Category Archives: Child Development

Executive Function and IEP/504 Plan Goals for Academic and Social Success

Dilemma:  School is back in session and Section 504 plans or Individualized Education Programs (IEPs) need to be developed, reviewed, or revised.  This is overwhelming.  Where to begin? My child is doing well in school on paper but is not connecting with others.  How long do I wait?  How about executive functions like organization or mental flexibility (i.e., moving from one subject or activity to another without difficulty) that are not graded but can significantly interfere with academic and social progress in grades 4 and up?

Solution: Consider the following video guide to a child’s social skills and executive function development:

Learn more at www.mysosh.com

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Filed under 504 Plan, ADHD, Anxiety, Asperger's, Autism, Child Development, Executive Function, IEP, Parenting, School, Social Skills

New Mobile App for ‘Tweens, Teens, and Young Adults with Asperger’s Syndrome

Sōsh, the only mobile app of its kind for children and teens with social skills difficulties, has been made available in a   Lite version in the iTunes Store.  Now everyone can have full access to all of the features of this app for a trial period of one week from the time of download before deciding whether to purchase the full version.  Don’t miss the chance to try out this app!  Members of the Asperger’s community are saying, “I have never come across something so great for people with Asperger’s.”  Experts in the field and app reviewers are saying:

  • “This is a marvelous autism app.  I haven’t seen anything like it.”
  • “It is one sweet app, is strength-based and best in breed; an app that is both dignified, and appeals to kids’ strengths while building social skills at the same time. Finally, something my tween will want!”
  • “Sōsh gives you virtually every tool you could possibly have in one electronic iPhone toolbox. It’s the Swiss Army knife of apps!”
  • “This app is the most comprehensive electronic and portable toolbox for social skills development!”

For individuals ages 9 to 22 years old with Asperger’s Syndrome, difficulty with social interactions is a leading cause of stress and one of the most common calls for help.  With over 60 screens of exercises, strategies, and practical information regarding social skills, the Sōsh app will assist with social skill development, and provide feedback and tools for parents, teachers and therapists.   Examples include tools to relieve stress, guidance for appropriate social behaviors, and self-monitoring capabilities. The app is available in the iTunes app store.

About The Developer

Dr. Mark Bowers is a Pediatric Psychologist in Ann Arbor, Michigan.  He specializes in neurodevelopmental diagnoses (i.e., Autism, Asperger’s, ADHD, and Learning Difficulties) and he is an expert in social skills.  Dr. Bowers has contributed to articles in WebMD magazine, Scholastic, and Parenting: The Early Years.  In addition to developing the Sōsh mobile app, he is the author of the book Sōsh: Improving Social Skills with Children and Adolescents.  Visit http://www.mysosh.com for a full review of the app’s potential to improve social skills.

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Typical Childhood Behavior versus OCD

Parents often ask me whether their child’s behavior is typical or something more significant such as Obsessive Compulsive Disorder (OCD).  In my clinical experience, OCD is a term that is often misused in ‘pop’ culture.   For example, I often work with parents who describe themselves as “OCD” because they are organized or meticulous in their everyday lives.  These behaviors may be orderly or repetitive, but they do not necessarily indicate obsessions or compulsions.  Another example is the junior high school or high school perfectionist I counsel who wants to have straight A’s and becomes upset if this does not occur.  Again, this is not OCD although many individuals with OCD tend to have some tendencies toward perfection.   Just because you have obsessive thoughts or perform compulsive behaviors does NOT mean that you or your child have obsessive-compulsive disorder. Many people have mild obsessions or compulsions that are strange or irrational, but are still able to lead their lives without much disruption.  In the case of obsessive-compulsive disorder, these thoughts and behaviors cause tremendous distress, take up a lot of time, and interfere with friendships, school functioning, employment, or relationships.  Thus, the amount of disruption that occurs and the amount of settings (at least two) that are affected in one’s life help to define true OCD from someone who is orderly, ‘anal,’ or a perfectionist.

