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Posts Tagged ‘poetry’

Is your child difficult to motivate? Does your child have big emotions or difficulty communicating in the usual ways? I remember the long years when my Peter couldn’t talk, couldn’t hold a pencil, and didn’t want to play,  when his only sure motivator was food. To add to that, in his teen age years, as often happens, his emotions exploded with massive dysregulation due to OCD and anxiety. I used to think that the arts were only for other kids, less impacted with autism, or maybe savants. But I’m telling you, I was wrong. It turned out that the arts played and continue to play an important role in Peter’s development. The arts may actually be a part of the solution for your child as well.

How do you begin? How do you lay a foundation for creativity? I believe  that for our family, doing hours and hours of floortime laid the foundation. Now mind you, more often than not, Peter didn’t look like he enjoyed it; he looked like for all the world all he wanted to do was withdraw and be left alone. We doggedly proceeded as a matter of faith. During the long years Peter had almost no language, we did a lot of play centered around reenacting emotionally charged events that happened in Peter’s life with stuffed animals or an analogous theme, at first demonstrating a more adaptive reaction, then eventually as he got more and more into it, letting Peter create his own new endings. It wasn’t until years later that I asked Peter what he thought of those many hours of DIR, and he said he felt like “Cinderella at the ball.” (see Profectum.org for parent training resources, especially the new free “Parent Toolbox”)

Once Peter started using a Vantage, an icon- based augmentative communication device, we added the habit of journaling and reflecting. See this little icon?  I would carry it in my pocket. On walks or outings, I would pull it out, and ask Peter, “So what do you see? hear, touch, smell, taste? ” whatever made sense, depending on the experience.  Later in the day, I’d pull it out again or draw it in reflections, during bedtime prayers or in conversations with his dad, asking “so tell Dad what we did? or how did you feel about that?”, so he could enjoy the experience, savor it,  thoroughly all over again. We would reflect on negative experiences too to reprocess them. So Peter built his foundation of emotional self awareness, perspective-taking, and internal standards at the same time he built his language. In fact, I’d go so far as to say that he put in the hard work of learning language because it was so emotionally relevant to him to talk about both the bad and good times of his life.

If you want to see the steps laid out methodically for building this kind of foundation using floortime and reflections for a child with minimal language skills, they’re all in a book I wrote in 2012, entitled “Teaching Your Child with Love and Skill: a Guide for Parents and Other Educators of Children with Autism, including Moderate to Severe Autism,” published by JKP.

What has happened in the 5 years since then? I would say an explosion or revolution in development. What made that possible was Dr. Ricki, who introduced Peter and me to Darlene Hanson, a speech pathologist from REACH who introduced Peter to supported typing (http://www.reach.services). Supported typing is a topic for a future conference; for now let me just say it is a way to support the child in all areas, and as Peter recently put it, “Darlene snared my fleeting thoughts, enabling my thoughts to get out and stand on paper rather than scurry for cover.” Typing gave Peter the means to show what he knows, such that he was able to eventually transition to diploma tract. Even more importantly, typing allowed him to express himself and develop his creativity with the written word, with the efficiency, speed, and flexibility that icon-based AC could not provide.

His poetry today (see “My World as a Poemhttps://www.amazon.com/dp/1544634110/) is very much a development upon our old journaling habits- he writes about his daily experiences and inner life. It came providentially at the time his OCD and anxiety exploded, as often happens in the teen years. So Peter had an outlet for and a tool to handle his emotional dysregulation in writing. Creative writing has been critical for Peter to process and handle his big emotions, and conversely, because necessity is the mother of invention, the big emotions have been a  driving force behind the development of his creativity. The illustration shows how stress can trigger the amygdala (lower brain) to activate a fight or flight motor response, but the frontal lobes (upper brain) may learn, with nurturing and practice, to modulate that response, especially using creativity as a strategy.

 

 

 

 

Let me show you how this works in a real life example.

Two weeks ago, Peter developed a new OCD. He discovered an extra long rubberband, which he enjoyed stretching and plucking in the usual way. But then he started holding it between his teeth, letting the end dangle like a long string from his mouth. I didn’t want him to swallow it, nor look really odd to others. But first thing when he woke up in the morning, he started lunging for the drawer where he had placed the rubberband the night before.

I sat between Peter and the drawer.

