Michael is an 11-year-old fifth grader with ASD I have worked with for the past year. My evaluation of Michael led to diagnoses of Autism Spectrum Disorder (ASD), the Combined Type of Attention Deficit Hyperactivity Disorder, mild depression, and a moderate learning disability. At the time of my assessment a year ago, despite receiving special services at school Michael had made minimal progress. Though Michael was a pleasant child, the adults in his life were extremely frustrated. Nothing they did appeared to have made a positive difference. Michael had few friends, rare success in school or any other area of his life and was becoming increasingly more hopeless and helpless.
The treatment plan Michael’s parents and I developed included input from Michael, his physician and teachers. Michael began taking a stimulant medication. This led to an immediate improvement in his general behavior, organization, attention and follow through in many areas of his life. His parents enlisted the aide of a community based tutor whom Michael likerd. Efforts were made to locate an out of school activity that Michael could succeed at, feel good about and use to bolster his self-esteem. Because Michael had always enjoyed golf, his parents enrolled him in a golf program in which he excelled. He was also enrolled in an after school socialization program for children with ASD. Now a year later, Michael is doing significantly better. Though he is still a number of grades behind in reading, he is not only keeping up but is slowly beginning to catch up. He has made a new friend. He feels better about himself and his daily life is filled with successes rather than failures.
This being the case, I was surprised recently when, during the course of our conversation, I asked Michael to describe a good day and he responded, “Dr. Sam, a good day is when bad things don’t happen.” It occurred to me that despite the improvements in Michael’s behavior and even the increased confidence he voiced in himself, the many years he had spent struggling had very clearly shaped his mindset about success and failure. Though he was doing much better he continued to view “good” solely as the absence of “bad.” Michael and I discussed this view and set in motion a strategy to help him change his opinion.
This experience with Michael reminded me of the multiple forces and complex processes by which we come to view ourselves, capabilities and our place in the world. This experience also reinforced my commitment to the direction I have taken in the past year, focusing my work and writing with my friend and colleague, Dr. Bob Brooks, on what is right, rather than what is wrong in our children. It is important to remember that when children leave school they are not asked about their worst subject, and, most annoying behavior and then assigned a job based on that. It is just the opposite; we determine where we are going in life through a combination of ability, support, opportunity and ultimately belief in ourselves.
It is because of this complex issue that I believe families faced with raising a child with ASD and developmental or emotional problems, even in the absence of significant risk factors, require comprehensive, intensive and flexible support throughout the years of raising that child. Such qualities define successful programs capable of demonstrating good outcome for those with high risk. As professionals across multiple vocations, it is our responsibility to see to it that parents of children with disabilities like ASD have opportunities to improve their parenting competence, develop the skills necessary to instill a resilient mindset in their children, increase the daily frequency and availability of positive social interaction and ensure that their children experience success in school. All of these factors will lead to more efficient and effective personal control later in life. We provide parents with strategies to help this process in our new book Raising Resilient Children with Autism Spectrum Disorders (McGraw Hill).
It has been suggested that one of the greatest human fears is losing control and that one of the strongest motivations of humans is to have control over one’s life. Psychologically normal individuals develop a greater sense of control than those with problems. The manner by which many struggling children attempt to gain and maintain control over their lives, unfortunately is impulsive and non-thinking. This mindset results in less control and coercively contributes to an increasing pattern of helplessness and, for some, a subsequent profile of maladaptive efforts to gain and maintain control. Thus, a central goal in our work with all youth is to help them develop skills to exert and maintain appropriate control over themselves, their lives and their environments.
As professionals, we must undertake and accept responsibility for the task of doing a better job, translating what has been demonstrated scientifically into the clinical setting and beyond. We must bring our knowledge to the families, educators and professionals with whom we work. We must take our expertise into their homes, schools and communities. We must possess a thorough knowledge of the developmental course, definition, evaluation and most important, proven treatments for children’s disabilities. Setting in place these treatments requires the interface of medical, mental health and educational professionals.
Our emphasis on the best interests of children, their rights and dignity, represents a bright star in our passage into the new millennium. As a society we must understand and deal effectively with the alarming trend of problems among our youth. For in the end, now matter how effective and efficient our treatments are, it is the course of society and the outcome for all children that will best predict and contribute to the successful life outcome for children with disabilities. What do you think?