When it comes to determining the presence of OCD in children, the following need to be considered:

Children and adolescents with obsessive-compulsive disorder (OCD) suffer intensely from recurrent, unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control. Rituals such as hand washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing them markedly increases anxiety. Left untreated, obsessions and the need to perform rituals can take over a person’s life.

It looks like this:

The Sequence of OCD Symptoms:

1) Evoking Event

2) Obsessing Begins

3) Distress & Anxiety

4) Urge to Ritualize

5) Ritualizing

6) Relief and Self-Criticism

While the onset of obsessive-compulsive disorder usually occurs during adolescence or young adulthood, younger children sometimes have symptoms that look like OCD.  However, the symptoms of other disorders, such as ADD, autism, and Tourette’s syndrome can also look like obsessive-compulsive disorder, so a thorough medical and psychological exam is essential before any diagnosis is made.  It is also important to note that OCD is an anxiety disorder, and in children, the symptoms of anxiety usually change over time.  So a child with OCD symptoms will not necessarily have OCD as an adult.  What is most important is to make environmental and behavioral changes to help reduce your child’s anxiety and provide support, yet do not give in to the anxiety or change your routine significantly in response to it.  Remember, some anxiety is good..it tells us when we need to fight or flee.  Making too many accommodations for your child’s anxieties will only serve to reinforce the fears.  As the old saying goes:  If you see a ghost in a graveyard, you should run toward it.  This is the essence of exposure and response prevention treatment for OCD, which will be detailed in future blog postings.

Dr. Mark Bowers is a Licensed Pediatric Psychologist at the Ann Arbor Center for Developmental & Behavioral Pediatrics in Ann Arbor, Michigan.

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Filed under Anxiety, Child Development, OCD, Parenting

Social Skills Part II: Behavior then Mood

I want my clients to begin their experimentation into the social world by making impressions.  In order to do this, they must be out and about.  Often times, individuals I work with do not come in to visit with me until self-esteem has begun to suffer.  As a result, I may also be dealing with some mood difficulties.  My role, provided that we are not dealing with a clinically significant major depressive disorder, is to begin coaching the individual with regard to the behavior preceding the mood.  In other words, my clients often times do not feel like they would like to go to the football game on Friday or feel up to attending the homecoming dance.  This consistently comes up in my social skills groups where at least one child does not want to participate or feel like they need to be a part of the group.  They have yet to experience the behavior of being in the group so how in the world would they know that they won’t like it?  Despite the potential to sustain the current social difficulties, there is usually at least one parent who gives in and allows their child to avoid attending the group.   Progress can never be made when this happens.

Staying home will do nothing more than exacerbate the current feeling (I don’t need to go to a group or be social).  Instead, the behavior must come before the desired feeling.  Specifically, individuals must attend the football game or they must attend the dance before they can begin to truly experience the feeling of improved self-esteem, for example.  Most of my clients, although they object to this initially, return to my office to inform me that although going to the dance or football game was the very last thing that they wanted to do on that particular evening, once they were there it was not so bad and they actually ended up enjoying themselves.  Keep in mind that although I use dances and sports games as examples, the behaviors preceding the mood applies to all ages: going to the playgroup, playground, birthday party, etc.

I think it’s also important to illustrate that we must take the pressure of social skills off of these individuals.  In other words, there is no expectation when we are just getting started with making impressions other than the individual simply must attend events.  That’s it, plain and simple: attend the event or activity.  I don’t care if you talk to anyone.  I don’t care if you make any eye contact with anyone.  We have plenty of time to work on that.  One of the biggest hurdles that I see is getting my clients to leave their home because they often do not feel like it.  This is the time that I remind individuals that the behavior must often precede the mood.

