The Family Room

Navigating Negative Emotions (Part One)

By Jordan Sadler, SLP

My 4-year old client threw himself on the floor and cried when sharp adult scissors were taken away from him, but wailed, "I'm happy, I'm happy..."

A 5-year old girl grabbed something from me and then immediately socked me in the nose when she saw my sad facial expression.

Another young boy, startled when his little sister cried, insisted to me, "Abby's happy.  She's not sad!  She's happy!"

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Susan recently proposed a topic that has been on my professional radar a great deal lately.  That is, why is it that some children want everyone to be happy at all times, and how can we help them process and accept negative emotions better?

I think there are probably quite a few opinions out there explaining why this is.  Last week I had the great fortune of having meetings with two colleagues - first I met with Liesl Wenzke Hartmann, SLP of Communication Therapy in San Francisco, and then with Emily Rubin, SLP, one of the creators of the SCERTS Model, a comprehensive educational program for children with autistic spectrum disorders.  I wanted to hear what each of them thinks this is all about, and their answers made good sense so I will try to summarize our conversations for you.

One of the core deficits in autism is difficulty in predicting social behavior in others.  To borrow a statement straight out of a SCERTS workshop hand-out, "Individuals with ASD have neurological differences that impact their ability to predict the intentions of others, comprehend social cues and share their intentions with others."

A developmentally young child with ASD who has difficulty predicting the intentions of others will have a very hard time knowing what is going to happen to him next, even when his communication partners think that they are making it very clear (e.g., putting on jackets and shoes, getting the car keys, saying, "Let's go to Target!").  The child is then picked up "out of the blue" from an enjoyable activity at home by his loving parents and taken outside where he is strapped into his car seat or stroller and perhaps brought to a noisy store or play group.  This can be confusing and dysregulating, which in turn has the potential to make a "simple outing" a great challenge to parents again and again.  Tension builds in the family's day-to-day life as everything starts to feel like a battle. 

In addition, the child may see absolutely no logic behind someone else's emotional reaction.  His sister, from his perspective, quite often begins to tantrum out of nowhere, which is very startling and - again - dysregulating.  If a child does not see it coming, because he has trouble reading social cues, he has no opportunity to initiate soothing strategies such as moving closer to Mom, covering his ears, or leaving the room to find his sippy cup before the tantrum escalates. The world becomes an unpredictable, often frightening, and stressful place.

No matter what the particular situations are, this child is developing what the SCERTS collaborators call negative emotional memory around a great many things; things as simple as Mom getting her keys or his sister starting to cry.  He has not yet had enough opportunities to:  a) predict the occurrence of something challenging, b) use coping strategies for self-regulation, or c) learn over time that he can make his way through these difficult feelings without becoming dysregulated.  Therefore, he experiences negative emotions but doesn't really connect meaning to them, becoming dysregulated immediately when he feels them.  And, when he has enough language to do so, may try to deny them out of fear. 

Put another way, in the words of the SCERTS folks, "When a child is not able to predict the actions of others and has limited history of positive emotional experiences in social interactions, social experiences become threatening, anxiety provoking, and worthy of avoidance."

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Let's face it.  As a society, we are very uncomfortable with negative emotions.  Adults so often say to a child, "Come on now, don't cry about that!" or "There's no reason to be so mad," or "That's a silly thing to be sad about!"  We tend to try to safeguard young people from those challenging emotions, especially our children with special needs, figuring they've got enough to deal with already. But the hard truth is that we must all learn to predict, cope with, and succeed in moving through negative emotions in order to feel comfortable with them and continue on our way up the developmental ladder.

[Part Two will address how to help guide children through this process.]

Communication Skills: Slow to Develop or Delayed?

By Jordan Sadler, SLP

New parents look forward to their child’s first words with great anticipation.  We want to hear that cute little voice, and start to understand better what our child is thinking about.  We dream about how easy parenting will be when our child is able to tell us what he wants with words rather than cries.

