Category Archives: PDD-NOS

Quote of The Day

“During any moment of any given day, I’m either obsessed with what I’m doing or bored with what I’m doing.”

–Student with Asperger’s explaining the difficulty navigating everyday activities.

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January 11, 2013 · 3:22 am

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

Social Skills Part I: ‘Impressions’ and Being ‘Out and About’

night_game

This is the first in an ongoing series I will be presenting on Social Skills.  I spend a significant portion of my clinical practice working with children and teens on social skills.  Many parents are curious about my approach and philosophy on teaching social skills, so I thought I would begin posting my thoughts on the matter (in no specific order).  I will being by discussing ‘impressions’ and the initial need to be seen and not heard.

I often discuss social interactions as similar to advertising impressions.  For example, when businesses buy billboard advertising on the side of highways, they often first collect statistics on how many “impressions” their billboard location has on a particular day.  The advertisers want to know specifically how many individuals will see their advertisement over the course of a day, week, month, or year.

Individuals with social skills difficulties often become dejected and suffer a loss of self-esteem when they make one or perhaps even a handful of attempts at engaging others in a social interaction and these attempts are unsuccessful.  I am often able to use my advertising analogy with my clients who will begin to understand that not every person who drives by the Pepsi billboard on the highway is going to purchase that particular product.

When the available options for friendships is smaller such as in an elementary school, certainly the stakes are higher and each impression that is made must count.  However, I often coach my high school-age clients that they cannot expect to sit in their basement playing video games every weekend and then come into my office wondering why they are not more popular in school.  We often discuss the ‘content and process’ approach to social interactions which can be loosely applied to various junior high school and high school activities.

For example, I may work with individuals who have little interest in sports especially when it comes to participating in them.  However, anyone who has attended high school is well aware of the fact that, especially during the fall and early winter months, the place to be is the local high school football game on Friday night.  When it comes to “impressions” such as those found in advertising, being seen even if not heard is a basic starting block for my clients.

I have to remind these individuals to relax initially and just be there rather than try to initiate interactions with others or practice social skills techniques they may have learned by reading a book or from a counseling session or group.  I am generally opposed to social skills techniques being ‘taught’ because the nature of individuals with social difficulties is to study and memorize something in a rote fashion or linear manner and social interactions are far from rote or linear.  More on that topic in a future posting…

Indeed, although these individuals would love nothing more than to reduce social interactions down into a mathematical formula where there is a very specific path that must be followed in order to reach the appropriate or correct outcome, social interactions are generally not linear or rote, and are instead fluid and contain millions of variables and exponents that might be comparable to the mathematical variable of (Pi).  Thus, 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.

Dr. Mark Bowers is a Licensed Pediatric Psychologist and Autism/Anxiety expert at the Ann Arbor Center for Developmental & Behavioral Pediatrics in Ann Arbor, Michigan.  Learn more about his Social Skills groups here.

© 2009 Mark Bowers, Ph.D.

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Filed under ADHD, Anxiety, Asperger's, Autism, PDD-NOS, School, Social Skills

“Cats Are Autistic Dogs” Part II: Notes on Asperger’s

ASD PuzzleThe response in my office and on the web has been so positive to my previous posting on Asperger’s features, that I thought I would share some more thoughts.  I would also like to thank the people over at CafeMom.com for adding my blog to their impressive Autism/Asperger’s/PDD awareness group.

