Executive function skills (EFS) encompass a broad array of important managerial capacities. EFS originate in the prefrontal cortex, which directs and orchestrates the rest of the brain to get something done. They include paying attention, selecting, focusing, initiating, inhibiting, shifting, monitoring, modulating, correcting, pacing, sequencing, anticipating, evaluating, prioritizing, organizing, and planning.

To encourage the development of planning skills, teach your child to make choices and set up his own visual schedule. For example, if he has several homework assignments, let him decide on the order he does his worksheets, and within reason, where to put in breaks, and what to do for his breaks.

You can even start smaller, in a more limited field. Say your child loves to stim by tapping a stick. Within one worksheet assignment, consider letting him decide where to put in short tapping breaks, so that if he has ten math problems to do, he might plan a break after the third and sixth problem. That way he will be more likely to persevere in working without stimming till each of his breaks. He also gets to practice how to plan, initiate, focus, and inhibit, while harnessing the self-motivating power of having more control.

If it was hard slogging getting through those ten problems with only two breaks, help him learn how to evaluate his own planning. “How did that go? Ah, so you could get through three problems without a break okay, but getting through four was very hard?” Give him the opportunity to learn how to modulate his plans. “What do you think you could do about that for the next set? Have a tapping break after every third problem? Sounds like you know what you need- great self-awareness!”[1]

Make planning ahead (anticipating) and putting away (organizing) part of the whole process of doing tasks or assignments. “What will you need for school tomorrow in your backpack?” Work in the practice sequencing. “Let’s go through your day tomorrow. What will you need for math? (workbook and pencil box) Reading time? (storybook) Recess? (snack)”

Teach your child to organize as he goes, instead of letting things accumulate. “Great that you finished that whole worksheet! So where does it go?” “Let’s see the work you brought home. Do you think you’ll need those papers in class again? What should we do with them? Where does this go?” Many parents color code their child’s bookcovers and notebooks, one color per subject. They place a box or shelf by the front door for things the child will need to take to school the next day, so there’s less to gather up at the last minute. The child is given a specific quiet place to do homework, with a drawer for supplies and a shelf for books, and is taught to create a place for everything, and to put everything back in its place.

Teach your child how to make a checklist of tasks and then rearrange the order so he learns how to prioritize. Have him check off boxes or put his word/icon labels of each activity in an “All done” envelope so he learns to monitor his own work completion. That’s the beginning of self monitoring skills. Organize his work in consecutive drawers or file folders so the environmental set up suggests and reminds him of the next step. Let him experience shifting his attention as he moves from drawer to drawer on his own. Once he finds the exercise easy, add some spice to the game with a timer and reward so he gets to practice how to pace himself. You can make use of such a set up to create an independent work station containing several file folders of maintenance activities, meaning activities that practice mastered concepts that you want him to retain (Chapter Seven), which you can rotate and vary. That may be your child’s first step toward learning how to study on his own.

Create worksheet exercises in which the goal is to find and correct mistakes you include intentionally, so your child learns how to check his work. Once he gets good at this, next time he looks at you inquiringly to see if he did his math problem correctly, direct him to think of correcting it himself saying, “It’s great that you want to know if you got the answer right. I know someone who’s really good at checking and correcting.”

Help your child practice using all these EFS with all the support he needs. If you feel overwhelmed, write down specific EFS goals the same way you set academic goals, and work on mastering a few at a time. (See sample at end of this subsection.)

Teach EFS the same way you teach everything else. Gradually reduce your scaffolding as the child becomes more able. Once your child can perform these EFS with minimal prompting, continue to give short, direct cues throughout the day on when to exercise them. “Look over here. I have something important to show you.” (learning readiness) “Pay attention, your teacher said this will be on the test.” (learning readiness) “Don’t start eating until everyone sits down.” (inhibition) “Timer rings in five minutes. Put your things away.” (pacing, anticipating, organization) “Put it back where it belongs.”(organization) “You’ll need to work quickly, as there’s not much time left.” (pacing) “Remember the order of the steps. What’s next?” (sequencing) “Does yours look like the model?” (monitoring, checking) “What’s the order you need to do things to get this task done?” (planning) and “Which of the tasks is most important?” (prioritizing)

Once the child gets used to performing EFS throughout the day on cue, make the cues subtler. Come up with single word substitutes or better yet gestures or hand signals. Then bridge each skill by making the cues more indirect like, “This will be on the test. What should you be doing?” (Looking at what you are pointing at, paying attention). “We need to be polite and start at the same time, so what should you be doing?” (Waiting till everyone sits down at the dinner table before eating.) “The timer rings in five minutes. What do you need to do?” “Where should you put that?” (Back to its usual place.) “We have ten minutes left. What can you do to help you track the time?” (Set timer.) “Oops, are we forgetting something?” (Say if you’ve paused expectantly, and the child skipped the next step in a sequence.) “What could you do to see if you did it correctly?” (Check your work against the model). “That’s a lot of assignments. What’s the best way to go about it?” (Prioritize in order, schedule.)

A good rule of thumb is to use the Socratic Method. Whenever possible ask, don’t tell. If the child is talking too loudly in the library, instead of saying “Use your indoor voice,” try “Look at all the people studying. Do you study better when it’s loud or quiet?” Use every success and failure to help your child understand the purpose of working on executive function skills, so that they become goals for the child, not just yours. “Wow! I’m so glad you did half of your book report last weekend. That way you finished up in time for us to watch a movie together before bedtime.” “Oops! You had your homework in your backpack the whole time, but couldn’t find it to turn it in. Can you think of a way to make it easier to find next time?” The more the child owns the problem and comes up with the solution himself, the more he will internalize executive function skills.

It is common for parents to find that even after teaching these executive function skills, and seeing their child perform them under observation, the child won’t use them on his own.[2] A job well done might be enough gratification for some children to practice EF skills independently. But many children also need a contingent rewards system which offers tangible rewards for performance. So consider putting up a chart listing a few EF skills at a time, and have the child check them off as he does them in return for extra screen time minutes, time with you playing a game, or whatever else he finds motivating that you agree upon. Over time, teach him to create these kinds of reward systems for himself, as a general self-help strategy to use to meet his own goals.