This is important because individuals who are feeling dejected or otherwise depressed in any manner may not have the energy, confidence, or motivation to make that initial leap into the social world.  My response is that continuing to avoid the social world only exacerbates the current difficulties.  I am not asking for these individuals to go out on any particular evening or to attend any particular event and come home with a new friend or social group.  I am simply asking that they be seen in the social environment and thus make an impression.  The behavior preceding the mood is important because these individuals may not feel like being social on any particular evening.  In fact, this often perpetuates the addiction cycle of video games as a self-medicating remedy.  Indeed, they will use video games as means of avoidance or as an excuse for why they won’t attend (“I don’t want to go because I’m really into this game…don’t bother me!”).

Client after client returns to my office to tell me that although they were very upset with me and did not want to go to the school dance or football game they took a risk (with the help of sufficient support and encouragement) and they went.  Although they felt ‘awful’ prior to attending the event, once they were there they realized it wasn’t so bad.  Further, the strategy of simply being in the social environment paid off because there were no pressures to achieve any outcome other than attendance.  I know we would all like to jumpstart this process and in our typical American fashion get to the outcome quicker and without much work.  Unfortunately, it does not work that way when dealing with social interactions.  If you are not prepared to take the preliminary steps you will not be successful.  If you rush this process you will not be successful.  Take your time and be willing to take a risk.  Some discomfort is inevitable before progress can be achieved.

“Progress always involves risk; you can’t steal second base and keep your foot on first.” –Frederick Wilcox

Dr. Mark Bowers is a Licensed Pediatric Psychologist at the Ann Arbor Center for Developmental & Behavioral Pediatrics in Ann Arbor, Michigan.

© 2009 Mark Bowers, Ph.D.

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Filed under ADHD, Anxiety, Asperger's, Autism, Child Development, Parenting, Social Skills

‘Tis the Season: Preparing Your Child for the Holidays

No matter the holiday traditions or customs you observe, one thing is for certain: the children will be home for a week or two beginning very soon!  No reason to panic.  After all, adults never experience any stress over the holidays so why should kids?  I tried to effectively demonstrate a tongue-in-cheek tone with that last sentence.  I was testing your electronic social skills.  Okay, back to the topic at hand.  The children will be home for a while and you are becoming anxious that tempers may begin to flare or boredom may ensue.  I offer the following general suggestions to hopefully sustain your holiday cheer throughout the school break.

  • Increase predictability at home.  This involves some scheduling, although flexibility should be allowed.  For teens who need to catch up on some sleep, there should be parameters such as “awake by noon” but no need to be so scheduled (“Be up by nine because I said so!”) that arguments are inevitable .  The more that children know what to expect, the less stress that will result when making transitions.
  • Have a portion of each day scheduled but plan the rest of the time with the child by allowing for their input.  You may need to offer a list of suggestions for them to choose from, but you should not be trying to win the contest for Entertainer of the Year.  thus, it is not your responsibility to ensure that your child is having fun all the time!  It may be useful to have a written or picture schedule for some children.  This is especially helpful when you are resting in the afternoon and your child comes to you to say, “I’m booooored!”  You can calmly refer them to the schedule and add, “I know you will figure out something fun to do from all those options, honey.”
  • Keep an eye on your own stress level as there is a trickle down effect.  As we reunite with family, all of those fun dynamics from childhood tend to surface.  Children generally have fewer demands on them during breaks which is why they tend to do better behaviorally.  If you need a break from your relatives, then don’t over schedule.  Your kids will pick up on your stress and react accordingly.
  • Remember to limit television time.  I know this sounds crazy.  After all it serves as an effective pacifier and most parents will ignore this suggestion.  However, trying to get the child away from the TV after they are allowed unlimited viewing will not likely be met with willingness from the child.  The recommendation for television viewing during the holidays is 1-2 hours each day (which includes other screen time such as computers and video games).  Some children can effectively manage more, other cannot.  Certainly, exceptions can be made for holiday movies, family videos, etc.  The general rule is to keep an eye on the time, though, because school will again be in session and the child will then have to “detox” from all the television viewing as they begin to focus on the “boring” schoolwork again.  Maybe reading a fun book in exchange for some of that TV time might keep the old brain cells fresh and sharp?
  • Whenever possible, prepare the child in advance for holiday visits.  If only someone would prepare you!  It never hurts to discuss who will be there, what will take place (as much as you can anticipate before the first family argument occurs), and how long the visit will last.  Children with sensory issues may need an escape plan that can be determined upon arriving to the party or gathering (or in advance if the location is familiar).  The child can use this “escape” for a set period of time to regulate him/herself and then must return to the gathering.  Bring a familiar item from home if your child is anxious about these visits.  Also, talk to your family members in advance and if your child is shy or anxious, remind them to let the child warm up and not force hug, kisses, etc. upon greeting the child.
  • Finally, prepare the child for transitions.  My colleague, Dr. Rick Solomon, has devised 20 Transition Tricks that he recommends for parents who have a child who cannot shift easily from one activity to another.  His general rule of thumb is to acknowledge the child’s feeling of not wanting to transition but then to begin to prepare them for what awaits.  There are a variety of strategies such as time warnings, use of humor, and bribes-but ultimately the child needs to go where we need them to or there will be a consequence.  Try to avoid these control battles whenever possible, though, and with some scheduling and preparation this will hopefully be a safe and happy holiday for everyone!  If it’s not the “Most Wonderful Time of the Year,” then join the club.  By keeping expectations reasonable and being able to laugh off some of the family dynamics that play themselves out across most households, this may result in the impression of a relaxing and enjoyable holiday!

