Sunday, June 29, 2008

Trouble, part four: Hypothetically Speaking

Last summer, when Ben’s troubles were at their all-time peak, he would exhibit a curious form of imagination.

When he became at all upset or frustrated, he would unleash a stream of imagined acts of aggression and destruction. He would say things like:

“I want to scratch [my classmate].”
“I want to hurt and scratch and push [my classmate].”
“I want to push Dora and Boots and they will fall down and they will have a big, big, big owie and they will be so sad.”
“I want to hurt ALL the children. I want to break ALL the children. I want to scratch EVERYBODY.”

We never quite knew how to respond to these statements except to acknowledge them and allow him to feel heard. I would try several different responses to see if anything helped him calm down:

“Wow, you sound like you’re pretty frustrated.”

“It’s okay to talk about hurting, but it’s not okay to hurt people.”

“I won’t let you hurt anyone. I’ll keep you and your friends safe.”

“Thanks for letting me know that you’re feeling mad.

None of these responses ever seemed to have an impact. He wasn’t in listening mode. His voice was anxious and panicked and tearful. Finally, I just started doing what all good friends do when someone needs to vent. I simply held him and said,

“I know, buddy. I know.”

This phase passed eventually and we only heard him say these things occasionally after that.

But recently, Ben discovered the linguistic tools for talking about cause and effect and that’s introduced some new, baffling verbal behavior.

It all started when we made up a game I call, “What will happen if?”

This involves playing with three juggling balls while Ben asks a series of questions:

“What will happen if the balls go in a puddle?”

“They’ll get wet,” I’ll reply.

“What will happen if the balls go in the oven?”

“They’ll get really hot.”

“What will happen if the balls go in the snow?”

“They’ll get really cold.”

The scenarios become progressively more silly, and there is much giggling.

When Ben behavioral episodes started to increase recently, we’ve seen him transposing this idea of “what will happen if…” to stressful situations. Now the last summer’s litany of “I want” has turned into “What will happen if…?”

When he starts to feel anxious, frustrated or angry, he starts to ask questions like:

“What will happen if I pull [my classmate’s] hair?”
“What will happen if I bit [my cousin’s] hand?”
“What will happen if I break the whole house?”
“What will happen if I break all the planets?”

These are generally unrelated to the frustration at hand.

No matter how I answer, he seems like he’s looking for me to say something different, something specific.

So, like with the “I wants” I just try different approaches. For example, if the question is, “What will happen if I bite [my cousin’s] hand?”

I’ve tried realistic:

He’ll get hurt really bad and he’ll be really sad. Uncle and Auntie will give him a band-aid.

I’ve tried dire and scary:

He’ll have to go to the hospital.

I’ve tried acknowledgement:

You sound like you’re really mad.

I’ve tried stern:

“I won’t let you hurt your cousin. Hurting is not okay.”

I’ve tried Socratic:

“What do you think will happen if you bite [your cousin]?”

None of these approaches seems to have any effect. He simply keeps asking and asking and asking, as if he’s not getting the answer he wants.

And occasionally, after he’s been doing this for several minutes and seems to be a bit more calm, I try humor:

“His hand will be down in your tummy and his hand might tickle your tummy and you would laugh so hard that milk would come out of your nose.”

If applied at the right moment, this works. He starts to laugh, and this gives him a safe way out of being stuck. Sometimes it works.

But sometimes, we're just in too deep.

We had a particularly difficult episode recently, one where Ben’s hypothetical imaginings seemed to fuel actual aggression toward both of us. It took a long time and plenty of tears (from everybody) to return to a state of normalcy.

Afterwards, Chris wondered aloud if when he’s asking “what will happen if…?” if he’s searching for a limit, if he’s trying to find the boundary he cannot cross. Our responses to his questions are designed to acknowledge his feelings and help provide explanations, but perhaps we just end up conveying a confusing and squishy world of no real consequences.

We decided that we’re going to try a single, consistent party line in response to any question involving the result of misbehavior – whether realistic or ridiculous, whether imminent or hypothetical:

“We will take away your shows.”

And we have decided that we will stick to this plan of limiting videos as a consequence of real – not imagined – misbehavior.

We haven’t had to do it yet, but now I find myself wondering, “What will happen if Mommy takes away Ben’s shows?”

I guess we’ll find out sooner or later.

Saturday, June 28, 2008

Recommended Reading

I love this piece by Susan Etlinger, a wonderful writer and special-needs-parent-advocate-blogger-extrordinaire.

It just so happens to serve as a nice variation on my current theme of "trouble." Please consider sharing it with your friends, family and school community.