But what does it mean when the child in your life is the last one in the playgroup to utter those first words?  What if you are the only one who understands those first words?  What if he starts to stutter all of a sudden at age 3?  And what about that 1st grader who is still lisping? When is it normal and when does it require remediation?  How do we know when we should become more concerned?

“Einstein didn’t talk until he was four,” well-meaning people are fond of saying.  Then there’s the other playground stand-by, “He’s a boy--boys are slower than girls to talk.”  And finally we have the pediatrician’s response, “Let’s just wait and see,” which does many children a huge disservice because it delays critical early intervention so often.

So how do we know? 

Book Review - Look Me in the Eye: My Life with Asperger's

by Jordan Sadler, SLP

John Elder Robison has just had a wonderful book published.  Mr. Robison lives in western Massachusetts with his wife and teenage son; he runs a successful company, repairing and restoring fine European automobiles.  Mr. Robison also happens to have Asperger's. 

For much of the book, this is the way the story plays out - the fact that Mr. Robison has Asperger's takes a back seat to his fascinating life story.  Despite many roadblocks - some of them enormous, such as his mother's mental health challenges and his father's alcoholism - "Look Me in the Eye" ultimately reads as a success story. 

Mr. Robison was blessed with a very high level of intelligence, but what he makes clear in his book is that he was unhappy for many years.  It was a long time before he found a job that fit his abilities, and his first marriage did not last. Asperger's was not an identified diagnosis when this author was a child, and none of the professionals he worked with understood his unique set of characteristics. That is, until a close friend bravely handed him Tony Attwood's book, "Asperger's Syndrome" (the link is for the current edition of this book), noting that the characteristics outlined in the book fit Mr. Robison perfectly.  At age forty, Mr. Robison agreed.

The author explains the enormous shift in his understanding of himself upon reading Mr. Attwood's book and the impact this had on his entire life.  The last few chapters were particularly insightful, chronicling the years after diagnosis and the ways in which Mr. Robison processes thoughts and emotions.

As a therapist I found this book to be immensely interesting.  It is a rare gift to hear from this fifty-year old man exactly what he wishes he'd known about himself as a child, how his logical brain works, and what kinds of skills he would have liked to have been taught.  Here are some of the highlights:

• Making eye contact with others has been difficult for him for most of his life and when he is looking at someone, he is "unable to form words".  Later in life, he taught himself to glance at the eyes of a conversational partner to check in, but mainly looks away.  This fundamental challenge led others to describe him as "hiding something", a "criminal", a "sociopath", and a "psycho", beginning at a young age.  He states, "I came to believe what people said about me, because so many said the same thing, and the realization that I was defective hurt.  I became shyer, more withdrawn."
• There is an account of a simple conversation with a good friend, in which the author details his internal dialogue and the difficulty he frequently has in knowing what the expected, socially appropriate response is.  He notes, "It's clear to me that regular people have conversational capabilities far beyond mine, and their responses often have nothing at all to do with logic.  I suspect normal people are hardwired to develop the ability to read social cues in a way that I am not."
• The author makes a fascinating argument that as he gained "greater insight into [his] emotional life", his logical thought processes took a nosedive; he states that when he looks at the complex electrical circuits he designed when he was younger, he is no longer able to understand them.  I was glad to hear the author state clearly that he feels this was a worthwhile trade.
• Mr. Robison makes it very clear that doctors who describe children with autism and Asperger's as "preferring to play alone" (which we hear all the time), are "dead wrong".  He writes, "I played by myself because I was a failure at playing with others. I was alone as a result of my own limitations, and being alone was one of the bitterest disappointments of my young life."
• The author described the ways in which his wife helps him with his sensory processing challenges (e.g., sleeping "in a pile" with him, petting him when he gets jumpy), and how she deals with his anxieties.  One of my favorite sections on his marriage was his extremely analytical dissection of choosing a mate; he wonders if he got the "best sister" (his wife has two sisters, or "units", as he calls them), and likens this to a man wondering for years after buying a new car if he chose the best model.  Although he has heard the reactions of his neurotypical friends, he is unable to relate to their arguments because his mind works in such a strictly logical manner.

