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So your child is “at risk” for autism, now what?

10/7/2019

 
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Some readers might be wondering what autism even is so I thought it might help to share a bit about it before continuing with the blog. In layperson’s terms, autism is term that describes a broad range of conditions that typically involve challenges in social relationships, verbal skills, nonverbal communication, general development, and can include repetitive behaviors or approaching the world in a more rigid, structured way. Because the term “autism” encompasses a wide spectrum of individuals who often experience the world in many different ways, it is difficult to generalize what an autism diagnosis will mean for your family or child. It is best to seek understanding for how your child may or may not experience the world, rather than to project ideas of what this might mean for them onto them. Also keep in mind that many common portrayals of individuals with autism in our media (example of Rain Man) are entirely inaccurate and do not describe everyone. 

By: Dr. Erica Wollerman 

Since one of my specialties is working with parents of kids with autism and working with individuals on the autism spectrum in general, a question I get asked a lot is about what to do when your child is either screened as being at risk for having autism or newly diagnosed with autism. Particularly because young children are often getting screened for autism starting at their well child visits with their pediatricians around a year of age or younger, this has become much more common for parents to wonder about and experience. 
 
In my experience, this can be such an overwhelming process for parents and one that unfortunately, not every pediatrician is skilled at handling well with them. Often, parents are given a long list of resources without much direction as to what would be most helpful for their child or they are steered towards Applied Behavioral Analysis (ABA) immediately. While ABA can be helpful for some children, it is becoming much more commonly referenced as a therapy to treat almost any childhood challenge. I find this a bit alarming because ABA therapy is very behavioral in nature and at times can miss the more emotional component of what is going on for children. 
 
So, what do I recommend to parents with either a newly diagnosed child on the spectrum or a newly screened “at risk” toddler?
 
Step One: Take a deep breath. 
This sounds silly but I find that parents in this situation are so overwhelmed and overcome with a feeling of urgency to get your child into the “right” treatment or intervention that is going to “fix” them. The thing is, it is okay and preferable to take some time with this experience. Your child is not different today than they were yesterday and while early intervention is very helpful, it is okay if you set it up next week or next month, rather than right this second. It is okay to make sure you are wrapping your head around what is happening first so that you can be a calm place to set up the services you feel comfortable with. In other words, take a deep breath and let yourself sit with this information before you do anything else. A calm, peaceful parent is going to be the most helpful as you go through the next parts of this process. 
 
I’d also like to note that there are a lot of myths out there about what it means to have autism and that the reality is not what you may see on TV, movies, or the internet. It is a BIG spectrum with a lot of variability so just because your child might fall somewhere on it, does not mean they will be a certain way or not be a certain way. For example, parents tend to worry that their child will not show them affection if they have autism and this is just not the case for all kids. Some kids are affectionate, some are not and this applies similarly to people on the spectrum too. 
 
While having a child with autism can be challenging at times, it is also pretty amazing at times – just like parenting any child. I am of the belief that we all have our struggles, and our children will too, and it is all about figuring out what our children need to thrive. Some of my favorite clients and people have autism and I truly love being able to know them and the way they experience the world. I could go on and on but my point here is simply, try not to panic or overreact to this news.
 
Step Two: Do a little research. 
By this, I mean that it would be helpful to consider what your child is experiencing and if you fully agree with their diagnosis or at risk status. Have you been having concerns yourself perhaps that their development is not where you think it should be or matching other kids you know or see? When you read more about children with autism, does it match your experience? Do you feel you might want a second opinion? Maybe read a few books or blogs from other parents or experts in the field to help you gage what you are seeing and feeling. Keep in mind that some children are going to get a positive screen and then not end up meeting the criteria for being on the spectrum when they are older. I always say that this is why I am so conservative in diagnosing children and teens because sometimes their symptoms are more developmental than pathological, though they may at times be problematic. 
 
Step Three: Seek Consultation
I would also encourage you to seek consultation with a therapist or psychologist who specializes in working with children on the spectrum or even to seek out a more formal full developmental assessment. Ideally, this person can help you chart a course of treatment individualized to your family and child’s situation. Often, parents are given so many ideas of what to do (Speech, OT, ABA, individual therapy, group therapy, etc.) that it can be overwhelming. Ideally, you can find someone who can help you determine what your child would benefit most from and start with that method of therapy. Therapists, psychologists, speech, and OT providers can be helpful to consult with to help you determine the best path forward. 
 
