It's All Over but the Clean-up

Well, friends and Romans, the seven-week journey of my summer job is nearing landfall. It’s all over but the clean-up. (That happens on Monday.)

We started with a full week of training, and then spent six weeks teaching theater games and making films with kids with Asperger’s Syndrome. This is an approach to teaching them social skills – the key deficit for people with Asperger’s, the one that all of them have in common to one degree or another. And an amazingly effective apporach it is, based on the gains I saw during the summer.

They know they’re there to learn social skills (and most, though not all, know that they have Asperger’s). But that’s essentially forgotten, and pretty quickly. The games are fun, and there are dozens of them, so each camper has at least two favorites. We played many of them each day. They get to be hams, to have their intelligence challenged, and to use their imagination nearly all day. In the moment, there’s no awareness going to “Hey! I just made sustained eye contact!” or, “Hey! I just conveyed real feeling with a loud tone of voice!” Or moved their bodies in coordinated ways. Or employed rapid, flexible thinking.

All these apparently small achievements are monumental for Aspies.

After they’ve played the games 20 times, it begins to sink in unconsciously that they are capable of initiating a full connection with another person (or entering a new environment, or doing all sorts of things that previously frightened them) and that good things will usually result. How wonderful is that?

There are many social pragmatics programs out there, and from their popularity, I’m inferring that they must be at least somewhat effective. But from what I’ve read (and heard from satisfied parents on the last day of camp), none of them pack that vital X-factor the theater games do: The gains in social skills come directly from the goals of the activity itself, which just happens to look like a fun game – not a “program” or a “lesson.”

Yet there are dozens of games (and more being created all the time, all over the world), and each targets a different set of social skills. So, they can be craftily combined to target specific kids, or to achieve carefully chosen group goals.

As you can tell, I’m fairly excited about the gains I saw kids make in six short weeks.

And it was both exciting and heartbreaking to see our teens – both the macho, crass, aggressive ones and the awkward, sweet, retiring ones – run up to us and give us hugs and good wishes and good-bye cards. We all milled around at the end of the day; no one wanted to say good-bye. When that last kid (who happened to be one of my favorites) got in his bus, we counselors looked around balefully, shrugged our shoulders and silently headed for the rooms to clean up.

(Of course, there was a wrap-up party last night, and it was boisterous -- a great way to blow off all that pent-up poignancy.)

It was a grueling summer session, five hours of intense contact a day with kids who often can barely stand 10 minutes of such (not to mention the hours of paperwork every day). But I wouldn’t trade the experience for anything. We made a difference in their lives – and they sure affected me pretty deeply. My favorites will be on my mind for weeks, I’m sure.

Autistic Girls Essentially Different from Autistic Boys?

If you've been enjoying my many earlier posts on my work this summer with teens with Asperger's disorder, I have a nice link for you. The New York Times Sunday Magazine has an interesting article on the gender differences within autism, focusing especially on Asperger's patients.

Now, it's been a mother of a week, and I'm supposed to be resting today, so I'm not going to launch into one of my usual psychology screeds right now. I need to get outside and enjoy the gorgeous summer day, and try to do as little as possible today.

I'll just say that the piece appears basically well-balanced. There are exceptions; in the seven weeks I've been working directly with kids with Asperger's, I've seen various examples that contradict some of the generalizations the author makes about boys or girls with the disorder. But even she admits that the field is still making up its mind about the larger facts on gender differences. Those points she does state firmly seem reasonably well substantiated. Moreover, the questions she raises are quite interesting and have important implications.

Enjoy!

Horseplay and Sensory Integration

The boys in my group of Asperger's campers wrestle with each other quite a lot.

We allow a little horseplay in our room, under well-defined parameters. We basically have to. These are 16- and 17-year-old boys, most of whom have ADHD along with their Asperger's. If they sit mostly still during games and meetings, we let them grapple a little during the less structured times, as long as they keep their distance from others, and keep it reasonably safe.

However, there's another piece to it beyond, "boys with ADHD will be boys, times two." Many Aspies have sensory integration issues, and they are often almost literally "going out of their skin." If you've heard of Temple Grandin's discovery that certain animals and autistic people both calm down when they feel pressure against their bodies, you have a very general idea of what this means.

