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Play therapy is just floortime with a specific purpose to work on an emotional issue. In the following example (published here with permission from both the parent and the child), the child is on the withdrawn, compliant side, so it was fortunate that the parent was attuned enough to the child to realize there might have been an issue that needed discussing that had occurred the night before.

This child communicates via typing on his ipad, so the interaction was captured in its entirety.

Sam and his mom had this conversation/play therapy this morning. The previous evening, they didn’t get to Sam’s ILS therapy (listening to altered classical music through headphones to help desensitize a child with sound hypersensitivity; motor exercises are done concurrently to work on sensory integration) until later in the evening. He took a bathroom break, and when they returned to the family room, Dad had turned on the TV. Mom tried to woo Sam into continuing the ILS, but that was not realistic, so she finally said, “I’m not going to waste my time, I’m going to take a shower.” She then set up a bath for Sam, and settled to watch TV. When he finished and came back into the family room, Mom invited him to come watch Frozen with the family, but he said, “Bed!,” pointed to his room, and put himself to bed.

Mom: How come you didn’t watch the new movie with us last night? Frozen was good.
Sam: i was in(side) sad
Mom: Why were you sad?
Sam: because you got mad
Mom: I’m sorry, Sam. I was just frustrated because I didn’t want to fall behind on your ILS schedule, but you got tired and didn’t want to finish the exercises. But I do understand. A person can’t work all the time. So I was hoping you would enjoy the movie with us.
Sam: ok. i hoope you kind(er) next time.
Mom: I deserve that admonishment. I should have gone after you when you went to bed to give you a chance to talk about your point of view about the ILS exercises, and to explain that I really wanted you to enjoy the movie with us.
Sam: ok.
Mom: Were your feelings hurt when I said I didn’t want to waste my time?
Sam: yes.
Mom: I’m very sorry. I could see that you really didn’t want to finish those exercises, and knew it was no use to keep trying to persuade you. That’s what I meant about wasting time. I never feel it’s a waste of time to be with you.
Sam: yes i understnd it was a miscommunication, so youdidn’t mean you very mad
Mom: Let’s do a re-do, ok? I’ll be the wolf, and you be Pooh, Ok?
Sam: ok

(Mom handed Sam a Winnie-the-Pooh stuffed bear, and she put on a wolf puppet.)
Wolf: Pooh, let’s finish your exercises. Let’s roll the ball 20 times.
Pooh: no i’m tired.
Wolf: What about our ILS today?
Pooh: i had enough. stop hurting me.
Wolf: What hurts?
Pooh: i don’t want to listen anymore. it hurts my ears.
Wolf: I’m so sorry. Is it too loud? or is it this particular piece of music? or are you just tired and would rather do it tomorrow?
Pooh: tired.
Wolf: So what do you want to do?
Pooh: let’s stop for now.
Wolf: It must be hard to have to practice listening to uncomfortable sound, even music.
Pooh: yes. it’s not too much trouble if i feel happy,but i’m too tired nnow.
Wolf: I’m so glad you told me. Please keep letting me know, so we can make this work out for you, ok?
Pooh: ok
Wolf: Do I push too hard a lot?
Pooh: i don’t think so.
Wolf: That’s a relief. I wouldn’t want to do that. I want you to learn, but at the pace that feels best for you. Will you tell me when I need to slow down or you need a break?
Pooh: yes i will by tyyyping
Wolf: Would you like to watch Frozen with us?
Pooh: yes
Wolf: That’s great! We really missed you last time. How about tonight?
Pooh: i feel like sausage now
Wolf: Ok, coming right up!

The conversation that preceded the play had already cleared the air in theory, but the symbolic play cleared it in practice. Being able to speak through his stuffed animal freed this gentle and sensitive child to be assertive and actually have the satisfaction of telling “Mom” outright to “stop hurting me,” without having to worry about hurting her feelings. The child got to be in charge of what to do next (“Let’s stop for now”) instead of Mom.

