Dr. Sherkow on Mother's Guide Through Autism Podcast & YouTube Video
Dr. Sherkow was delighted to join Brigitte Shipman on her podcast, Mother’s Guide Through Autism. The episode is available to watch on YouTube, and also to listen to via Shipman’s website, Spotify, and Apple podcasts.
In the episode, Dr. Sherkow outlines her career and decades of clinical experience working with children with ASD and developmental disorders, gives an overview of current neuroscience on ASD, and offers some revelatory strategies for approaching tough moments with your ASD youngster. We put a list of convenient timestamps for the YouTube video for specific pieces of advice, below.
Brigitte Shipman’s coaching and content creation focus on the experience of raising a child with ASD. Dr. Sherkow is the featured guest on Episode #155 of the Mother’s Guide Through Autism podcast (there’s plenty more to explore!). Shipman co-wrote a book with her son who is on the spectrum when he reached adulthood. The book is titled A Mother’s Guide Through Autism, but when flipped over, the book begins again with the title Through the Eyes of the Guided— her son Joseph’s side of the shared experience. This unique format is a touching dual memoir and offering to others on the journey.
We thank Brigitte Shipman for her work. Dr. Sherkow will soon return to the podcast for an episode on ASD in Adolescence. Stay tuned!
Timestamps for YouTube:
25:50-28:30 How to think about and respond to repetitive quoting behavior (ie: from film and tv)
32:45-33:-19 Strategy: Routine and “terrible twos” in adolescence
35:18-36:52 Strategy: Giving choices
37:32-38:05 What the ASD child is experiencing
39:15-40:24 How to set boundaries & handle meltdowns
Eva Navon & Chloe Haimes
Puberty and ASD
By Cynthia Stegman M.A.
What is puberty?
Puberty is a developmental stage that begins approximately anywhere between the ages of 12 and 16, and is initiated by changes in the brain that signal the beginning of bone growth and the maturation of the bodily organs responsible for reproduction. Signals are sent to the centers that produce hormones, and to the reproductive organs that ready the body to make sperm or ovum.
Puberty marks a time of change and adjustment for every youngster, but children on the spectrum are susceptible to undergoing a tremendous disconnect as they enter this stage of development.
It is not uncommon for any child to be caught off guard by the changes that puberty brings, changes which will occur even if the child is not prepared to understand or undergo these changes firsthand. Not only are bodies changing with the appearance of breasts, erections, new hair and new odors, but the brain itself is also changing. Here, we will look at how these brand-new body parts and feelings come about, and how they affect someone on the autism spectrum.
The physical changes of puberty are the most obvious. As hormones begin to prompt the body to change and grow, the brain is likewise being signaled to spark and reinforce new connections between neural pathways. The sudden arrival and intensity of puberty-directed thoughts can be an abrupt and scary change for someone with autism: the brain’s operation manual is literally changing, and change does not come easily to those on the spectrum.
Next, it is important to understand what the brain is doing to everyone who goes through puberty.
The pubertal brain changes how social information is processed. As a result of the new connections forming between neurons, there is heightened self-consciousness, mood variability, novelty seeking, increased risk-taking, and special susceptibility to peer influence, evaluation, and rejection. Preteen girls and boys entering puberty are extremely peer-orientated and programmed for conformity, as they begin to seek acceptance by a group other than their family. The pubertal brain’s executive functions also lag before they fully mature, due to interference in the capacity for delay of gratification and future-planning, although there is an increase in the brain’s working memory. All of this contributes to the generalized character of a brash, rash teenager with little thought of the future and its consequences. This is a normal stage of development, but each person’s reaction to it and journey through it will vary.
Now, how does being on the autism spectrum make this process different?
A preteen on the spectrum who is entering puberty is left stranded in this pubertal process with little or no tools to navigate these new waters. They similarly feel the drive to seek out and conform with peers, yet they often lack the knowledge of how to conform, exactly, and as a result are much more susceptible to the influence, acceptance, or rejection of others. Theory of Mind plays an important role in forming relationships, but for those on the autism spectrum, this is a process where deciphering the needs and concepts of "other" is typically incomplete, not easily available and not fully integrated.
It is indeed known that a key feature of autism is difficulty in grasping key aspects of Theory of Mind, or understanding how another person has a unique point of view, with their own perspectives, intentions, fears and desires influencing how they interact with the world at large. When one is unable to use the concept of Theory of Mind to “walk a mile in another’s shoes,” it is unlikely they will be able to understand how to fit in and conform to the group or individual from whom they are seeking approval. It is often the case that those on the spectrum simply do not have the knowledge to create a template for conforming.
These youngsters on the spectrum are driven to seek out and fit in with others, but it is common for frustration and anxiety to surface instead, rather than a sense of belonging or accomplishment. Without a social template to conform to, appealing to a group or gauging social reactions are difficult, if not also extremely daunting tasks. The changing pubertal brain’s interference with gratification delay also makes any setback that much more intolerable. There is a building conundrum for those on the spectrum of how to recognize or act on the feelings that puberty brings.