Sample of Executive Function Goals for Peter Tran 2014-15


EF Skill Baseline Goal
Planning, evaluating, adjusting, pacing, inhibition Peter makes the effort to follow a timer schedule to restrict picking up sticks on walks, so he is less enslaved to that intense sensory need. Set up his own schedule of increasing minutes of walking before picking up a stick, adjusting the timer up or down according to ability, and creating his own reward or shrinking reward system
Planning, organizing Peter occasionally remembers to grab his bib or earplugs before outings. Peter will pack his swim bag.
Organizing Peter is learning how to save work on the computer into files. Peter will learn to copy and save important work from notes to pages and sort work into different subject files
Evaluating, planning, organizing Peter often resists putting used favorite clothes in the laundry basket, but occasionally changes his mind and makes a big effort to dump a favorite item in the washer. Peter will learn to do a sniff test or # of days worn test to put dirty laundry in the laundry basket, and select and put out fresh clothes on his bathroom shelf
Self-monitoring Peter occasionally independently toilets and puts his clothes on in the morning. Peter will use a check-off list to do his entire morning routine and bathroom routine, including wiping, flushing, dressing, hand-washing, and tooth-brushing.
Self-monitoring, correcting Peter occasionally corrects a misspelling or goes back to capitalize a letter himself. Peter will edit one line of writing himself for each assignment.
Prioritizing, ordering, organizing, initiation (self-study), shifting Peter makes choices as to which assignment he wants to do first. Peter gets three maintenance “homework” tasks like a worksheet of a couple of questions each of math, grammar, and reading paragraph/comprehension fill in the blanks to put in the order he wants to do them, complete them, and put them in a homework notebook with subject dividers.

Like all brain development, learning executive function skills takes time. Try not to get too frustrated about it. We provided virtually all the executive function for Peter, organizing, pacing, and monitoring him, for years as we worked on the fundamentals of engagement, communication, and cognition, before we started introducing EF skills as goals in themselves. As your child grows more capable in the fundamentals, whenever you see the opportunity, such as planning a picnic or deciding on the order of doing homework assignments, try to work on them. If you intentionally and persistently do so, you will see progress. Just try not to get frustrated if progress is slow. You can’t rush brain development. Modulate your own expectations. It happens at the child’s own pace.













[1] So what do you do if your child grabs the stick and stims before finishing the third math problem? One idea is to make a checklist of 3 reminder boxes. Each time your child stims before the agreed upon time, remind the child of the contract, have him put the stick down, and check off a box. If all three boxes get checked off, explain to your child that he needs more help in inhibiting the stimming, and move the stick farther away, or even out of sight to reduce access.

[2] This is especially common in those children with comorbid attention deficit disorder (ADD), which is associated with a 40% decrease in measures of dopamine receptor and transporter activity in the reward centers of the lower brain. (Vulkow, 2009) For these children, a top-down approach of just teaching EF skills isn’t enough to get them to use them in real life. A bottom-up approach is necessary concurrently in which you supplement their deficient internal reward centers with external rewards.



As parents, we are all used to doing a lot of emotional regulation, ie soothing and calming. This is especially true when your child has autism, where the amygdala (center of fight or flight responses) may be intensely active, but the frontal lobe inhibitory and modulatory connections take extra time and practice to develop. That translates in real life to lots of tantrums. meltdowns, acting out, and other emotional storms we parents have to figure out how to navigate through every day.

A lot of us have been given a lot of information from our kids’ OT’s on first looking at sensory needs and making sure that we get the hypersensitive child out of noisy, crowded environments, remember hunger, thirst, pain, or the need to go to the bathroom in the child who can’t tell you, and make available the sensory toys they need like putty or trips to the swing or trampoline. This “bottom-up” approach is all good and essential. Got to make sure the lower brain/body essential needs are met.

Assuming those immediate body needs are not the primary issue, our kids’ psychologists make sure we understand how it’s important to address the child’s emotion before we start trying to fix a situation or attempt to problem-solve together. So they tell us to do lots of reflective listening, balance or buffer the child’s mood with our either calming or upregulating (high affect) demeanor, and remember all the hugs and affection our kids might need. That’s what Dr. Dan Siegel (2012, “The Whole-Brain Child”) coins “connecting to the right brain” before you can access the left. Got to make sure essential emotional needs are met.

Our kids’ SLP’s make sure we work hard on helping our kids to verbalize or otherwise communicate their distress, so they don’t have to act it out, and so they have the language they need to negotiate solutions together. This more “top-down” approach develops frontal lobe connections and communication capacities, and is also excellent and essential. Got to make sure the child has the language tools she needs. (Teresa Cardon, 2004, “Let’s Talk Emotions”)

Eventually, gradually, and with repeated practice of walking our kids through these fundamental processes, our kids do improve in emotional regulation. But there is another level that most of us parents perhaps don’t do enough of, sometimes because we aren’t sure our kids have the capacity to do it. That is what Dr. Siegel  calls connecting the left brain with the right brain. That’s when after you’ve done all the above steps, and the child is calmed and regulated, you talk about what happened. You can make learning even more efficient if you not only walk your child through emotionally stressful situations at the time, but reflect and replay them later in conversation and/or play therapy. Ask your child what was going on inside when the explosion hit. Give him/her a chance to identify the emotion, learn to talk about feelings, and recognize gradations or degrees of intensity of feelings, perhaps with an emotional thermometer. You want the child to develop the capacity to recognize an earlier stage of emotional dysregulation, so she can take steps to calm herself and get her needs met before the emotion becomes overwhelming.

Help your child review the event, reprocessing it as you lend your perspective to help her understand what happened. “Oh yes, the circus did seem frightening at first, so we do understand why you cried and screamed so we had to leave for a while. But Mom and Dad were right there the whole time, with a comforting lap to crawl into. And wasn’t it fun to peek into the tent at the last act and see the acrobats? Plus there was that really fun pinwheel you got to blow.” Bring in other memories and experiences that bear upon the situation. “Remember how it was also hard to get out of the car last week when we went to the zoo for the first time? But once you got out and looked around, you saw the elephants and really liked it. Sometimes things are hard at the beginning, but if you give it a chance, you might like it.”