If you feel your child’s diagnosis is accurate, this is where you want to start collecting treatment options to see what would be a good fit for your family. It might help to join some Facebook groups with other parents in the same situation so that you can check in with what other parents are doing and what their experiences have been with different therapies and providers. I have found that treatment options really vary depending on your child’s presentation and needs so remember that none of this is one size fits all!  A great resource in San Diego can be San Diego Regional Center also so this might be a good time to reach out to them. 
 
I hope these ideas are helpful to you!  If you have questions or are a parent of a newly diagnosed child with autism or even an “at risk” child, feel free to reach out to us to see if we can support you at our office. We love working with parents in parent consultation sessions or even individual therapy to help support you throughout this process. Raising a child who is developing differently can be very challenging at times and we are happy to help however we can! 
At Thrive, we take a positive, client centered approach to therapy that is focused on creating a genuine connection with our clients.  If you would like to talk with a Thrive Therapist about yourself, your child, or teen attending therapy, please reach out to us by phone at 858-342-1304. 
 
As always, thanks for reading and comments are always welcome regarding any issues around child or teen psychotherapy services in San Diego by Thrive Therapy Studio.  
 
To stay in the loop on the services offered and to receive updated information about Thrive, please feel free to sign up for the newsletter through the following link: http://eepurl.com/cvGx5n.

Guest Blog:  The Day I “Truly” Received My Son’s Diagnosis of Autism: How Acceptance Led to Resilience

3/27/2018

 
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​By: Shoshana Shea, Ph.D.

Today’s guest blog was written by an extremely knowledgeable and talented psychologist, who is also the mother of a son diagnosed with autism. She shares about her experience receiving this diagnosis and the way she used her work utilizing strategies from ACT, CBT, etc. to eventually reach acceptance in this situation. We were truly inspired by her story and her detailed discussion of how psychological theory and coping strategies helped her and felt compelled to share with our readers as well!
 
The Day I “Truly” Received My Son’s Diagnosis of Autism: How Acceptance Led to Resilience
By: Shoshana Shea, Ph.D.

 
Daniel Gottlieb was a young, burgeoning psychologist, husband, and father when quadriplegia entered his life. He was driving on the freeway when he was struck by a giant wheel that unhitched from a tractor-trailer, flew across the freeway, and crushed his car. He was instantly paralyzed from the neck down. As he lay in the hospital contemplating how he could end his pain and suffering, one of the night nurses, who suffered from depression and had heard that Gottlieb was a psychologist, shared that she felt suicidal. Unaware that he had been contemplating that very idea himself, they talked through the night. Now, a prominent writer, therapist, and radio talk show host, he acknowledges that by listening to her experience, Gottlieb may have not only saved her life, but she likely saved his: Why? Gottlieb says that was because the nurse saw him as a person. We become identified with the waves and we forget that we are the ocean (Brach, 2012). When the waves thrash us around, we suffer. Gottlieb later shared in two of his books, Letters to Sam and The Wisdom of Sam that he stopped striving to be the man he always wanted to be and finally realized the man he was.
 
I will never forget when one of those waves came into my life on a crisp, fall day in November. When picking up my son from preschool, his teacher told me to call his pediatrician because there was “something wrong” with him. Those words numbed me; I wondered out loud “And what should I tell the doctor?  That something was just wrong?” Indeed, when I spoke with the doctor, I catatonically echoed the preschool teacher’s words, “There’s something wrong with my son.” I might have said what I feared, “I did something wrong.” The doctor responded by saying, “Well, we all worry about the big ‘A,’… autism, that is.” I don’t remember much more of that day; the specifics are a blur to me now. I was completely submerged under the wave, being dragged along the ocean floor. Coming up for air was a long way off. This felt like a tsunami to me, and I had already counted myself a casualty.
 