In moments of sensory overwhelm younger Aspies might flop on the floor and pile bean bags over their own bodies. If they're 16 or 17, and too "cool" to do that, they'll wrestle. (Some have other self-soothing mechanisms, but space doesn't permit me to detail those here.) It does get annoying, because some of them cannot sit still for more than 15 or 20 seconds at a time. While others are trying to have a quiet meeting, or do acting games, they'll be twisting each others' wrists, fingers, elbows, and so on. It looks a lot like the old "boys will be boys" behavior, but underneath, there's more going on.

We try to walk the line between letting them self-soothe and keeping the group attentive and cohesive. It gets very, very tiresome sometimes. But if I ever doubt their genuine need for it, I just look at the happy smile of one particular camper who is perpetually trapped in a head-lock or full-nelson, pretty much all day. He complains the whole time, but without it, I think he would actually drive himself, and us, even more crazy.

Theory of Mind

First things first: It's still survey week at Thinkulous. I'd love it if you helped me out by taking the survey via the link at the top-right-hand side of this page.

Interesting post recently on Mind Hacks, one of my favorite blogs (part of me is a huge psych geek). Since I've been writing about this recently, I thought I'd post an excerpt that explains theory of mind rather well in a brief way:

People with autism or related conditions are often poor at both deception and recognising deception in others. It's not always the case, but it's quite a common attribute.

Baron-Cohen's article explores what we know about some of the differences in autistic thinking, and what might be so different that an effective understanding of deception becomes almost impossible.

He argues that a key skill is 'meta-representation', the ability to think about other thoughts, imaginary scenarios or abstract principles in yourself or others.

The key is that it's not just thinking or imagining, it's being able to think about thinking or imagining.

When this specifically involves thinking about what other people are thinking, understanding their perspective, it is often called 'theory of mind'.

You can see why this is a key skill in deception. You need to have a theory or understanding of what the other person is thinking or is likely to think, to work out how to hide the real state of the world from them.

I recommend the post and much of the site to those who like to explore why and how we think and feel what we do.

Boys' Psychology and Asperger's, Pt. II

Yesterday's post outlined the general ways that Asperger's and boy-code behavior. We also met camper Will, a sensitive, highly literal-minded Aspie who, by dint of his defecits, gets hit even harder by the boy code than most.

(To reiterate: All persons are fictional composites here.)

Envision now a highly boisterous game of keep-away, involving seven campers and three counselors. Will – a good athlete – is in the middle, and, at a blatantly easy opportunity, fails to gain the ball.

Now, Camper Evan is in high spirits (the more so because he is one of the boys exchanges teasing quite good-naturedly, and there’s a lot of that going on with his friends at the moment) and he quickly calls out in a playful way, “You suck, Will!” Things are happening fast in this moment, and, though he’s quick physically, processing delays prevent Will from making any interpretations to counteract his natural literal interpretation (though he’s quite intelligent).

In other words, Will simply knows that, “Evan just told everyone very loudly that I suck.” And that’s all he knows.

Confusion and shame almost instantly slam Will like a big ocean wave, followed quickly (faster than his delayed thoughts can mediate) by anger and fear. I think you have the general idea of what follows; space doesn't allow for details.

I want to reinforce here that what Asperger's kids go through socially often varies only in degree from what neurotypical kids go through. I can admit that I had many moments like the one above while growing up. However, Aspies go through more extreme versions of social distress because their unique characteristics make them more apt to experience social awkwardness or cruelty. The situations and attendent emotions might feel familiar, but don't let that fool you. Aspies are different.

I’ve probably raised more questions with these posts than I’ve answered. I would have to write a bona fide academic paper to thoroughly address all the issues. I mainly wanted to describe how interesting it is that the code of neurotypical boys comes into play so directly with our campers, too – yet with a twist that can make it all the more confusing and damaging.

Boy's Psychology Applies, Regardless of Asperger's

(All names in this post are fictional, and all case examples are composites.)