Children often offer more when they feel they are the ones taking the initiative. Sam offered more information about the music “hurting his ears” that Mom had not unearthed in direct conversation. Therefore she was able to express sympathy and understanding about how hard and uncomfortable the ILS was for her son, and probe deeper into the more general issue of how hard she was pushing her son overall. Sam even came up with the seminal plan for how to solve the ILS problem for good by offering the information that it’s only a problem for him when he’s tired, but “it’s not too much trouble if… happy.” Initiative begets more initiative, and Sam ends the conversation by telling Mrs. Wolf that he’s really more interested in breakfast right now than watching a movie with the family.

The mother told me that events later that day confirmed the value of the play therapy. When Sam’s big brother asked him why he didn’t watch the movie with them the previous night, Sam, already emboldened by the earlier encouragement to express his true feelings even negative feelings, went a step further. He replied, “Because I was mad.” (Note now he admits he was mad, as opposed to just sad, and as opposed to Mom being mad.) When asked why, he revealed another as yet undisclosed piece of information, “because I didn’t want ILS and mom said no carride.” He actually said this in front of Mom as she was helping him with his typing. That gave Mom the opportunity to say, “I’m sorry, that was unfair. I should have given you a chance to type before handing down a demand, and you could have told me the ILS was hurting your ears because you were tired.” Shortly afterwards at dinner grace when all the children were giving thanks, Sam’s prayer was to thank God that “I and mom made up.” Later that evening, even though he was getting tired, Sam finished up the last 20 minutes of his ILS session, not in a spirit of anger, but cooperation and perseverance because he also wanted his noise sensitivity to get better.

Don’t feel that play therapy needs to be as direct a re-do as this illustration. Most of the time, therapists set up play scenarios that are much less specific. They observe the child for his favorite toys and stories, and then set up a play scenario using them to introduce a theme of nurturing, aggression, control, or whatever is immediately emotionally relevant to the child. The key element is freedom- to give the child an opportunity to freely express his emotions and act on them in a completely safe environment in which he is encouraged to do so and in which he is handed the control of the action in the play scenario. This gives the child an opportunity to retell his own emotional story obliquely and in as much part as he wishes. Dr. Dan Siegel, author of the outstanding book “The Whole Brain Child,” would probably say that helps the child process his right brain emotional memories with his logical left brain, and bring implicit memories into consciousness so that they don’t have to be acted out later in real life as inexplicably explosive reactions to triggering events that are similar in emotional content.

The recent Profectum conference in Pasadena highlighted the enormous value of symbolic play in both effectively addressing emotional issues and moving development forward. In this illustration, Sam learned how to express his negative feelings in words, came up with the beginnings of a logical solution, and learned how to negotiate and effectively resolve conflict. What a better way to handle anger than allow it to get bottled up inside. As parents of kids with autism, we’ve all seen the self-injury and aggression that can result from anger. We have to give our kids another channel. Make symbolic play a regular part of your interactions with your child, and it will bring you closer, give you a more peaceful home, and most importantly empower your child to not only deal with negative emotions and learn to express it a regulated, organized way, but push his cognitive and emotional development forward.

from fit.webmd.com "Old MacDonald Had a Farm"

from fit.webmd.com “Old MacDonald Had a Farm”

I wish to thank two outstanding child psychologists, Dr. Mona Delahooke and Dr. Connie Lillas, for their inspiring presentations on play therapy at the Profectum conference. Both of them practice locally in the Pasadena and Los Angeles areas.

Time for Peter’s triennial IEP. For those of you with children with autism, you know that means lots of testing. (For those who don’t, the IEP stands for “individualized educational program,” and every three years, the school does comprehensive testing to help direct the construction of the child’s curriculum to match his/her level and capabilities).

It was the end of a two hour testing session. Peter and Belinda, his typing aide and beloved tutor, sat across from the psychologist.
“Peter, I’m going to tell you a story, then have you retell it.”
(The following story has been modified to protect the test.)
The psychologist typed: “An ant wanted to cross a stream, but the water was running fast. The ant was scared. So the ant hopped aboard a duck, and rode on its back across the stream.”
Peter read the story. Then the psychologist put the story away.
Peter started humming and flapping. He typed, “I need car ride please.”
The psychologist said, “We’ll be done soon. Let’s talk about that car ride after you finish this last story. It begins like this, (and she typed) ‘An ant wanted to cross a stream…’”
Belinda put her hand on the back of Peter’s right shoulder, as her usual sign of support, and Peter commenced typing, “But the water was scary so…”
Peter started humming louder and looked around wildly. Belinda let go of his shoulder, wanting to relieve the pressure of working, thinking Peter needed a break.
Peter lunged toward the keyboard, “hevgot a car ride.”
“Just a moment, Peter, it’s okay. Just see what you wrote,” said Belinda as she placed her hand back upon his shoulder.
“no. duck ride,” typed Peter, as he self-corrected.