To use a metaphor from Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), picture a man trapped in a deep hold, with only a shovel by his side. In despair and desperation, he picks up the shovel and begins to dig. Not being one who quits, he puts all his effort into digging his way out. He toils through the night and as the sun rises, he takes stock of his progress. He is not only still stuck in the hold, but it is deeper than he ever would have imagined. He is baffled; why was the shovel there if it was not a means to get out of the hold? He things, “this is all I have…” Tara Brach, clinical psychologist, author, meditation teacher and dedicated leader in training therapists to integrate mindfulness into their practice of psychology, calls this a “false refuge”; a tool that is seemingly helpful and certainly available, but which is not. The first thing a man must do is drop the shovel, and yet he fears he cannot because what would he do then? Sit in the darkness and the pain of being in a terrifyingly deep hole?
 
In her book, When Things Fall Apart, Pema Chodron writes, “Reaching our limit is not some kind of punishment. It’s actually a sign of health that, when we meet the place where we are about to die, we feel fear and trembling. A further sign of health is that we don’t become undone by fear and trembling, but we take it as a message that it’s time to stop struggling and look directly at what’s threatening us… How we stay in the middle between indulging and repressing is by acknowledging whatever arises without judgment, letting the thoughts simply dissolve, and then going back to the openness of this very moment. That’s what we’re actually doing in meditation. Up come all these thoughts, but rather than squelch them or obsess with them, we acknowledge them and let them go… We can meet our match with a poodle or with a raging guard dog, but the interesting question is – what happens next?”
 
When I initially received my son’s diagnosis, I did more than my fair share of shoveling; I went through shock, anger, guilt, shame, reasoning, begging, pleading, bargaining, blaming, rage, numbing, and most of all, rigorous inquisitions of myself. If the shovel had not worked before that point, I was not going to let my son down, so I shoveled harder, with more gusto than ever before. It would take me six months until I finally stopped digging when the RAIN began to fall. The RAIN soaked my body and I bathed in my pain and tears.
 
I attended a workshop led by Tara Brach as part of a conference on Mindfulness (FACES, 2009). Dr. Brach led us through an exercise where she asked us to take something we were struggling with in our lives and say “yes” to what we were experiencing. She elaborated, “Saying “yes” does not get rid of the pain; it actually allows the experience to be freed and unfold itself; a space opens up. Some people notice fear, however, and do not get that sense of freedom. When we get stuck, it usually means we have not looked deeply enough into the nature of our experience…”
 
The acronym RAIN has been used in mindfulness to engage in a progressively deepening process:
 
R stands for recognize: “What is going on? What are we noticing?”  “They say there is something wrong with my child, or, maybe not?” “He seems alright…” This process involves also recognizing equivocation.
 
A stands for acceptance, wherein we allow the situation to simply be. Without knowing it, we often say, “this can’t be happening.” With acceptance, we say “yes,” and allow it to be. But I didn’t want to say “yes.” I was saying “No! This can’t be happening; this can’t be happening; this can’t be happening…” It was like if I admitted there was “something wrong,” I was signing up for my son never having a “normal” life. I was giving up on him. If I truly accepted his diagnosis, maybe it didn’t have to be that something was “wrong”; maybe it just was.
 
Another ACT metaphor is that of a ball and chain attached to our ankle. Burdens are cumbersome, often shameful, their weight unbearable. So we tend to act like they do not exist, and valiantly try moving forward in our lives. We try and drag our ankle but it just won’t budge. We tell ourselves, “I can’t be having this pain; more importantly, I won’t allow it!” So we stay stuck. Acceptance is bending down and picking up the ball and holding it close to our bodies. This way, we will likely move at a very slow pace, but at least we are moving. Jack Kornfield reminds us of the Zen Buddhist saying in his book, The Wise Heart, “If you understand things are just as they are. And if you don’t understand things are still just as they are.”
 