This book is a treasure for people with Asperger's as well as their families, friends, and the professionals who work with them, but it is also a very interesting book for anyone interested in human interaction and psychology.  It deserves a special place on the bookshelf right next to Temple Grandin and Daniel Tammet.

Map It!

By Jordan Sadler, SLP

Last week, a post at the blog From Here to There and Back prompted me to suggest that the blog's author create a visual map of a challenging situation her son experienced at school.  The subsequent off line conversation about this with the writer - and comments from her readers showing great interest in the topic - led me to think that perhaps this is a topic worthy of further explanation.

There are many ways to use visual strategies to map out a social situation for children.  What I do in my work is ultimately a combination of ideas I have picked up over the years at numerous workshops given by Michelle Garcia Winner, SLP, who runs The Center for Social Thinking and Carol Gray of The Gray Center for Social Learning and Understanding.  I give both of these amazing women full credit for the way I approach the teaching of social understanding and social thinking to children.  Their work fills gaping holes in what is considered best practice for kids with social-pragmatic difficulties right now.

The ideas proposed by Ms. Gray and Ms. Winner make perfect sense once you've heard them explained, but are not, apparently, intuitive to many therapists because so rarely are children (or adolescents or adults) taught this way.  In effect, we - therapists, teachers, and parents - are encouraged to approach social-pragmatic awareness not as a series of skills to be trained (as has been done in social skills groups and traditional ABA-type therapy), but as a process in which we help people to understand why we communicate the way we do. We want children to understand what kind of impact their behavior and language has on others.  We don't say, "Look at my eyes!" to teach eye contact but rather explain, "People's eyes are a window into what they are thinking about - if Ben is looking at the clock, he might be wondering if it's time to go home."   Non-verbal communication is explained in such a way that it carries meaning and becomes motivating to our clients.  Of course, there is so much more to this, and I highly encourage those interested to seek out books and workshops with the experts in this field.

I am going to provide an example of a behavior map, and in order to maintain confidentiality for my clients, I will use an experience from my own family. 

When my neurotypical older son was about 4 years old, we were at a neighbor boy's home.  Now the neighbor boy's parents were both early childhood educators, and there was no place in the world as fun as their house.  They had a big climbing structure right in their living room!  It is no surprise that my son didn't want to leave.  Ever.  On one occasion, after ample warnings (the "5-minute countdown", I call it) it was time to depart.  My son refused and became quite belligerent.  After trying every strategy we well-trained adults could think of, I ended up carrying him home as he kicked and screamed; I was hugely pregnant, exhausted, and incredibly frustrated.  I know we've all been there in one way or another.

When we got home, I was at my wit's end.  We were infuriated with each other.  I did all I knew how to do in that situation, which was to sit silently on the floor and pull out paper and a marker.  I quietly started to draw.  Now, let's get something straight: I am no artist.  That is not a requirement for this!  In this situation, I sketched out the scene like a cartoon, and my son immediately sat down to watch.  It started with two boys playing happily.  Always show emotion on the faces throughout a social map!  In the next frame, there was a smiling mother giving a 5-minute warning and the boys were still smiling.  As we got down to the 1-minute warning, I showed the expression on my son's face start to shift into anger. 

When the stick-figure mother announced in her little "speech bubble" that it was time to go, I drew a boy with the angriest face I could muster and limbs out of control.  But I think what was critical here was that I also drew the neighbor boy and his parents - all with concerned, sad faces - and myself looking angry.  In the midst of a tantrum, our kids are not generally aware of how their behavior is affecting anyone else.  If you can represent visually to a child the ways in which his actions affect how others think and feel, you are giving him the key to social thinking, or theory of mind.   I pointed out to my son that he did not say "thank you", nor did he say "good night" to our hosts and that when we left they were all feeling sad.  He was really impacted by this.  I explained that when you leave nicely, you are more likely to be invited back soon.   

