Neuro vs Psych and definacy/discipline?

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Neuro vs Psych and definacy/discipline?
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Sat, 04-15-2006 - 11:29am

I got in touch with the child consultant at Asperger's Assoc. of NE this past week and got some referrals for consultants for Sam's school (AS, nearly 7, 1st grade)

We had an interesting conversation about attacking AS issues from a neurological standpoint instead of the psychological standpoint that most behavior modification techniques use. Well that makes total sense to me and I think at home we do a pretty good job of heading off most issues using routines and rewards. Lately it's been difficlt because half of our things are still upstairs on the 3rd floor and slowly trickling their way down to the 1st floor apt and we're all thrown off our schedule....etc. Mornings and evenings and homework time is difficult. I think spring break will go a long way in helping us get settled and rework our routines.

But my question (or is this more like thinking out loud?) is that there are times when Sam is out right defiant. This could be just a kid thing that all kids do, but he responds differently because of the neurological condition. An example, he's finally gotten good at doing BMs on the toilet. We're working on using the correct amount of toilet paper. He downright refuses to use less than what he feels is neccessary which is of course enough to wipe an elephant. I've tried showing him how to flatten the paper so you have more surface area with less paper...etc. Well, last night I'm nursing DS #2 at bedtime and I can see Sam getting ready to wipe in the bathroom. He's got the tp roll on the floor and he's rolling rolling and rolling the paper around his hand. So I say, "that's enough Sam, stop. You're using too much, stop." He keeps going, looking at me straight in the eye with no expression at all. If the toilet wouldn't overflow I could care less. He had already been having a crazy night getting ready for bed; didn't want to do anything and was giving DH a really hard time about it, so I took away night time stories (which he hates and so do we.) I'm not sure it will help in the long run though.

How do you deal with that kind of defiance? Is that an AS thing or just a normal kid thing? And what about the neuro vs psych. thing. Isn't all discipline, reward systems, behavior/chore charts.....etc psychological techniques? What neuro. based techniques do you find helpful because while I get what she's saying I'm not clear on the difference between the two.

Chrystee

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Sat, 04-15-2006 - 10:36pm

oh ((((((Chrystee)))))))


I wish I had some great words of wisdom for you.

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Sun, 04-16-2006 - 10:36am

What is it with kids on the spectrum and bowel movements??? Now, almost any time I know of another parent having those difficulties I watch the kids and I'd swear they are ALL on the spectrum.

As far as the defiance, the way my sons' psychiatrist (whose sole practice is children and she is such a wealth of information on ASD) explained it to me is that they are not really being defiant in the normal sense. Stubbornness is an expression of being "stuck" and unable to get around the issue. I suspect the toilet paper is a sensory issue. He may be afraid of soiling his hand when wiping, and feels the need for extra paper as insulation from what he is wiping away. Or, his bottom may be sore and he needs the extra cushion. Or maybe there's an association with rolling up all that paper and using the toilet that he can't get past (or maybe the act of rolling all of it up is comforting during a process he finds unpleasant). I would ask some leading questions to get to the bottom (hehe) of this. If you don't understand the source of the problem, behavior mods may not be very effective.

My boys like to use flushable wipes. They feel they are getting really clean and it makes them feel more secure. It may be a hold over from when I used to clean them up as infants and toddlers. To them, maybe it's just "how ya do that."

(I never DREAMED I would be on a bulletin board discussing this stuff, LOL!)

Kelly

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Sun, 04-16-2006 - 11:35pm

"(I never DREAMED I would be on a bulletin board discussing this stuff, LOL!)"

No kidding huh!

The issue you mentioned with getting "stuck" we like to call in this house "sticky thinking". A CORE ASD issue that we deal with here.

Thing is getting at the route of why a particular child is stuck.
Is it a communication issue and they can't communicate what is frustrating them? Or perhaps they didn't understand the direction in the first place?

Is it a change/transition issue? Some unexpected change that if they were warned in advance would be fine?