Then help your child apply what he thereby learns from his mistakes. Try what Noel Janus-Norton (2013, “Calmer, Easier, Happier Parenting”) calls “think-throughs.” In anticipation of entering similar stressful situations, you think through the upcoming event with your child as to what to expect and what emotionally self-regulatory strategies the child might initiate if needed. “Hey, tomorrow we’re going to Sarah’s birthday party. It’s a new place, but remember when you went to the circus? That was new too. Yes, you did get anxious, but in the end. remember how much fun we had? Remember this picture? Yep, there you are with a big smile. What did we do when you got anxious? Oh yes, we went outside for a while. You crawled into my lap, and we rocked and hugged under your blanket, and then we got that pinwheel and watched the wind blow it. And then we came back. You know I’ll still be there, I’m coming to the party too. And we can bring the blanket and the pinwheel. And you can tell me if we need to go outside for a while. How do you tell me? Sure, if you can’t find your words, you can point to the door. That will be our secret signal, and I’ll know.” When you do a reflection or a think-through, you are actually walking the child through the steps of cognitive-behavioral therapy, naming the emotion to objectify it and help your child see that it is something she can work on, part of her but not her, identifying the false thought (“all new places are scary and must be avoided”), replacing it with a more realistic thought (“I’ve been to lots of new places before and had a great time”), and brain-storming alternative strategies to screaming or crying (like making a signal to leave for a while, crawling into a parent’s lap, and bringing a transition object).

This process of left-right, top-down brain connection is taking an incident of emotional dysregulation, and making use of it to grow those frontal lobe connections by both looking back and looking forward. Each episode of emotional dysregulation is an opportunity to walk your child through this process, and grow those frontal lobe connections. Especially as she practices initiating the strategies herself, and as you allow her to walk herself through this reflective process, using narration first, then yes/no questions, then leading questions, and finally open-ended conversation, your child will learn to emotionally regulate herself, essentially learning how to do self-CBT (Ann Marie Albano, 2013, “You and Your Anxious Child”).

And I would add, be even more ambitious. Go ahead and introduce your child to bigger concepts like morality and community and virtues. I go ahead and name them. “Hey, Peter, looks like a good opportunity to practice some flexibility.” Or, “Maybe this would be a great time to exercise the temperance muscle.” Madrigal and Winner (2008) have a great book out called “Superflex.. A Superhero Social Thinking Curriculum” where they give the maladaptive behaviors goofy villainous names like “Rock Brain,” so that the parent can say, “Hey, I think Rock Brain just showed up,” and the child can take on the personae of “Superflex Hero,” and brainstorm alternative more flexible courses of action.

Does this all really work? Maybe for your “high functioning” child, you might say. But most parents I’ve met of seemingly less able children tell me they suspect there’s a lot more in their child than meets the eye. Peter was labeled as severely autistic, nonverbal, and low functioning at one time. But even when his expressive communication was at a very primitive level, I kept talking to him as if he could understand, just in case he could. With each episode of emotional dysregulation, I went through all the steps of bottom-up, right-left emotional regulation to try to help Peter feel his needs were met and that he was understood. Then after he had calmed down, we’d work on the top-down problem solving, and at the end of the day do reflections to work on the left-right brain connections. I started out doing nearly 100% of the work, but scaffolded my support and let him do more and more of the work, as he showed the capacity to do it, and developed more and more communication. Believe me, it wasn’t at all as smooth as this summary is making it sound. I didn’t know what I was doing, until I read authors like Cardon, Siegel , Norton, Albano, and Winner later and could be intentional about it. (That’s why I’m sharing this with you, so you can be intentional and efficient to begin with.)

In any case, whatever bumpy, twisty road we took, Peter did learn. He has developed frontal lobe connectivity to an extent that at one time I would have doubted possible. The other day, we went to the community park to watch the Memorial weekend fireworks. What I saw on the outside, was a somewhat anxious teenager who was holding onto my arm for part of the time, but seemed to have matured a great deal compared to his level of anxiety as a child. What I found out later after reading the poem he typed about the experience, was all the hard work of emotional regulation he had been doing for the most part on his own, and the sense of community and love, a highly top-down approach, that ultimately held him together and transformed his experience. (In the story, Joe, Teddy, Luke, and Judy are all siblings; Judy, his oldest sib has two young children of her own.)


Memorial Weekend Fireworks, 5/24/15,

by Peter Tran
“Hurry, hurry, Luke put on your coat.”
grab your shoes and open the door.
“Grandpa, tuck those elbows in,
don’t you remember banging them
through the last doorway?”
We rolled him safely through the front door,
and hoisted him onto the front seat.
We all piled in.
Then we arrived,
corner of Foothill and La Canada Blvd,
heart of our fair town,
busy, bustling.
We spied two tall lanky figures,
Joe and Teddy waiting to receive us.
We paused behind a firetruck
and unloaded Grandpa and his wheelchair.
I felt numb.
Crowds of people
all smiling and talking.
Mom grabbed my arm sand propelled me through a maze
of picnic blankets, chairs, and baby strollers.
It was chaos.
I heard a flood of brassy notes,
the high school jazz band playing their hearts out.
Hold on, don’t panic, it’s all just in fun.
I relaxed as the noise diminished.
Phew! the music stopped.
I sank  into my comfy lawn chair.
Dad was there, Luke, coughing from asthma, rolled on the blanket,

Teddy positioned Grandpa’s chair, and Mom miraculously
found Judy and the babies.
Then after a  brief lull,
darkness descended.
That’s  when it started.
Boom, sizzle!
Nothing prepared me for what followed.
The sky exploded in color!
Gold, crimson, all shades of brilliant hues,
spinning, darting, bursting bouquets of flashing stars.
The sights and sounds engulfed me.
I didn’t have ears enough to hear all the music,
reverberations from the explosions filled my head.
Then it was all over.
The lights went on,
and everyone started gathering
their blankets, ice chests, and children.
Pressed in by the happy crowd,
we flowed liked molasses slowly down the street to our cars.
I felt safely insulated by my family,
and families like ours,
my community,
And even Grandpa was smiling.



My point is, even though developing emotional regulation may be hard in our kids, and takes a lot of work and time, don’t despair. Over time and repetition, those frontal lobe connections do grow. Tackle episodes of emotional dysregulation from the bottom-up, top-down, and left-right, looking back with reflections and forward with think-throughs. Each episode of emotional dysregulation may thereby become an opportunity to connect the parts of the brain and get them to work together. If you miss a few, don’t sweat it. Heaven knows our kids give us plenty of opportunities to practice again!

