Tag Archives: child development

Social Skills After Quarantine

In 2021, as we are beginning to come out of the isolation of COVID-19, parents may feel a special urgency to make up for lost time on social development. Learning about developmentally normal stages of social development can help you to prioritize what support your child needs and how to help them make connections.

Making Up for Lost Time

Early childhood is prime time for learning social skills. For children that were socially isolated during those years due to coronavirus, parents may worry that their child’s social skills will be irreparably damaged. But children are so resilient – when social play opportunities open up, they’ll catch up!

First, remember – your child has been practicing social skills! Even if it was just one child and one adult living together, there was plenty of opportunity to practice talking and listening, taking turns, playing together, and conflict resolution. (If there were additional people or animals in the mix, even better.) If you want to evaluate whether they’re on track with social skills, check out this checklist of play skills (or this one) that children typically develop at each age – you may discover they are right where they should be developmentally. If they haven’t yet mastered some of the typical skills, the checklist will give you a sense of what to work on.

Learn what’s normal / what’s next:

It’s helpful to know what we’d typically expect at each age for children so as they start to play together, you can watch for these skills. It’s also helpful to know what’s next in typical development, so you can foster opportunities for learning.

Infants – if your baby was home with only you during the first few months, that’s fine! A young baby can get all the social cues and interaction they need from just one or two caring adults. Just practice serve-and-return interactions, where your baby smiles at you and you smile back. Your baby coos and you coo back. (Learn more.) And learn about infant cues to guide your responses. If your baby has the opportunity to interact with additional adults or older children, they will likely happily engage with anyone.

Older Babies. From 6 – 12 months, your baby learns to play more interactively with you and will likely enjoy peek-a-boo, copying your actions, clapping with you, passing toys back and forth, and finding toys you have hidden. Some babies may play happily with all they encounter. However, it is important to know that even in normal times, many infants develop a fear of strangers at around 7 to 8 months, so interacting with other people in person prior to that may help to reduce that. If you’re just introducing your child to other people at this age, reassure yourself that stranger fear is developmentally normal, not just a product of coronavirus quarantine… they will outgrow it just as all babies have always outgrown it. Here are tips on reducing separation anxiety. And more tips.)

Young Toddlers – up to 2 years. Before 18 – 24 months, children primarily engage in solitary play, where they engage with toys, but often appear uninterested or unaware of other children. So, if your child was in isolation during this period, don’t worry about it! If you bring them back into connection with other kids during this period, know that it’s normal for them to not really engage much. They do engage with adults or older children more effectively than they do with peers, so if you’re choosing only one COVID playmate to help build your toddler’s social skills, 71 year old grandma or 17 year old babysitter may be as good a match as a 17 month old buddy. To build social skills, try Floortime play, which begins with child-led play, then “stretches” the play to be more interactive and turn-taking.

Onlookers: Around 2 years old, they begin to shift to spectator play, where they may begin observing other children more. This is a great time to take them to public parks where they can watch other children at play, up close or from afar.

Older Toddlers – 2+ years. Children begin to engage in parallel play. They will play next to each other, often mimicking what the other child is doing. They may not often engage in reciprocal back-and-forth play with a peer, but they are learning from each other. If your child was isolated during this stage, they almost certainly did parallel play with you. If you’re re-integrating them into social play at this age, they can do fine one-on-one or in groups, with familiar kids or with children they’ve just met.

“Stealing” toys is very common at this age. They are not intentionally trying to deprive the other child of something… it’s just that they noticed what the other child was doing and they want to do it now. One of the most effective ways to handle this issue is distraction – let the child who seems more focused on the contested toy keep it, and distract the other child with a new toy. That will work better, and is more developmentally appropriate than telling children to share.

Three Year Olds. Around age 3, children begin to do more associate play. They start to interact more with each other, trading toys, copying each other, or “inviting” the other child to participate in what they are doing. They become more interested in the other child than in the toy. They may work together on a goal – like building with blocks, but there aren’t usually “rules” to the game. They can learn social skills by playing with adults or with older children, but it’s great if they can have peer interaction at this age. It does not have to be in a large group pre-school. One-on-one or a few children at a time is fine. It may be tempting to enroll in classes as your primary place to connect with other kids, but if your main goal is social skills, it is easier for children to learn those in settings that allow lots of free play (a playground, playdates with other families, a play-based preschool, or a family size child care setting) than in a structured class (like a gymnastics or soccer class where the teacher is trying to keep them on task.)

Check out the “skills to practice at home” section below.