I’m working this summer at a camp that has found a very fun way to teach social pragmatics to kids who have Asperger’s Syndrome (go here for all related posts). Yesterday marked three weeks in – the half-way point. The group seems to have taken a step forward this week, as various individuals come out of their shells and get more comfortable.

Others, in my group and elsewhere, are still suffering. Some of that derives from their inability to understand typical boy’s behavior. One of the deficits that defines the disorder is an extreme literalism in all interactions. When this literal quality runs up against the kind of teasing and rough-housing to which boys have subjected each other from time immemorial, you can imagine the results. Even high-school-age boys end up deeply wounded and permanently on the outside of social acceptance.

(I focus here on boys because I’m very intrigued by boys’ psychology, and because boys are the overwhelming majority in the Asperger’s population, and thus at our camp. We have one girl in our group of nine campers, and some groups are all boys.)

I’ve said elsewhere (and it has been seconded in learned comments on one of my Asperger's-related posts) that just because someone has Asperger’s doesn’t mean he doesn’t have a personality separate from the disorder. Our teenage boys curse, wrestle, and insult each other in every offensive flavor their considerable creativity and intelligence can generate. American boys (as a vast but viable generalization) have always found it easier to connect with each other in this manner than to express direct, non-ironic affection for each other. Call it sad, call it fun. Call it all-American, or call it oppressive cultural gender role influence. Call it what you will, but it is real and prevalent. And many Aspies end up on the painful end of the exchange, because they simply can not get it.

About this literalism: Let’s say camper Will asks me when we’ll be going outside, and I casually reply, “In half an hour.” If 31 minutes go by, Will immediately, loudly protests my violation of my word. There are other Asperger characteristics at play in that interaction (inflexible thinking, rule-bound behavior), but literalism is a big one.

Keep in mind also that Will has entered our highly rambunctious camp group after 10 or so years of relentless teasing of a much more vicious sort, at the hands of truly mean boys at school. They find his other Asperger traits (a speech defect, or obsession with favorite topics, or slow mental processing time) easy fodder – and then zero in all the more cruelly when they find out Will can quite easily be deeply wounded. By the time he arrives at camp, he often takes any comment as a sword through the heart, much less one that – heard literally – contains clearly negative language directed at him.

Tune in tomorrow to find out what happens when Will’s literalism runs up against boy-code behavior.

The Tao of Therapy

Things are progressing well at the camp I work at for kids with Asperger's Syndrome. (See previous posts, and this one will make more sense.) Once again, I've learned that the relationship can do most of the work of healing.

Many years ago, Carl Rogers astutely and repeatedly insisted that people basically will heal themselves when they are in the context of a healthy therapeutic relationship. Subsequent research has strongly supported this; the school of therapy used affects the outcome far less than the qualities of the professional in the relationship (as perceived by the client).

During the first week or so of camp, I was, Thinkers will remember, a little distressed by all the obscene language, digusting references and endless physical wrestling. (Not that we wanted to outlaw all of this behavior. A little of it in teenage boys is to be expected.) Today, incidents of that kind are less frequent, and eager participation is up noticeably. Some of this probably flows from kids getting used to the new people they were suddenly supposed to hang out with five hours a day for six weeks in a row. Also, one of the prime instigators was going through a medication change and might now have settled in with his new prescriptions.

But I think that the biggest factor of all was simply time -- spent in a group that is framed around fun, creative activities and mutual respect. We counselors work quite hard to respond to the campers in a positive way, looking for the campers' strengths in any situation, no matter what they do, or, for that matter, don't do.

They have seemed to begin to understand that we mean it. They're so used to being ostracized for their different behavior (unusual tone of voice, pedantic speech patterns, obsessions with one particular interest, physical awkwardness -- all visible in many teens, butfar more so in most Aspies). Perhaps they were simply pre-empting our expected criticism with negative behavior, to maintain a sense of control of the social situation, a sense that is rare for them. They come to us already bruised, and perhaps if we continue to handle them with care, they'll flourish even more. Time will tell.