Dr. Mark Bowers is a Licensed Pediatric Psychologist at the Ann Arbor Center for Developmental & Behavioral Pediatrics in Ann Arbor, Michigan.

© 2009 Mark Bowers, Ph.D.

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Protecting Self-Esteem Among Children and Teens

This is an area that is important regardless of a child’s developmental history, socioeconomic status, gender, or race.  As parents, we watch as our children are generally so carefree and assured, with the slightest compliments effectively reinforcing their every move.  Then we have to let them go at some point; to go away from the safety and comfort of our homes, and enter into the land of school.  We now don’t have any control over who they will meet or how they will be treated.  We must simply wait and pick up the pieces as we try and put on our best ‘poker face’ listening with angst, guilt, and anger (among other emotions) to our child recount being teased earlier that day.  I used to believe, perhaps hope, that self-esteem was not at risk until the junior high/middle school years, or what I like to call: “the years in which all kids should either hibernate or be allowed to stay home until maturity sets in.”

Unfortunately now I know better.  Self-esteem is at risk the moment a child enters preschool or daycare.  It just looks different.  Kids as young as preschool age can be heard telling each other, ‘I don’t want to be your friend,” or “I don’t like you.”  I recently listened to one of my colleagues recount how when her son was younger he came home one day and told her, “Johnny told me that he didn’t want to be my friend!”  She recalled how she bit her lip and was ready to give him a big hug as he was surely on the verge of tears.  She put her ‘poker face’ on and asked her son, “What did you say?”  Her son responded in a matter-of-face tone, “Who cares!?”

There has to be something to that response.  Some kids are simply born with a suit of armor that can repel these meaningless comments while others are devastated at the very thought of anyone not liking them.  Self-esteem begins to be chipped away each day in school whether a child is having a difficult time with math, or reading, or friendships, or basically anything that the child begins to internalize as making them ‘defective’ or ‘flawed’ in any way.  This is the same reason why the notion of a child being deemed ‘lazy’ by their teacher is ridiculous.  Kids are absolutely devastated when they cannot keep up in class, don’t answer a question correctly, take longer than their peers to complete an assignment or test…the list goes on and on…  You tell me how that is lazy.

So what is self-esteem and how can we help our kids achieve and maintain it?  My favorite definition comes from a pioneer in the field of psychology, William James.  He defined self-esteem with the following equation: Self-Esteem = Success/Pretensions (or Success divided by Pretensions).