Looking on as an observer, I found this episode fascinating. Clearly, Peter understood what he read, and could retell it. But more interesting than the test result itself is how he did the test. The interaction between Belinda and Peter said a lot about the importance of relationship. During other parts of the test, when Belinda would remove her hand upon Peter’s shoulder, Peter would simply stop typing. He would flap and hum and look dysregulated until she gave him that encouraging look and place her hand upon his shoulder, as if to say, “I’m with you, I will hold onto you, we’re in this together.” As a whole separate reality going on apart from the testing, the looks and smiles they gave one another were a beautiful thing to behold.

When Peter was getting tired and hungry at the end of the test, that relationship was crucial for Peter to hold himself together to make that last big effort to concentrate on higher level cognitive function. When Belinda released her hand, it was as if Peter’s basal ganglia released the gate to automatic thinking, and what came out was what Peter types for the most, “car ride,” his favorite regulating activity. When Belinda came back into the picture, restoring the support of the relationship, tangibly with her hand upon his shoulder, Peter was able to switch back on his higher cognitive pathways, self-corrected, and finished the test.

What this episode so clearly illustrated for me was the profound truth of a fundamental floortime/DIR principle- the critical importance of the relationship. Our children face such overwhelming challenges and obstacles. Peter was hungry and tired. Trying to complete that test required huge efforts to overcome his bodily sensations, maintain attention, tax a short working memory, overcome dyspraxia in order to type, and use language, which is always difficult. Watching that scene, I felt as if Peter was flying a plane, and his relationship with Belinda, her love and support, was his gas. No Belinda, and the engine cut out. Truly, relationship and affect are the glue that holds a child together and through an interaction or task, the fuel that powers development forward and makes it possible.

from Daily Motivation Quote.com

from Daily Motivation Quote.com

“Neither defiance nor denial is of the least use here: one takes arms by learning how to negotiate or navigate a sea of troubles, by becoming a mariner in the seas of one’s self.” Oliver Sacks, 1990

 Peter was struggling this weekend. Couldn’t be left alone a second or would tear something up. Took out the sole of his shoe and ripped it into pieces in the time it took me to get to the kitchen  and back. Repetitively rifling through his basket of scrap paper he was allowed to tear. One of those days Peter was definitely uncomfortable living in his body. So we had to get out. “Carride, airplane!” Peter said over and over. We set out looking for any kind of change, doing something or being somewhere Peter could find calm in the storm.

Papa drove us to Descanso Gardens. Peter immediately started hunting for sticks, one after another, each of which he peeled and broke into bits. I asked for a map at the entrance (Peter likes maps, and they’re organizing), and struck a deal. “Ok, Peter, let’s try to get a grip on this tearing things up compulsion. Let’s exercise that frontal lobe inhibition and get you back in control.” “Okay, okay,” said Peter, still furiously dissecting a foot long branch he picked up at the entrance. “So here’s the map. You pick 5 places to go, and we’ll trace our way to each place on the map and then find a bench there. Make a comment on the scenery, earn a stick. No sticks in between. Sound like you can do it?” “Okay, okay.”

I stuck my finger at the entrance where we were, and Peter decided where to go. Getting to the first bench stop was the hardest. Peter was dying to pick up a stick, so we made the first distance very short. “Hold on Peter! First the comments.” I closed my eyes. “I feel a soft breeze.” Papa said, “I see the tall sycamores.” Peter typed, “I hear the water.” Then he made a dash for a stick. But gradually, as we made our way, progressing from bench stop to bench stop, the peaceful garden worked its quieting peace upon Peter.  The rests became longer, the drive for the sticks less immediate. Peter’s comments grew more elaborate. I ran a soft fern over one hand and had him feel the rough bench with the other. “I feel a soft fern and a hard bench.” “I see a big pile of rocks stacked.” Then wow! “I see a green wall of branches.” Peter was waxing poetic!