  • Aspies are usually the offspring of Asperger’s fathers who are socially shy and usually have careers in engineering, computers, accounting, or the math/science fields.  The moms of Aspies tend to be teachers, social worker types who are very outgoing, social, and often Type A or ‘organized’ personalities.
  • Siblings of Aspies tend to be gifted/talented, have ADHD or OCD features, or even have anorexia diagnoses (there is a perfection element somewhere in the gene pool).
  • Group projects in school are one of the biggest difficulties because of the social element.  This is the same reason why Aspies do so well in solitary occupations like computer programming but then begin to struggle when they are promoted to management.  Aspies do not manage people and social interactions well.
  • We don’t give Aspies enough credit for how hard they work during the school day.  They keep it together during school and then ‘fall apart’ or are completely exhausted when they return home.  They work at least three times as hard to keep up with the social environment inherent in the school setting.  REMEMBER: Aspies need to learn both academics and social skills in school while neurotypicals only need to learn academics (the social aspect comes naturally).  Imagine the energy differences between the two groups after the same school day!
  • Aspies in history were found in monasteries or were carpenters, jewelery/watch makers, and explorers.
  • Young Aspies may look like children but they act like adults.  Their social difficulties attract bullies as well as female peers who are the ‘caregiver’ type.
  • We usually make the error of telling Aspies, “I shouldn’t have to tell you…” when in fact we have to instruct them every step of the way when it comes to social interactions.  Remember to use logic, not punishment.
  • Aspies value intelligence more than anything.
  • When trying to get an Aspie to stop a behavior, use their desire for intellect to your advantage.  For example, if your child has difficulty sharing, try telling him, “Smart people share.”  Sometimes Aspies will hear foul language and repeat it without knowing the meaning behind it.  Telling the child, “Smart people don’t use those words” will usually do the trick.  The other technique is to exaggerate your response to the word such as holding your hands over your ears if your child repeats something inappropriate and yelling “Ouch!  That hurts my ears!”
  • Aspies often tune out during class lectures or social situations because their thought is, “If this is not one of my strong interests then why should I involve myself with it?”
  • The rigidity in thinking inherent among Aspies also creates difficulty converting thoughts and emotions into speech (communicating feelings) as well as getting thoughts from one’s head onto paper for a report in school, for example.
  • As the chronological age of the Aspie increases, the emotional, maturational, and social development stays at a younger level.  Younger neurotypical siblings will eventually surpass their older sibs in social and emotional development.
  • Aspies look at the action, not at the motives of the action.  So when they are ‘hit’ by a peer who was giving them a joking tap on the shoulder, they tend to retaliate because their thinking says, “He hit me, I ‘m going to hit him back!”  Guess who ends up in the principal’s office?
  • The nature and severity of Aspie symptoms vary dramatically from day-to-day.  This is a ‘swiss-cheese’ developmental presentation with no clear, consistent pattern.  This not only complicates the diagnosis, but schools often try to argue that a child does not have Asperger’s because of having ‘good’ days at times.  They also say things like ‘he is so smart’ or ‘he makes good eye contact.’  Parents often know that a particular day is a ‘good one’ versus a full-on ‘Aspie day’.  Also, full moons actually seem to have an effect on severity of symptoms!
  • Aspies misinterpret behaviors.  An adult may raise their voice to be heard in a crowded room or to make a point.  An Aspie will always see shouting as anger and thus the reasons for raising one’s voice must be explored in depth.
  • If your Aspie child is upset, consider the following:
  • People are confusing to Aspies.  Thus, you want to eliminate the social context when the child is upset.  This is not the time for a face-to-face chat…face the wall if you need to!  (Dr. Mark sits to the side of the child and speaks in the same direction the child is looking..don’t worry about eye contact at this moment!).
  • Tell the child, “I don’t need to know what happened right now.”
  • Keep emotionally calm yourself.  Adding your own emotion at this time is like pouring gas on a fire.  Be sure to tell the child, “I’m not upset with you.”
  • Begin helping the child to calm down by suggesting closing their eyes, deep breathing, and other relaxation strategies.
  • Compliment the child and give them something to look forward to.  “I think you handled this situation with intelligence and I know that the next time you are upset you will do another good job.  What do you say we go look at your book of the planets?!”
  • Children with Asperger’s should be allowed to complete a project on emotions/social skills at least one hour each week while in school beginning in Kindergarten through 12 years of age.  Schools need to do a better job of teaching these children the Hidden Curriculum.
  • For every hour an Aspie is social, they need about an hour to unwind and decompress.  Thus, there is not enough time to unwind after a full school day.  Ever wonder why the stress level is so high during the school week?  How about the trouble getting homework completed?

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

© 2009 Mark Bowers, Ph.D.

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Filed under Asperger's, Autism, PDD-NOS

Autism Diagnosis: Now What?