I stands for investigate our inner experience with heart, with kindness, with compassion. We use the Four Foundations of Mindfulness to further deepen this investigation (Mind, Body, Feelings, and Dharma, Kornfield, 2008).”
  1. Mind: We ask, “What am I believing? What am I really afraid of? What is most distressing to me?” “What stories or judgments do I have of this?”, “I failed him.”
  2. Body: “Where do I feel this in my body?” My head aches. My chest is tight. My stomach is churning.
  3. Feelings: Agitation, sorrow, and fear.
  4. Dharma: “The elements and the patterns that make up experience” (from The Wise Heart), “How locked in are we?” “What would I see if I were to go beyond this small self?” But I can’t come into my present moment because it won’t be OK; he won’t be OK. I won’t be OK. Pema Chodron says, “We can meet our match with a poodle or a raging guard dog, but the interesting question is - What happens next?”
 
This leads us to the final step of RAIN.
 
N stands for non-identification or non-attachment. We see our thoughts as thoughts, and not as who we are as a person. In ACT, this is called “defusion.” Tara Brach ended the exercise with the following words: “We unhitch ourselves, and we come home to who we really are. We are fully present. No longer identified with the small self. Back to natural loving presence. And we are then able to really ask ourselves, ‘So what am I needing in this moment?”
 
Before going through the steps of RAIN, I really thought I was accepting the situation. I had taken my son for a private evaluation. I was calling professionals to figure out whether I really needed to intervene. I was fighting against well-meaning friends and family, by telling them that he needed to be assessed, and they would push back and tell me to just leave him alone and that he would grow out of it. They would then contradict themselves by looking worried at other times, and asking me if I noticed he was doing something that other kids don’t normally do. I would perseverate, equivocate, and hide in silence and drown in self-pity. In the end, I came to realize that I was completely unwilling to accept that this was indeed happening. This lack of acceptance was impeding my process of resilience, and the ability to truly help myself and my son. I was never going to drop that shovel, and then, I did.
 
Resting in my awareness, I was able to let go of the struggle; my exit strategies had become defunct, and the tears flowed freely. At the next break, I stepped out and called the school district to schedule an evaluation to arrange for intervention. I haven’t looked back since. It is not that I haven’t indulged in self-pity or other avoidance strategies since then; it is that I always return to the truth and come back home to natural, loving, presence. I am willing, and I have dropped the shovel. My son has become one of the greatest teachers and remains so.
 
If you can rest in the ocean, you are not afraid of the waves (Tara Brach).
 
References
 
Brach, T. (Producer). (2012, March 7). Freedom in the Midst of Difficulty. Retrieved from URL https://www.tarabrach.com/freedom-in-the-midst-of-difficulty-audio/.
 
Brach, Tara. (2012) True Refuge: Finding peace and freedom in your own awakened heart. New York, NY: Random House Publishing Group.  
 
Chodron, Pema. (1997) When Things Fall Apart: Heart advice for difficult times. Boulder, CO: Shambhala.
 
FACES Conference (2009, April 2-4) Awakening to Mindfulness. La Jolla,  CA.
 
Gottlieb, Daniel. (2006) Letters to Sam: A Grandfather’s lesson on love, loss, and the gifts of life. New York, NY: Sterling Publishing Co.
 
Gottlieb, Daniel. (2010) The Wisdom of Sam: Observations on life from an uncommon child. Carlsbad, CA: Hay House.
 
Hayes, S.C., Strosahl, K.D., Wilson, K.G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guildford Press.
 
Kornfield, Jack. (2009) The Wise Heart: A guide to the universal teachings on Buddhist psychology. New York, NY: Bantam Dell.
 
As always, thanks for reading and comments are always welcome regarding any issues around child or teen psychotherapy services in San Diego by Thrive Therapy Studio.  Please also feel free to check out Dr. Shea’s website here.
 
If you would like to talk with a Thrive Therapist about yourself, your child, or teen attending therapy with one of us, please reach out to us by phone at 858-342-1304.
 
If you would like to receive updated information about Thrive Therapy, please feel free to sign up for our newsletter through the following link: http://eepurl.com/cvGx5n.
 


Introduction to Therapy Series: 6 Reasons you should bring your child/teen to therapy:

10/9/2017

 
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By: Dr. Erica Wollerman 

Making the decision to start therapy for your child or teen is usually a pretty difficult one for parents riddled with concerns about a variety of things… Does this mean something is “wrong” with my child?  Will my child think something is wrong with them? Are they just going to complain about me?  Will therapy even help them with the things I want it to help them with?  And the list goes on, and on, and on! 
 