These rising levels of confusion and anxiety might make the body rely on former outlets during this confusing transition. For example, a baby on the autism spectrum might have relied on hitting and kicking his mother before learning to use language to signal he was hungry or tired; early intervention services likely taught him how to recognize and deal with the pattern of these emotions, along with internalizing and scaffolding key concepts of self, so that he learned to verbally request what he wanted and learned to self-soothe. However, at the onset of puberty there is an entirely new set of emotions to identify and process with appropriate reactions, and these former tools cannot be adequately stretched or adapted to deal with them.
When a young male on the spectrum begins to notice necklines and hemlines he may become sexually excited, and agitated that he does not understand why he is excited, and anxious about why he is feeling both angry and happy, and scared because this is all new territory. The autistic youngster entering puberty might once again begin kicking and hitting others, even after years of seeming well-adjusted. The pubertal world is brand new, the brain's neural pathways are brand new, but he is left with the same tools of childhood. These tried and tested tools no longer work, and more than that, it is difficult for these youngsters to even give voice to the inner turmoil that puberty brings. They are unwilling or unable to ask for any kind of help, to find new tools and strategies for navigating the pubertal world.
This inevitable transformation only complicates the experience of puberty for those on the autism spectrum. It is vital that these adolescents receive the additional support and resources they need at this developmental milestone to overcome these difficulties.
In our experience, youngsters on the spectrum seem to develop the psychological piece of adolescence before they show physical signs of puberty, which can be very misleading for parents who are not expecting those early changes.
Our next blog will address this topic, along with some techniques and tips for helping your youngster make the transition into puberty.
An Online Spark Social Skills Group
By Hallie G
Because of COVID-19, Spark switched from in person to online in mid-March. When we meet in person so much of Spark is about interacting and using the physical space, so at first, I wondered how we could make the switch to zoom and still have our fun at Spark as usual. In an in person session, we start with an introduction activity and a dance-move circle, ending forming the Spark star. Then, we go over the schedule and make any announcements we need to make.
Fortunately, it wasn’t hard to make this switch and discover a productive, fun way to have Spark. On zoom, it’s different because sessions are 1-on-1 rather than with the whole team. We don’t do the introduction circle or Spark star, but we still go over the schedule. This helps keep a sense of order. In person, we would then start with an activity. Over zoom, we developed a different routine. We start with a mini workout since we are sitting around all day. This workout is done to the music of my buddy’s favorite song, so it keeps him engaged, and lets us move around. Then, we do an activity that would either be word association games, talking about a certain subject, or answering questions about our lives. Then, we play an online game that my buddy loves. The online games are either matching games or baking games, and it is fun to play with him, which we’d be doing in person. Since online Spark usually happened after a full day of online school, we realized doing something entertaining and intriguing was more useful. By keeping my buddy engaged, we were able to develop this routine and realize what worked. Although these sessions are very different, I think it is important to create a fun Spark routine, because this makes Spark feel predictable and safe.
A Spark Mentor's First Year
by Hallie G., Spark Mentor
[note: "buddies" refer to clients in the Spark Psycho-Social skills program, which you could read more about here]
I started Spark in the fall of 2018 as a 10th grader. Before beginning Spark, I was invited to come to a group session the past spring to get a sense of what Spark was like. When observing the group session, I wasn’t sure what to expect. I knew that mentors were paired with buddies and they did activities together, but I didn’t realize that they would have such a special relationship. One activity that stuck out to me was when mentors and buddies were simulating a working store. Buddies were practicing taking and counting money and interacting with “customers,” who were mentors. I remember seeing everyone laughing together, and it showed me what Spark is really like. Spark is a place where not only buddies, but mentors too, can come to have fun and try new activities. I’ve experienced this myself over the past year, doing activities I would never do myself: painting with marbles, playing matching games, doing taste tests with chocolate, and doing relay races, to name a few. As well as having fun at Spark, I’ve developed a great relationship with my buddy. He went from never knowing my name to greeting me every Wednesday with the same two questions: “What’s your favorite color?” and “What’s your favorite number?” I’ve had a very memorable first year at Spark and I can’t wait to continue in the future!
CAMERON OVERCOMING COMPETITION IN SOCIAL SETTINGS
By Carlotta Bettencourt
Meet Cameron, one of our 9-year-old youngsters from The Sherkow Center.
Cameron was diagnosed at the age of 2 with Autism Spectrum Disorder (ASD). Fortunately, Cameron received early and intensive treatment at a critical time. In 2002, Cameron and his mother began working with Dr. Susan Sherkow in dyadic therapy. At the age of 3, Cameron presented as a very friendly, intelligent and charming child. He nevertheless struggled with many developmental difficulties, including issues with language, social and emotional development.
The Sherkow Center’s therapeutic approach not only facilitated an opportunity for a mother/child bond to develop, but also allowed the mother to begin understanding her son’s internal world and behaviors; what caused Cameron’s meltdowns every time he would play with his brother or with other children?
At the age of 6, while still continuing his intensive individual therapy with Dr. Sherkow, Cameron joined the Spark Social Skills Group at The Sherkow Center.
By this time, Cameron’s language, behavior, and stimming/flapping had significantly improved: as a result of his treatment, Cameron’s diagnosis became less visible and less problematic.
However, Cameron was still struggling with temper tantrums and outburst of aggression towards family, peers and occasionally his therapist. Dr. Sherkow identified the significance of the underlying meaning of his problems across certain domains, such as self- regulation, performance anxiety, and finally sibling rivalry.
