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Is there an over-diagnosis of autism?

Is there an over-diagnosis of autism?

12 April 2019

For my blog this week I want to share this article from Nicole Rogerson, the CEO of Autism Awareness Australia. She shares her opinion on the rate of diagnosis of autism and why we need diagnoses. An interesting read.

Is there an over-diagnosis of autism?

Commentators, politicians and childhood ‘specialists’ can often be seen in the media and online discussing the potential ‘over-diagnosis’ of conditions like autism, occasionally inferring that something sinister might be at play. The term ‘doctor shopping’ is thrown towards parents like a judgmental grenade – which often misses the whole point of what is really going on.

Society seems to be having real difficulty with how many children around the world are on the autism spectrum. A condition that was quite rare 50 years ago, but is now seemly everywhere. It seems everyone knows a family affected by autism. It’s the subject of multiple television shows, is talked about and reported on constantly and yet there is a niggling sense behind all of this attention that maybe, just maybe, the number of children is over-blown. The question seems to be, ‘where did all of this autism suddenly come from’? Maybe that discussion is a reflection of our society’s uneasiness with difference and disability issues.

Lately, I have read a lot on the topic of the ‘over-diagnosis’ of our children. The new and increasingly popular view suggests that children across the first world are subject to over-diagnosis. That we are now diagnosing completely ‘normal’ aspects of childhood and medicalising them in some way. Autism, ADHD, Asperger’s and Oppositional Defiance Disorder are just some of the conditions we now hear of regularly.

There is no denying that we have seen an increase in the number of children being diagnosed with these types of conditions.

The main question here is, are there more children with these disorders or are we just better at diagnosing them?

The answer is both!

Yes, we are much better at identifying children with these conditions and parents are rightfully looking into treatments that will help their child. No longer are we denying children access to timely assessment, diagnosis and support. So now that we know how to detect these conditions and how best to deal with them, the result is, of course, more children being diagnosed. The idea that this is a false increase and that parents seek a diagnosis to somehow make them feel better is preposterous. In fact, that argument is quite sinister. It suggests parents want to label everything which isn’t considered ‘normal’. That our society wants to diagnose any child not identifying as perfect. This is of course ridiculous. What if we don’t diagnose children with obvious delays and challenges? What happens if we minimise these issues and brush them aside? Will children eventually ‘catch up’ or ‘come good’. Will they magically speak in sentences by kindergarten, play violin, ace their first grade exams and be well on the way to a law degree?

Receiving the diagnosis…

For many years, my job in the autism field was meeting parents just after their child had been diagnosed. They were new to all of it. I was there when the tears were still fresh, the grief was raw and the overwhelming burden of ‘what do we do now’ was very real. The idea that those parents were fist bumping me and high-fiving one another because they had received an official diagnosis is preposterous. Wow, with all those endless funds to pay for early intervention…oh, that’s right, there aren’t any!

Apparently, the increase in diagnoses doesn’t seem to be society patting itself on the back for identifying children with additional needs, but rather an overreaction to children who have symptoms and behavioural challenges which would otherwise be considered ‘normal’.

The lack of these types of diagnoses 30 years ago didn’t necessarily mean they weren’t there or went away, they were just called something different. We were good at sweeping it under the carpet. Outside the norm wasn’t welcomed then and really isn’t welcomed all that much now.

If little Johnny, who wasn’t learning at school because he couldn’t sit still and concentrate, wasn’t diagnosed with ASD and hence received no treatment for it, would he have eventually ‘settled down’ gone on to achieve at school and now be mid-way through a medical degree?

Would Susie, who had appallingly limited social skills, repetitive speech and inappropriate behaviours be better off if we hadn’t recognised that what she had was Asperger’s? Would she have just shaken that right off and now be the host of a TV show?

How do you explain autism? Children whose speech and communication delays are so severe, that if left untreated at a very early age may never go on to lead an independent life. Should we just hold off diagnosing that one?

In my opinion, not diagnosing a child who has developmental delays because we are concerned about ‘over-diagnosis’ is akin to child neglect.

