Therapy for flexibility/coping skills???

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Registered: 03-31-2003
Therapy for flexibility/coping skills???
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Wed, 08-31-2005 - 7:56pm

David has been seeing a developmental pediatrician for a year now, but so far the only thing she's done is prescibe medicine. In David's case, that has been absolutely necessary, and a real life-saver, because he has a mood disorder as well as AS. But we're at a point now where he is "stable", but he could use some additional help.

In particular, I see lately that he is having a lot of trouble handling disappointments. For instance, he often gets obsessed with the idea of building a certain Bionicle, and if it is ten o'clock at night, I have to say no. The night before last, he was really tired and all ready to fall asleep, and then he suddenly got the idea to build a big Bionicle. I kept saying no, and he became so disappointed that he gave himself a stomach ache and cried himself to sleep. I've seen that he often gets stomach aches when he doesn't get his way, but usually he's not sleepy enough to fall asleep. Last night, the same thing happened, except he didn't fall asleep. I could tell that he WANTED to be able to just accept "no" for an answer, and to accept that he could build his Bionicle tomorrow, but he just couldn't. I ended up compromising and letting him put together a small piece, just so he'd be at peace enough to sleep. That wouldn't have worked if his brother had been awake, because I don't like him to see David "get away with stuff". (BTW, he woke up bright and early before anyone else, which is unusual and finished the Bionicle before school.)

He also gets real disappointed if he wants me to play with him and I can't/don't want to. I could play with him for five hours straight, and if I quit before we're "done" (whatever THAT means), he gets so distraught he can't function.

To someone who doesn't understand kids on the spectrum, it might look like he's simply being bratty and just wanting to get his way as a control issue. I know that's not what is happening. He has an idea of what he wants to do, and he really suffers when things don't work out as he envisioned it. You guys get it, right? I'm seeing that he REALLY needs help in learning to be flexible. So...is this where therapy comes in? What would a therapist do to help him with this? I feel like I have a pretty good handle on it from my end; I'm not punishing him for acting bratty, and try to "give in" consciensciously, with an eye towards helping him cope and learn. I feel like we're on the right track; lately he's been coming and hugging me in a "help me cope with this, Mom" kind of way.

Do any of you have kids who are receiving one-on-one or family therapy for this kind of thing? What helps, what is just a waste of time/money? Any BTDTs? Any thoughts would be appreciated.

Evelyn, mom of David, 7 AS and Nathan 4 (who has his own issues but no dx)

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Registered: 03-26-2003
Wed, 08-31-2005 - 10:56pm

We do see a therapist that would work on that. She works on a number of such issues. One thing that seems like it may help is social stories for him and shaping. Pick one particular challenging item at a time and focus on that with the stories and shaping.

Currently "Dr. Sarah" is working playing games appropriately and things for Mike like not yelling at his brother. She also worked on hygiene skills with cait and always in all sessions she is working on communication skills. It is what ever the kid needs to work on she does it in a play or therapy session type way. She also will set up individual sessions with me to give me ideas too. She is a clinical psychologist that specializes in children on the spectrum and with similar challenges.

I know you have a good handle on it, but you are right it is time for him to work on this. If it is so interfering that it is causing him to cry and stay up late because he can't stop then it needs to be addressed.

Also, perhaps a bit of a med adjustment could help. I know this is specifically the kind of thing they used luvox for with my kids initially. Works great for my nephew too.

Renee

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Registered: 10-24-2003
Thu, 09-01-2005 - 12:15pm

We have had therapy for rigidity/inflexibility issues in the past

Pat

Happiness is a conscious choice, not an automatic response. --

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Registered: 12-24-2004
Thu, 09-01-2005 - 6:41pm

Evelyn,

I would recommend you look into RDI (relationship development intervention). I am not a dyed in the wool RDI'er, but I like a lot of it's principles and have found them helpful in working with Cassian. RDI has a lot of principles which help you work on flexibility with ASD kids (see www.connectionscenter.com). The main one is called productive uncertainty. With PU, you are supposed to interject moments of uncertainty at a level that your child can cope with. Then, you work your way up to the bigger issues. Not being able to build a favorite Bionicle would be too big an issue to start with, but you might start with a smaller issue like changing plans slightly one day, changing a route you normally take when walking to school or the park, serving a different brand of chicken fingers for dinner, etc.

I also like the book series by Elizabeth Crary that deals with emotional issues. We have the following titles: I'm Frustrated, I'm Mad, I'm Furious. These books have alternative endings that the child can choose to see how different decisions will work out. You can also write social stories that apply exactly to the situation your child is having difficulty with. I have done this a lot with Cassian when he cannot cope with a situation. Often, I will write a procedure on our dry-erase board, which will outline steps he needs to follow to achieve gratification. Usually, the problems we encounter have a lot to do with his need to delay gratification, which seems like a "no" situation to him.

We also use floortime and incorporate difficult situations into dramatic play this way. Maybe, you could do this with a Bionicles scenario, so that the Bionicles have to deal with accepting "no" for an answer and they work out their frustration. At least, you could play around with it and see how your son responds. Often play will give you an idea of what is going on inside a child's head, even if he/she doesn't work out the issue within the given scenario.

I also think that what your son might be experiencing is obsessive thoughts or rumination, regarding the problem of not being able to complete his beloved Bionicle project. This is an OCD (obsessive compulsive disorder) trait that many ASD kids have. I don't know what meds he is on, but SSRI's are supposed to help reduce this tendency, so you might bring it up at your next visit with the DP. If you say you are seeing rumination or obsessive thoughts, she may alter his meds to reduce this problem. From a personal perspective, I do not have OCD, but I have had episodes of depression that are characterized by rumination. The first thing I notice after taking a very low dosage SSRI is that my tendency to ruminate goes away, and I feel instantly less stressed.

Suzi

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Registered: 03-31-2003
Thu, 09-01-2005 - 7:14pm

We have had issues with Ian's flexiblity. He is really on his own agenda and this is something we have had to work a lot on. We have actually had a lot of success with RDI. Part of what we work on with him is social referencing (looking to us for social ques) and the master/ apprentice relationship. It has helped us tremendously and has helped him make transitions much better. Our RDI therapist is also a behaviorist, so we are able to work with her on specific sticking points to help solve the issues though.

I can only speak from my experience, but having Ian go through RDI in addition to EI has been a lifesaver for us. The difference is amazing and a lot of the techniques that we have been taught are so helpful. I really think it is a least worth looking into. A website that can tell you about it is www.rdiconnect.com and I would be happy to share if you have any questions.