Dr. Sherkow and the Spark Team worked on improving these persistent issues following The Sherkow Center’s Method, by continually addressing Cameron’s needs and goals with a similar approach in every setting.
Cameron’s difficulty with performance anxiety seemed to have a negative impact on the way he related to, interacted with and played with others. This translated into a constant source of inner anxiety about competition, which inevitably affected his ability to play.
This internal conflict took shape in several ways: whether at school, at Spark group or during individual therapy, Cameron would act out by changing the game’s rules, controlling who the winner or loser would be, and having significant temper tantrums. This was especially true whenever he felt not in charge, unconsciously contradicted or overwhelmed with his emotions and anxieties.
Eventually, Cameron began developing his own skills at school and showed a talent for writing, reading and sports. This allowed him to discover and develop his natural abilities so that he could now safely feel self-confidence and thus capable of being his own independent person.
Cameron did not have the need to corrupt the games anymore. He could now be flexible about any game, while still working on regulating his anxiety about the competition and the other players. He enjoyed participating, rather than obsessing about who the “best player” was. Clearly, Cameron had reached a developmental milestone; he knew he could trust himself and feel like a valuable participant, whether he won or lost, because he could accept himself as a person with both talents and flaws.
On September 10th 2019, during an individual session with Dr. Sherkow, Cameron set up an elaborated mock tournament with superheroes, of all shapes and sizes. At the end of the intense battle, there was only one winner. He then placed all the superheroes figures in a circle and put the “winning” figure in the middle, with its arms in the air in celebration of his victory. Dr. Sherkow engaged Cameron by putting words to his actions and talked about the other superheroes’ “feelings” as well as the winner’s. Cameron concluded his thoughts by saying:
“The Phoenix is the champion, but they are all winners anyway!”
Cameron’s comment here portrays the successful internalization of his issues around competition and performance anxiety, he has now reached a new level of awareness and maturity.
Since he was able to resolve this internal conflict, it did not matter to him who won or lost.
Cameron’s statement speaks highly of the tremendous progress he has made throughout his treatment at The Sherkow Center and highlights the fact that developmental difficulties associated with ASD can be overcome.
Our 2018 Yoga Benefit Success Story
We would like to express our gratitude to everyone who participated in our Annual Yoga Benefits, to our yoga leader Helene Kerheve and the Om Factory, and to all of those who contributed to The Sherkow Center Treatment Scholarship Fund this past May. This year alone, we are able to raise 100% scholarship funds for TWO CHILDREN for the Spark Program next semester!
As a non-for-profit organization, we aim to not only promote the optimal development of all our clients, but to also provide the lowest possible treatment cost for our services; approximately 75% of the annual cost of the Spark Program is covered by the Center, which leaves 25% of the cost to the family of the child. Unfortunately, along with the various additional expenses of individual and related therapies, many parents struggle to afford even this small portion of the overall cost. The Junior Committee was created to address this exact issue: we are a devoted team dedicated to raising money to help our clients, through various community events and fun activities centered around autism awareness.
Thank you again for your generosity, and for helping us make a difference in the lives of The Sherkow Center’s children and families.
The Benefits of SPARK: An Intern's Perspective by Agathe de Pins & Tess Jacobson
The Benefits of Spark: An Intern’s Perspective
As Interns that have worked with numerous populations of individuals with atypical development, we have observed many different approaches to therapy, including Assisted Behavioral Analysis and D.I.R. (Developmental, Individual-differences, Relationship-based) Floortime Therapy.
As new interns at The Sherkow Center, we were — and continue to be — interested in learning Dr. Sherkow’s psychoanalytic approach to treating children on the Autism Spectrum.
Spark’s “Yellow Team”
Sherkow Center Interns
While our daily training includes observing how psychoanalysis impacts children with ASD through therapy, we have also been given the opportunity to participate in The Sherkow Center’s Spark Psycho-Social program. Although Spark is geared more toward creating a social atmosphere rather than a clinical one-on-one therapeutic experience, there are multiple aspects of the Spark program that stand out to us as characteristic of The Sherkow Center’s psychoanalytic approach to ASD treatment.
SPARK’s Green Team
Psychoanalysis and the Spark program
To begin with, Spark’s social setup of pairing each child with a similarly-aged mentor is a quality that immediately stood out to us and set the Spark program apart from other social groups targeting children with ASD. In addition to allowing each child to bond with a specific mentor each week, peer-mentor pairings serve a number of different purposes. For instance, on different occasions, we have observed the children opening up to their mentors by sharing their feelings, articulating frustrations and even sharing jokes that reflect the individuality of a particular peer-mentor bond.
Consequently, we have come to view mentors as social outlets for the children to communicate with as they become more comfortable with them during Spark.
Each child expresses his or her anxieties differently and, thanks to the uniqueness of these peer-mentor relationships, over time the mentor will recognize these specific behaviors and have a better understanding of the child’s mental state, and of the progress he or she has made. This allows the staff to understand more clearly the children’s thought processes and behaviors, which can then be further addressed during one-on-one therapy.
Spark’s “Green Team”
Group Discussions lead to more Insight
Another major feature of Spark is the post-group debriefing meeting with all of the mentors at the end of each of session; this group discussion allows mentors and staff to discuss the day’s events in-depth, and thus better navigate the inner workings of each child’s mind — a process we have not seen with other therapeutic social groups for ASD children.
