Mendel Psychological Associates' blog » High-Functioning Autism

New Support Groups

Dr. Mendel — Mon, 26 Apr 2010 21:23:12 +0000

Family members taking care of special need child need tender loving care too. Thus, Ginger Poole is forming several support groups to address this need:

Support group for moms with kids on the Spectrum
Support group for brothers or sisters of a special needs child

We hope that you can join us.

Autism and Health Insurance

Dr. Mendel — Tue, 16 Mar 2010 19:35:51 +0000

On March 5th, 2010, Raleigh’s News and Observer published an article about insurance companies not covering mental health and “behavioral” treatment for individuals with Autism Spectrum Disorders (ASD), including Aspergers. I have been leading social skills groups for children and teenagers with Aspergers and other ASD’s for over a decade and have been confronted repeatedly with the fact that various insurance companies do not cover this service if a child’s diagnosis is an ASD. They do, however, cover the same services if a child has a different diagnosis, such as an Anxiety or Mood Disorder, or Attention Deficit Hyperactivity Disorder (ADHD). Since problems with social interactions are at the heart of Aspergers and Autism, this, to me, is a supreme – and infuriating – irony. These children and adolescents are generally extremely socially awkward and often oblivious to social cues and the nuances of social interaction the rest of us find natural and obvious. Participation in a social skills group with similar peers is the ideal way to help such youngsters. Through such groups, these children learn to interact more and more appropriately. They make friends, first in group, and eventually outside of group as well. Their behavior becomes less awkward and they become able to compromise, to take turns, and to see things from the perspective of others, generally for the first time in their lives. While I have no doubt that this type of intervention is the best way to help kids and adolescents with ASD’s, I certainly understand and share the frustration of their parents when this best practice is not covered.
Fortunately for their parents’ pocketbooks – though unfortunately for the children themselves – many of the kids with whom I work have other diagnoses in addition to Autism or Aspergers. Many have Anxiety Disorders or Obsessive Compulsive Disorder. Others have Mood Disorders, in part because as they approach adolescence and begin to realize how different they are from their peers, their social isolation and repeated experiences of rejection become increasingly frustrating to them and they become depressed, dejected, and withdrawn. When a diagnosis other than Autism is present, my social skills groups are generally covered by their insurance. But this service – so essential and beneficial to treat their core disorder: Autism – is not covered on that basis. This, to me, is utterly ridiculous. I would call on all insurance companies to recognize that Autism Spectrum Disorders are brain-based mental health problems like any other and to cover effective and appropriate treatment of ASD’s through interventions such as social skills groups.

Parents: Talk to your Kids about Sex!

Dr. Mendel — Mon, 27 Jul 2009 16:54:07 +0000

I know that this sounds like an utterly uncontroversial bit of encouragement; surely everyone believes that parents should speak to their children about sex – providing them with information, guidance, and moral direction.

But here I’d like to bring up a somewhat trickier, more challenging proposition: talking with your son who has Aspergers Disorder or High-Functioning Autism (HFA) about sex. I suspect that many parents think that there’s far less urgency to talk with these boys about sex. Consistent with their general social deficits and lack of peer interaction, boys on the Autism Spectrum begin to date much later than do their non-Autistic peers and sexual activity starts significantly later.

I believe, however, that it as least as important to speak with these boys about sex. Because of the rigidity in their thinking, their confusion about “gray areas” and subtle nuances of interpersonal interactions, I have found that kids and teenagers with Aspergers or HFA are often extremely confused about various aspects of sexuality and harbor significant distortions in their understanding. I believe that this tendency is maintained and amplified by their social isolation: they do not have the sort of friendships and peer interactions in the context of which they could bounce their thoughts off of others.

These points were brought home to me very dramatically over the past few months when pre-teens and teens in my middle school and high school groups brought up sexual topics for discussion in group. In the context of the ensuing discussion I saw the extent of their confusion which, in a couple of examples, was a source of considerable distress. One boy recalled a time when he was playing with a female friend of the family and, to his shock and horror, found himself getting an erection. This signified to him that there must be something terribly wrong with him and rarely has a day gone by since then when he has not mentally “beat himself up” over this. Another time, the topic of pornography came up. A boy commented that babies see pornography all the time. I asked him what he meant by that and he replied “breast-feeding.” To him, a breast, since it represents an erotic image for him is, ipso facto, pornographic. Another boy picked up on this point, commenting that while people think that there’s more pornography in the United States, really there’s much more in Europe, since they have lots of nude and topless beaches there. Again, to this boy, nudity equaled pornography.

I encourage all parents – and especially those with children who have Aspergers or High-Functioning Autism – to open a dialogue with their children about sex. You will be helping them immeasurably if they can gain assistance in understanding this part of life which is so confusing for all adolescents, and that much more confusing for them.

Learning to make friends

Dr. Mendel — Thu, 11 Jun 2009 00:59:18 +0000

As many of you know, I lead several social skills groups for kids and teenagers with Aspergers and High-Functioning Autism. Six group members has always been my maximum for my groups. Recently, a boy was ready to join the high school group a little while before another boy was going to graduate from the group. I brought up the idea with the group of briefly having seven members and asked whether that would be alright with them.

