Sunday, October 25, 2009

Children with Social Reasoning Difficulties

I have always been a fan of Amelia Bedelia. She’s a character in a children’s book, and she takes life very literally. My favorite scene in one of her books occurred when she was playing baseball. She was on third base, and the next batter hit the ball. Her teammates told her to run home, so Amelia Bedelia ran to her house. Little did I know back when I was first reading about Amelia’s escapades that many of the children I work with live life much like Amelia’s character.

Children with social reasoning difficulties often communicate very literally. Hidden meanings, inferences, or sarcasm are quite confusing. In addition, they do not understand idioms. If you told a child with social reasoning difficulties that you had a green thumb, she might very well grab your hand to check it out. If the weatherman said it would be “raining cats and dogs,” this child might stare out the window all day waiting for the first animal to fall from the sky. Children with Bipolar Disorder, Asperger’s Syndrome, Nonverbal Learning Disability, Seizure Disorder, and some with Attention Deficit Disorder struggle with understanding some of the social nuances that we come to understand as we mature.

How does this play out socially?

Children, or adults, for that matter, who see life in its most simple terms, very factually and literally, expect people to respond in a very predictable manner. The child with social reasoning difficulties often experiences anxiety, confusion, frustration, and feels annoyed when people don’t respond as expected.

Since thinking is so literal and concrete, statements feel like promises, and disappointment is often felt when those statements don’t happen. There are very few, if any, gray areas. If a parent tells a child that “we will try to get to the toy store,” but it turns out there isn’t enough time to go, the child feels let down because he heard it as a fact.

There is an inability to generalize information to other, similar situations. The child walks into many of his experiences without any preparation or understanding of what will happen, creating high anxiety. A child who learns to cope with life as a fourth grader is panicked at entry into fifth grade. He doesn’t use his prior knowledge to predict how his day will be.

When a situation has passed, talking about ‘what happened’ doesn’t really make sense because the experience has ended. While understanding how she dealt with an issue, what she can do differently next time, and how others reacted makes perfect sense to us, the child with social reasoning difficulties doesn’t make the connection between past and future experiences.

Some children want to have friendships, but don’t understand the social rules that go along with it. The child with social reasoning difficulties doesn’t have awareness of some of the basic friendship necessities, such as staying on topic, talking about mutual interests, taking turns, using eye contact, or attending to nonverbal cues.

How can we help teach social understanding?

The key to success is patience, understanding, and teaching. While typically developing children pick up on these lessons through life experiences, children with social learning difficulties don’t naturally attend to the very things that could guide them. So it is our job as parents, friends, teachers, social workers, and community members to assist. Here are some tools that each of us can use when we encounter a child who seems to fit the description.

Preview the experience. Carol Gray has coined the term 'social stories.' Basically, help the child prepare for what's coming through telling the social story of the situation. Going to a birthday party, getting ready for a new school year, going to a family gathering, or going on a trip all can be converted to a social story! While you can't predict every moment of a situation, you will relieve a great deal of anxiety by helping the child to understand what's going to occur. Here's an example if you're going to Grandma's for Thanksgiving:

Talk about who’s going to be there and who the child will probably sit near at the meal. Discuss the types of food to expect, and what to do if he doesn’t like some of the foods. Talk about what activities might be going on – football game on TV, kids playing games in the basement, or people helping clean dishes in the kitchen.

Compare and contrast. Helping a child to learn to generalize, or relate two different events, is crucial in reducing anxiety. Comparing and contrasting Thanksgiving at Grandma’s and Christmas at Aunt Lisa’s helps the child to make the connection between the holidays and get-togethers. Learning to identify commonalities helps the child to predict or anticipate his experiences.

Supervise and guide in the moment. Chronological age is not the predictor of social maturity. Children with social reasoning difficulties need direct guidance beyond the age typically expected. It is not unusual for a parent of a seventh grader with social difficulties who has a friend coming over to discuss activities that they can do, and then help negotiate transitions between those activities. As difficult as it might feel, remaining within earshot helps to guide the child in having a successful day with a friend.

Break down the abstract. It’s easier for us adults to explain things in a more literal fashion than to expect the child to understand the abstract or hidden messages. Here’s some examples of what we say, and how they’re heard:

"Wait a minute." This means, "I'm gonna count 60 seconds and then Mom will
answer me."

"Don't bother me now." Interpreted as, "I can bother her in 60 seconds."

"Can't you see that I'm busy?" The child might respond, "Yes, I see that you're busy, now answer my question."

It takes more time and thought for us to have to explain our intentions in a direct, concrete way, but it is so important in helping the child understand us. "I have to finish putting the steaks on the grill, and then I will help you with your homework" is much more concrete than "wait a minute." The child can visualize what will happen.

Cut out faces from magazines. Make cards from faces you cut out of magazines that depict different emotions and activities. Play games such as "What's the story?" or "What are they feeling?" with the cards. Teaching children to look at faces for social clues helps them begin to recognize feelings from facial expressions, and teaches them to tune into people's expressions for communication signals. Work to translate the face card recognition to real life by pointing out nonverbal expressions on people around you. An example of this might be, "Look at Daddy's smile - he is so happy to see you!"

If you know a child who resembles the description above, it is a good idea to read the book, The Curious Incident of the Dog in the Nighttime by Marc Haddon. The author, a man who spent years working with autistic children, wrote this story from the perspective of a 15-year-old boy named Christopher, a child with autism. In it, Christopher negotiates the events of his life with the literal interpretation, peculiarities, and anxiety typical to children with social reasoning difficulties. Seeing his life as he feels it will open your eyes to the lives of these children. Understanding their view of the world is key to knowing how to guide and support them. These children represent one of my favorite groups of clients. Perhaps it is their innocent perspective on life, or maybe it’s their incredibly enduring spirits. Each one of them leaves an indelible mark on my heart because of their resilience, strength, and courage. While we have a lot to teach them about our fast-paced, sometimes cynical world, we can also learn a lot from them.