During these meetings, mentors are given the chance to share insights, anecdotes, concerns, conflicts that came up during Spark , or any other details related to each child’s progress. Both a learning experience for the group of mentors and a vital source of information for staff, these meetings reflect the Center’s goals to treat and understand children with ASD through the lens of psychoanalysis.
Cooking skills at SPARK
What role does Psychoanalysis play?
As seen in Dr. Sherkow’s therapeutic approach, Spark is not about correcting “bad” or “wrong” behavior, nor do mentors or staff aim to reprimand children for expressing their anxieties through symptomatic behavior. Rather, we have seen mentors and staff work together to address the children’s concerns by acknowledging their feelings and verbally articulating their anxieties.
By directly addressing the behavior that stems from frustration, anger or anxiety, the children are able to feel understood and reassured.
As a result of feeling heard and supported, these children tend to gradually become more likely to express or vocalize their feelings. Without being explicitly told how to act or what behaviors to stop doing, the children learn to shift how they communicate their anxieties, which, in turn, allows the people around them to better interpret their thoughts.
Practicing our cooking skills in Spark.
These are just a few ways in which we, as interns, have observed a difference in the way The Sherkow Center addresses the neurobehavioral disorder of Autism in a social skills group compared to others we have witnessed.
We look forward to continuing our observations and further learning the benefits of psychoanalysis on behavior and the mind!
Elopement in Children with Autism Spectrum Disorder: How to Address and Prevent It
Elopement occurs when a child with autism suddenly wanders away from a parent or caregiver in public.
This is a common issue encountered by caregivers which can create a difficult, scary, and high-pressure situation for the child’s family. When a child with autism runs away in public, not only is it hard to make him or her come back to his or her senses, but it is often a complicated process just to understand the root of this elopement.
Practice safe travel with ASD children.
The Root Issue of Elopement
Dr. Sherkow believes that the underlying issue in this situation is often related to an inner conflict, fantasy or a specific trigger in the child’s life. From a developmental point of view, it is normal for all children to have the unconscious wish of eloping from their caregivers.
However, children with ASD have more trouble developing patterns and processing such desires, often resulting in bigger tantrums or making it more difficult for caregivers to redirect their attention once they have become fixated on this idea.
The time and way a child with autism elopes often reveals the cause of this inner anxiety.
Dr. Susan Sherkow
In fact, even the smallest change in routine can be difficult to process for the ASD child. This difficulty, in turn, can trigger an emotional outburst — eloping— or a desire to test the person responsible for this change by running away. The child might want to see if the relationship with the caregiver is reciprocal: if the child ignores the rules and runs away, will the nanny fulfill her duty, and follow the rules, to run after the eloping child?
Elopement can occur with a parent, nanny, or other caregiver.
As interns at The Sherkow Center, we have been in situations where a child has run away from us in the street. More often than not, the child always stops after a short distance to check if we are still behind him- if we have been watching, and keeping up with him! This issue of elopement often occurs when a scheduled visit has been abruptly canceled, or a previous session missed, which is a big change in an autistic child’s routine.
The roots of this physical elopement are often similar to those of an emotional elopement: when a child verbalizes his desire to leave his or her family. This other type of elopement will be addressed in our next blog post.
Here are some approaches you can take, from a psychodynamic point of view, to deal with the physical elopement of ASD children in public.
1. Determine what the internal conflict is.
When a child with ASD decides to elope or wander off, it is often the product of some inner anxiety or conflict. Thus, in order to properly deal with such a situation, the first and most important thing to do is to try to understand the root of this inner anxiety or conflict.
First, think about the child’s usual routine and try to identify any changes that could have prompted the elopement. Even minor changes are incredibly disruptive!
If no changes are found, then one can think about how the specific setting and situation might be making the child anxious. The caregiver should verbalize this thought process out loud with the child: “We are at the park after school, and are on our way to see the dentist…”. Do any words employed trigger a reaction from the child, such as laughter, screaming, a tantrum? Once the child shows any type of reaction, the caregiver will be aware of what might be at the root of the elopement, and thus able to handle the situation more directly and effectively.
2. Verbalize the anxiety.
After identifying a potential cause of the elopement, it is important to voice the specific anxiety in order to make the child feel understood. By verbalizing the anxiety and acknowledging the child’s feelings out loud, you will help the child feel reassured and safe in his environment. The statement can be as simple as, “I understand that the dentist must be very scary and give you worries, but everything will be fine.”
Another method for verbalizing the anxiety is to speak in a sing-song tune, while still identifying the trigger and child’s reaction: “I want to go in another direction / but they are not letting me, / maybe next time I will be able to, / run so fast away and go weee!” This tactic makes the interaction between caregiver and child more playful, and the child might forget about his opposition and instead focus on the lighthearted tune.
3. Redirect the child’s attention.
Another useful method for stopping elopement is to redirect the child’s attention to something other than the source of the anxiety. Hyper-focusing on the elopement, and making the child increasingly nervous about the fact that he is eloping, will only make the situation more difficult to deal with.
Instead, try asking the child about something completely different such as what he has planned for the rest of the day, or pointing out something that is going on around him. This will help the child re-center himself in the situation and better control his impulses.