Many families that come to my office for an appointment with an existing diagnosis tell me that they received a “general autism spectrum diagnosis” and the clinician did not really discuss treatment options beyond the diagnosis.  If this is actually the case, then it is frustrating to hear.  I can only imagine the frustration that these families must be experiencing: so many questions and so few answers.  Indeed, I often spend my time calming parents down and gaining their trust as an advocate and ally for them who is ready to give very specific suggestions based on their child’s specific developmental profile.  For the families that do not have the opportunity to be seen in our clinic or who are going to be making an appointment in the near future, I thought I would share what the science says you should do following your child’s autism diagnosis.  I will reserve my thoughts on alternative treatments that are not based on the science for a  future blog posting.  For now, I prefer to guide my families toward treatments that science supports as effective.  So here are the main starting points for treatment following autism diagnosis that are based on the National Science Council Research Report:

1)      20-25 hours per week of intervention

2)      With a 1:1 or 1:2 teacher to child ratio

3)      That is engaging

4)      Has a strategic direction

5)      And starts early (Between the ages of 18 months to 6 years)

Typically these interventions (which count toward the 20-25 hours per week) include:

Two highly recommended websites:

1)      Your Child: Autism Spectrum

2)      P.L.A.Y. Project

Another nice resource for what can be done during the First 100 Days following diagnosis can be found here.

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

© 2009 Mark Bowers, Ph.D.

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Filed under Autism, DIR, PDD-NOS, PLAY Project

Autism and OCD in Children

hand_washingAutism Spectrum Disorders (ASDs) and Obsessive-Compulsive Disorder (OCD) can and do occur at the same time.  OCD is a specific diagnosis under a larger umbrella of anxiety.  Children with OCD experience unwanted and intrusive thoughts that they can’t seem to get out of their heads (obsessions), often compelling them to repeatedly perform ritualistic behaviors and routines (compulsions) to try and ease their anxiety.  Children with ASD generally have repetitive, perseverative thoughts that are intense in nature, much like children with purely OCD symptoms.  The big difference is that children with OCD do not like the experience of having repetitive thoughts and would do anything to get rid of the thoughts (such as washing one’s hands 25 times).  Children with Autism Spectrum diagnoses are not bothered by their repetitive behaviors and thoughts, and instead are usually comforted by them (such as playing with a train in a repetitive fashion for hours at a time).

Anxiety is highly prevalent among children with Autism Spectrum diagnoses (greater than 35% of children experience both).  This is due to a combination of genetics, brain development, and higher levels of stress.  The error that many schools and therapists often make is attributing a child’s anxiety symptoms to his or her Autism diagnosis (i.e., “The only way to really reduce  anxiety and aggression is to treat the Autism.”)  For example, many children are referred into social skills groups when what they really need is help with anxiety that is interfering with their social functioning.  Highly anxious children with OCD may begin to act out behaviorally in school prompting teachers to encourage (some might say ‘coerce’ or ‘force’) parents to begin medicating the behavior.  The concerns here is twofold: 1) the behavior is numbed with medication and the root anxiety is never truly addressed (i.e., stop the medication and everything returns to the way it was), and 2) the school may begin to implement safety nets such as increased para support to keep the behaviors from occurring while again failing to adequately address the underlying anxiety symptoms.

The question often asked is, “Can you really treat a child who has both an autism spectrum diagnosis and OCD?”  The answer is “yes” and new research is beginning to show that there are some exciting recent behavioral treatments out there for these children.  Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for anxiety that has been established by the American Psychological Association as effective for children.  A recent study of CBT for neurotypical children with anxiety (Wood et al., found):

  • Childrens’ school performance improved & they attended school more regularly
  • Children had more friends & better quality friendships
  • Children got along better with family members
  • Children had higher self-esteem

The authors of that study have adapted the neurotypical CBT protocol for children with autism spectrum and are finding some promising results.   In general the results suggest that the authors’ adaptations of the pre-existing CBT manual can be effective for treating anxiety such as OCD in children with autism (research article link).  This treatment manual is available to practitioners and families, a sample of which can be viewed here.   Thus, there is hope for effective anxiety treatment for your child who also has an autism spectrum diagnosis.  It is highly recommended that you seek out services from a pediatric specialist who has training and experience treating children with co-occurring anxiety and autism spectrum diagnoses.

On a personal note and aside, I will be spending tomorrow with noted Asperger’s guru Dr. Tony Attwood  so stay tuned for a blog later this week where I hope to share some new ‘nuggets’ of information.

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

© 2009 Mark Bowers, Ph.D.

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Filed under Anxiety, Asperger's, Autism, CBT, OCD, PDD-NOS

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