It isn’t a lot of fun diagnosing a child with anything, but denying the delay or disorder and hence obstructing treatment for that condition is appalling.

Diagnosis is just that, nothing more. It suggests we have looked into something, measured it, assessed it with recognised assessment tools, matched it to criteria and determined that this problem is indeed outside of the ‘norm’. It is what we do then, that is truly the key for me. A diagnosis is nothing more than a snapshot in time to say this is what we are looking at. It is what triggers effective intervention, medication and support strategies that go on to determine a child’s long term outcome. There seems to be no lack of professionals prepared to be part of the assessment and diagnosis stage of a child’s condition, but see the numbers dwindle when we get into the messy nitty gritty of intervening post-diagnosis.

The concept that we over-diagnose children to make ourselves feel better is quite frankly an idea that would only be touted by someone who doesn’t have a child diagnosed with anything. The day your child is diagnosed with something as severe and life-altering as autism spectrum disorder is devastating. There are few words to describe that pain. However, the fact that someone recognises this issue, can see that your child is struggling and isn’t writing it off to ‘bad behaviour’ is in a way, some kind of relief. Not relief like putting cream on a burn, more relief like removing the axe from your head.

It is quite frankly patronising to minimise a child’s condition to something he or she will ‘grow out of’. Maybe they will, but do you want to take that gamble? I don’t and I don’t want any child to be left behind because the grown-ups in the room didn’t analyse and act. Let’s look at these conditions and then get busy treating and helping our children who need it. After all, isn’t that what being a good parent is all about?

 

Nicole Rogerson
CEO, Autism Awareness Australia
Co Founder & CEO, Rockmelon

 

TIME TIMERS; a powerful tool for visual thinkers of all ages and abilities.

TIME TIMERS; a powerful tool for visual thinkers of all ages and abilities.

4 April 2019

Have you ever wondered WHY therapist’s love using time timers as apart of their therapy. Check out our reasons WHY we think they are such an integral part of learning:

o   They allow us to measure and manage time more effectively

o   They provide an innovative visual to show the passage of time remaining

o   Provides a stress-free management at home and in the school environment

o   Tells students HOW LONG and WHEN they are going to FINISH an activity

o   Pre-warns the student about what is happening e.g. 5 more minutes of iPad’s before we pack up for reading

o   They help us answer many questions students have e.g. “what’s next?”, “How long?”, “What order?” or “What’s happening?”

o   Stick to a routine

o   Keeps activities on track

o   Empowers students to manage own time

o   Equal time for turn taking,

o   Supports break times

o   Support rotation leaning stations

o   Manages screen time or special interests

o   Helps children to slow down

o   TIMERS CREATE A FINISH point

 

If you feel a time timer could support your child, student or even yourself, don’t hesitate to get in contact and we can support you in this process.

 

TOP TIP: Add visuals to your times by using Velcro visuals

Parenting a Child Who Has Experienced Trauma

Parenting a Child Who Has Experienced Trauma

29 March 2019

Following on from my trauma training earlier in the week, I reflected on how difficult it can be for the parents and carers of children who have experienced trauma to know how to best meet their needs. Here is some helpful information about childhood trauma and how to help your child.

What Is Trauma?

Trauma is an emotional response to an intense event that threatens or causes harm. The harm can be physical or emotional, real or perceived, and it can threaten the child or someone close to him or her. Trauma can be the result of a single event, or it can result from exposure to multiple events over time.

Potentially traumatic events may include:

  • Abuse (physical, sexual, or emotional)
  • Neglect
  • Effects of poverty (such as homelessness or not having enough to eat)
  • Being separated from loved ones
  • Bullying
  • Witnessing harm to a loved one or pet (e.g., domestic or community violence)
  • Natural disasters or accidents
  • Unpredictable parental behaviour due to addiction or mental illness

For many children, being in the child welfare system becomes another traumatic event. This is true of the child’s first separation from his or her home and family, as well as any additional placements.

