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.
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
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.