Is it medical/physical and they are feeling just plain yucky and don't really sense thier body they way and NT does so they don't understand that they feel yucky, are hungry, are hurting? etc

Tonight we had this problem in a big way with Cait. Tomorrow school starts up again and she needed to take a shower and do her evening checklist. Well she has been feeling yucky since Friday. She forgot tomorrow starts school and wasn't ready for the transition to school routine again and she got STUCK big time. She just cried and bawled and couldn't be reasoned with about taking her shower. Take a short one and be done.

Finally, I asked if it would help if I helped her. And there I was showering my nearly 12 yo, 5'5" dd who totally looks like a woman while I was trying to give her as much privacy as possible.

Sometimes you gotta do what you gotta do. She may look 15, she may desire with all her hear to act 12 (or like a middleschooler/adolescent) but in many many ways she is still 6 and still autistic.

But she is showered, feeling better and on the road to her old sweet self again.

Renee

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Sun, 04-16-2006 - 11:42pm

I also wanted to say that often times, folks who do not understand this part of autism will want to label our kids as defiant, ODD (oppositional defiant disorder), manipulative, difficult, etc.

Thing I have found is if I keep how they think in mind and try to plan for these things that will get them stuck and be flexible and help them when they are stuck, they are actually very complaint, sweet, helpful kids.

You are on the right road of discovery.

Renee

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Sun, 04-16-2006 - 11:51pm

"Thing I have found is if I keep how they think in mind and try to plan for these things that will get them stuck and be flexible and help them when they are stuck, they are actually very complaint, sweet, helpful kids."

When we quit labeling the behavior as oppositional and started trying to find out why he was stuck, Ian became a much more loving and sweet kid. We liked him again, and a mutual respect has grown.

Kelly

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Mon, 04-17-2006 - 7:46am

Chrystee,

I think Kelly is onto something with the "stuck" theory.

To me, Sam's behavior and demenor didn't sound like out-and-out defiance. It sounded to me like there is something deeper going on. There is probably little point in addressing the "defiance" aspect, until you address the 'something deeper' KWIM? It is probable that taking this approach will cause the "defiance" to self-correct.

-Paula

-Paula

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Mon, 04-17-2006 - 6:50pm

Yeah, the BM thing is a pain.

I think part of it with the defiance/stubborness issue is my pure laziness. Sigh, I'm just so tired of making every little thing we do some kind of learning proces. Sometimes I just want him to shut up and do it my way ;) LOL I do so much with him to keep him together that I'm just tired.

I'll try asking him about the tp issue. I seem to remember that questioning him about this in the past has ended up with an "I don't know" but it couldn't hurt to ask again.

Thanks!!!

Chrystee

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Mon, 04-17-2006 - 7:46pm

OK, the bm is just and example of other things that happen. I know that there are many various reasons why he may not like to wipe his butt at all; these are things that we are working out.

It's when I tell him to stop doing anything and he looks me in the eye and does it anyway that I have a problem with. Sometimes if I try to stop him he starts to laugh and hit me so he can keep doing whatever it is that is off limits, inappropriate...etc. I should say that we use timers, give warnings, have a visual schedule.....etc to help transitions. In the case of the tp he'll often laugh then throw the ginormous wad of tp in the toilet and flush before I can show him how much is ok and how to make it work. He'll often say, "no, I'm not going to do it that way" at the top of his lungs.

Again, I get this can be attributed to other things and is not defiance per se. But what do I do about it, at the time, in the situations, at that exact moment. If I'm nursing the baby and he is about to do something that's inappropriate, I tell him to stop and he doesn't.....what do I do? What happened to the "listening the first time" rule someone mentioned; wouldn't that apply here? Just 'cause Sam has an AS dx doesn't mean he should be allowed to continue to use too much tp despite our best efforts to teach him and find out a better way to help him learn.

Yes, we need to figure out what's up so he can learn better, but before it clicks, before he gets it, he's still not allowed to climb on the furniture and jump on the cat, run out in the street or hide in the grocery store. If I tell him, no, stop, it's still no, stop.