I then pulled out a new sheet of paper and we started with the same beginning but recreated the sequence of events as he would like them to unfold in the future.  He decided that he could say, "I don't want to leave!" and he could feel as angry as he wanted to, but that he would leave without a tantrum, and we drew the whole thing as he described it.  This sounds like a very long process but we really only spent about 10 minutes doing it.  It's not about the art - it's about keeping the child's attention focused on the unfolding events - so it can move fairly quickly, depending on the situation and the child's processing speed.

We went back to that friend's house a great many times after that night and we never, ever had a problem leaving again. 

There are as many ways to create a visual map of a social situation as there are different social situations for our kids to experience.  There is no required format for this.  Depending on the situation and the age of the child, you could create a cartoon strip, a flow chart, or any other picture that shows a sequence.  The important part is that you visually and simply represent the ways in which the child's actions impacted other people's feelings and how they thought about him, and led to a specific outcome.  Having the opportunity to remap the situation is critical!  Your child will not learn enough from simply seeing the unsuccessful scenario portrayed; he needs an opportunity to think through an alternate ending in order to use different behavior the next time something similar arises. 

Michelle Garcia Winner has a recent publication called Social Behavior Mapping which will undoubtedly provide many terrific strategies, and Carol Gray (who came up with the concept of Social Stories) has a great little book called Comic Book Conversations which outlines another means of using visual support to aid understanding of language within social situations.   There is always more to learn about helping our children and clients improve in their social thinking; we are so fortunate to have these experts as resources.

Those of you in the Bay Area might be interested to know that Michelle Garcia Winner and Carol Gray are running a workshop together December 4th and 5th in San Francisco. They are very parent-friendly speakers!

What Are You Saying?

By Jordan Sadler, SLP

 We sat at the dining room table this morning, my family and me, enjoying breakfast together.  My almost 3-year old held up his oddly-shaped, partially-eaten bagel and chirped, "Yook, Mommy, dis yooks just yike a [cao]!"  "A cow?" I asked, trying to see a bovine in his breakfast.  "No!" he said, immediately irritated, "A [cao]!"  "Oh, a car!" I said, relieved that I had gotten it.  At this point, the child burst into loud sobs.  I am talking about from-the-gut, frustrated, no-one-understands-me sobs.  He simply could not recover.  There was to be no more guessing, no more trying to say it another way.  Leaving my untouched coffee behind (the true maternal sacrifice), I got up from my chair, made my way around the table, and knelt by my child.  All I could do was hug him and say the familiar words, "I know you're trying, sweetie...we want to know what you were saying...sometimes it's so hard," and then, "It's going to be okay, honey, it's going to be okay," and then: nothing.  In the end, I took him from his chair and held him on my lap.  He asked for a story, and listened to it as the sobs gradually subsided.  We never made it back to the table; I never knew what funny thing his bagel looked like this morning.  And I was sad about that.  Very sad.

For more than 10 years now, parents have been asking me the important question, "What can I do when my child is trying to tell me something that I don't understand?"  Each time, I've shared all the tricks I knew: "Listen carefully and try to figure it out.  If you can't, though, don't fake it - they'll know your response is not genuine", "Ask him to try showing you", "Ask him if he can say it another way, with different words", and "Be sure he always knows that you want to understand, that what he's saying is important, that you're trying."  Of course, I'd been in that position with their children as well, in our speech therapy sessions, and I knew it was really challenging.  We don't want to damage a child's self-esteem, and we're doing our best to keep frustration at a minimum whenever possible, but sometimes it is very upsetting for a child who is already working so hard to communicate with us.

Now that I have a young child of my own who came into the world with some oral motor and articulation difficulties, I know that it feels qualitatively different to a parent than it does to a therapist: sometimes, when a child is working on speech production these suggestions don't cut it - they aren't enough - and at times this struggle leaves both parent and child feeling very, very sad. 