As a child/teen therapist, I get these questions a lot and while I understand where the questions come from and the concerns parents have, I as a therapist am also, unsurprisingly, pretty pro-therapy. I believe that any and all of us can benefit from therapy and that going to therapy does not mean that anything is necessarily “wrong” with us or with our lives. Therapy can provide a safe space to explore ourselves, our lives, our reactions, and can provide us with a supportive person to walk with us through life’s challenges. I also think that children and teens respond particularly well to having an unbiased adult in their lives who can talk through situations and challenges in a way that parents, coaches, and teachers just can’t. So, I generally think that anytime is a good time to start therapy, but I thought a nice list of reasons to start might help parents make this decision!
 
  1. Your child is experiencing symptoms that are starting to interfere with their life: This is very important – if your child is having symptoms of depression, anxiety, social skills issues, or behavioral issues that seem to be increasing and impacting your family more, that do not resolve within a week or so, an initial appointment with a therapist is definitely a good idea. Often, I find that parents struggle so much with the decision of bringing their child to therapy that they wait far longer than I would recommend. So, sooner is better than later in my eyes!
  2. Your child or teen has experienced a significant loss or challenge. Therapy can be particularly helpful following a move, divorce, death of a significant person, or just a challenging time perhaps transitioning to a new school, grade, or family situation. Even if it is a short term experience just to make sure your child or teen is coping well, I would say all of these events are a great reason to bring your child or teen to therapy.
  3. Your child or teen struggles to talk to you about challenges in their life. If you have a child who is either just not very verbal or who shuts down in response to difficult conversations with you, it’s a great idea to get them in therapy so that they can work on sharing and exploring their thoughts and feelings as well as learn how to have difficult conversations! 
  4. 4.You believe your child does not fit in socially or is being bullied or bullying others. Kids who struggle socially or who are bullied or doing the bullying often will benefit from extra support. Considering that our social interactions are a huge part of our lives, it can be so tough for kids who feel that they do not fit in or who are being mistreated. Unfortunately, these issues place children and teens at greater risk of developing depression or anxiety in the future so it is important to support them before those issues develop.
  5. 5.Your child has a diagnosis or an IEP. If your child has a medical diagnosis or challenge going on, they will likely benefit from additional support. Additionally, if your child is diagnosed with a learning disorder, has an IEP for supports at school, or is diagnosed with a psychiatric disorder such as Autism, ADHD, Non-Verbal Learning Disorder, etc., providing them with the support of therapy can be so helpful. Children and teens who feel different for any reason greatly benefit from having outside supports where they can be themselves and work on developing coping skills to manage their challenges.
  6. 6.You have thought about how your child might benefit from therapy more than a couple of times. If you are spending a lot of time considering IF you should bring your child/teen to therapy, just go ahead and bring them in. Even if you are not sure why you are thinking it would be helpful, there is something that you are picking up on as a parent that I think you need to trust!  Trust your gut and call for an intake… In my experience, sometimes parents do not know exactly what is “wrong” but get the sense that something is going on with their child/teen that they do not know about. In these situations, it is always better to be overly cautious than not provide support that could have been beneficial! 
 
As I mentioned previously, as a therapist, I am definitely pro-therapy as you may have noticed through this blog!  I will always recommend that it is better to call in and talk with a therapist about your family, child, or teen and see if they think therapy could be beneficial, rather than wait and let problems or challenges manifest into more problems or challenges. However, it is important to note that at my office, we are conservative in diagnosing children and teens (meaning we do not jump quickly to labeling and diagnosing unless those diagnoses are truly warranted) and that we will let you know if we feel your child or teen does not need services. So, just because you make the call as a parent, does not mean that you are signing your child or teen up for a lifetime of therapy!!
 
If you would like to talk with a Thrive Therapist about yourself, your child, or teen attending therapy with one of us, please reach out to us by phone at 858-342-1304.
 
If you would like to receive updated information about Thrive Therapy, please feel free to sign up for our newsletter through the following link: http://eepurl.com/cvGx5n.
 

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Thrive Therapy Studio Therapists Offer Child, Teen, Adult, Marriage and Family Psychotherapy Counseling Services in San Diego, California.
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