I don’t think most people realize the beliefs of Margaret Sanger, the founder of Planned Parenthood and movement to legalize abortion. I was shocked when I googled her name on Wikipedia. The following is taken from http://en.wikipedia.org/wiki/Margaret_Sanger#Eugenics

“Sanger’s 1920 book endorsed eugenics.
As part of her efforts to promote birth control, Sanger found common cause with proponents of eugenics, believing that they both sought to assist the race toward the elimination of the unfit. Sanger was a proponent of negative eugenics, which aims to improve human hereditary traits through social intervention by reducing the reproduction of those who were considered unfit. In ‘The Morality of Birth Control,’ a 1921 speech, she divided society into three groups: ‘the educated and informed class that regulated the size of their families, the intelligent and responsible who desired to control their families however did not have the means or the knowledge and the irresponsible and reckless people whose religious scruples prevent their exercising control over their numbers.’ Sanger concludes ‘there is no doubt in the minds of all thinking people that the procreation of this group should be stopped.’  Sanger’s eugenic policies included an exclusionary immigration policy, free access to birth control methods and full family planning autonomy for the able-minded, and compulsory segregation or sterilization for the profoundly retarded. In her book The Pivot of Civilization, she advocated coercion to prevent the ‘undeniably feeble-minded’ from procreating.
Sanger also supported restrictive immigration policies. In ‘A Plan for Peace’, a 1932 essay, she proposed a congressional department to address population problems. She also recommended that immigration exclude those ‘whose condition is known to be detrimental to the stamina of the race, and that sterilization and segregation be applied to those with incurable, hereditary disabilities.'”

I don’t know about you, but her writing sends chills down my spine. Her view of the worthlessness of whom she calls the “feeble minded” and “unfit” is so cruel, dark, and untrue that reading her words makes me feel like I’m looking down a black hole of death and despair.

On the other hand, my sweet Peter is on his way soon to the state capitol to receive an award for winning first place in a state high school competition for literature. Here’s the poem he submitted:

The world as a garden

the green stillness of an oak forest.
the sound of birds singing, squirrels chattering, crickets chirping,
the sun upon the mountaintops,
the blueness of the sky
these make the world beautiful.

The taste of chocolate chip ice-cream,
the swirl of a hot Jacuzzi
the thrill of a roller coaster,
the joy of riding my bike
these make the world a fun place.

the warmth of my mom’s smile
the chatter and laughter of my little nephews,
the gruff nod of my grandfather
my tall brothers playing card games,
my little brother sharing his snack
my papa when in a good mood
these make the world a warm, loving place.

you and I can be friends.
we can plant a garden,
make the earth a garden
that we tend with loving care
with room for everyone to
to be free to be themselves
loved for what they are.
that would make the world a better place.

Contrast the two writers. Their visions could not be more diametrically opposite. When I read Peter’s view affirming the value of every individual and the vision of the people of the world tending the earth like a garden together in loving friendship, I know in my heart that that is the vision I choose as well. I will not go down the slippery slope of abortion to a vision of a society that decides who is worthy of life and who is not. Peter and the other beautiful individuals I have met in my journey in autism are my real experience. Margaret Sanger is absolutely wrong to the core. I am prolife and stand against the culture of death together with my brothers and sisters of all “unfit” and misfit diagnoses. As Peter put it, “I hope our nation never loses its belief in God because then some people will seem to cost more to help than they are worth.” But to Jesus we were all worth dying for, “fit” and “unfit,” more gifted and more challenged, saint and sinner. I pray we may all open our eyes to the beauty in each person, and plant a culture of life with love and respect for everyone as a nation.

Currently our nation is at another crossroads. Let’s pray together that the Holy Spirit enlighten the Supreme Court as they make their deliberations and move the justices to make the right decision, with the grace of humility and wisdom, that they might lead our culture to the Lord, following His holy will.

“NO, Peter! You are not an animal!” I cried, as I brandished a towel like a whip to drive my son away from the food. He had that crazed “raw amygdala” gleam in his eye that I have seen on too many occasions, as he bit into a family-sized apple strudal that he’d lifted whole from the platter. I returned the strudal to the platter, only to protest in dismay as Peter snatched a sizzling sausage from the pan with lightening speed. “Stop it! Stop it! Peter, I told you we were having breakfast after Mass!”

We’d already had a long history that Sunday morning. I had to play tug-of-war with Peter to get the bedcovers off, then had to hang the goggles he loves to tap on the thermostat in the hallway so he’d have to get out of bed to get them. I had to set the timer twice for him to finish his bathroom routine. Even so, he refused to get dressed till I’d fetched the black underwear his rigidity demanded be exchanged for the white one I had previously laid out. It was getting so late by that time, that I didn’t even protest, but just ran to make the extra roundtrip to his bedroom clothes drawers.

Getting from the church parking lot to the front door was another struggle. Peter tends to grab my arm and lean hard upon it. I was so frustrated with him, that I shook him loose. I dashed a few paces ahead of him, saying, “Come on, Peter! You know Peggy (one of Peter’s therapists) keeps saying you should practice walking independently.” I kept walking ahead of him, pausing every ten feet for him to slowly catch up.

By the time we made it into the side chapel, we were really late, and had missed nearly half of Mass. I was so upset with his impulsivity and inertia that I didn’t even want to look at him. But when I turned to my Missalette, I saw the responsorial psalm of the day, “Have mercy on me, O God, in your goodness; in the greatness of your compassion wipe out my offense. Thoroughly wash me from my guilt and of my sin cleanse me. A clean heart create for me, O God, and a steadfast spirit renew within me. Cast me not out from your presence, and your Holy Spirit take not from me.” (Psalm 51:3-4, 12-13)

I felt convicted in my soul. What was I doing, punishing my son with my attitude? He didn’t ask for autism. It’s not his fault that his prefrontal cortex doesn’t have the ready connections to the amygdala that neurotypicals have (NIMH study by Richey and Dichter, Journal of Autism Developmental Disorder, Jan 2015); neither is the miswired circuitry through the basal ganglia causing rigidity and inertia voluntary in the least. But it was Peter who took the initiative. Taking the keyboard, he typed,

Peter: i asdm sorry mom forf everyything.
Mom: I’m sorry too. will you forgive me for the towel and unkind words?
Peter: yes., i actedc badly. i’ll try to do bettter.
Mom: Thanks, Peter, so shall I. Love you.
Peter: i love you too

The rest of Mass flew by. Freed from the heavy angry feeling I carried before, my heart felt light and joyful. My sweet, humble son had not only forgiven me, but had asked for forgiveness, for behavior that was not even his fault, but due to autism. Autism is a heavy cross our children carry. I should be helping Peter carry his cross, but how often do I instead add to it by blaming him for behaviors he can’t control? When he really can’t help it, blaming him for them is like blaming him for having autism, like blaming him for having this cross to carry. I am sorry, Lord. I looked down at the beautiful words on the pages of my Missalette again.Pointing to Psalm 51, I showed them to Peter.