Four and Five Year Olds. At this age, they have moved into true cooperative play. They share toys, they share ideas, they create “rules” or agree on which role each one will play in a pretend game, and work together toward goals. They start learning more about cooperation, compromise, and fair turn-taking. Whereas at younger ages, it’s fine to have your child play with lots of different kids, this is an important age for children to have a few consistent buddies to play with repeatedly, to build friendship skills. If they are enrolled in a group setting, like preschool or extracurricular classes, look for children there that they most connect with, and try setting up playdates with that family to give them more opportunity to connect. Or, if you’re still limiting exposures to other kids, find just one to three families for a low COVID risk playgroup. Check out “skills to practice at home” below, and my post on “Teaching Friendship Skills.”

Reducing Coronavirus Risk

Every parent has to make their own calculations, but here are some things to consider.

  • If the number of vaccinated people in your community is high, and the number of current cases are low, there is less risk of community transmission than when there are fewer vaccinated folks and case numbers are growing.
  • The risk of transmission in outdoor, socially distanced settings is lower. The risk at indoors, poorly ventilated, non-distanced settings is higher.
  • If the parents at the playdate are vaccinated and wear masks, the risk is lower.
  • If children (over age 2) wear masks, the risk is lower.
  • Fewer people involved means fewer exposure risks.
  • You can plan activities that make it easier for children to stay distanced, or provide supports to help them remember to be distanced (like hula hoops or sit-upons to mark places to sit.) Teach them to wave hello rather than hugging or high fiving. Have them wash hands before and after play. Save snacks for after the gathering.

Skills to Practice at Home

You can boost their social skills by practicing in advance of playdates. Do lots of pretend play, puppet shows and role plays, and talk about the social and emotional experiences of characters in stories that you are reading.

When teaching about emotions, I have always taught children to recognize how facial expressions, body language, and tone of voice all communicate emotion, but especially when masks cover up much of our facial expressions, the other non-verbal cues are especially important to teach.

Practice give-and-take conversations, where you take turns fairly, don’t interrupt each other, and ask the other person questions about what they said rather than always just telling them things. Role model social skills by how you interact with friends, family and people in the community.

Introduce the ideas of taking turns. Play side by side with your child, and occasionally ask: ‘can I play with that toy now?’ Or say ‘you can have that toy for one more minute and then it’s my turn.’ If they try to take a toy from you, say ‘I’m playing with it now. You can have it in a minute. Here’s another toy you can play with now.’ Don’t expect 2 – 3 year olds to be good at sharing and taking turns! It’s a skill that needs to be learned and practiced, and they just have to reach a stage of development where they can empathize with another child’s feelings. But practicing at home gives them a chance to build trust in the idea that if they let you have your turn that you will give it back when it’s their turn.

If your child seems shy or withdrawn, don’t assume it’s because of COVID. It could just be their natural temperament. Just search online for tips to help with a shy or introverted child, or what I like to call a “slow-to-warm-up” child. Some simple ways to help them are: get together in smaller groups in quiet, not chaotic environments; arrive before the other child(ren) to get settled; sit on the ground and let your child sit on your lap till they feel ready to venture out. Don’t push.

Learn more in my post on “Teaching Friendship Skills.” Also check out “Making Up for Lost Time” from Bright Horizons, Helping Your Child Make Friends Again from PBS, and my tips for Successful Playdates.

Keys to Brain Development

In the first five years of life, a child’s brain grows from 25% the size of an adult’s brain at birth to 92% the size of an adult’s brain. All that growth comes from making connections – connections built through hands-on, multi-sensory experiences of their world. There are several ways parents can support their children’s growth and development. This video gives a quick summary, and I’ll give more details below.

Novelty – New Experiences

The parent can provide a diverse array of new experiences. These don’t have to be fancy, they don’t have to be expensive, they don’t have to be based on advanced scientific research. These are just the everyday experiences of life. Just simple activities like going for a walk, looking at the clouds, stomping in puddles, touching a slug, coming home and making hot chocolate together, snuggling up on the couch with a good book, playing with blocks, then drawing pictures. Any new experience builds connections in a child’s brain.

And if you don’t have the energy to think of something new to do, try putting together two familiar things in a new way, and see what your child does differently. For example, take the rubber duckies from the bathtub and put them with the Duplos, or take the colander from the kitchen to the bathtub. Your child will be delighted by the new possibilities. Learn more about “invitations to play.”

I have a whole collection of easy free activities with toddlers to get you inspired. (Not all are do-able in the coronavirus era, but most are.) Everything from “nature shopping” to “counting cars”, from “construction theater” to year-round egg hunts.

I want to encourage my child’s growth in all diverse knowledge and skills. I find it helpful to think about categories of development – have we done anything today to build large motor skills? What about fine motor skills? I also find the theory of multiple intelligences to be a helpful guide to inspiring new ideas – have we tried out any music today? And spatial challenges? Here’s an article I wrote on choosing toys and activities for toddlers that build multiple intelligences.