So now I will add to my list of suggestions, "Sometimes, you just have to sit with him, hold him tight, and not say anything at all."

Some Thoughts on Prognosis

By Jordan Sadler, SLP

Susan asked an excellent question of the Family Room contributors recently: How do we as therapists talk to parents about a child’s prognosis?

Yes, parents do sometimes ask, “What is my child’s prognosis?” and that is understandable.  As a parent, I am sure I’d be asking it myself.   However, it may be as difficult for therapists to answer as it is for parents to ask.  For one thing, what do parents mean by “prognosis”?  Does it simply mean, “What will the outcome be for my child after all this therapy? What will his future look like?”  Or is it a way of asking, “How close to typical do you think my child will become?”  Although the latter is a perfectly fine (and understandable) goal for one’s child, I always bear in mind just how broad the range of “typical” really is; it’s a moving target.  Is your typical the same as my typical?  Is “quirky” as okay with you as it is with me? I like to think more in terms of “How comfortably will this child be able to socialize, play, and learn with others?  How can we help him be his best self and be happy with who he is throughout childhood and into adulthood?”

The short answer is, we don’t know. I always begin my answer to that question with the “I don’t have a crystal ball” response.  And I do wish I had a crystal ball. I wish I could look a parent in the eye and say with confidence, “Oh, your child will be just fine.  Simply do x, y, and z!”  But I can’t.

Over the years, I’ve occasionally started working with a child who appeared to have everything in place to succeed and yet the progress was slower than I expected.  Conversely, there have been times when I doubted in my heart how far I could get with a child and then was happily surprised to see him gain new skills quickly.  Without a doubt, I am better at predicting this than I was when I started out as a therapist; experience makes a tremendous difference.  But I can still be surprised, because children with special needs are as unique as anyone else, and each has to follow his or her own developmental path.  If only we had the map ahead of time!

What I feel I can say with confidence is that I pay attention to a cluster of “good signs” for a positive prognosis, which to me means that the child will have the best shot at growing to his or her fullest potential, no matter what the diagnosis is or how old the child is at the time. I’m sure we all have different internal criteria to determine prognosis, depending on the way we look at and think about the children we serve. 

When a parent asks me, these are my top concerns:

1)    Involved caregivers.  Now, hold on a minute!  You do not have to quit your job, no matter what that mom told you in the waiting room at OT.  But you do need to be very involved with your child’s intervention program.  You do need to make sure your child’s IFSP or IEP has appropriate, attainable goals and addresses your concerns.  You do need to know all of his therapists and what they are working on.  You do need to hand pick your private therapists and be as involved in sessions as you possibly can be.  Organize team meetings with therapists.  Have regular communication with them.  Ask lots of questions.  And you need to know what you can work on at home – and do it!  It’s a lot of work, whether you are working outside the home or not.

2)    Quality therapists. Another key to a positive prognosis is going to be the quality of your child’s intervention team rather than the quantity of therapists.  You need to hear from the therapists on a regular basis; if you don’t see the therapist every week, be sure you are getting notes or regular phone meetings to discuss how things are going.  I’d prefer to see a child working with just a couple of excellent therapists rather than running around to see many different people who are working on different goals in different ways.  Because if your child is doing that, how on earth can you as a parent keep track of what each therapist is doing, and generalize the goals at home (see #1)?  And also, isn’t everyone stretched too thin?  In the long run, who does that benefit?

3)    A developmental program.  Yes, this is closely tied to #2, but cannot be stressed enough.  If I see a child with a therapeutic program that is focused on teaching skills without foundational skills truly in place (e.g., joint attention, referencing, reciprocity, emotion-sharing, perspective-taking, strong non-verbal communication skills), I won’t feel that the child has as good a prognosis.  Perhaps he will succeed academically in school, at least up until 3rd or 4th grade, but not socially.  And believe me, when it comes time for your grown-up child to get a job, it is not going to be those academic skills that pay off in an interview or help him keep the job.  It is going to be his ability to interact with others and work as part of a team.  Without an appropriate developmental program, his future success will be tremendously impacted.