Friday, June 27, 2008

Trouble, part three: time outs and the limbic brain

I’ve been revisiting a book I read years ago before Ben was born. It’s called A General Theory of Love.

Despite the seemingly chick lit title, the book is a scientific exploration of the parts of the brain that are involved in the feelings of connection and relatedness and intimacy with others. It’s beautifully written and fascinating; and if you’re the type of person who likes a few Shakespeare quotes with your science, this book is for you.

The central thesis starts with the idea that human beings’ brains have three parts – a reptilian brain that controls basic functions, a limbic brain that controls emotions and relationships and a neo-cortex that handles reasoning, planning, creativity, algebra, conjugation of verbs, and the like.

Obviously the neo-cortex is what separates us humans from other beings that don’t solve for x, or manage hedge funds, or invent color names like “sage” and “putty.”

But this book focuses on the limbic brain. What separates all mammals (including us) from those creatures who have not evolved with limbic brains is that we are wired to care about each other. A lizard will watch it’s offspring being eaten by a bird and not bat an eye, but a mother tiger will attack – or risk her own life – to protect her cub. This is the work of the limbic brain.

Not only are we wired to care about each other, but we are wired to need each other.

Animals with limbic brains suffer, and even will die, when they lack connection. This has been studied in lab settings with animals, but also seen clearly in the cases of mismanaged orphanages where children tragically languish without love and comfort of adults.

The authors of the book refer to this as phenomenon as limbic regulation.

Closeness – both physical and emotional – with another person actually optimizes our bodies’ systems. We send and receive messages from others around us that affect our limbic brain. These unconscious messages that pass, for example, between mother and newborn ensure that a newborns’ breathing and heart rate remain regular, as well as govern a host of other physical functions.

In short, humans in close relationships regulate each other.

The reason I went back and read the book is because I began seeing references in others’ writings about children on the spectrum referring to a difficult moment or a tantrum as dysregulation.

In the light of this idea of the limbic brain and how relationships help us function, it made perfect sense to speak of tantrums and other difficult moments as dysregulation; or the state of not being regulated.

When Ben was about two and a half or three, we decided to try the normal “time out” strategy. When he was misbehaving – throwing things, hitting us – we’d warn him and then remove him from the situation for a time. (see: 1, 2, 3 Magic.)

For most parents, this means having the kid go sit in a special chair or stand on a special rug in the corner or to their room.

Apparently (and to my amazement) I learned that most children actually stay in these spots during time out.

That’s not the way it worked for us. Leaving Ben in his room alone while he was in this state meant that we risked having him hurt himself or at any rate break stuff – big stuff.

He would not stand or sit in one spot. So a time out meant sitting with one of us with us holding his arms so he could not hit us or himself. Sometimes we would lay him down on the bed and hold him there until he was calm.

While holding him down seemed preferable to allowing him to hurt himself or us, it never seemed like it was helping him to learn how to behave differently the way a typical time out is supposed to. I was never sure if he saw it as a consequence even though he clearly did NOT enjoy time outs: he protested these episodes with kicking and screaming.

The phase of frequent throwing and hitting passed, so we were doing time outs a lot less frequently. But we started to notice that Ben was sometimes saying when he got on edge, “I want a time out.”

Why, I asked myself, does he want a time out? He hates time out.

“You don’t need a time out, Ben. You didn’t do anything wrong.”

“I want a time out.”

“No, we’re not going to have a time out.”

Then he would throw something or knock something off a table.

He started doing this at school, too. Asking his teacher for a time out and then misbehaving flagrantly when he didn’t get one.

His teacher asked one day, “Ben, what happens when you get a time out?

“Daddy holds my arms tight.”

There it was. While he never seemed to like the time outs we did, he was craving something about the feeling he got when we held his arms during a time out.

This is when I first learned about proprioceptive input. Many children on the spectrum respond well, his teacher explained to us, to pressure applied to the joints and muscles. And from then on, we offered him “tight squeezes” and “tight hugs” all the time, especially when he appeared to start getting on edge, anxious. The staff at school did the same thing, and we saw a huge decrease in behavior problems.

While proprioceptive input is generally regarded as treatment for sensory issues, the concept made me recall what I read about limbic regulation. Maybe it wasn't just the pressure itself, but the also something about the feeling of closeness and connection it provides.

We now make a point try to offer a steady, preventative limbic diet of hugs, squeezes, cuddles and close, physical play.

Perhaps we need a new PSA:

This is your limbic brain. This is your limbic brain on hugs.

Wednesday, June 25, 2008

Trouble, part two: The Robot Rampage

Parental advice literature is chock full of guidance about how to deal with temper tantrums.