By the time we finished our last comment, the restless drive of that lower brain had been tamed by exercise of the body and mind in contemplation of the beauty of the garden. It’s loveliness and serenity for a time cast a spell over the mental monsters that plague Peter. This time the monsters had not won. Peter had ridden the storm of his tearing compulsion by confining it to a small place in a larger schedule, purposefully replacing it with other thoughts, turning his attention to the beauty surrounding him. For now the wave had passed, and we all felt refreshed and renewed, with hope in the power of mindful contemplation.

I exchanged glances with my tempest-tossed son, now at peace. “So who’s in control now, Peter or OCD?” “Peter,” he said with a smile. “All right, buddy! Give me that high five. You’re getting stronger, and the OCD’s getting weaker. And the doctor promised the more we practice, the easier it’ll get.”*

descansogardens.org

descansogardens.org

* So how does one work on OCD? What did the doctor mean by practicing?  Basically she meant the more Peter resists carrying out his compulsions until the obsessions pass, the more he experiences success in “riding the wave,” the more he’ll realize he does NOT have to obey the obsessions. It’s best to work on this in conjunction with  a formal exposure/response prevention program, in which you practice regularly under more controlled, less intense conditions.

You and your child need to first be able to identify the enemy, to recognize that it’s the OCD, not the child himself, who is the problem. OCD is a problem the child has, but can choose to work on and diminish to manageable proportions.

You explain how OCD is a brain miswire that makes you feel anxious unless you do something that doesn’t make sense or may be actually harmful. The child has to understand that the way to make the OCD weaker and for him to regain control, he needs to resist doing the compulsion (the dysfunctional behavior that the OCD is telling him he must do), and the need/desire to do it will diminish and eventually pass like an ocean wave that comes and goes.

It’s very hard to resist initially, but with each time you do, it gets easier and easier. With really strong OCD’s, you can’t just tell yourself “no.” Sometimes the best you can do is just somehow modify it, by engaging in it a shorter amount of time or repetitions (set the timer and tear up sticks for just 1 minute instead of 5), delaying when you allow yourself to do it (do the dishes before you get to grab a stick, or walk a block first), or changing up the way you carry it out (play a clicking sticks together pattern together with the parent before you get to tear it up). Peter’s favorite strategy is to “trick” the OCD by creating a whole schedule of things he has to do before he gets to do the compulsion, and by then often the need to do it has passed, and he doesn’t ever have to obey it at all.

Then you and your child make a list of OCD’s and start working on one at a time, usually starting with the less intense ones so the child experiences success which encourages him to keep moving up the list. But it’s most important for the child to have a lot of input into what he chooses to work on, and what’s most meaningful to him. This is critical for two reasons. One obviously is motivation. But the other is that we parents can have a hard time distinguishing between dysfunctional obsessional perseverative behavior and perseverative behaviors that may be serving as useful sensory accommodations for your child. For example, flapping and tapping may be a child’s way of figuring out where he is in space, and unilaterally insisting that  a child stop it may leave him with overwhelming feelings of disorientation which could make meltdowns inevitable.

Say your child chooses to work on a compulsion to tear off branches from bushes he passes. You might decide to start with setting the timer for 5 minutes he has to wait before tearing off a branch while gardening outside and pulling weeds or harvesting vegetables (and/or doing deep breathing exercises) instead. (It often helps to initially pick a substitute activity that physically exercises the body and/or one that keeps the hands busy such that doing the activity is incompatible with doing the compulsion. Eventually you want to work on helping your child learn to become aware of other interests and ideas he may have, and help him learn how to turn his attention to a different one of his choice. That is working on building what’s called “mindfulness.”) You gradually increase the timer till the child loses that crazed urge everytime he steps outside. You and your child agree to work as a team to strengthen his control over his OCD by deliberate practice, with you there to help keep him regulated with your calm redirection.