Mom: Beautiful words, aren’t they? They are the words of a famous psalm by King David. Pretty cool that the same words written thousands of years ago express the longings of our hearts even now.
Peter: just marvelous. thanks mom, for making the words real for me.Mom: Peter, you are the one who makes them real for me!
Peter: dear jesusm, may we honor you with our lives and minds, and hearts, amen i thank you for helping me just helping mom hagve gtrace (have grace). amen
Mom: and Peter too! Amen!

Forgiveness. It’s a beautiful thing. It gives life to the dead, and makes all things new. It’s so elementary, we forget about it. Every good parenting book I’ve ever read from Noel Janis-Norton to Dan Siegel talks over and over about how restorative and critical it is for parents to repair rifts in their relationships with their children. How there’s no better way to walk them through the process of asking for, giving, and receiving forgiveness than to demonstrate it in real life situations. How it’s such a great opportunity to grow the children (and oneself!) in perspective taking, problem solving, and emotional understanding. How it makes everyone and the relationship even better and more resilient. But at the time I read all that, I just said to myself at the time, “Yeah, yeah, yeah, I know, I know.”

But at that moment in the chapel the rubber finally hit the road. It shouldn’t, but for me it took supernatural grace to say those words, “Will you forgive me?” When I did, it was like opening a door. I felt a mighty rush of a river of grace, love, and forgiveness from Peter. He was waiting for the opportunity. He was just waiting for me to open the door. So I just wanted to pass on the encouragement I received from this experience to encourage you to open the door. Your children are waiting. They need to hear those healing words, and experience the joy of forgiving and being forgiven, a process that is beautiful, even life-giving to a relationship.

It doesn’t even need to happen right away. It’s never too late. We all need time to reflect. When rifts occur, it’s hard to take in the whole situation at the time. That’s okay. The important thing is not to shy away from reflecting upon and confronting the challenges in our lives, including negative interactions with our kids. So don’t be afraid to go back and recollect; take the time and effort to do so. It’s not just my experience, but on talking with other parents it seems that our children may be the most forgiving people on the planet towards us. They want so much to forgive us because they love us so. So if one messes up, or if there’s a misunderstanding, don’t despair. You can always repair. which leads to restoration and respect. Just open the door.








Thanks be to God and our Savior Jesus Christ for the great gift of forgiveness!

Happy Easter to all!

“I’m so tired of this!” I moaned, walking through the hallway after Peter and I had struggled through his toothbrushing routine for the 16,000th time. Peter has never got that forward and back toothbrushing motion down despite literally working on it three times a day for 15 years. I guiltily stopped myself too late. Could he have overheard?


Later that evening, I steeled myself as I handed Peter a damp towel to wipe down the dining room table, having finished dinner. I had asked him to clear his dishes and bring them to the sink, but he had stayed rooted to his usual spot at the table. After a long pause, I wearily pointed my finger to a spot on the table for his hand to aim for, and back to edge, back and forth over and over to create targets for his hand to move between. When he finally finished wiping the section of the table he could reach from his seat, I said, “Come on, Pete, stand up now, so we can do another section of the table.” Nothing happened. Long pause.


I took a deep breath, and made a last ditch effort. I pulled all the chairs far enough away from the table so that a person could easily move from one chair to the next. “Come on, Peter! Here we go!” I sat down on the chair next to him and wiped down the table space in front of me, then scooted to the next chair. “Your turn!” Peter got the idea at once, and slid his bottom to the adjoining chair, wiping the table space in front of him with gusto. Wipe, wipe, wipe, scoot,… wipe, wipe, wipe, scoot,… Without having to stand up, Peter moved from chair to chair, wiping the table with alacrity, grinning ear to ear. I felt at once amazed and delighted, but also deeply humbled. Here I had been feeling so annoyed and impatient, and clearly, Peter was eager to help. He just needed help getting started.


We talked about the episode later.

Mom: Did you like our goofy “musical chairs” game to get the table wiped?
Peter: yes.it wwas ffun. i couldn’t get myself to move. i could,n’t gett my feet to srtand up.

Mom: How did the stuckness change when we played musical chairs?
Peter: i dion’t know hiows it works butv when you finally started a game, my body got into a rhythnm.

Mom: Do you know what to do, but just can’t get your body to do it?
Peter:  I do know what to do on most of my chores, but sometimes I feel like I am climbing an unsurmountable height to get my body in motion. Thanks for the game it makes all more manageable.
Mom: This seems to happen a lot. Most of the time when I ask you to do chores or self-help skills, you sit there until I get close to you and offer verbal encouragement and often also physical assistance or gestures.
Peter: i do want to cooperate, but my boddy just won’t move. i really can’t stress enough how hard i try to move. of course i understand how frusttrated you must get with me, but i can”t makee my body go.
Mom: Bet it makes you feel even more frustrated when i get frustrated.
Peter: just sad.

Mom: I’m sorry I make you sad sometimes.

Peter: the sad part is that you try so hard, but i disappoint you.


As we were talking, Peter’s dear friend and tutor Miss Belinda came walking up. She started chatting about a talk show she’d just been listening to about changes in American culture. That reminded me of an incident along the same theme that occurred to Peter and me the day before. We were approaching the family/handicapped locker room at the YMCA after swimming when a little girl darted in front of me and opened the door to the single use locker room.