“Peter, slow down! Is something driving you crazy?”

Peter tried to reach past me for the drawer, that crazy, driven OCD gleam in his eyes.

“Ok, calm down. Take a deep breath. That’s it. Come on, tell me what’s going on. How badly do you need to do this, on a scale of 1 to 5?”

Peter typed, “4+,” as he perseverated, “Rubber band! rubber band!”

“Remember Peter, if you feel that driven, this may be an OCD. If so, it’s probably telling you some false thought like, ‘If you don’t get that rubberband, you’ll explode.’ Right? Ok, how about we slow down a minute, and just talk about it first. So tell me, what’s so appealing about that rubberband? What would you do with it, if you could get to that drawer?” Peter started typing about all the great qualities of a rubberband. Always fun to think about a compulsion. After he got his thoughts down, I suggested we play around and divide the thoughts into short lines of verse. We picked out the most vivid vocabulary,   made lists of words that rhymed with them, then rewrote the corresponding lines to get the rhymes  in at the end. After one stanza, I asked another question,

“But what’s the down-side of holding that rubberband in your mouth?” We brought in a little perspective-taking and reasoning as Peter repeated the process of getting down his thoughts, then organized them into the structure of poetic form. At this point, he was already into the rhythm of the game, and willing to continue, thereby almost unconsciously beginning the process of resisting the OCD. By the time we finished the second stanza, Peter’s upper brain was now engaged, warmed up, and had come to the conclusion that cons outweighed the pros and that longing for the rubberband did not make sense and therefore must be a compulsion. So finally I asked, “So Peter, you have a choice. If this is really an OCD, what does Dr. Gwen say to do? That’s right, take a baby step away. What are your strategies? That’s it, put it away and distract, or if that’s too hard, turn the mad dog into a sled dog and use the compulsion as a reward. (We often picture OCD as a big dog companion that Peter has to learn to live with, so we use that image of harnessing the motivation of a compulsion to get work done a lot.) What do you think you can manage?”  We repeated the same process of writing, dividing thoughts into verse lines, creating rhyming lists, and editing.  Here’s Peter’s finished product:

Rubberband, rubberband, elastic and round,

Rubberband, rubberband, sing your song.

“Boing,” stretch, dangle, and pull,

I can’t seem to get enough “boing!” to the full.

 

But holding it between my teeth,

Is not a thing to really eat.

OCD, the very picture I look,

Dangling like a fish on the hook.

 

So instead of keeping you in my head,

I’ll use you to get out of bed.

Mom, put it in my bathroom cup.

I’ll chase it there, and thus get up.

“So, Peter, did you enjoy writing your poem?”  I could see it in his face, the relaxation of the muscles, the crazy, driven gleam diminished from his eyes.

“Yes,” he typed.

“How did your stress level fare?” We use an emotional thermometer, scaled 0-5.

“From 4+ to 3+.”

“So how powerful is your creative power?”

“Very.”

There’s an addendum to this story. Once Peter put his plan into action, and got out of bed, I lined up his soap, toothbrush, and mouthwash in a row, putting the cup with the rubberband in it at the very end, so he had to go through the sequence of his self-help tasks first to get it. By that time, so much time had passed, that he was at a different place in the compulsion wave. It was passing, not totally, but he was at a better point. So it was time for another negotiation.

“Peter, how long do you think you should get the rubberband? You don’t want to lose all the ground you’ve gained, so it probably shouldn’t be too long.”

“Ten minutes,” he replied.

“That seems a bit long to me. How about you keep it as long as you don’t put it in your mouth. If you do, I take it away.”

Peter thought a moment, then abruptly took the rubber band out of the cup and placed it back in his drawer and walked away to the kitchen for breakfast.

So rather than lose control of the rubberband, he decided to hide the visual trigger and not engage in the compulsion at all. It was the best possible outcome. Peter’s choice, to carry out his own initiative, a strategy he came up with himself, that did not carry out the compulsion and therefore not reinforce it or strengthen that OCD circuit in any way, all while exercising his frontal lobes and strengthening his brain connections top to bottom (point to first stanza, slowing down the reactivity), left to right (bringing in reason), so executive function could come online (point to third stanza). You could just watch those synapses grow, and watch the development of emotional regulation.