If the child is too anxious to focus on your words, trying to catch the child’s gaze and make eye contact is also useful in redirecting attention.
4. Define boundaries.
Defining boundaries with the child and making him feel more in control of the situation will help avoid elopement in the first place. There are multiple ways to predetermine boundaries with a child. Before going anywhere, first talk with the child about what route he expects to take, which will prevent unpredictable transfers or paths that might upset him.
Then, you can show a visual representation of the path you will be taking that day, so that he internalizes it and is not surprised by the route.
Another option, if indoors, is to put paper cut-outs of “footsteps” on the floor. This type of visualization is meant to show the child exactly where he is allowed to walk, and where he is not allowed.
Finally, when asking a question of the child it is better to give the child two choices, rather than asking an open-end question. Instead of asking, “How do you want to travel to the dentist today?” try narrowing down the question with a specific choice between two things, such as “Do you want to take the A train or a taxi to the dentist?”. This tactic limits the overwhelming possibilities and unpredictability of the question, and most importantly, the child will feel more in control of the situation, as they had a palpable choice in the outcome.
These tactics will be useful in deescalating an elopement, or even avoiding it entirely.
Elopement in Children with Autism Spectrum Disorder: How to Address and Prevent It
By Agathe dePins
Yoga Tips for Autism
On April 24th, The Sherkow Center staff attended a workshop presented by Dr. Deborah J. Gruber at The Shema Kolainu School. This workshop addressed the benefits of practicing yoga for atypically developing children, specifically those with autism.
At The Sherkow Center, we had already discovered the need for beginning each Spark group with a consistent activity in order to help our ASD youngsters transition from the waiting room into the play-space. By implementing a few minutes of yoga poses as a warm-up, we provide a consistent and calming activity as a prelude to the session’s various scheduled activities.
Little did we know, there are a number of additional benefits to practicing yoga! As with other physical activities for children with autism and developmental delays, it provides much-needed predictabilitythat engages the body and all of the senses.
It is already known that yoga helps cultivate consciousness of one’s own behavior. In addition to the mental and physical health benefits of yoga, various yoga techniques also prompt the development of crucial skills, namely those that are communicative and social in nature. Improvements in communication and sociability influence the ability to form healthy relationships, which a child with autism may benefit from.
Yoga Tips for Autism Spectrum Disorder clients
Dr. Gruber introduced relevant and useful behavioral strategies such as utilizing physical prompts, picture schedules, video modeling and positive reinforcement, which can be used during physical activities such as yoga.
While teaching yoga to children with autism, it is important to be aware of the motor limitations of each child. Sometimes, a seemingly “easy” position can be challenging and frustrating for a child. Breaking down the position into a sequence of simple movements will prevent the child from being overwhelmed and allow him or her to follow instructions and stay on task. This also provides a chance to work on and improve the child’s attention span, and to provide an opportunity for imitation.
Video modeling provides a visual demonstration of the position so that the child can process the sequence of movement before practicing and achieving the proper form. Once the sequence of movements has been processed, children can be paired up with peers and take turns demonstrating what they have learned from the following video.
The instructor should notice and praise positive behavior [as Dr. Gruber says “catch’em being good”.] This will increase the probability that a good behavior or position might “stick” and occur again.
Depending on the level of motor coordination of the child, you can adapt your approach by introducing “pretend play skills.” For instance, asking the child to pretend to be a literal “dog”or “tree” will reinforce the child’s mental representation of the pose’s name, allowing him to feel free to do his own version of the position. This creates the opportunity for some lighthearted play and bonding between the instructor and child, as well as for some interesting interpretations! The instructor should imitate the child’s own portrayal, before guiding them into a traditional position with a Downward Dog position for instance.
The use of music during the practice of yoga may be useful for a group-wide sing-a-long, as well as for providing a lighter, more enjoyable environment than an over-stimulating one.
Finally, another way to engage children in developing awareness of their body is to play “Yogi Says,” aversion of the traditional “Simon Says.” This helps children practice body part identification as they work with each yoga pose, making them concentrate on their own bodies as well as the body parts involved in each sequence of the movement.
Tracking Passion in ASD
Tracking Passion in ASD
BY Carlotta Bettencourt
The Sherkow Center team was fascinated to read the New York Times article, For Autistic Boys, the Subway Is Actually Soothing. In fact, we at the Center already know that it can be difficult to transport some children on the spectrum, and as such offer transportation services: in lieu of a more traditional nanny, a trained staff member escorts an ASD client between school and other activities such as our Spark social group, and ultimately serves as a therapeutically-informed and supportive figure for the child, helping the child process the transitions between school and other activities, and is supportive if a difficult moment arises from a transition or other trigger.
As an intern at the Center, I have had first-hand experience taking the NYC subway with autistic boys. Although each boy is on a different “level” of the spectrum, I have always been astonished by the fascination each one has with the subway system. While therapy treatment for ASD mostly focuses on behavioral and emotional regulation, it is important to also strengthen the child’s sense of identity by emphasizing remarkable abilities. In this case, the unique ability to memorize the subway routes and excel at spatial navigation seems to be a remarkably common strength for these children.