The Impact of Untreated Trauma

Children are resilient. Some stress in their lives (e.g., leaving caregivers for a day at school, riding a bike for the first time, feeling nervous before a game or performance) helps their brains to grow and new skills to develop. However, by definition, trauma occurs when a stressful experience (such as being abused, neglected, or bullied) overwhelms the child’s natural ability to cope. These events cause a “fight, flight, or freeze” response, resulting in changes in the body—such as faster heart rate and higher blood pressure—as well as changes in how the brain perceives and responds to the world. In many cases, a child’s body and brain recover quickly from a potentially traumatic experience with no lasting harm. However, for other children, trauma interferes with normal development and can have long-lasting effects.

Trauma may affect children’s…

In the following ways

Bodies

  • Inability to control physical responses to stress
  • Chronic illness, even into adulthood (heart disease, obesity)

Brains (thinking)

  • Difficulty thinking, learning, and concentrating
  • Impaired memory
  • Difficulty switching from one thought or activity to another

Emotions (feelings)

  • Low self-esteem
  • Feeling unsafe
  • Inability to regulate emotions
  • Difficulty forming attachments to caregivers
  • Trouble with friendships
  • Trust issues
  • Depression, anxiety

Behaviour

  • Lack of impulse control
  • Fighting, aggression, running away
  • Substance abuse
  • Suicide

 

Factors that determine the impact of traumatic events include the following:

  • Age. Younger children are more vulnerable. Even infants and toddlers who are too young to talk about what happened retain lasting “sense memories” of traumatic events that can affect their well-being into adulthood.
  • Frequency. Experiencing the same type of traumatic event multiple times, or multiple types of traumatic events, is more harmful than a single event.
  • Relationships. Children with positive relationships with healthy caregivers are more likely to recover.
  • Coping skills. Intelligence, physical health, and self-esteem help children cope.
  • Perception. How much danger the child thinks he or she is in, or the amount of fear the child feels at the time, is a significant factor.
  • Sensitivity. Every child is different—some are naturally more sensitive than others. The effects of trauma vary depending on the child and type of traumatic events experienced.

Understanding Your Child’s Behaviour

When children have experienced trauma, particularly multiple traumatic events over an extended period of time, their bodies, brains, and nervous systems adapt in an effort to protect them. This might result in behaviours such as increased aggression, distrusting or disobeying adults, or even dissociation (feeling disconnected from reality). When children are in danger, these behaviours may be important for their survival. However, once children are moved to a safer environment, their brains and bodies may not recognize that the danger has passed. These protective behaviours, or habits, have grown strong from frequent use (just as a muscle that is used regularly grows bigger and stronger). It takes time and retraining to help those “survival muscles” learn that they are not needed in their new situation (your home), and that they can relax. It might be helpful to remember that your child’s troublesome behaviour may be a learned response to stress—it may even be what kept your child alive in a very unsafe situation. It will take time and patience for your child’s body and brain to learn to respond in ways that are more appropriate for his or her current, safe environment.

Trauma Triggers

When your child is behaving in a way that is unexpected and seems irrational or extreme, he or she may be experiencing a trauma trigger. A trigger is some aspect of a traumatic event that occurs in a completely different situation but reminds the child of the original event. Examples may be sounds, smells, feelings, places, postures, tones of voice, or even emotions. Youth who have experienced traumatic events may re-enact past patterns when they feel unsafe or encounter a trigger. Depending on whether the child has a “fight,” “flight,” or “freeze” response, the child may appear to be throwing a tantrum, wilfully not listening, or defying you. However, responses to triggers are best thought of as reflexes—they are not deliberate or planned. When children’s bodies and brains are overwhelmed by a traumatic memory, they are not able to consider the consequences of their behaviour or its effect on others.