“Excuse me, little one, but do you think Peter and I could use this room since you and your sister are both girls and can use the girls’ locker room? Peter and I can’t be together in either the boys’ or girls’ locker rooms, and he needs my help,” I said.

“I just have to get my shampoo,” said the girl, who looked around ten years old. I stepped aside as she entered through the door.

Just then, a strikingly beautiful young mother came running from behind and pushed her two girls into the locker room. “Peter, I do believe these ladies really want this locker room,” I said to Peter, who was already partially in the room, gesturing for him to come out towards me in the hallway. Peter promptly came out. We eventually found a bathroom we could use, and did fine. But I described the incident to Belinda as an example of how times have changed. When I was growing up, little girls were encouraged to be sweet and gentle, but I suppose the current trend is to put a priority on assertiveness. Just then, Peter chimed in on the conversation. He typed,

“Mom, i’m sorry you were offended but i personally felt ok to let them ha ve uit (the family locker room). ”

“Peter, I am truly sorry for every time I get unfairly impatient with your movement. You most certainly do not disappoint me. Rather, you refresh my spirit, my dear.”

“Just natural,” replied my little gentleman.


I share these stories with you to encourage you. We parents get so exhausted accommodating and remediated our children’s deficits. The beauty of their inner selves gets hidden, buried under the weight of their challenges. If we hadn’t fortunately struck upon the musical chairs game, Peter would not have been able to show me his eagerness to help. If we hadn’t reflected on it later, I wouldn’t have known how much he hates to disappoint me, and how sensitive he is to both how hard I’m trying and when I get frustrated. If Belinda hadn’t come along and got us off conversing about that locker room incident, I would not have realized what a courteous gentleman he is. I would have just breathed a sigh of relief that he left the locker room willingly, and chalked it up to a lucky day. But whereas I was annoyed, he was truly happy to defer to the needs of others.

When our children can’t move, can’t express their beautiful intentions through actions because of a faulty start mechanism in the basal ganglia, it’s automatic for us to underestimate them. How they must suffer with constant misunderstanding. So these incidents are a good reminder for me. To take the time to make that extra effort to pull out the electronic keyboard or bring with me everywhere that handy paper alphabet board to check-in with Peter, so he has a chance to be “seen” and understood. And to give him the benefit of the doubt that he has earned over and over throughout years of struggling that he is doing his best, that I keep forgetting, in all my impatience.

“…the Lord seeth not as man seeth; for man looketh on the outward appearance, but the Lord looketh on the heart.”  1 Samuel 16:7



Many of us struggle with how to help our children cope with their lower brains. One of the most challenging aspects of autism is the underconnectivity of the frontal lobes to the centers of the brain that initiate action. Since the more primitive connections to the amygdala appear to be much more intact, our kids tend to behave with instinctual “fight or flight” (or “grab!”) responses to environmental stimuli rather than thoughtful, intentional actions. They tend to react rather than respond. Clinically, that looks like aggression and impulsivity, and a general lack of self control.

So as parents we do our best to give the upper brain an advantage by preparing our children before stepping into events, having them read social stories, rehearse, and play out scenes with their stuffed animals or dolls. We monitor and engineer the child’s environment, trying to remove triggers for aggression or impulsivity. Still, many are the times when the lower brain gets the upper hand and goes out of control. We’ve all experienced the crazy, domineering lower brain insisting upon its way, and suffered along with the child as he sorrowfully apologizes afterwards. Clearly, the child’s upper brain cannot get the upper hand of its lower counterpart on its own, and needs our help. How do we help our children stop their lower brain rampages, and reconnect their upper brains?

Peter taught me how important it is for him to receive support in subduing the lower brain. When I asked him if an imperative tone of voice or physical restraint calmed or escalated the acting out of his amygdala, Peter basically told me it was a balance. “by my experience it does help my lower brain to let know who is in control. but my lower brain sometimes gets more aggressive.” So the assisting adult needs to take charge firmly, but not too harshly, to be strong but not domineering, to be authoritative, but also calm and reassuring.

This is definitely easier said than done, especially as our children outgrow us in size.

I tend to overreact , speaking and acting too quickly or loudly, which leads to more dysregulation. But I’ve been trying to change by observing and imitating the two people in Peter’s life who regulate him best. Peter’s tutor Belinda is a petite motherly type. She responds to his acting out by stepping forward (or at least not backward), standing tall (or as tall as she can), firmly and immediately insisting he sit down, and using a calm, very quiet voice to talk him down as she applies deep pressure to his arms, morphing into interactive upper extremity squeezing and clapping games. Peter listens to her based upon the trust built between them over many years.

Peter’s big brother Jeffrey also uses a calm, “I’ve got you, you’re going to be okay” tone of voice. He has the added advantage of competency in martial arts. He custom-created the “teddy bear hold” to keep Peter from hurting himself or others. Step toward the child as you reach for his hands and hold them behind his back, leaning him against the wall with your shoulders and side of the head matched against his shoulders and side of the head, placing one foot upon one of his feet to maintain location. If the child moves or struggles, match your movements with his exactly so as to maintain close, snug contact, your side of head pressed against his side of the head (so you don’t get head butted), your shoulders matching his. This hold is basically a restraining “hug” that prevents the child from acting out in physical aggression while comforting with deep pressure. It works on Peter because he loves deep pressure. It might not work on others; for example, the child who bites might bite the neck of the restraining adult, and one who has had some martial arts training might figure out how to use his free leg to sweep yours away. So think carefully before applying this to your own child (do so at your own risk!).

Peter is the one who basically tells me what works and what doesn’t. After an episode where he lost control when I inadvertently interfered with a compulsion, he was the one who encouraged me.

Peter: I’m sorry i wiped my lips on the couch. you were right, you were just mad so that got my fight reflex activated. sorry mom but hard in getting pushed to behave when i was already trying to handle the wiping ocd.  i very proud of how you managed to get me not violent by holding me down.
Mom: So did the teddy bear hold work?

Peter: yes. i like it.
Mom: Well that’s great. I guess I’m proud of myself too then for learning it. Jeffrey is a genius.
Peter: i think it is effective because it gets my lower brain to give up.