So my question to you is, could there possibly be anything more therapeutic than the arts? With the arts, the child has a positive means to channel and let go of all the anguish inside, to fully express, understand, and process his emotions, positive and negative. Those brain glitches may be companions our children have to live with the rest of their lives; how much healthier it would be to learn to accept, channel, and transform negative emotion, rather than simply try to squelch it all the time. This is by cartoonist Matthew Inman. Peter and I love this image, which has become our modus operandi for dealing with emotional dysregulation.

dong-combat-your-monsters.jpg
M. Inman

 

 

 

That’s one of the most important lessons Peter and I learned from DIR. Negative emotions are not all bad. We can learn not to be afraid of nor to  make an enemy of those big emotions. They can serve as powerful motivators for development.

 

 

 

 

I encourage all of you to explore the arts as the integrating and transforming channel that may turn emotional challenges into the development of emotional regulation, creativity, self-awareness, and self-esteem. And to make something potentially beautiful and enlightening for others in the process. With art, you can be yourself, at your own pace, and there are no restrictions or disabilities in the imagination. It can’t get much better than that.

Don’t take my word for it. Peter wrote this poem, revealing how the arts have transformed his life. (The poem is symmetrical, with the last four stanzas corresponding to the first four in reverse order.)

I am autistic,
Greedy eyes and ears,
Wet in the rain of sensory deluge.

I’ve been a prisoner,
Captured in silence,
Voiceless and unintelligible.

I’ve been a slave,
Strapped to my obsessions
Ordering me to do nonsense, perverse to my character.

I’ve been a paralytic,
Feet stuck to the street,
People swirling around me.

I’m a listener,
Watching and receiving
Like a peaceful tree. 

I’m a tiger tamer,
Harnessing  the energy of my compulsions
To write one more line.

I’m an escapee,
Flying my soul like a kite
On a string of words.

I’m a poet,
Exploring the world with keen senses,
Sharing with you a bite of fresh air.

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The refrigerator door stood open, as Peter hesitated. He handed me the chicken, then snatched it back and put it into the refrigerator, while handing me the fish. Then it was the leftover rice in the pot with an abrupt switch to the leftover rice in the tupperware box. He finally handed me something he wouldn’t even eat after I microwaved it, but instead ran into the family room. He turned on the TV, then quickly positioned a chair facing the corner, back to the TV. He ran down the hall to his little brother Luke’s room, and returned with one of the boxes Luke stores Pokemon cards in (cards emptied out), and started tapping and turning it. I firmly took the box out of Peter’s hands and hid it under the sofa.

“Peter, slow down! What’s going on?”

Peter’s eyes burned as he reached for the box and gasped, “Bok, bok!” (for “box, box”)

“Ok, calm down. Take a deep breath. That’s it. Come on, tell me what’s going on. So what happened there at the refrigerator? Can you write about it?” As Peter started squeezing my hands, I said, “You will get that box. But first let’s put some brakes on this. Remember, when you have an intense OCD, what does Dr. Gwen tell us we can do to delay it?”

Peter typed, “I can harness this sled dog. I can let myself have the box if I finish.”

I told him that was a great idea. If only he would write down his thoughts about what was going on at the refrigerator, then with the chair, then with the hand squeezing. Knowing he loves poetry, after he finished that, I gave him the challenge of putting it into verse, and adding rhymes. After he completed each stanza, I asked him to rate his OCD intensity as higher, same, or lower. I kept hoping he would say “lower” as writing bided time for us. Unfortunately, he kept saying “Same.” I tried to make the best of it, “Hey, you see, it’s not getting worse!” Here are Peter’s first three stanzas (English sonnet form abab, cdcd, efef).

Give me chicken, no let’s not.

Give me fish, no, another mistake.

First the rice in the box, not it’s the rice in the pot.

OCD picks the one thing I hate.

 

The chair in the corner is where I must sit,

Facing away so I can’t see the TV.

It doesn’t make sense, not even a bit.

No matter, OCD’s punishing me.

 

I’m squeezing your hand to wring out my pain.

Give me the box you put under.

I’m taking deep breaths but still going insane.

OCD rips and tears me asunder.

 

Finally after the third stanza,  I asked Peter to rate his OCD. He typed,

“The box compulsion is surprisingly better,

As I delayed it while writing this letter.”

(That couplet completed the 14 lines of an English sonnet.)

