to effects of alcohol consumption during pregnancy, can often look the same as autism. Basically, if you are overly concerned there is only one way to know what’s going on and that is to have the child evaluated by trained professionals trained to do such evaluations.

CHILDREN WITH AUTISM, PART II

This post, the second in a series, is courtesy of Dr. David Jenkins, Sr., a Licensed Specialist in School Psychology and Lead for Psychological Services at Lubbock, TX. Dr. Jenkins has provided psychological services to school districts in Lubbock, Texas and surrounding school districts for over 25 years and has served on the Texas Education Agency statewide networks for autism and behavior.

Behavioral Deficits in Autism  

 In my previous post I talked about the continuum and how it applies to sensory reactions shown by children with autism. The same wide variety of characteristics, that is, the continuum, applies when we consider behavioral deficits. Every parent who suspects autism wants to know what deficits to look for. Being aware of difficulties a child may face is certainly the first step in learning to cope with them, and awareness of these deficits can reduce parental concern and anxiety. The reality is, however, that the expression of autism can vary tremendously from child to child. No two children will look the same.  

 Consider verbal ability. Deficits in verbal language skills can include not using spoken language by the time the child is two years old. Or a child around 18-24 months of age may stop using words already learned. Sometimes the child may sound like a parrot, simply repeating everything heard. Mommy says, “Do you want a drink?” and Johnny replies, “Do you want a drink?” Children may repeat songs they have heard or portions of movies they like as they are going about their day to day activities.  

 Some children acquire good vocabulary but may use odd word choices when they communicate.  My friend Jack talked about getting to ‘hack’ the turkey one Thanksgiving. While ‘hack’ can mean cut, it is not the word most people would typically use to describe carving a turkey. Some children may talk and talk and talk about their favorite topics and interests but never ask you a question about it or ask for your input. 

 Jack was an expert on 50’s and 60’s rock and roll music. He could tell me everything about it, such as who wrote the words, who wrote the music, who produced the album, what recording company was involved, what year it was written, etc. I grew up listening to that music and know a little about it.  However, during the course of providing counseling to Jack over 1½ years he never, ever asked me anything about it. Jack also loved stamps. He had multiple five-inch binders full of postage stamps from around the world, and he could tell you everything you ever wanted to know, and more, about them. But he never asked what I knew.

 I evaluated 4-year old Mary who could read everything on the label of the fire extinguisher as we passed by it in the hall on the way to the room used for testing. She couldn’t answer any questions about what she read, but she had no difficulty pronouncing any of the words she saw. Some children may be able to carry on what appears to be a conversation, but they are really just talking on and on about their favorite topic. 

 When thinking about any aspect of autism, think of the continuum. With respect to language, for instance, at one end of the continuum is the child who uses little, if any spoken words, while at the other end of the continuum is the child who uses lots of words.