They responded enthusiastically: not only was it alright with them to have seven group members for a short period of time, why not expand the group more generally? Why not have eight or even ten teenagers in the group? As one boy put it, “that way we can make even more friends!”

I found that moment moving and profound. Here was a set of kids most of whom had always been on the fringes of any social group, kids who rarely if ever had friends. These kids had chronically been the target of teasing, bullying, rejection and humiliation. But here, in this group, they had discovered that social interactions with peers could be rewarding and fun. They welcomed the opportunity to meet more kids because having that opportunity would enable them to “make even more friends.”

That view, and the sea-change it represents from the experience these kids have had previously in social settings, is what these groups are all about.

April is Autism Awareness Month

Dr. Mendel — Fri, 03 Apr 2009 23:28:18 +0000

In order to highlight the growing need for concern and awareness about autism, ASA has been celebrating National Autism Awareness Month since the 1970s. The United States recognizes April as a special opportunity for everyone to educate the public about autism and issues within the autism community.

We encourage you to visit the ASA website which contains a wealth of information about living with autism.

We, the therapists at Mendel Psychological Associates, write about our experiences with clients who have Aspergers and High-Functioning Autism and about our approach to working with these unique, fascinating, challenging, rewarding children and teenagers.

Aspergers and Social Skills Group

Dr. Mendel — Fri, 09 Jan 2009 04:18:08 +0000

More often than any other question, I am asked to describe my social skills groups. I lead three groups, for upper elementary school students, middle school students, and high school students. While no particular diagnosis is required for a child to be in one of these groups, most have diagnoses of Aspergers Disorder or High-Functioning Autism. Others struggle with social anxiety or extreme shyness. What all the kids in these groups have in common is that they have trouble making friends and interacting comfortably with their peers. These are the kids who have always lived on the fringes of their peer group. They are teased, bullied, tormented, and ostracized.

And something magical happens when they join the group. Quickly, they realize that here is a place where they will not be taunted or humiliated. Here, they will not experience bullying and social rejection. They see that there are other kids like them, dealing with the same struggles, sharing the same longings for social connection and a sense of belonging. For many if not most of these kids, group is the first safe peer setting they have ever known.

These children thrive in this environment. They form friendships with one another; together, they practice social skills that seem so natural to many of us: making eye contact, listening without interrupting, giving feedback, asking questions. After a while, I’ll hear from them and their parents that they’ve begun making friends outside of group. They start to carry their new skills outside of group and practice them in “the real world” of the classroom and playground.

For me, leading these groups – getting to know these wonderful children, seeing them blossom and flourish, watching their confidence and competence grow – is one of the most rewarding things in my life.

How to Say No

Dr. Mendel — Sat, 25 Oct 2008 23:59:32 +0000

As you all know, I work with lots of kids with Aspergers Syndrome or High Functioning Autism. This advice applies particularly to these children, but I think it’s probably relevant for many if not most kids.

I have had several experiences in which the children in my groups become annoyed at me, insisting that I’ve promised to do something for them or give them something. I have felt at least equally confident that I had not said anything of the sort. For example, in my groups, I provide pizza as part of a celebration whenever a child graduates from group. I have provided pizza for the group on a few other occasions as well (which I think was a mistake, but what can I say?). Well, at various times, kids have asked me if I could get them pizza the following week. To my utter surprise, when the next week rolled around, they were dismayed and upset to learn that I wasn’t going to buy them pizza. Several of the kids stated emphatically that I had “promised to buy [them] pizza.” Looking back on the previous week, I think I had said something like “we’re not going to talk about that now; we need to listen to Jimmy’s sharing.”

A vague, non-committal response, will be heard as whatever the child hopes it to be

I’ve come to realize that a vague, non-committal response, will be heard as whatever the child hopes it to be. If I do not provide a firm “No,” my answer will quickly evolve into a promise that I am then bound to break. It struck me that I’d heard similar, flabbergasted complaints from parents over the years, that their children mishear things and insist that they said something that they had not. My advice to all such parents – advice I need to follow myself – is to make your answers very clear. Kids with Aspergers are often virtually obsessed with clarity, precision and specificity. They don’t do so well with vagueness and open-ended circumstances.

I think that there are truly only three categories of answer:

If your child asks you for something and you can provide it, by all means reply “Yes.” Be aware, however, that this is a commitment and a promise and should be kept in all but the direst of exceptional circumstances.
When the answer is no, simply say “No” (and, of course, don’t proceed to provide that item or do that favor).
Sometimes the answer is not definite. You may not be sure whether you can provide the item requested, or you simply may not want to discuss the request at that point, or you may just need to take more time to consider it. In that case, I recommend saying something like this: “The answer right now is No, but I’ll think about it more later on and we can discuss it more after you get home from school.” No guarantees, but I think that it would be hard for any child to construe this answer as a promise to do something.

A couple more quick points about this approach: if you say “No, probably,” and later change your mind and say “Yes,” your child has gotten a pleasant surprise, which is a heck of a lot better than a broken promise or the perception of a broken promise. Most importantly, if you give a firm “No,” stick to it. Saying “No” to a child’s request (or demand) and then giving in to placate him or her or reduce his or her whining or nagging sets a truly bad example and sets you up for your future “No’s” to be ignored and battled. If you choose to say “No,” stick with it, hard as this may be to do.