“Wow, Peter!” I exclaimed, look at that! See how strong your creativity is!

Peter typed, “Strong enough to resist a 5/5 compulsion.” All lit up, he said with a big smile and gesture, “Bok, peez!”

“At this point, you have definitely earned that box several times over. But I want to know what you, Peter Tran, upper brain, really want to do now. Because OCD has been bossing you around all night and made you pick something you didn’t like out of the refrigerator and sit in a punishing corner. Wouldn’t you just love to slug OCD back one more time? Why not eat a piece of delicious piece of pizza first for dinner, and then get the box?”

I held my breath. I truly was totally prepared to let Peter take the box from under the sofa. Instead, he did something remarkable. He stood up and slowly walked to the kitchen. At one point he stopped, and started to turn back, but I positioned myself between his body and the sofa. Smilingly I encouraged him, “You are doing great, Peter.”

Peter turned abruptly back to the kitchen and headed through the door.

I’m sharing this story because I want to encourage you kids suffering from OCD and you parents trying to help your children deal with it. It may not be possible to completely change the wiring glitch that causes OCD, but you can build up the attention shifting and compulsion inhibition skills required to achieve a long enough delay for the compulsion wave to wane, and the frontal lobe engagement to move that broken record on a different track. Use deep breathing and the hope of eventually getting to do the compulsion to create some relief from anxiety. Help your child to recognize that it’s the intrusive thoughts of OCD, not his own, that are making him feel he needs to do something that doesn’t make sense. Distract him, help him shift attention away by engaging the upper brain/frontal lobes into an exercise you know he likes (In this case, I know Peter loves to write). Support him to initiate a strategy like delay that you’ve talked about together beforehand, and to self-monitor his state of being so he can watch the intensity of the compulsion fall and be encouraged by his own success. Doing something creative is especially powerful and rewarding because the child can create his own ending to the story; if he pretends to be successful, chances are greater he will become successful by being able to process what’s happening and envision a positive ending. Be transparent in your coaching, and tell your child what you are doing and thinking so that he can understand, want to cooperate with, and imitate it. It’s a goal for him to learn how to talk to himself in the same way. Most importantly, signpost his accomplishment. Be the banner bearer of his success. As Dr. Gwen tells us, the one thing that equips your child best to combat intrusive thoughts is the realization that “I can do this. I do have a choice.” That self concept and self esteem is built through accomplishment. So whatever progress your child makes, whatever small step in the right direction he is able to accomplish, even a baby step, proclaim it and rejoice! Developing emotional regulation is a slow process, but with each victory, another inhibitory or attention shifting synapse is born.

Admonition by Dr. Gwen Palafox, illustrated by Clarissa Kano

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“Come on, Peter, let’s keep going. You can do it,” I said unconvincingly as we slowly trudged down the promenade. We came to Descanso Gardens to try to walk off a 230 calorie ice cream bar Peter had snatched from the grocery store freezer right before check-out.

 

I got him past several benches. Finally it was clear that the inertia was too much to overcome. Peter started squealing, and I knew that the chin-banging would soon follow. We spied a bench next to a duck pond at the end of the promenade.

 

Peter looked at me, hopeful. “Ok, just for a minute, Peter.” He made it to the bench and plopped down in relief. I sat next to him, a ball of frustration and worry. The doctor had told us that exercise was imperative, both to control Peter’s weight gain (due to his insatiable appetite) and to help temper his stimming, impulsivity, and emotional dysregulation (chin-banging). But how were we supposed to exercise when he has catatonia?

 

I didn’t know what to do. But the gardens were beautiful. There was a heavy, dark branch of a large oak draped over our heads like a canopy covered in tiny green leaves, sparkling in the late afternoon light.

 

I pulled out Peter’s iPad. “Under a green bower,” I typed, then offered the keyboard.

 

Peter started typing. The magic of the garden cast its spell of peace over the two of us, as Peter crafted his poem.

 

The quack of ducks. caw of crows,

flap of wings,

the rush of water,

the murmur of voices

happy sounds of a fall afternoon.

 

Under a green bower,

the water ripples, cool and quiet.

A school of goldfish swim by,

a streak of color.

Green heads, blue underwings,

a splash and flash of bright yellow,

The ducks preen,

hoping for a fish.

 

A boy sits and points,

disappointed at the dancing ducks.