Signs of Trauma in Children of Different Ages

Young Children (Ages 0–5)

School-Age Children (Ages 6–12)

Teens (Ages 13–18)

  • Irritability, “fussiness”
  • Startling easily or being difficult to calm
  • Frequent tantrums
  • Clinginess, reluctance to explore the world
  • Activity levels that are much higher or lower than peers
  • Repeating traumatic events over and over in dramatic play or conversation
  • Delays in reaching physical, language, or other milestones
  • Difficulty paying 
  • Talking about the trauma constantly, or denying that it happened
  • Refusal to follow rules, or talking back frequently
  • Being tired all the time, sleeping much more (or less) than peers, nightmares
  • Risky behaviours
  • Fighting
  • Not wanting to spend time with friends
  • Using drugs or alcohol, running away from home, or getting into trouble with the law

  • Difficulty paying attention
  • Being quiet or withdrawn
  • Frequent tears or sadness
  • Talking often about scary feelings and ideas
  • Difficulty transitioning from one activity to the next
  • Fighting with peers or adults
  • Changes in school performance
  • Wanting to be left alone
  • Eating much more or less than peers
  • Getting into trouble at home or school
  • Frequent headaches or stomachaches with no apparent cause
  • Behaviours common to younger children (thumb sucking, bed wetting, fear of the dark)
 
  • Talking about the trauma constantly, or denying that it happened
  • Refusal to follow rules, or talking back frequently
  • Being tired all the time, sleeping much more (or less) than peers, nightmares
  • Risky behaviours
  • Fighting
  • Not wanting to spend time with friends
  • Using drugs or alcohol, running away from home, or getting into trouble with the law


For many children who have experienced trauma, their development lags behind their age in calendar years. It may be normal for your child to exhibit behaviours that are more common in younger children.

These signs alone do not necessarily indicate that your child has experienced trauma. However, if symptoms are more severe or longer lasting than is typical for children the same age, or if they interfere with your child’s ability to succeed at home or in school, it is important to seek help.

Trauma and Mental Health

Trauma symptoms that are more severe or disruptive to a child’s ability to function at home or at school may overlap with specific mental health diagnoses. This may be one reason why nearly 80 percent of children aging out of foster care have received a mental health diagnosis. For example:

  • Children who have difficulty concentrating may be diagnosed with ADHD (attention deficit hyperactivity disorder).
  • Children who appear anxious or easily overwhelmed by emotions may be diagnosed with anxiety or depression.
  • Children who have trouble with the unexpected may respond by trying to control every situation or by showing extreme reactions to change. In some cases, these behaviours may be labeled ODD (oppositional defiant disorder) or intermittent explosive disorder (IED).
  • Dissociation in response to a trauma trigger may be viewed as defiance of authority, or it may be diagnosed as depression, ADHD (inattentive type), or even a developmental delay. It may be necessary to treat these diagnoses with traditional mental health approaches (including the use of medications, where indicated) in the short term. However, treating the underlying cause by addressing the child’s experience of trauma will be more effective in the long run.

Helping Your Child

Although childhood trauma can have serious, lasting effects, there is hope. With the help of supportive, caring adults, children can and do recover. Consider the following tips:

  • Identify trauma triggers. Something you are doing or saying, or something harmless in your home, may be triggering your child without either of you realizing it. It is important to watch for patterns of behaviour and reactions that do not seem to “fit” the situation. What distracts your child, makes him or her anxious, or results in a tantrum or outburst? Help your child avoid situations that trigger traumatic memories, at least until more healing has occurred.
  • Be emotionally and physically available. Some traumatized children act in ways that keep adults at a distance (whether they mean to or not). Provide attention, comfort, and encouragement in ways your child will accept. Younger children may want extra hugs or cuddling; for older youth, this might just mean spending time together as a family. Follow their lead and be patient if children seem needy.
  • Respond, don’t react. Your reactions may trigger a child or youth who is already feeling overwhelmed. (Some children are even uncomfortable being looked at directly for too long.) When your child is upset, do what you can to keep calm: Lower your voice, acknowledge your child’s feelings, and be reassuring and honest.
  • Avoid physical punishment. This may make an abused child’s stress or feeling of panic even worse. Parents need to set reasonable and consistent limits and expectations and use praise for desirable behaviours.
  • Don’t take behaviour personally. Allow the child to feel his or her feelings without judgment. Help him or her find words and other acceptable ways of expressing feelings, and offer praise when these are used.
  • Listen. Don’t avoid difficult topics or uncomfortable conversations. (But don’t force children to talk before they are ready.) Let children know that it’s normal to have many feelings after a traumatic experience. Take their reactions seriously, correct any misinformation about the traumatic event, and reassure them that what happened was not their fault.
  • Help your child learn to relax. Encourage your child to practice slow breathing, listen to calming music, or say positive things (“I am safe now.”).
  • Be consistent and predictable. Develop a regular routine for meals, play time, and bedtime. Prepare your child in advance for changes or new experiences.
  • Be patient. Everyone heals differently from trauma, and trust does not develop overnight. Respecting each child’s own course of recovery is important.
  • Allow some control. Reasonable, age-appropriate choices encourage a child or youth’s sense of having control of his or her own life.
  • Encourage self-esteem. Positive experiences can help children recover from trauma and increase resilience. Examples include mastering a new skill; feeling a sense of belonging to a community, group, or cause; setting and achieving goals; and being of service to others.