I experienced a similar curve at my internship at the college counseling center this year. I charged out of the gate determined to make a difference in my clients' lives -- in a brief 10 sessions at most. By half-way through the year, I realized that, while I was having a positive effect a reasonable amount of the time, I was putting out way too much effort. When I relaxed and trusted the intelligence and instincts of the person sitting across from me -- and, most of all, the process of the relationship -- clients actually improved more quickly and effectively. And *they* were the ones, appropriately, who did the work, although I might instigate it here and there, or keep it on track.

It's certainly not the same thing as laying back. In some ways, I'm more tuned in more of the time using this approach. But it's a relaxed alertness. I love this discovery (even the second time around), because it means that I don't have to do anything other than what comes naturally to me in order to be helpful. I listen, I reflect or comment or react, I give respect, I am honest and genuine. And they see that, feel that -- and start acting the same way, especially toward themselves. And that, of course, is when the improvements really start, and are most likely to last.

Group vs. One-on-One: Being Aware of Lenses

I've written a few posts about my new job working with teenagers with Asperger's Syndrome. Today, yet another insight dawned on me on the drive home. I've worked in the human services with people in groups before, but never in a psychological setting like this, and of course, the experience is bound to give rise to a few realizations.

Today, I realized that some of my campers aren't too terribly different in age and functionality level from some of the clients I had this year at the university counseling center where I interned. Then I realized that those same campers would look radically different to me in that dyad format.

Since the university is small, I occasionally had the chance to observe my clients interacting with their friends around campus. Occasionally, I was quite surprised to see someone behave quite differently than I expected. Folks I had worked with at the counseling center who were polite and eager-to-please sometimes behaved quite differently with a group of their peers. By the same token, when we counselors have a one-on-one conversation with any of the campers this summer, they almost always come across much more intelligent, kind and aware than they present while in the group.

Though we are taught this in school, it's coming home to me now in a three-dimensional way. As I grow as a counselor, it'll behoove me to bear in mind the settings in which I don't get to see the client. It's often in their day-to-day relationships that folks experience their psychological distress most acutely. If I only see them one-on-one in a quiet room with a professional atmosphere, I need to do a lot of translating while they give accounts of their daily lives.

By the same token, if I only see them working it out within the bump and bustle of group dynamics, I might miss the graceful intelligence or glowing generosity hiding within their quieter heart of hearts.

Now Entering the Swampy Middle-time

I have to admit, for all my high-minded posts lately about how enlightened I want to be in my approach to my campers, who all have Asperger's Syndrome, or something similar (but a few of whom are also just annoying teenagers), I'm not doing very well walking the walk.

I know they might be reaching out for connection through their oppostional behavior, pseudo-violence, and inappropriate or profane language. I know that being a teen is hard, and that being a teen with a disorder that makes you even more "weird" than typical teens feel is even harder. I know that I would be better off "going with the flow," (as I wrote about so elaborately on Sunday) and letting them blow off steam, and come around to us on their own terms.

See? I know a lot of wise things. And I also know that, by the end of the day, it's all I can do to keep myself from yelling my head off at them. They do wear me down.

It's great to remember that various of the less trouble-making kids have taken some wonderful and visible steps forward in just the 10 days since we started. Certain parents have written high praise for we counselors in their responses to our daily notes. And also... tomorrow's another day.

On a more global note, I never cease to be impressed by the difference between knowing all about a disorder intellectually, and actually being in the room day after day with someone who has that disorder. Some of the differences sneak up on me; some have to be pointed out by more experienced counselors, or the clinical director. But when I step back, sometimes I feel the forcefulness of their difference in a tangible way.

I hope I will always feel fascinated and delightfully challenged by such differences.

Is It Asperger's, or is it Boys Being Boys?

I’ve been posting a bit about the lively kids with Asperger's Syndrome that I'm working with this summer. One of the challenges in our group is that there are two kids bent on aggravating the counselors and discovering our limits – and theirs. Cursing, repeatedly introducing inappropriate topics, and wrestling and play-fighting ad infinitum.

There are numerous interesting questions here. First is the issue of whether and how their disorder influences their misbehavior.