I feel the same way.

How I long to hold you

Pretty, fluffy duck!

But you get away.

 

We sat a few minutes, the poem impressing the beauty of the scene into my spirit.

I said, “Peter, I loved your poem! The Lord gave you the gift of words, a gift of something lasting. Whenever I read this poem I can come right back here to this pond and experience it again.” Peter typed back his reply, “Thanks Mom, good poem. I enjoyed it. I wish we could do this every day forever.”

 

Just then, a man appeared behind us. He unlocked the gate to the Rose garden which was sealed off for a ticketed lighted carved pumpkin display to open later that evening. He drove through the gate in his tractor, leaving the gate open.

 

Peter stood up. He took my arm and led me away from the pond back to the path. “Peter, did you want to go this way or that way?” Peter pointed to the gate. As Peter pulled me along, I became intrigued. Before us were hundreds of Jack O Lanterns, some laying on the grass, some suspended in the air, wearing every variety of expression, many glowing softly with lights. Peter urged us on deeper into the Rose Garden, now transformed into a giant pumpkin patch. “Peter, I don’t think we’re supposed to be here. And the gardens are closing, it’s getting late.” Spooky music started wafting through speakers stationed overhead. That persuaded Peter. He turned me round and escorted me swiftly back through the gate, down the promenade, into the parking lot. “We made it, Peter! And no one saw us!”

 

As I related our adventure to Peter’s psychologist, Dr. Gwen, she pointed out how it had demonstrated the efficacy of floortime therapeutic principles. When a child shows signs of emotional dysregulation, consider the possible causes- a sensory or motor issue, primary emotional cause (such as panic attack or OCD), or behavioral (such as anger or frustration from not getting something preferred or trying to get out of something nonpreferred). In this case, Peter had a motor issue, inertia/mild catatonia, and we relieved the dysregulation by sitting down. That addressed Greenspan’s FEDL (functional emotional developmental level) one, getting a child into a calm, regulated state. When I offered the “stem sentence,” “Under a green bower…” Peter engaged with me. That was accomplishing FEDL two, joint attention and engagement. The poem allowed Peter to shift his attention completely away from the frustration of being made to walk when walking was hard and effortful to the beauty of the natural scene before us. Sharing and discussing the poem brought us into FEDL three, back and forth communication, and of course much beyond to a bit of self-reflection. Fully re-compensated, Peter was then ready to engage those frontal lobes to exercise the curiosity that overcame his inertia/catatonia completely and take the initiative (FEDL four) to explore the Jack o Lantern display, and power me swiftly back to the car. Intent, driven by the emotion, not conscious, voluntary, heavy handed willpower was what circumvented Peter’s motor disability, the faulty start signal in his basal ganglia that initiates motor actions.

 

I was both stunned and grateful. Just as embryology recapitulates ontology, so we parents must recapitulate the levels of functional emotional development in the individual scenarios of daily life. When dealing with any dysregulated individual, keep in mind what you do with a fussy baby. You first take care of physical needs and adjust environmental stimuli and demands. (Get in a quiet room, rock the baby back and forth. Choose a beautiful natural place for Peter, let him sit down when motorically exhausted.) Invite, don’t pull the child into engagement. (Smile gently at the baby and coo. Offer Peter the keyboard with a stem sentence.) Constantly attune to your child’s feedback to create a fun back and forth. (Wait for the baby to smile back at you, and adjust the pace and amplitude of your coos and smiles according to the baby’s feedback. Scaffold the offering of encouragement and more stem sentences or phrases unobtrusively, and as needed as Peter crafts his poem). Recognize and encourage initiation. (If the baby starts laughing, widen your eyes and chuckle back. When Peter started pulling me through the gate, I went, though cautiously.)

 

We had a wonderful afternoon at Descanso. I may not have known what we were doing, but upon reflection, I learned a lot. You can’t rush. Those fundamental stages of emotional regulation and attunement are critical, and you must take whatever time it takes to address them thoroughly. I often feel myself pulling, doing 90% of the work to move Peter through an episode of dysregulation. That’s what happens when you’re trying to get through to an upper brain that may be mostly inaccessible at the time. Take down the emotional affective filter first, and then you can talk. The heart has reasons the head knows none of, and dealing with autism frequently requires the heart to lead the way.

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