How we Understand this Fascination
At the Sherkow Center, we emphasize the importance of neurobiological wiring, as well as prediction and pattern making: these are the tools that a developing child uses in order to scaffold his cognitive resources and, ultimately, how he learns what to expect as he navigates the world. Our classic example of this principle is the image of a mother with a baby bottle: a hungry, crying infant will summon a mother with a baby bottle or breast for food, and after numerous repetitions of this scenario under normal development, the baby will begin to react to and be soothed by just the image of mother arriving. Ideally, baby will internalize this pattern (that mother’s arrival ->leads to food -> leads to positive feelings), and even before seeing the bottle or getting the nipple in his mouth, he will now calm down just at the sight of mother, as he is able to predict that food is now on the way!
Clearly, pattern making and internal scaffolding is an integral part of development. In the ASD population, which has a slightly different neurobiological wiring of the brain, these youngsters still receive pleasure from the pattern-making and prediction process. Of course, this makes the MTA public transport system incredibly appealing to these children! As the article already acknowledges, the set routes and timetables are a huge attraction for autistic boys, but we believe that this is due to their photographic memory as well as the inherent pleasure of making patterns and predictions. An autistic child refusing certain train lines may seem “stubborn,” but what we cannot see is the complexity of the issue: he is reciting every stop on the Z line out loud because of his superb photographic memory, and his excitement is building as he predicts each stop and then arrives at each one, and then there is an opportune service delay and a chance for one of two transfers, which means a chance to be creative!
New or “unknown” things may seem scary to an autistic child, but as all of this occurs in the static, relatively unchanging MTA system, the child can exercise a choice and some control over the route while remaining in the “predictable” realm. It is incredibly important to understand how satisfying it is for a child, to allow his strengths to shine, and subway riders should keep this in mind when they see an excited or “stimming” subway rider.
A Typical Trip
New Yorkers certainly don’t idealize the MTA. Sure, it is convenient at times, since the city traffic is horrible. However, very quickly the loud noises, disturbing smells, and big crowds become very overwhelming even for an adult. One would think that for a child with ASD, these sensorial aspects would make the experience even more difficult. Yet, we have noticed that the sensorial aspects do not seem to bother these children at all, and their excitement becomes contagious along the way in spite of these “negative” aspects. The normally irritating sound of an arriving train suddenly becomes a positive stimulation, even to my own senses, as I clearly watch each boy’s eyes brighten up when staring at an arriving train.
As we enter a subway car, the normal routine is to immediately look for available seats to claim. However, when we are with our ASD clients, the main priority becomes being in the very first car at the front-facing windowed doors: this allows for the best uninterrupted view of the tracks. As mentioned in the original article, one other subway feature that may appeal to autistic children is the rapid visual stimulation passing train cars and tracks offer. Depending on the boy, some might prefer to go to the end or the beginning of the subway train, but the goal seems to be the same: to claim a prime viewing spot on the first or last car, for an uninterrupted and intimate experience between the boy, and the tracks. The sparkle in each and every boy’s eyes are unexplainable.
The mastery of the subway lines, linked to these children’s uncannily perceptive photographic memory and pleasure with pattern-making, allows the child to personally interact with geography and public transport, and as discussed before this creative process can lead to limitless route possibilities within the closed MTA system. One time while transporting a boy from school to the Center, a subway line I usually took to get from point A to point B was down. I immediately starting searching for the subway map to find an alternative way. Effortlessly and before even seeing the map, the boy immediately cited two other ways we could arrive, by making one or two different transfers. Many times during previous transports, this same boy requested and then guided us through many different subway and bus routes; by this time, I knew I could blindly trust an eight-year-old when it came to find a reliable subway route!
Encourage their Passion
It may be surprising that autistic boys enjoy the subway, even in spite of the overwhelming sensorial aspects of it, but again and again we have witnessed this common fascination among boys on the spectrum. To those who have or know a child on the spectrum, there is a high probability that you have seen them wear t-shirts, socks, or any kind of clothing with a subway line logo. This kind of clothing is so popular that it can even be found at the Transit Museum at Grand Central. If you have a child on the spectrum that enjoys public transportation, an idea for a fun family outing might be an afternoon spent exploring the MTA routes, discussing together the fastest or most exciting route options, and making a final stop at the Transit Museum for a chance to see all of the different subway-related books, clothes, and toys they have to encourage your child’s interest.
A Baby’s Ability to Self-Soothe
Our Readers Ask:
I currently have a 2 month old baby. Although I am a stay at home mother, I tend to the house and also pay the bills, which is time consuming. I love my baby and obviously do not want to leave him alone, or upset him while I am working. For this reason, I am wondering when and how does a baby develop the capacity to soothe himself? Is there anything I can do to help the process? Thanks!
This is a great question because there is a common misconception that young infants should be encouraged to self-soothe. While the ability to self soothe starts in infancy, over the course of the first few months of life, a baby must first develop a sense of his mother taking care of him, from which he will create an internal model of soothing and care taking. Babies develop the ability to amuse themselves for brief periods of time around 2-4 months, at which time Mother is often surprised to come into her baby’s nursery and find him awake, looking around his crib, and maybe even babbling to himself or making cooing sounds. Later on, from about 4-6 months, this process can also include a developing interest in his feet and hands, reaching for things in and around his crib, and turning himself over. Eventually, a baby’s ability to explore his environment, and entertain himself without his mother in view, is wonderful and rewarding evidence that he has experienced his mothering as “good enough,” and now, he doesn’t need his mother to be there immediately at all times.