Sometimes, it seems clear that they’re just being teenage boys. I’ve read some great literature on the cutting edge of boys’ psychology, and seen some great documentaries. (I highly recommend Michael Thompson’s lively film Raising Cain as a basic primer on the subject.) To sum up only one sub-theme in a crude way, we need to let boys be boys much more than we are (within reason and in thoughtfully considered ways). They are being squashed by the school systems, standardized testing, and increasing gender discrimination. Generally, I agree.

In this light, our boys’ behavior needs to be allowed to the limits of the counselor’s abilities to tolerate it (and as long as everyone is safe and not unduly offended). Our clinical director has suggested this very approach, and she knows these boys from previous years. She feels that if we let them range a bit, they’ll settle down and start focusing on their own. She’s seen it happen with them before. We tried this approach today, and, though it’s too early to tell, there were promising differences.

Then we get to the Asperger’s angle. Features of the disorder include getting stuck talking about one topic over and over (perseverating), inappropriate comments that “typical” people sometimes find shocking, and an inability to conceive of other people’s points of view. My impression is that these problems aren’t at the heart of the misbehavior. At least one of these boys is extremely smart and pretty high-functioning. I think he might even be using the Asperger’s profile as an excuse to repeat behaviors that he knows will annoy people.

However, the clinical director made a good point yesterday. The boys might just be trying to connect with this behavior. This relates to a deeper deficit in Asperger’s people: The inability to make social contact in the ways you and I take for granted. Now we might be getting somewhere.

It’s very possible that the boys are using this behavior in a sort of self-soothing capacity. Aspies usually find everyday human interaction impossibly confusing. But ticking off an adult is a fairly short, predictable process, which they internalize every time we say to them “Stop that!” (It also has the secondary gain of making the kid look cool in others’ eyes.) In other words, the inner equation might read, “I feel edgy -->I can’t take the edge off by talking to someone in a typical way (because I’m an Aspie)-->I curse/hit my friend/get scatological--> authority figure reacts negatively -->this predictable response from my action makes me feel more secure because I am more in control of my environment.” The content of our response might be negative, but that barely registers.

Now, it’s possible many non-Asperger’s kids have the same motivation for their misbehavior. But Aspies have a lot of extra need to control their environment. Through their eyes, it is always, always going haywire on them.

Just some thoughts on Day Three. I'm sure they'll change with seasoning.

Asperger's Teens are Also Just Teens

As many of you know, I'm in the process of earning a masters degree in counseling psychology. Along these lines, my new job involves teaching social skills to young people with Asperger’s Syndrome, via theater work. Before I started, I knew a little bit about the disorder itself, and the people who deal with it. I learned a lot more during training week (and all the reading that led up to it). But nothing can prepare one for the infinite variability of real people.

My students are all teenagers, from 15 to 18. I’ve lived with them only five hours a day for a mere two days (and a bunch of talking and writing about them before and after each day, as part of the job). What has struck me more than anything is the same thing that stood out when I started my internship at a college counseling center this past school year: People are people. With disorders, without disorders, these kids are basically typical teens. They are warm, smart, funny and talented. And they are exasperating, underachieving and worrisome. Sometimes all in the same kid. Sometimes all at once.

It’s been very poignant to watch them quickly divvy up into cliques. Each kid is falling into patterned teenage behavior that serves the purpose of identifying them to the larger crew: “I’m a cool kid. You can’t touch me.” Or, “I’m hilarious and over-the-top; I’ll do anything goofy to get your attention.” Or, “I’m mature. I don’t notice the offensive things you do, so don't expect me to join in.”

The particularly difficult thing is to watch the “cool” kids. First of all, they are, of course, anything but. Moreover, though, every once in a while, a little fissure appears in their veneer, and what peeks through is an eager little kid (much littler than the age they are trying to act) who just wants to play. One of our projects in our brief time with them (the summer session lasts only six weeks) will be to see if we can help those young people to let out their inner kid, before society gets them to squash it for good.

That’s a pretty good description of how I want to approach them. I’ve already slipped into a more parental, finger-shaking mode, and I know very well that will just put us on opposite sides of a six-week war, with no winners. We don’t want to represent “society” to them. We want to help them at least take another step in learning who they are, and bringing that wealth to each interaction out in the world.

More thoughts on this anon.