Your child works on his pre-planned “OCD homework” every day, working up to say up to 1/2 an hour twice a day (see John March’s excellent manual for parents and kids called, “Talking Back to OCD”), strengthening those frontal lobe inhibitions and basal ganglion “stop!” signal, while diminishing those OCD circuits by decreasing their use. Setbacks are normal and expected, so don’t let them upset you. You and your child can expect that if he gets up again, doesn’t give up and keeps trying, with consistent practice he will get gradually and eventually get more and more in control, and the OCD less. It’s important to realize that OCD is a condition one has, like diabetes, that seldom completely goes away, but can be managed successfully with consistent vigilance and habitual effort, such that a  functional, fulfilling life is possible. It’s just necessary  to make and take the time to deal with it.

For the most part, since Peter learned to type, life has been incredibly exciting. It has been an astonishing wonder to appreciate the beauty and depth of an inner person whom you have only seen from the outside before. It’s like discovering a geode- plain rock on the outside, beautiful, colorful crystal on the inside.

rmahmoud@ucsd.edu

rmahmoud@ucsd.edu

However, sometimes I still pull my hair out. For example, this is what the outside of this geode looked like yesterday when we went up to Mountain High to ski for the day.

Very patient at first doing long controlled curves and detailed work on learning the footwork on how to advance from wedge kristies to parallel skiing, but suddenly tired of it and took off down the hill at a million miles per hour, straight down the hill. No curves at all. First time, I took it in good humor, telling him, “Guess you deserved some fun after all that hard work. But … (explanation about safety, etc.).” But by the third time, I was done for, a panicked maniac screaming, “Left! Turn left!” as my crazy teen shot down the mountain, leaving me far behind in the dust. Then there was that tactic of claiming needing a bathroom break, although we had just had one, involving taking all the skis off, trudging to the bathroom in heavy boots, etc. only to find one did not really need to go. Then there was the real bathroom break in which a certain person undressed completely waist down, finished first, and took the initiative to find mom and rattle the door of her stall to get her help getting re-dressed, all in the ladies’ room. At the end of our last run, as I was kneeling in the snow, getting the skis trussed up in a carrier, I noticed out of the corner of my eye that Peter was excited to have taken his ski boots off and was preparing to jump up and down on the icy ground in his socks. At least I learned he knows how to get all those complicated ski boot buckles and velcro undone, all by himself.

In other words, emerging self generated ideas and the initiative to put them into action (Greenspan Functional Emotional Development Level 4) looks a lot like incredibly irritating  impulsivity, especially in a late bloomer who’s more capable of greater and bigger ideas and actions. I was so frustrated, I came home exhausted and discouraged, thinking what is the point of my kid having wonderful thoughts when his actions are still those of a 2 year old? When I got home, I put down my heavy armful of ski equipment, and fell on my knees. And the Lord convicted me of my narrow vision.

I should be celebrating, same as I would if a toddler was showing those milestones of initiative. But just like we tear our hair out sometimes with our “willful” toddlers, I can expect this phase to be hard work too. It’s not willful, it’s hopefully not permanent impulsivity. Like dealing with toddlers, it will take patient hard work to teach. Peter needs to learn and master the all important “Stop! Think! then Act” sequence. So we need to practice the talk/think through’s (see Noel Janis-Norton’s work at http://www.calmerparenting.com), teach thinking and planning ahead, all the steps involved in a project, and finishing what we begin. Creating and reinforcing those inhibitory and executive function frontal lobe connections and memory associations that make drawing from past experience and looking to the future more automatic.

I got off my knees and went to look for Peter, only to find a big pile of clothes where he had taken the initiative to get out of his ski clothes himself, and dump out a drawer of pants looking for something more comfortable to wear. I automatically refolded the clothes and put them neatly in the drawer, then thought about it. I went back, took the clothes back out, and went to get Peter to work through the cleaning up process, step by step, together.

art by Klara Viskova

art by Klara Viskova

Here’s our conversation that followed later that evening:

(I’m in upper case, Peter’s typing in lower case.)

SO HOW WAS YOUR DAY?

I had a nice ride. i mean skiing. i love skiing.