4)    An integrated team.  Your child’s team, whether it is made up of public therapists, private therapists, or both, must communicate with each other.  Team meetings are an excellent way to do this, although they can be very difficult for parents to coordinate.   I have seen many families in Chicago set up Yahoo! Groups for their child’s team, and this has been an excellent forum for therapists and parents to communicate notes, reports, comments, and questions.  These are private and you can have an email sent to you each time there is a new post; I highly recommend it.  A coordinated team is a committed team.  And a committed team is working hard on behalf of your child.  Therefore, integration of services will naturally lead to improved prognosis.

Every child is different.  But until someone hands me that crystal ball I’ve been asking for, I’m going to have to rely on these other factors.

Searching for Therapists

By Jordan Sadler, SLP

As Susan wrote about so eloquently, the period of time around an autism diagnosis is acutely distressing for parents.  One of the first things parents are generally told to do is to go home and immediately gather a team of competent therapists to work with their child; whether this is done through a school district, early intervention, or privately, this is a daunting process - and would be even without the overlay of grief and anxiety.  Parents then discover the variety of treatment strategies available to them; sometimes this may give them a burst of hope for their child, but my sense is that initially it's nothing short of overwhelming.  So Susan has asked the therapists contributing to The Family Room to do what we can to help parents figure out what to look for and what to ask when searching for good therapists.

There are many ways to approach working with a child with an autistic spectrum disorder.  I have read recently that, really, any of the most popular strategies will result in positive gains, assuming the child is receiving enough of it as soon as possible, and the parents are involved in the treatment as much as possible. This is not to say that I have no preferences when it comes to treatment, but the fact is, it is going to be up to the parents to determine whether they are most comfortable with DIR/Floortime, RDI, SCERTS, ABA, PECS, and/or TEACCH, to name a few big ones.  Some families will find that one clearly resonates with them immediately and others will need to ask the diagnostician, their pediatrician, other parents, and the Internet for advice before making the decision.  Of course, you want to find therapists with experience, proper license, and good training.  But here are some additional things to look for - and pitfalls to avoid - when searching for your therapists:

1.  If a therapist suggests to you that you have "wasted time" by not getting help earlier or by taking part in another type of treatment, do not hire that person.  A good therapist has no interest in making you, the parent, feel guilty or incompetent. 

2. Similarly, consider all statements about missing out on your child's "window of opportunity" to be scare tactics. Yes, those neuronal connections develop quickly in the early years, but they continue to develop throughout the life span.  By waiting two weeks for your first session because of that family vacation you already had planned, you are not harming your child.      

3. When a therapist or treatment center has a blanket policy of not allowing parents to take part in therapy sessions, consider this a red flag.  If your child seems to be overly distracted by your presence in the room and needs a period of time alone with the therapist to establish a relationship before introducing you back into the sessions, so be it.  But for a parent to be denied all access to view and participate in therapy, and for no coaching to take place?  When the parent asks for it directly?  Not good.

4. Pay attention to the attitude of the therapist when you make the initial contact.  Does he/she try to sell you on a particular treatment, assuming it works for all children, or are you asked questions about your specific child?  Be cautious about one-size-fits-all approaches and those who feel they can treat all children with one treatment approach.  You want to find therapists who see your child as a unique individual; the good therapist will meet your child where he or she is and build from there.

5.  Find therapists who are willing to take the time required to establish a positive relationship with your child before expecting any learning to take place.  There are children who will walk in the door and feel comfortable, connected and ready to learn.  Then there are others who need a lot of time with a therapist - time without demands, when the pair can simply work up to joyful interactions at the child's own pace.  This might involve spending a session lying on the floor together, listening to the child's favorite music, and requiring absolutely nothing of the child.  The child may start the session cautious and disengaged, but by the end of the hour may be cuddled up with the therapist, stealing glances and smiling at her.  This time is well-spent because within a few weeks, the pair has formed a trusting relationship in which the child is willing to take some risks and move outside of familiar patterns.  Now learning can take place.