  

Credit - Child Welfare Information Gateway. Resources on Trauma for Caregivers and Families [Webpage]: https://www. childwelfare.gov/topics/responding/trauma/caregivers.

 

Finding opportunities for language learning in every day: A busy family’s guide

Finding opportunities for language learning in every day: A busy family’s guide

21 March 2019

Before I came a parent, I honestly didn’t understand why parents couldn’t find the time to sit down with their children to complete therapy. It just goes to show you how naive I was about having children.

Family life is busy and chaotic! Day care, work, social and sporting commitments can be quite a juggling act.

We as parents often feel responsible for making sure that everything gets done and sometimes it can be overwhelming trying to figure out how to fit it all in. The good news is that you can easily fit in language learning opportunities with your other routines. This makes it easier to ensure your child continues to develop their language skills, and you still get all of your daily jobs done. Win-win!

Here are some ideas on how to incorporate language activities into your everyday routine:

1. Getting ready for school

This is a great time to practice following routine directions, such as “put your lunch box in your bag”, “go brush your teeth” and “put your shoes and socks on”. When your child gets more familiar with these instructions, you can use this as an opportunity to learn about sequence concepts, “before” and “after”. Ask your child questions such as “what do you need to do after you finish breakfast?”

Tip: If your child is struggling with following routines, visual resources and aids can help your child complete these instructions with more independence.

2. In the car

Use this time to comment on what you can see happening around you. Play “I-spy” and have your children guess what you are talking about. Whilst traditional “I-spy” is a great way to practice listening for the sound at the beginning of words, you can mix this game up to learn about finding items based on a description. For example, “I spy something red with four wheels”, or “I spy something that is barking”.

3. Day care/School pickup

Asking your children about what they have done during the day is a great way to practice retelling events and sequencing. Asking your child questions using the terms “before” and “after”, or “first” and “last” helps them to understand the sequence of events. For example, ask your child “what was the first thing you played at lunch?” or “what did you do after recess?”

You can also use this time to practice answering a range of “wh” questions. When your child tells you something they have done that day, such as “we played cricket”, you could help them to expand this information by asking “where did you play?” or “who did you play with?”

4. Dinner time

This is a great time to practice learning about different describing words and concepts, such as “wet” and “dry”, “big” and “small” or “hot” and “cold”. Ask your child to describe the items you are preparing (e.g. the lettuce might be ‘wet’ after you wash it, the garlic bread might be ‘hot’ when it comes out of the oven, the potato might be ‘big’)

Getting children involved in food preparation (where appropriate) can give them hands-on experience with these concepts, as well as providing them with valuable life skills. Try making up a photo recipe book/diary with your family so that you have a visual representation of how to make all your favourite recipes.

Tip:  You can use visuals to help younger children engage in this important family time.

5. Bath time

Bath time is great for learning body parts, actions (such as “splash” and “wash”) and to learn the difference between “wet” and “dry”. For younger children, try making up a bubble bath and having them find a named body part before putting a handful of bubbles on it (e.g. “find your foot”, before you put bubbles on their foot).