WHAT’S YOUR FAVORITE PART?

when in the ski lift you feel like you go home.
DO YOU MEAN YOU HAVE THE SAME HAPPY FEELING AS IF YOU WERE GOING HOME?
no i mean going to herrven. heaven.
WOW, THAT’S POETIC.
WHEN WE STARTED YOU WERE DOING WEDGE KRISTIES, MEANING YOUR SKIS WERE IN PARALLEL WHEN TRAVERSING THE HILL, BUT WENT INTO WEDGE WHEN TURNING.
yes, its hard to not go into wedge.
IS IT AUTOMATIC?
yes.
I COMPLETELY UNDERSTAND. I ALSO HAVE THE HABIT OF GOING INTO WEDGE WHEN MY SKIS POINT DOWNHILL BECAUSE I CAN FEEL MYSELF GOING FASTER. IS THAT HOW YOU FEEL?
yes i want to control my speed.
EXACTLY HOW I FEEL. DO YOU KNOW WHAT TO DO INSTEAD OF WEDGE TO CONTROL YOUR SPEED?
i should rotary then edge then go bend my knees.
PETER, YOU REALLY GOT IT. THAT IS EXACTLY CORRECT. YOU BEND YOUR KNEES AS YOU EDGE INTO THE MOUNTAIN, MEANING PUT YOUR WEIGHT ON THE UPHILL EDGES.
yes but i forget.
ME TOO. WE JUST NEED TO PRACTICE MORE, OK?
good.
I CAN’T SEE MYSELF SKIING OF COURSE. I WOULD LIKE TO KNOW HOW I LOOK WHEN I SKI.
you sKi good.
THANKS, PETER. AM I STILL WEDGING WHEN BEGINNING A TURN?
lt look kind of nice.
THANKS, DEAR, THAT’S VERY ENCOURAGING.
HEY PETER, I WANT TO ASK HOW YOU FELT ABOUT MY TEACHING TODAY.
you are boopylopoping.
WHAT? DID YOU FEEL LIKE I WAS BULLYING YOU, LIKE BEING TOO DEMANDING? OR DID YOU LIKE BEING CHALLENGED TO CORRECT YOUR WEDGE HABIT?
Both kind of.
I DO THINK I GET OVERLY EXCITED. I’M SORRY.
it’s ok, i know you know i can do it more corre ctly.
THAT IS TRUE. I AM VERY IMPRESSED WITH YOUR ABILITY TO LEARN. SKIING IS HARD, YET YOU ARE REALLY GETTING IT.
i like to learn

YES, I KNOW. YOU’RE A GREAT LEARNER.

 

And, I should add, a great teacher. Peter’s comment, “it’s ok, i know you know i can do it more corre ctly,” exemplifies looking at something from the other person’s perspective, seeing the positive, and thereby understanding and forgiving. Exactly the opposite of what I had done with the same experience. You can learn a lot from the inside of a geode.

 

 

Fractured Fairytales

How does one do floortime with a teenager? Try a fractured fairytale. That’s a spoof of a classic fairytale that you can create together.

I was trying to get Peter to get up this morning.

We had read the story about Jack in the Beanstalk five days ago.

(Peter didn’t like the story. When I asked him how he liked it, he typed he didn’t like it because “everything Jack did was hard.” When I asked what he meant by “hard”, he typed, “heartless.”)

Anyway, we started out with a game I had been doing with a peer at Teen Buddies, feeding a puppet wolf some toy sausage and eggs. Peter obligingly fed the wolf, and I talked about how Peter’s sausage was hot and ready to eat, but that didn’t work. Peter stayed planted in his cozy bed.

So then I brought Charmander over. “Fee, fie, fo, fum, I smell the blood of an Englishman. Or could it be a Chinese boy?”

Peter ducked under his covers.

Charmander sat by Peter’s side. Mrs. Wolf rushed in, carrying a pan of toy sausage and eggs.

“No, no, no Charmander! You are not smelling a Chinese boy, you are smelling this delicious sausage and eggs I just made for you!”

Peter’s hand obligingly popped out of the covers and fed Charmander the sausage and eggs.

Charmander leaned back and said, “My, my, my! That makes me sleepy! But before I take a nap, bring me my goose that lays the golden eggs!”

As we do not own a stuffed animal goose, Mrs. Wolf came back with Toucan who sat on a pillow.