Of course, once the worst of the physical aggression subsides with the hold, you still need to use all your other strategies. See if your child can do some deep breaths with you to activate the parasympathetic nervous system to counteract the bodily hyperarousal of the child’s fight or flight response. Use a calm, reassuring tone of voice. Once the child’s body relaxes, you can see if the frontal lobes have reengaged and the child can communicate with you. You may then bring in whatever emotional regulatory strategy works best with your particular child, whether that be CBT (cognitive behavioral therapy), meditation, music, distraction, exercise, or more talking.

Although subduing the lower brain is necessary, Peter consistently tells me that love and understanding are most important in helping him cope. Someone once said, “How many times can one say sorry, and still be believed?” If you’ve got a run-away out-of-control lower brain that you have to watch helplessly while it does exactly what you don’t want it to do, such a statement would be the death of hope. Whether dealing with addictions, OCD, or other developmental or acquired mental illness, I finally am beginning to understand Jesus’ answer “seventy times seven.” Hope is so important. As Peter puts it, “considering you are not discouraged, then I am not discouraged.” And forgiveness is necessary to maintain hope.

Again, easier said than done. Individuals should not be blamed for what is truly out of their control, but it’s not easy to feel that way when their misbehaviors are repetitive and hurtful. I feel as though I haven’t arrived yet, but it’s a journey my family is on of faith and hope, praying hard, struggling to keep forgiving, keep hoping, keep trying.

And so for 2014 I wish the best for you and all of us, that God grants healing to our kids and the grace for us to effectively help them.

John 10:28-29

“28 I give them eternal life, and they will never perish, and no one will snatch them out of my hand. 29 My Father, who has given them to me,[a] is greater than all, and no one is able to snatch them out of the Father’s hand.”

Sometimes when I feel like I’m just barely hanging onto the hem of Jesus’ garment, I try to remember this promise, and relax. If I can’t hold on, we’ll still be okay, because it’s He who’s got me, and my child.

Happy New Year!

A Big Hug for You Teddy Bear Graphic

A Big Hug for You Teddy Bear Graphic

When Peter was little, he would make funny faces, squinting and staring at his fingers held up to the side. He would flap and squeal and race up and down the hallways repetitively. It was hard work and took split second timing to get him to attend and engage, a constant staying a step ahead to “akido” his autism by turning a stray whim into a playful game, engineer situations into incidental teaching moments, and create curriculum and educational materials fun and relevant enough to pull him out of autismland into a learning world.

Things did get better. Peter learned to think and communicate. We discovered the warm, loving, hard-working, and compassionate person inside that faulty, uncontrollable body, who would type encouraging words to his friends, patiently endure the noisy splashing of his toddler nephews because he wanted to hang out with them in the pool, and delay coming out of the bathroom not to interrupt an important conversation he overheard his brother having with his aide that he thought “was important for him.” But sadly, the preponderance of his demonstrations of heroic courage, effort, and perseverance occurred in the context of a battlefield- the arena of a constant struggle against mental illness.

I don’t know how many of you, my dear readers, have lived with mental illness, but I imagine if you’re friend or family to someone with autism, you are well familiar. Like many things, it was something no one told us about. Possibly just as well, as the prospect of facing it would probably have dampened our hopes that were so necessary to help us help Peter move up the developmental ladder through his childhood. And thank God for the development of those cognitive and language skills, and the gifts of relationships and emotional bonding that occurred in those childhood years, without which he could not now do battle against the extreme emotional dysregulation that has arisen in his adolescence.

Battle it is. Every day, hard, constant, yet ever changing. You parents of older children with severe autism probably know what I mean. We’ve comforted one another in low whispers in waiting rooms as we’ve shared this world of aggression, self-injury, uncontrolled libido, stims that evolve into massive perseverations and OCD’s, hyperarousal and anxiety, racing, disconnected thoughts and actions, and obsessive eating. Well do we understand the tale of “Dr. Jeckyl and Mr. Hyde” and “Alice in Wonderland.” We’ve met the characters. We know the mad gleam of the eye, and seen the reptilian transformation of a warm, caring upper-brain-controlled beloved son or daughter into a lower-brain- controlled amygdala, determined to have its way. As armor bearers of our children, we support them in battle, handing them weapons of deep breathing, progressive muscle relaxation, trigger avoidance, delay, distraction, exercise, and even CBT (cognitive behavioral therapy) and meditation for some. Sometimes they work, but often the monsters our children battle are overwhelming, and we receive their blows. We try medications, which are double-edged swords. And as the incidence of the incidents cycles up and down, we ask ourselves, will this ever get better?

A couple of moms with young adult children with moderate to severe autism have reassured me that overall, yes, the aggression and self-injury did improve as their children moved out of the teen years. Perhaps the brain adjusts to the hormone surges and the frontal lobes eventually reorganize and myelinate. That gives me hope that if we can just endure this period, some of the worst will pass. I can even see how doing battle everyday with his mental health issues is pushing Peter’s development forward, as he exercises his multicausal and grey zone thinking, perspective taking, sense of values and self-awareness, compassion (which we try to encourage also for himself), and problem solving. Still, until it gets better, in the meantime, living with mental illness can feel exhausting and painful. How do we endure it? How do we help our poor children, who suffer even more, to endure it?

I would not presume to have answers to the mystery of our children’s (and therefore the whole family’s) suffering, but I can share what has helped Peter (and myself) most of all. It is the confidence and knowledge that all this suffering and struggle is not senseless or meaningless, but has a great value. In fact, it can be a very great treasure. This is an ancient belief taught by the Roman Catholic Church, with its roots in the Cross of Christ.

St. Paul writes in Colossians 1:24 “Now I rejoice in my sufferings for your sake, and in my flesh, I complete what is lacking in Christ’s afflictions for the sake of his body, that is, the church.” In Romans 12:1-2 he says, “I appeal to you therefore, brothers, by the mercies of God, to present your bodies as a living sacrifice, holy and acceptable to God, which is your spiritual worship. Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect. ” St. Peter writes in 1 Peter 4:12-13, 19, “Beloved, do not be surprised at the fiery ordeal which comes upon you to prove you, as though something strange were happening to you. But rejoice in so far as you share Christ’s sufferings, that you may also rejoice and be glad when his glory is revealed… Therefore let those who suffer… entrust their souls to a faithful Creator.”