Tip: Use can also use visual resources and aids to help your child complete these instructions with more independence. You can make these as detailed as you wish.

6. Bed time

Unwinding before bed has traditionally been an ideal time for families to fit in storybook reading. Reading stories helps your child develop important literacy skills and is a great way to practice comprehension. With younger children using picture books, it is important to follow their interests on the page, rather than reading every word on the page.

Hayley

 

Credit: Small Talk Speech Pathology

How Do I Discipline My Kids?

How Do I Discipline My Kids?

15 March 2019

This is a pretty contentious topic, with varied and often conflicting opinions, even down to the meaning of the word ‘discipline’ (in brief - discipline is not the same as punishment). Today’s blog isn’t about strategies for disciplining kids or managing behaviour, rather it is about the importance, as a parent, of having a ‘Discipline Philosophy’. This is a concept I came across myself, when struggling with my own child’s behaviour. While I found it really helpful, it was also quite confronting to look at my own behaviour as a parent.

 

Responding versus reacting

A discipline philosophy is about being intentional in the way we respond to our kids when they misbehave. Rather than reacting emotionally or dramatically, or with a one-size-fits-all approach that doesn’t consider the situation or the needs of our child, we respond from a place that is consistent with our parenting beliefs and that also shows respect for our children.

 

How intentional are you?

Take a moment to think about your normal response to your kids’ behaviour. Do you automatically spank, give a time-out, or yell? Do you have some other immediate go-to for when your kids act out? Many of us simply do what our parents did – or we strive to do exactly the opposite. The real question is, how much of your disciplinary strategy comes from an intentional and consistent approach, as opposed to simply reacting or relying on old habits?

 

Here are some questions to ask yourself as you think about your overall discipline philosophy:

  1. Do I have a discipline philosophy? How purposeful and consistent am I when I don’t like how my kids are behaving?
  2. Is what I’m doing working? Does my approach allow me to teach my kids the lessons I want to teach, in terms of both immediate behaviour and how they grow and develop as human beings? And am I finding that I need to address behaviours less and less, or am I having to discipline about the same behaviours over and over?
  3. Do I feel good about what I’m doing? Does my discipline approach help me enjoy my relationship with my children more? Do I usually reflect on discipline moments and feel pleased with how I handled myself? Do I frequently wonder if there’s a better way?
  4. Do my kids feel good about it? Discipline is rarely going to be popular, but do my children understand my approach and feel my love? Am I communicating and modelling respect in a way that allows them to still feel good about themselves?
  5. Do I feel good about the messages I’m communicating to my children? Are there times I teach lessons I don’t want them to internalise – for example, that obeying what I say is more important than learning to make good decisions about doing the right thing? Or that power and control are the best ways to get people to do what we want? Or that I only want to be around them if they’re pleasant?
  6. How much does my approach resemble that of my own parents? How did my parents discipline me? Can I remember a specific experience of discipline and how it made me feel? Am I just repeating old patterns? Rebelling against them?
  7. Does my approach ever lead to my kids apologising in a sincere manner? Even thought this might not happen on a regular basis, does my approach at least leave the door open for it?
  8. Does it allow for me to take responsibility and apologise for my own actions? How open am I with my kids about the fact that I make mistakes? Am I willing to model for them what It means to own up to one’s errors?

How do you feel right now, having asked yourself these questions? Many parents experience regret, guilt, shame, or even hopelessness when they acknowledge what has not been working and worry that they may not have been doing the best they can. But the truth is, you have done the best you can. If you could have done better, you would have.

The more compassion you can have for yourself, the more compassion you can have for you child. Even the best parents realise that there will always be times they can be more intentional, effective, and respectful regarding how they discipline their children. When we know better, we do better.

If these questions have got you thinking and wanting to know more, why not check out the book ‘No-Drama Discipline’ by Daniel J Siegel and Tina Payne Bryson. It’s the source for this blog, and a great resource. The authors are also behind one of the Collective’s favourite resources - ‘The Whole-Brain Child’. If you or your child are a client, chances are we’ve recommended it to you at some point!

 

Happy parenting!

 

Karen

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