Don’t give in to the demand. Let the episode play out. Keep the kid safe and simply let the storm pass – walk away and ignore the behavior when possible.

This assumes you’re dealing with a typical tantrum. The kind where the child cries and screams, sits or lies on the floor, maybe rolls around for effect, but essentially stays in one place. Spend more than twenty minutes at Target on a Sunday afternoon and you’ll see at least one excellent example.

I’ve never seen Ben do anything even close to this. Ben’s tantrums are unique enough that the normal parental guidance doesn’t really even make sense.

Chris came up with a fitting way to describe Ben’s tantrums when he coined the term, “the robot rampage.”

A robot rampage is usually triggered by frustration and loss of control: the DVD we’re watching skips or freezes, something goes awry with the train track, we set a limit on something Ben is doing.

The episodes start off with an immediate, reflexive action. He grabs, throws, pushes or hits what ever or who ever is in front of him. Emotion triggers his muscles to react, bypassing cognition entirely. This is the lizard brain at work.

Unlike a lot of children who start to cry at this point, Ben rarely cries during the robot rampage. (Hence the term “robot.”) He often shows surprisingly little emotion except for what I would describe as focused determination combined with controlled panic.

After the initial burst, Ben will, for example, walk – not run - over to something else in the room and throw it, or knock something off a table. A stern reprimand this point tends to throw gasoline on the fire, often causing him to escalate and become more aggressive.

So we just hold him and try to calm him down.

It's hard to know when the worst is over. We've seen him appear calm and have let him out of our grasp, only to have him walk into the next room and attempt to pull a bookshelf down on himself, or throw himself on the pavement of a parking lot, or scratch the face of a playmate.

This strikes me as totally different than what people refer to as children “acting out.” Acting out implies the child is aware of being watched and is performing – in order to get a reaction or make something happen.

Ben’s rampages are indeed some kind of communicative act, but they are not manipulative the way that a typical toddler tantrum is designed to say: “I hate you and you are making my life miserable with your rules and limits.” Ben’s robot rampages seem to be saying, “Help me. I don’t know what else to do.”

Often, the look in his face when I've picked him up to restrain him is one of fear and surprise rather than anger, as if he's saying, "Holy crap. What just happened?"

As his language has been developing, we are noticing that the rampages have become a bit less robotic in nature. He’s more likely to tell us what he’s upset about before he starts to react physically (i.e. “Oh, no! The sticker book is RIPPED!) and it’s easier to engage him in the midst of things, to redirect him. He is a little more whiny, a little more expressive, a little more like a typical kid who’s having trouble.

We often will encourage him to cry since it seems to help release him from the tension of being stuck in frustration. “You have a mad feeling stuck in your body right now.” I’ve started to tell him. “Crying helps get the mad feeling out of your body.”

Most parenting advice urges not to “give in” to the tantrum because you are teaching the child that this is an effective way to get what he or she wants.

But what this approach assumes is that the child is able to learn in these moments. I don’t believe that Ben is receptive to learning when he is in these anxiety-driven rampages. This is not a teachable moment.

That’s why we’ve taken to treating tantrums like panic attacks rather than misbehavior. You do not punish a person who is having a panic attack – you try to help them change the state they are in, from anxious to more calm, which is exactly what we do with Ben.

So, if holding a child and comforting him is giving in, then by the typical standard, I’m not going to win any mother-of-the-year awards.

The panic attack metaphor guides a lot of what we do to try to help Ben through difficult times. It certainly isn’t always successful, but, it’s the best we’ve got – especially when we’ve got a rampaging robot on our hands.

Tuesday, June 24, 2008

Trouble, part one

I have not written much about Ben’s tantrums or other troubling behaviors.

Partly (and thankfully) this is because for maybe nine months or so, incidents have been relatively mild and infrequent.

Over the course of this school year, the rate of behavior issues seems to be at an appropriate level for a four-year-old. Mostly, he just does things like shout at the top of his lungs, “I DOOOOOOOON’T WANT TO TAKE A BAAAAAATH!!!!!!”

This, I can handle.

But that isn't the whole story.

I've tried to write about behavior issues, and the truth is, it's really, really hard. It’s not that I don’t have reflections and ideas and things I want to share.

In fact, I have several unfinished posts that I’ve abandoned midway through. I just gave up on trying to explain or describe those times when he seems out of control and doesn’t bear much resemblance to the happy, goofy, easy-going kid that I’m used to.

As this past school year came to a close, the frequency of Ben’s tantrums increased, and he’s had several incidents of aggressive behavior toward other students in his afternoon preschool program.