“Uh, uh!” grunted Toucan. I’m trying to lay something, but I need some food!”

Peter’s hand popped out again and fed the Toucan the same breakfast.

Toucan sighed in contentment, jumped up, and pop! out upon the pillow appeared Peter’s noise cancellation headphones!

Charmander said, “Ah, how nice! But I feel so very sleepy… zzzzz!” and started snoring.

Peter grabbed the headphones

“Quick, now’s your chance to make a run for it, before Charmander wakes up!” cried Mrs. Wolf.

“One minute!” said Peter, and turned over in bed.

But he did get up after that minute, and all on his own.

Later that morning, we had the following conversation:

Mom: Did you recognize the story we adapted this morning?

Peter: Yes, it was Jack and the beanstog.

Mom: Who was the goose that lays the golden eggs?

Peter: Toucan

Mom: Who was Jack?

Peter: (verbally “me” as he typed:) Peter

Mom: What was the golden egg?

Peter: my headphones

Mom (trying to trick him): Wasn’t the wolf a good giant?

Peter: no. the wolf was not the giant. it was Charmander.

Mom: Guess I can’t fool you! Did you like our little drama?

Peter: Yes.

Have you ever seen the wonderful film, “Awakenings” with Robin Williams? It’s a dramatization of the experience of a doctor working with patients who had catatonia. He got them to move by providing all kinds of visual and behavioral supports. In one line, a nurse comments how she feels the patient who will only ambulate with her is “borrowing her energy.” That really resounds with my own experience with Peter. He knows how to type, but will only type with specific people.

Here’s a conversation we had the other day, talking about a recent Christmas party.

Mom: Did you like talking with our friends the McNicolls through typing?

Peter: Yes

Mom: But I heard from Mr. McNicoll that you stopped typing soon after I left. Why?

Peter: Because it’s hard to type when you aren’t there.

Mom: I’m trying to understand what I am doing that helps you type. Is it that sometimes I can guess what you want to say and give choices?

Peter: no, it’s that you believe in me.

Today we bumped into an old friend I had not seen for a long time at the YMCA. Nina has always been full of love and warmth- she’s a real angel of positive energy. When I called her name, “Nina?”, she immediately looked up and ran towards us with gentle hugs for us both and genuine affection. Peter started to glow. He looked up and smiled at her. When I introduced him, he typed on my iPhone, “I ann pleased to meat you.” When she replied how happy she was to meet him as well, he spontaneously reached over to type, continuing the conversation with a completely appropriate question, “How was your Christmad?” Nina described her frosty visit to New York, then asked Peter how his Christmas was. Peter replied, “It was great. We saw a boat parade, Ocean Newport.” This whole time, he kept glancing up at her shyly with a little smile.

I was completely floored. It’s as if your child just suddenly skipped several grades in a moment. Though we have good conversations in quiet settings, one on one, Peter had always required lots of prompting to make even rote social interchanges on the fly. He looks away, rarely into a stranger’s eyes. Yet here he was, standing in the crowded, bustling atrium of the YMCA, engaging in small talk like the most fluent of social butterflies! Not having known Peter from the past, Nina flitted away to exercise, oblivious of the miracle that she had just enabled.

In “My Stroke of Insight,” brain scientist Jill Bolte Taylor describes how attuned she was at the time of her stroke to the kind of energy various people would bring into a room. When a loving, kind nurse would enter, take her hands, and talk to her gently, she responded with hope and engagement. When a brusque doctor would walk in and talk about her as if she wasn’t there, she felt disconnected and lost. Even for those of us with our whole brains available to filter and process our perceptions, we function far better in the presence of encouragement and acceptance. But for stuggling brains, positive energy is absolutely crucial. It is not a nebulous, superfluous though pleasant accoutrement. It is a tangible, critical support without which function is not possible.