Monday, October 12, 2009

“Hey Mom, what’s for dinner?”

One of the most important things we can do with our children is share a meal together. If you’re like many families, finding time to prepare, let alone eat a meal together, amidst carpools for dance, soccer, Hebrew School, CCD, and violin practice is nearly impossible. Yet it is one of the most connecting times you can spend as a family. Take a look at what you can do to bring the family together for dinner at least 2-3 times each week. And let’s talk about what you can do to create harmony in your family during these times.

1) No cell phones, television, or other distractions. Treat this time as truly family-focused. Unless you, as a parent, are on call for your job, it is important for you to model the time as ‘family first’ by not answering your phone or allowing other things to distract you from this sacred time.

2) Don’t be a short order cook. When you plan your family meal, keep all members in mind. Make sure there is something on the table that each person will enjoy. This doesn’t mean you have to make 5 different entrees. Instead, make sure the vegetable, salad, or potato is something that even the pickiest eater will enjoy. Offer each member a taste bite of everything. This is really just a ‘pea-sized’ taste. Sometimes tasting a food over time will help develop a liking for it. But don’t force-feed the food. That creates more food issues with children than just exposing them to it and allowing them to experiment. I still don't eat green peppers or olives, and I think I'm doing ok!

3) Be creative. In our house, we once used a Sunday meal to taste different sauces. What the kids didn’t pay attention to was that they were actually eating chicken that they normally didn’t eat. But because we were tasting sauces, they attended to the teriyaki, BBQ, ketchup, honey-mustard, etc. that was on the table, and had a sheet of paper to rank each flavor. It was fun, and I learned that almost anything became edible if teriyaki sauce was used!

4) Serve your food family style, and let your little ones help themselves rather than put the food on their plates. All three of my kids were picky eaters. I was so frustrated when they were little because even spaghetti was on the list of ‘don’t like’. Spaghetti – who ever heard of a kid who didn’t eat spaghetti! One day, I was running late and didn’t have time to fully prepare the meal. So the noodles were in the strainer, the sauce in a bowl, and I just brought it all to the table. Each child was so excited to put the noodles and sauce on her plate and they all took second helpings. I never realized that having them scoop it out themselves made the difference in them ‘owning the meal’, and thus, eating the meal!

5) Once I realized that they liked to serve themselves, I also began to let the little chefs into the kitchen. Each child picked a Sunday, created the menu, went shopping for the food, and helped prepare it. Because a child was involved, there was more willingness by her sisters to try different foods. The chef was delighted to eat what she prepared, and typically had a menu choice that was kid-friendly. Our favorite was a sloppy joe recipe that combined some of the most unusual ingredients into a delicious tasting meal! The kids loved putting the odds and ends into the frying pan and were shocked at how it turned out so yummy. I’m including the recipe here for you to try. This comes from a District 102 cookbook, but the ingredients have been slightly modified. Thanks to Fran Horwitz for the recipe.

Sloppy Joes the Fun Way

1 ½ lbs. Ground beef or ground turkey
1 small bottle of ketchup
2 Tablespoons brown sugar
1 Tablespoon grape jelly
1 Tablespoon mustard
1 Tablespoon white vinegar
Onion powder, salt and pepper to taste

Brown beef or turkey in a frying pan and drain.
Add all other ingredients and simmer for 20-30 minutes.
Serve on buns.

6) Don’t force your children to eat just because it's dinnertime. Babies feel when their bodies are hungry, and signal their hunger with crying. As they get older, we put them on a schedule because it socially and logistically fits into our lifestyles. Having a family meal is more about spending time together as a family, talking, laughing, and sharing about each person’s day. Food happens to be a part of it. Kids who are given opportunities to taste different foods, but are given the ability to decide how much they want to eat actually develop healthier eating patterns than children who are given platefuls of food and made to consume what’s in front of them. Sometimes a child is truly not hungry at that moment. It is important to make sure they are not snacking from 2 p.m. until 6 p.m. without regard to their body hunger, because that is not listening to the hunger cue either. But a child who can get a snack when he feels hungry can also let you know when he is not hungry – and sometimes it coincides with dinnertime. Don’t make a big deal of it and most likely it will not become a behavioral or attention-getting issue.

7) Don’t make dessert the reward for finishing dinner. When you place such importance on dessert, you increase its inherent value to a child. Dessert is just a snack. Make sure you help your children attend to what kind of snack they feel like eating. Sometimes, that cool feeling of ice cream, rolling down the back of your throat, is the perfect thing. Other times, the crisp, crunchy bite into apple slices, juice dripping down to your chin, is what you desire. My favorite snack is cold, creamy vanilla yogurt, mixed with crunchy grape nuts and chewy raisins. Teach children to think about what they want to eat – this is the beginning of attuned eating - eating when you’re hungry, and eating what you’re hungry for. Sometimes it’s sweet, sometimes it’s chewy, sometimes it’s hot, other times it’s cold.

Above all, make sure family dinners are a time to check in with each person. Make dinner last as long as you can, but not so long that the children are squirming and misbehaving, so that becomes your focus. Sometimes, ten quality minutes of sitting down, self-serving the food, and sharing a few thoughts together is all it takes to help your family feel more connected. Try it tonight!! Bon appetit!