So I decided that I need to write about this as a way to understand it better. And perhaps as a way to engage some of you in discussion, and maybe get ideas and advice - or at least perspective.

It’s going to take a series of posts because it feels so complicated and convoluted and encompasses several different themes that I can’t possibly tie together in a single post.

So bear with me on a multi-part journey into the darker side.

Wednesday, June 11, 2008

Let's run through that again...

Here's a little thought experiment for you: Imagine if you woke up tomorrow morning and lost the ability to ask questions. I bet you'd feel pretty frustrated when you couldn't get the information you needed or couldn't interact with people the way you wanted to. You might even get mad and start to behave rather badly or you might just go off to be by yourself and avoid the trouble all together.

Most children start asking questions around age two, but hyperlexic children tend to have some serious delays in this area. Ben just learned to ask questions this past year. It seems like a simple thing but questions are a linguistic breakthrough. They give Ben ways to engage the world in all sorts of ways that were beyond his grasp.

It's also helping to eliminate some sources of frustration.

Last year at this time, if he experienced any kind of mishap, he would immediately try to do it again, even if it meant endangering himself. No crying or whining - just a nearly emotionless and intense and deliberate repetition of whatever had happened.

If he spilled a drop of milk, he would dump the entire glass over. He once stepped off the bathroom stool by accident and I caught him before he could fall. The next thing I knew, he was hurling himself backwards in an attempt to recreate the moment.

Eventually, we theorized that he was recreating these moments to help him understand things that happened too quickly for him to process. He needed to know what happened but didn't know how to ask.

When you combine Ben's strong need to understand how things work, plus neuroprocessing that's a bit slow on the uptake, add in the adrenaline rush you get when you lose your footing, and top it off with an existing need to repeat things (probably related to the processing thing) you get a kid that not only gets back on the horse, but throws himself off it a second time.

So we started to help him with his recreations by allowing him to do them safely. "Do you want to know what happened?" we'd ask. "I'll show you."

Then we'd walk him through the mishap - the spilled milk, the trip on the step, the bump on the head - by offering to "spot" him, explaining the events as he went through the motions again.

"You were walking here and your toe hit the step and - ohh - you took a tumble and landed - bonk - like this."

When we did this, he didn't have any need to re-enact the moment. He was satisfied, could unhook and move on.

I'm reminded of the cartoon Rabbit Seasoning, where Daffy Duck says, "Let'" after being tricked by Bugs Bunny into demanding to be shot by Elmer Fudd. (Come to think of it, the whole premise of that bit is that Daffy is confused by pronouns, another hyperlexic trait.)

But I digress.

Now Ben can actually ask the question, "What happened, Mommy?" when anything happens that moves faster than he can track or process. And he does - a lot. It's a new and different and more sophisticated way to say, "Again." He asks for help to understand, we explain, he listens. Now there's less panic, there are fewer rampages.

Because Ben has this new way to ask to "run through it again," the "what happened" question is no longer just for mishaps. It's become a joyful refrain for almost any action that he wants to repeat. When a super ball ricochets around the hallway, when he flips over on the couch cushions, when the huge stack of blocks finally collapses: "What happened, Mommy?" he shouts - now dozens of times a day - sporting a huge grin.

And now Ben is venturing into a new grammatical territory that shows how his ability to ask questions is developing his sense of cause and effect. He's asking "What will happen if...?" And he's using it in some pretty mystifying ways.

But more on that in the next post.

Thursday, June 5, 2008

yo bama bama

It's heartening to me that there is a chance that the first President of the United States that Ben would ever know about could be Barack Obama.

As a contrast, the first president I knew of was Richard Nixon. How's that for the early shaping of one's political consciousness? I vaguely remember the televised Watergate hearings and footage of Nixon boarding the helicopter after his resignation.

It's likely, however, that during the first years of a hypothetical Obama presidency, Ben may be under the impression that DJ Lance of Yo Gabba Gabba is actually in charge of the country.


My fellow Americans...let's do a dance to get our wiggles out!

Tuesday, June 3, 2008

Ladies' Man

We called another family today to express our regrets that we would not be able to attend a birthday party in a few weeks.

The party is for Samantha, or Sammy, one of Ben's classmates at the Montessori school where he spends the afternoons. She is a bit older and taller than Ben, with red hair, freckles, and confidence to spare.

Sammy's mom said, "Oh, she will be so disappointed. Laura [their teacher] told me that Ben and Sammy have been kissing lately."


So I asked Ben about it tonight.

"Ben, do you and Sammy kiss?"


"Do you do little kisses or big kisses?"

"Big kisses."

Apparently, Ben's social skills have improved even more than I thought.