Pretensions are viewed as goals, purposes, or aims, whereas Successes constitute the perception of the attainment of those goals.  Thus, we essentially decide in our own minds when we have achieved success based on our own expectations for that success.  When self-esteem begins to suffer is when an individual comes up short in his or her perception of reaching a particular goal, especially when the individual compares his or her achievement of a goal against the achievement of others.   So, for the child who either tells himself (or hears it from his parents) that he must get straight A’s and then gets a ‘B’ in gym class only to be outdone by one of his academic rivals, self-esteem has just taken a ‘hit.’   Whereas the child who really struggles in gym class and has lower expectations but eventually achieves a ‘B’ in the class may have a rise in self-esteem.

The bottom line, which is as important for adults as it is for kids, is that we have to have multiple ‘columns’ or ‘pillars’ of support to our self-esteem.  If we rest all of our esteem on how well we do in school and then do lousy on a test, then we are in trouble.  This is why I strongly encourage kids to pursue a variety of interests beginning in middle school even if they only end up liking a few things.  I don’t expect that they will like everything they try, but having at least a few new interests to add to the old can insulate them down the road if just one of their previous interests does not go well.

Imagine that I, a pediatric psychologist, enter a contest and win the opportunity to throw out the first pitch at a baseball game.  I practice a little so that I don’t embarrass myself on the big day and then the day arrives.  I step up on the mound, try a bit of a wind up, and throw a wild pitch that sends the catcher scrambling and draws jeers from the fans.  It’s all in good fun and I laugh it off.  Why don’t I hang my head and beat myself up about this?  Why hasn’t my self-esteem suffered?  Well, for starters I am not a trained professional pitcher so why should I be expected to throw an accurate pitch from that distance?  But what if I were and I performed the same way?  Then my self-esteem might be in jeopardy because my pretensions are different.

The young boy I discussed earlier comes to mind.  As a psychologist, my reaction to my wild pitch can safely be “who cares?”  There are plenty of other things I do well and my pretensions for throwing the ball well were low.  As a result, not achieving success was okay.  This is exactly why we need to have multiple pillars of support.  If my entire self-concept is tied up in how knowledgeable and helpful I am as a psychologist, and a child comes to see me that I can’t seem to get through to, then I might beat myself up and question my competence.  However, if I go home to my family that night and watch as my daughter runs to greet me and play with me, I am reminded that there is more to me and my self-concept than what I do at work.  Adults as much as kids run into this problem and it gets them into big trouble.  The workaholic father, for example, who is so angry with his family every night because he can never truly be successful at work due to his extremely high pretensions.  His goals are too lofty and as a result he cannot find happiness in other areas…work is his only pillar of esteem and he has little energy left for much else.  Kids need to be reminded multiple times each day of their lives to find successes in what they do and increase the chances of that by doing a variety of different things.  A bad day at school is only devastating when the pretensions of how school should go are set too high.

Often what I worry about with the kids I treat is that they have suffered too many losses of esteem and don’t like the feeling anymore.  As a result, they fall into the cycle of avoidance.  Indeed, in their minds they think: With no attempt there can be no failure; with no failure no humiliation.

So our self-feeling in this world depends entirely on what we back ourselves to be and do. It is determined by the ratio of our actualities to our supposed potentialities; a fraction of which our pretensions are the denominator and the numerator is our success: thus…

Self-Esteem = Success/Pretensions.  Self-esteem is ultimately increased by increasing our successes in life while also decreasing our pretensions.  I would strongly encourage all of us to keep our pretensions realistic and not depend on too much success in any one particular area of our lives.  The more we spread it out, the safer we are or the more intact our self-esteem remains.  Keep your options varied and open and don’t lose sight of what you are good at, even when you have a bad day and one of your columns of support happens to collapse on that particular day.

Dr. Mark Bowers is a Licensed Pediatric Psychologist at the Ann Arbor Center for Developmental & Behavioral Pediatrics in Ann Arbor, Michigan.

© 2009 Mark Bowers, Ph.D.