All Christians believe that Jesus died on the Cross for our sins, that the “wages of sin is death,” and he paid for them in our place with his own suffering and death. We Catholics believe that as part of the mystical body of Christ, Jesus invites us also to offer up our sufferings in union with his own on the Cross, for the atonement of our own sins and those of others, for the salvation of souls. To do so requires that we offer them up with the Spirit of Christ, which means that we strive to “entrust (our) souls to a faithful Creator.”

This is not easy when you and your child are in the fire. “How can I trust in you, God, when my innocent child is suffering like this?” I have cried out upon my knees in front of the Tabernacle. But looking up at the crucifix at the suffering face of Christ, I knew I was angry at the wrong person. No, my God is there upon the Cross. There could be no greater proof of his love than that. Jesus completely identifies with the victim. He came down from heaven to share our suffering and sorrows and lead us through them. To show us the way through the valley of the shadow of death by descending into it himself. And so we strive to endure our suffering the same way Christ did, with faith instead of doubt, hope instead of despair, love of others instead of self-pity, acceptance instead of bitterness.

An old priest once gave a homily on persecution. He said that many of us do not suffer persecution for our beliefs, but do suffer from illness, injustice, betrayal or other blows of life. He offered what he admitted was only a poor analogy. When he was under local anesthesia for eye surgery, the doctor kept telling him to relax, as his terrified, anxious tensing up was only making the surgery harder and longer. He said though it is much easier said than done, we too need to learn to surrender and accept, even embrace our Crosses, for in rebelling against them we only make the suffering worse. It is certainly true that if after doing all we can biomedically and behaviorally to treat and manage effectively our children’s mental illness, we still have to endure a degree (often a very large degree) of it, dwelling on how miserable and unfair it is only intensifies the suffering.

So how does one embrace the Cross? With each crazy incident of OCD or aggression(usually resulting from not allowing performance of a compulsion), Peter and I work through it as best we can (see prior blogs on Stopping, Taking deep breaths, Observing oneself which includes identifying the emotion and doing some self-CBT which involves replacing false, negative thinking with more realistic thoughts and positive coping, and Proceeding with a “Superflex Hero” tactic to replace a maladaptive, reactive behavior with a wiser, more intentional choice, such as removing oneself from a trigger and/or delaying a compulsion instead of obeying it, and talking/typing instead of acting out). Once the crazed wave of emotion and behavior has passed over, we pray about it, offering up our struggle in union with Christ’s on the Cross for the good of souls. Sometimes we pray for a specific person or intention, which makes the offering more meaningful and tangible.

When one offers up one’s sorrows and struggles in this way, in union with Christ’s, they are transformed into a treasure. That treasure is the opportunity to love, trust, and follow Christ even when one doesn’t understand one’s painful circumstances, when one continues to faithfully obey, not for a visible reward, but for love. So one gets to help to make up for what much of the world does to Jesus, rejecting him or ignoring him, saying , “We don’t want this king to reign!” There is a saying that our King rules by serving, and the tribute he asks of us is proof of our love and faith. That is just the tribute we get to offer our Lord when we choose to love, serve, and believe in him, even as we suffer. We get to show him that we follow him not because we get something out of it, but because we really love him. The good thief could see who Jesus was, even when to most others, his Kingship was veiled. Upon our own crosses, we are so close to Jesus upon the Cross that we have the great privilege of consoling him with our love right there in that moment of eternity when, as our beloved Good Shepherd he suffers and “gives up his life for the sheep.” Seeing Christ upon the Cross gives us the courage to in turn stand firm in times of adversity, firm in faith against doubt and fear, shepherding our own little flocks at home and in our communities, “turning all circumstances and events of our lives into occasions of loving You and serving the Church, the Pope, and all souls with joys and simplicity, lighting up the pathways of the earth with faith and love.”

A dear friend of the family, Father G, a visiting priest from Ghana, once told Peter how much he admired him as he could see how hard Peter struggles against his OCD (he resists obeying them, as performing the compulsions only makes them stronger). Father G asked Peter to pray for him and his ministry. Peter replied, “I will do more than that. I will offer up my struggles for your ministry.” Father G told Peter how much he appreciated that, and rejoiced to receive his help. The next morning to get out of bed (always a struggle for Peter with his unruly body and catatonia), I told Peter that in getting out of bed, we could be missionaries to Ghana. After he managed to arise, we offered up the getting out of bed for Father G’s ministry. Peter laughed, “Mom, you love to trick me!” Peter has been offering up his struggles every day since then. The next week was Thanksgiving. Peter was typing what he was thankful for, and among the top of the list was “Thank you for Father G, for giving my struggles a firm vocation.”

We now have a “joke” between us. After a big battle with OCD or catatonia, Peter and I look at each other, and say, “Maybe that one got another soul out of Purgatory!” But seriously, anything we can do to pray for the living or the dead, we rejoice in the opportunity to do so. We are so grateful to our Lord for inviting us to take part in the “priesthood” of our baptism (we believe that every baptized person shares in Christ’s mission as priest. prophet, and king with a commission to offer up spiritual sacrifices and prayers, spread the word of God, and share the joy of being an adopted son or daughter of God, and member of the kingdom of Christ). This is what is called by the Church, the “joy of the Cross,” the knowledge that out of suffering can come good when borne and transformed by the love of Christ; indeed, the greater the suffering, the greater the good that may ensue.

So my prayer for my brothers and sisters in faith and especially for those of you who share this cross of mental illness or helping a loved one deal with it, is that you receive the gifts of faith and grace to endure, and more than endure. May the crosses we all bear lead us all to heaven and bring grace to those we love and pray for.

May you have a prayerful Advent season, with God’s blessings for a hope-filled New Year!




First reading of today’s Mass: Isaiah 41:13-20

I am the LORD, your God, who grasp your right hand; It is I who say to you, “Fear not, I will help you.” …you shall rejoice in the LORD, and glory in the Holy One of Israel.
The afflicted and the needy seek water in vain, their tongues are parched with thirst. I, the LORD, will answer them; I, the God of Israel, will not forsake them. I will open up rivers on the bare heights, and fountains in the broad valleys; I will turn the desert into a marshland, and the dry ground into springs of water. I will plant in the desert the cedar, acacia, myrtle, and olive; I will set in the wasteland the cypress, together with the plane tree and the pine, That all may see and know, observe and understand, That the hand of the LORD has done this, the Holy One of Israel has created it.


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