However, although the ability to self-soothe may be emerging during the first 6 months, you should neither depend on this, nor try to foster it. Babies as young as yours will not benefit from being left, even temporarily, to “figure it out.” They will become better self-soothers by reliably being soothed by you in this early period. Steadily, over time, as your baby begins to identify himself as a person, separate from you (6 months and beyond), he integrates his experience of being cared for into an ability to do the same thing for himself.
I appreciate how difficult this can be, but try to bring him wherever you go, in his bassinet or on some blankets, or perhaps you could carry him in a sling or pack as you work. Also, talking to him while you work is a great way to connect with your infant. Babies love to hear the sound of Mother’s voice, which they recognize more quickly than they recognize Mother’s face. And, check on him frequently during his “awake” time, smiling and cooing to him–it will pay off in the end!–Dr. S and Dr. G
Can Theater Ditch Surprises for Compassion?
BY SUSAN SHERKOW M.D.
It’s no surprise that ASD children may want to experience the thrill of seeing a live performance. However, the reality of sitting quietly, not moving or talking for more than an hour, can be very difficult for children on the autism spectrum.
The issue of theater etiquette and compassion arose recently after one actor posted, in response to audience members’ complaints about a disruptive child: “When did we as theater people, performers, and audience members become so concerned with our own experience that we lose compassion for others?”
Luckily, in this age of immersive theater, Trusty Sidekick has nurtured such compassion, and created a performance specifically for Autistic children! The company’s name is taken from the idea that each cast member is meant to serve as the sidekick to each child—who, in a sense, becomes the hero throughout the journey of the play as it is experienced together. From this alone, it is clear what the company’s priorities are: that each ASD child is free not only to attend a real theater performance, but also to experience it however he or she chooses.
On September 25, The New York Times published a review of Trusty Sidekick’s performance of the production “Up and Away,” describing in detail how the company tailored their production to meet the needs of their very special audience of ASD children. It is truly refreshing to see how a theater performance can still be “theater,” even while it is guided by strategies and flexibility that takes into account the way an ASD child would likely react to a live theater experience.
In particular, almost every aspect of the production of the play is aimed at easing the transition into “watching a theater performance” for ASD children. We, at the Sherkow Center, applaud not only their overall intentions, which were evidently very successful, but the ways in which they tailored their production values to be most effective in working with this population.
In particular, these particular elements tailored to the special needs of the ASD audience members:
Before arriving, an online video is sent to each child in the audience, so that he knows what to expect from thetheater and cast. Here, the goal is to gradually diminish the factor of the “unpredictable”– the sense of surprise one has when seeing a live theater performance for the first time. ASD children have great difficulty experiencing anything “new.” (See our earlier post on the issue of “unpredictability” and anxiety about “surprise” in the ASD population.) While this might seem to go against the ideals of traditional theater, one of Trusty Sidekick’s founders knowingly states, “[ASD children] need to have information ahead of time to feel safe.” Far from detracting from the experience of live theater, the ASD child comes to the theater prepared to participate in the wonder of the story-telling, a feeling enhanced by having been able to anticipate and process the story when it finally arrives!
The cast themselves assist in transitioning the children from the outside world into the world of theater. As each child arrives at the theater, he is greeted by his own personal cast member who is waiting for them. He or she allows each child to acclimate to the new surroundings of the lobby before casuallycontinuing to a solarium, which is filled with lounging chairs. Then the child is taken to the performance room, where each cast member sits next to his or her child in the fused set/audience space of hot-air balloon replicas. When the performance is finished, each of the cast members then escorts her child back to the lobby with a celebration song, in lieu of a curtain call, and waves goodbye. Not only is this a casual encounter from start to finish, but the close presence of the cast members throughout helps avoid any sudden changes that may trigger anxiety for an ASD children.
The solarium room itself is an innovation that allows the children the flexibility of leaving and reentering the production space during the performance should they feel the need to “take a break.” The personal cast member even follows their child, leaving the rest of the cast in the performance space to adapt, improvise, and continue the story in their absence! No child is forced to sit still the entire hour, and the freedom of each child to move about and experience the performance as he or she wishes is truly unique.
Trusty Sidekick’s methods of providing entertainment for ASD children is groundbreaking. They fully embody the essential compassion, knowledge of ASD children’s psychology, and remarkable thoughtfulness that make it possible for parents to bring new experiences to their ASD children. If you have an interest, we encourage you and your child to experience this for yourself!
How Are Guinea Pigs Helping ASD Children?
BY LOUISA REVSON
An article recently published in The New York Times (6/29/15) titled “Guinea Pigs Are Autistic Child’s Best Friend,” discusses a fascinating new study in which the presence of guinea pigs was found to reduce the anxiety of autism spectrum disorder (ASD) children in a social environment, improving their ability to interact with their peers and enhancing their overall success at school. While the benefits of having a class pet, such as a guinea pig, have been recognized in past research, this study goes one step further by providing physiological data which proves that these creatures have calming effects on ASD children.