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Scripting and The Autistic ‘Veil’

trainsThe nature of Autism is the brain’s desire to keep the world the same.  This is why one of the hallmark diagnostic features of Autism is repetitive, perseverative, and stereotypical behaviors.  One of the most common is scripting in which the child takes dialogue that he or she heard someone else say (usually a favorite cartoon or television character) and applies it in a repetitive and often nonfunctional fashion.   Scripting is often referred to as a Comfort Zone behavior.  This posting attempts to provide some strategies for how to deal with scripting as well as some reflections on the nature of Comfort Zone behaviors.

For children with Autism, the Comfort Zone is what the child will do when you let them do whatever they want to do.  Examples include: playing with/lining up cars, watching portions of the same video, flipping through familiar books, scripting, opening/closing doors/drawers, visually stimulating on an object (e.g., spinning), and staring off in the distance as if in a trance or daydream.  By the way, ever wonder why the fascination with trains?  The answer is that there is not likely anything much more linear and repetitive than a train going from one place to another and then back again.  I digress, so in this comfort zone, children are not connected or engaged with the world.  In fact, by the time kindergarten starts, one measure of school readiness is that the children are connected with the social environment most of the time and turn consistently to their names.  You probably notice that your child does not turn to his or her name being called consistently if they are absorbed in a particular activity.  If your child is ‘stuck’ inside their comfort zone and not paying attention to the environment, not easily engaged, not able to interact in a back-and-forth fashion; then they are going to need help leaving this comfort behavior for longer periods of time (i.e., you will need to engage them more and not allow them to be off on their own in a perseverative or repetitive behavior).  The key to remember here is that as engagement with others increases, perseverative/repetitive behaviors such as scripting decreases.  Thus, we must be aware of when the child is in his or her comfort zone and not allow them to remain there for too long.

I do want to take a moment to acknowledge, however, how it must feel for a parent to see the Autistic ‘veil’ drop in front of the child’s eyes as they check out from the real world for a moment and become absorbed in a repetitive behavior.  Especially for parents who have been working with their child for a number of months or years and have begun to see progress; the child’s return into scripting and other stereotypical behaviors is a glaring reminder that the child has Autism.  It also serves as a reminder to the world that something is not quite connecting in the child’s brain.  I often conceptualize this as a neurological tug-of-war that is taking place inside the child’s brain.  The hardwiring of the Autistic brain is determined to keep the world simple and the same, with little (if any) interest in relationships or social connections.   However, as the child makes progress and begins to learn how much fun can be had with others and the value of having play partners, another part of the brain begins to compete for dominance.

I see a similar phenomenon take place among children with OCD that I treat.  They experience what I refer to as “brain hiccups” that play tricks in one’s mind, often convincing the child that unless he washes his hands 15 times in a specific fashion, for example, something awful will certainly happen.  This thought will not go away (hence the ‘hiccup’) until the child engages in the ritual of the brain’s liking.  What these children describe to me, however, is the rational part of their brain telling them that they don’t really want to have to wash their hands that many times (or at all for that matter) to make the thoughts go away.  There are often strong similarities between the brains of children with OCD and brains of children with Autism.  However, one critical difference is that the OCD brain ultimately wants the repetitive thought to go away while the Autistic brain is comforted by the repetitive and familiar nature of the thought.

Remember:

  • The child in their comfort zone seems like they don’t want to be part of our world.  However, this is not regression or a lack of progress.  In fact…
  • Perseverative and stereotypical behaviors are not ‘bad’.  These behaviors help child regulate a chaotic world.
  • However, these behaviors may become habits & keep the child isolated.  These are potentially addictive for the child and need to be monitored.
  • ‘Joining’ in these behaviors helps our engagement with the child.
  • As our engagement with the child increases, the perseverative and repetitive behaviors naturally decrease!

For more information on this topic, visit the work of Dr. Rick Solomon and the PLAY Project.

Dr. Mark Bowers is a Licensed Pediatric Psychologist at the Ann Arbor Center for Developmental & Behavioral Pediatrics in Ann Arbor, Michigan.

Mark Bowers, Ph.D. © 2009

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Filed under Autism, Child Development, Parenting, PDD-NOS, Scripting