I don't want it to sound like he's running rampant all over the place. He's not, he's ususally a good, compliant kid. He likes his routines and usually gets ready for school and bed fine, does his small chores fine....etc. But there are times, perhaps when nothing we do would help anyway (like allergy season or a rough day at school) when he cannot hear/listen. Do I let it go, what kind of consequence is appropriate that will help him learn that what he did was inappropriate? Is any consequence appropriate for this kind of behavior considering the neurological issues we're dealing with. Each kid is different so the consequences would be different too.

Chrystee

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Mon, 04-17-2006 - 11:18pm

When I need to ask my son about something (i.e. "does it hurt when you poop?"), it helps to ask him during a "non-threatening" time.

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Tue, 04-18-2006 - 1:03am

Chrystee, I so feel your frustration! I know exactly what you mean, too. Sometimes it IS just seeing how far they can push the limits and boundaries. It may not be politically correct, but on occasion I have found a spanking to be effective. I'm not talking about a beating, just a swat on the behind. It never worked for Ian, but it does for Duncan. It is rare that I do it, and in fact if we are in public and I KNOW he is testing to see what I'll do, I get right down to his level, look him in the eye and say, "Right here in front of all these people I will spank you if you don't stop right now." I've only had to spank him in public for testing me one time. We were in the check out isle at the grocery store and he wanted candy (don't you love how they place that stuff right where you can't avoid it???). I would not get him any and he started to yell at me, call me dumb and kick me in the ankles. There were two young men behind us in line and they were just cracking up, because I'm sure it was really funny to watch him. Everyone knew exactly what he was doing. I asked him about 5 times not to kick me, that kicking me and calling me dumb would not get him any candy, but he kept doing it. All the while everyone was trying very hard not to laugh because they didn't want to embarrass me any more than I was and they didn't want to encourage him to continue, but yet it WAS funny. Very calmly, although I was embarrassed to do it, I spanked his bottom firmly three times. He cried because his pride was hurt, but he has never done anything like that again. He thought because we were in public he could embarrass me enough to get his way. Not all autistic kids are incapable of manipulation, which I didn't know, and so thought him to be NT. Not, so, not so, LOL!

On the other hand, Ian went through a stage where he would argue with us no matter what it was. I don't mean argue as in angry arguments, but more like an attorney. He had an argument for EVERYTHING. He had his own logic and felt so entitled to follow his own desires. He was openly defiant on a regular basis. He had absolutely no concept of authority and seemed to think we were his peers instead of the grown ups in charge of him. Of course, I had no idea what I was dealing with, but I had visions of him ending up in juvinile detention or institutions. Once we got him on the proper meds for his ADHD, it stopped. Maybe a lot of it was poor impulse control and the inability to listen long enough to be persuaded. I just don't have any really good advice for you on the defiance unless it's ADD because NONE of the behavioral techniques consistently worked for Ian until he was on the proper medication. Absolutely none of them. What I did with Duncan at the grocery store would never have worked with Ian. He truly had a condition that rendered him incapable of responding to any form of discipline. Now it's a different story. He responds very well to logical consequences.

I do the "calm down" step or with Ian a "break" in his room. I don't like the "naughty" step because it emphasizes the undesirable act rather than what I want him to do, which is to calm down and be reasonable again. I have actually gone to sit on the calm down step myself, and Duncan will come over and say something like, "Are you feeling calmer, now?" which cracks me up because he's so solemn when he says it. Anyway, I like the calm down step because if I punish for anything but true boundary testing, he gets stuck and dwells on whatever bad feeling he has and there is no place for learning to occur. This baby has a proud streak, and I have to help him save face whenever it comes to sensory issues or anxiety. I will say to him, "When you feel calm enough to cooperate you can join us again." With Duncan, and now with Ian, too, I use a lot of insentives.

As far as books that have helped me with discipline, I personally am a big fan of "Parenting Your Spirited Child" which is wonderful for autistic kids even though it wasn't (I don't think) intentionally written for them. But I don't think any one approach is the be all and end all, and what works for one kid won't necessarily work for another kid. So much of it is trial and error (or trial by fire, LOL).

I hope I don't come off as preachy or like I have all the answers because God knows, I am constantly struggling. I have had days when I can't figure out WHAT to do with my kids. It usually passes, though, and eventually it works out. And then the next challenge comes, LOL!

Kelly

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