All of the 192 children participating in this study– of which 64 were on the spectrum and 128 typically-developing– wore special wrist bands that tracked their arousal levels, or levels of anxiety, by measuring electrical signals in their skin. The children were separated into groups of three with one ASD child and two typically-developing children in each group, and their arousal levels were measured as they were directed to perform specific tasks.
Performing any task, whether playing with a toy or even reading, in the presence of a small group caused an increase in each ASD child’s arousal level, indicating an increase in anxiety. The moment that two guinea pigs were introduced into each small group, however, the ASD child’s arousal level dropped. For all of the ASD children, completing tasks in front of or with the two other typically-developing children no longer caused their anxiety to rise, and, in addition, they displayed an increase in sociability.
The researchers controlled for whether the guinea pigs’ calming effects resulted from the distraction that they provided for the ASD children just by virtue of diverting attention away from the stressful social situations. This was tested by introducing a toy into each group as a “distraction object” in place of the guinea pigs. The same calming effects were not seen, which indicated that there is something in particular about these small, friendly creatures that helped abate the social anxiety experienced by the children on the spectrum.
While The New York Times article does not go beyond stating that the mechanisms behind the guinea pigs’ calming effects are currently unknown–they hypothesize that they act as “social buffers”– we at The Sherkow Center believe it is vital to uncover and understand these mechanisms, in order to gain a more comprehensive understanding of ASD.
What are the mechanisms at work here?
Children on the autism spectrum are born with a neurobiological difference that makes it difficult for them to process information and stimuli— to make sense of the information from the external and internal world coming at them. The processes by which infants learn about other people’s feelings and ideas, and about their own emotions and ideas, are the ingredients necessary to forming a relationship and maintaining it. ASD children seem to be neurobiologically altered in some way that affects making sense of the social world.
We also know that the more predictable the patterns of their experiences, the easier it is for an ASD child to absorb social, emotional, and cognitive information. By contrast, the more unpredictable a system, the harder it is for an ASD child to process or make sense of it. The technical term for this is “failure of theory of mind,” referring to the diminished ability of an ASD child to form a coherent picture of what is going on in his own mind—or in the mind of his mother or father, his teacher, or his school mate.
A school mate is an unpredictable source of information. In a group setting, the study demonstrated what we have seen in our work: an ASD child becomes anxious at the prospect of sharing with or in front of peers because his processing difficulties interfere with his understanding the expectations of others. However, in a group scenario where a guinea pig is the shared object, participation in such sharing is much easier for the ASD child. Not only is the guinea pig able to elicit an emotional bond from the ASD child and typically-developing children alike, its lively actions are safely predictable. Even though the guinea pig’s behavior is hardly static, as it moves about, drinking and nibbling, it remains predictably unpredictable!
Another important element of this study is that unlike toys, or the demands of a social group, playing with a guinea pig doesn’t demand the use of imagination or pretend play, areas classically difficult for an ASD child. The guinea pig makes no demands or expectations of the child, yet another source of potential anxiety for ASD children.
Last but not least, all of the children, typical or ASD, can experience the guinea pig in an identical fashion, importantly providing a source of joint attention that enables a social interaction between two people to get started. The typically-developing and the ASD children will process the experience of the guinea pig in exactly the same way, providing a source of shared experience as a springboard for a relationship between the children. Thus it stands to reason that the presence of the guinea pigs would decrease anxiety while enhancing the capacity of the ASD child to grow in the context of participating in a group.
The physiological data collected in this study demonstrates very concretely not only how anxiety-provoking social interaction is for children with ASD, but how relatively readily this stress can be reduced simply by introducing a joint-attention inducing phenomena into the social group. That the ASD children so readily displayed an improved ability to play and socialize with their peers points to the key role anxiety plays in exacerbating the social deficits we seen in children on the spectrum
What Prompts Rage in Adolescents
ASD children who are not particularly symptomatic in early childhood may still manifest features of social isolation (difficulty with forming and maintaining relationships) as well as suffer from difficulty with transitions. This may progress through middle childhood and adolescence, and these children often experience anxiety and depression. In the course of their development, having not received early diagnosis nor early intervention, many overtly high functioning ASD children fail to develop the building blocks essential for recognizing and modulating their angry feelings, and can run into severe problems with their aggression.
When ASD teens are given unlimited access to video games and social media that have aggressive and/or sexual content, there can be significant consequences. Too often, this type of media exacerbates the poorly regulated sexual and aggressive urges that can morph into horrific fantasies. These fantasies have the potential to turn deadly.
It is of paramount importance to address these children’s needs for attention, care and success at every stage of development. The public and professionals alike must understand just how crucial it is to find the means to identify and help this very vulnerable population.
An Excerpt from The Book "Autism Spectrum Disorder"
Here is the inaugural post to the “On Autism” blog, excerpted from Dr. Sherkow’s book Autism Spectrum Disorders: Perspectives from Psychoanalysis and Neuroscience:
“… optimizing parent-child interactions plays a major role in successful early intervention and, with early diagnosis and treatment, perhaps even prevention… While neurobiology informs us about the workings of the brain, a psychodynamic understanding of development can open a window to the inner world of the ASD child. Understanding the dynamic interplay between biological and psychological processes in autism is of utmost importance in the development of vital interdisciplinary collaboration in ASD research and treatment.”
Promoting the optimal development of children and adolescents through services and education is the mission of the Sherkow Center.