6.  Be sure you are getting consistent communication from your therapist and find out if he/she communicates regularly with other team members via phone calls, email, sharing notes, etc.  A therapist operating as a cooperative member of a larger team is going to have a greater impact on your child's development.

In the end, you want to work with professionals who respect you as a parent and love your child for being the amazing individual he or she is.  When these qualities are in place, so much growth can happen for your child.

To reach Jordan directly, email: Jordan [at] communicationtherapy [dot] net.

On Being a Mother with a Therapist's Eyes

By Jordan Sadler, SLP

His name is Will.  He is around 3 years old and beautiful: big brown eyes that twinkle when he makes fleeting eye contact, and one large dimple.  He stands in the center of the circle of children, and when the music starts, he grins and starts to spin, joyfully.  I can't help but smile when I watch him. I also can't help but perform an unconscious assessment.   I haven't heard him utter a word, but I've heard a few vocalizations.  He claps his hands when the song says to, I note.  He seeks out eye contact and returns my smile.  He goes to his nanny for comfort when he needs it.  Should I hand them a report when they leave?, I ask myself sarcastically, wishing I could just focus on the class. On occasion, Will runs from the group and does laps around the periphery of the room, looking at the place where the wall meets the floor out of the corner of his eye until his caregiver corrals him back.  At least once during each class, a particular sound in a song becomes too painful for his over-sensitive auditory system and he screams.  And cries. The intuitive music teacher switches to a lullaby in an effort to calm him.  Sometimes he can be soothed but often his nanny carries him out, speaking kindly to the frightened little boy.  She knows, I think.  She understands this.

Then there is Sam.  He is 2 years old.  He sort of manages in the "gym" part of Gym and Swim, but I notice him engaging in self-stimulatory behavior with the lights up on the ceiling.  If left alone, he seems content but when another child comes close, he screams loudly and pushes the child away.  When it's time to get into the pool, he sobs.  It starts in the locker room and rises to a fevered pitch when he sees the pool.  "I don't understand why he doesn't like this," sighs his mother, holding his shaking body with her own feet dangling into the water.  Clearly, she is the one who wants to be in the pool with the others, singing "Five Little Ducks".  She wears an agonized, exhausted expression.  She too leaves the class early, deflated.   I find it painful to watch.  She doesn't know yet.  She doesn't understand. 

I am not there as a therapist.  I am there as a mother myself, attending classes with my own toddler.   Without fail, there is a child in each class we attend.  A child who may or may not fall somewhere on the autism spectrum, but without a doubt has significant language and sensory needs.  I do not doubt the new 1 in 150 estimate.  Each time, I can't help but watch the child and his mother with both a therapist's and a mother's eyes.  I want to reach out, say something.  Something beyond, "What a beautiful boy," or "Wow, look at him climb!", the words I find to point out all that is wonderful about their children.  Especially to the ones I suspect don't understand yet.  I find their confusion and pain unbearable.  I have to forcibly tear my attention away to focus on my own child, who is so happy to have a special day with me when I'm not at work.

I grapple with this question often:  can I say something?  If so, what?  I believe that it would be in the child's best interest to let his parents know that there are other children who struggle with these things, that there are people who can help them.  Especially when they could be getting early intervention.  Especially when the child's mother looks so overwhelmed.  And yet, when I am there as a fellow parent, dancing around the circle with my own child or negotiating over a toy, it doesn't feel right.  I feel that it would be very intrusive.  What is appropriate? 

What would that mother want to hear that wouldn't put her on the defensive or leave her feeling criticized?  Or, if she is angry at me but weeks or months down the road does hear my words and pursues help for her child, is it worth it?   I welcome any experiences and insights readers want to share.

To reach Jordan directly, email: jordan [at] communicationtherapy [dot] net.