Peter had a dental appointment today at Children’s Hospital dental clinic. He was assigned a new doctor, a young, lovely Dr. Annie. As soon as she stepped into the room, you could feel her warmth and kindness. We were doing breathing exercises with Peter, who was desperately anxious and in definite flight mode. She quietly observed as we had Peter sit down in five second increasing increments between deep breaths, accommodating his need to sit in an ordinary chair, and timed it perfectly to insert herself before him and deftly examine his teeth in the 30 seconds we eventually worked him up to. She was quiet and quick, and gave not a hint of impatience. If she had tried to take over, take control, direct the situation, Peter would have flown. In floortime we have a saying, “Don’t just do something, stand there!” Truly, what made that visit successful was her quiet patience as she observed and attuned to her fearful patient’s needs, acting with precise timing, no more and no less than what was required, and providing critical support with her constant positive energy and kindness.

Today I was at Teen Buddies. Our small group was trying to slog through a boring board game. You could see the eyes drifting to the door. I suggested a different game I’d read about in Dan Siegel’s book “The Whole Brain Child” in which each participant relates three things that presumably happened that day, the challenge being for the others to guess which of the two are true, and one is fabricated. It took some warming up, but the teens soon caught on to it, delighting themselves with the cleverness of the made up happenings they could come up with. It was truly a joy to see that gleam in each of their eyes, especially how proud one of them was who is usually trumped by the creativity of the others, but came up with “traveling to Lala Land” and “winning a million dollars at Patagonia Casino,” which we all agreed were brilliant fabrications. The kids didn’t need a director or teacher, they just needed someone to get them started, heartily appreciate their jokes, and cheer them on.

Dr. Taylor makes the point that a provider must be cognizant of the energy he/she brings into a patient’s room. It’s a big responsibility. Truly, we humans are both body and spirit. Love is as essential as food and water. Just who you are and the genuine caring you bring are as important and empowering as what you do. And sometimes you can do much more by not just doing something, but standing there with the love and encouragement that light a fire.

illustration by Marianne Richmond (front cover of her book)

illustration by Marianne Richmond (front cover of her book)

farmhouse-window-devonshire-3Typing has become Peter’s voice, providing a precious window into his thinking. What he types has confirmed what we suspected all along, that inside that faulty operating motor system is a truly gentle, beautiful little soul, doing his very best. Peter has given us so many insights into what it’s like to have autism. “I wish everything wasn’t so difficult.” “very hard. very anxious. i cant get my body to move” “(tearing) paper consumes all of my attention.” “I am sorry I hit. You must be mad. I can’t control it.” When we asked him if it’s hard to have to work so hard all the time in order to quiet the noise in his brain, he replied, “yes. yes more than you know.” Regarding typing itself, Peter typed, “typing is hard but under my conditions it does allow conversation” and ” type(ing) determined the new direction of my life.” Peter has advised us to “try to give me time to say the rest of my thought.” He empathetically added, “very hard helping but not controlling.”

Besides displaying all of this astonishing perspective taking and reflective thinking, we have discovered that Peter has sized us all up. “i do like to play around especially with mom she is so nice and kind so it is kind of funny to see her mad.” When asked if he ever tries to push Belinda’s buttons, he typed,  “i dont as much because belinda does not get mad ever. she is calm saint like really.”

Indeed, as Vinh put it, we now know we have a philosopher in the family. “I want to be a person that shows the beauty that God created.” “I really want knowledge.” When asked what helps him when he feels he needs to hit, he typed, “Only giving love.” When he witnessed a peer having a meltdown, we asked him what we could do to help, and he said, “understand.”

Peter also has a theological bent. When we play-acted the story of the presentation of Eve to Adam, Peter typed for Adam to Eve, “Let’s get married. You are perfect.” When asked to describe the men Jesus chose as disciples, he said, “They were full of flaws.” Then when I asked, “Then how did they become great saints?”, Peter replied, “They grew with Jesus’ love.” I asked Peter, “How do you think Jesus feels about my getting mad or your tearing important papers?” He typed, “He forgives us and still uses us. he will help us… become the disciples he wants us to become.” “What do you think Jesus wants us to do as his disciples?” “he wants us to love people.” When one of his teachers was being overly politically correct for his straightforward teen tastes, asking, “So what do you know about God that can help you in your life?” Peter replied, “hint.heloves you.”

I am deeply humbled. How we think we know our children, yet know so little. As his typing mentor Darlene Hanson once said, “Peter, I bet it’s easy for you to learn, just hard to show us what you know.” Peter emphatically agreed.

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