I do encourage you to offer your child lots of learning opportunities, but please don’t feel like you have to be doing a non-stop song and dance, tossing new things into the ring continuously. That would be exhausting for you! But it could also teach your child that the only way to be happy is to be continually entertained with new things. They would also be missing out on the full depth of possible learning if you did this and ignored the next two keys to brain development: repetition and down time.

Repetition – Doing it Again and Again Builds Mastery

Doing something for the first time makes a connection. Doing it again strengthens that connection. Doing it again in a different setting strengthens that connection and also makes connections to this new setting. Combining that activity with another deepens understanding. Think of a child learning to walk – they fall again and again until the a-ha moment happens. But then they still stumble and wobble along for a while. But the more they walk, the better they get at it. Or think of anyone learning an instrument – we don’t become expert by going to a class once a week. To become a skilled musician requires playing those same scales again and again till you reach mastery.

Don’t rush them. If they’re just barely starting to understand something and you push them onward, they’ll have a shaky foundation for future learning. For example, if you have a child who has just barely learned to count to three, don’t feel like you have to rush them on to 4, 5, 6… 10… 100. Let them stay at three for a while – really exploring three, getting to the point where they can tell at a glance if they have three objects or more than that or less than that. If you can do this, your child will have such a solid understanding of the fundamentals of math, everything later on will make more sense.

When my oldest kids were little, I probably over-did the novelty. I felt like I continuously had to provide new experiences. My oldest child resisted transitions so much, and looking back, I think a big part of it was that he was always feeling forced to move on before he was ready. By the time my third child came along, I had learned a lot about the importance of repetition for brain development, so I was willing to let him do things again and again. It’s a good thing, because that little boy has deep passions and wants to immerse himself in the same things for weeks or months on end.

But with him, I saw clear evidence of everything the research says about repetition and also about following a child’s interests. When he was wild about dinosaurs, we could teach everything else he needed to learn in that context – we could teaching counting, and colors, and music and art, all focused on dinosaurs. When he had the chance to do something again and again, he developed so much self-esteem in seeing himself as a competent learner. Whenever he was feeling anxious about anything else, returning to this familiar territory helped get him grounded and feeling capable, then he could take on new challenges.

There is a concept called Schemas of Play, which addresses how children tend to be working on a few key ideas at any given time. They might be exploring: Trajectory – kicking and throwing balls, or Transportation – carrying things everywhere, or Connecting – assembling puzzles. They may repeat the same activity over and over, but know that they are learning important concepts by doing that. Check out some ways to support your child’s schemas of play.

Down Time – to Process it All

Children need rest. It is during sleep that we build myelin sheaths that insulate our nerve pathways, helping us access information more quickly and efficiently apply that knowledge to new situations. (Nutrition is also important. To build myelin, they also need a diet with plenty of healthy fats, like fish oils, nuts, avocados, olive oil, and whole milk. Learn more about nutrition for growing brains.)

They need down time – time to putter around the house “doing nothing.” Time to play aimlessly. Time to “waste time.” When they don’t appear to be doing anything, it may be because they are processing all the new learning they’ve been experiencing, and they need time to take it all in and incorporate it.

Don’t feel like you have to constantly entertain your child. When they are “bored” is when they may come up with some of their most creative ideas. They might make connections between things on their own. I remember once my daughter, who was 5 at the time, was complaining about how bored she was. I told her “I need to finish this work… figure out what to do for 15 minutes, OK?” My work took longer than expected, and when I went to find her 45 minutes later, she had all the toy horses arrayed on the table, and proceeded to tell me all their names, ranks and how they were related: “Princess Snowy is getting married to Duke Blaze – he is from a different kingdom where his sister… ” She’d created this whole complex imaginary play world, which she would never have done if I was hovering over her guiding her play.

I think it can feel tricky to find the right balance between feeling like we should introduce novelty and guide learning and knowing when to step back and let them explore on their own. It could be something as simple as having a bedtime story routine – each night, we read two stories – one for novelty, one for repetition, and then I let my child look at books on her own for a few minutes before turning off the light. (Here’s more about choosing books for your child.)

Read this article on How Much is Enough, How Much is Too Much which looks at questions like how many toys to buy, how many activities to schedule, and how screen time fits in.

Check out my past writing on brain development, which includes more about the science of brain development.

Screen Time in Coronavirus Time

sciemcenews

So, you’ve all heard the cautions about too much screen time. For example, the 2016 statement from the American Academy of Pediatrics, which talks of risks like obesity, sleep challenges, exposure to inappropriate content and more. We’ve worried about how much screen time was too much.

And then… covid-19 came. And for most kids, screen time began to fill way more hours than in life before coronavirus.

We have a 9 year old and he spends so many hours on screen now: 2 – 3 hours a day on school work; teleconferences for school, for Sunday school, for appointments with his psychologist; Skype calls with his siblings and grandparents who we can’t see in person; playdates on Zoom; Wii sports on rainy days; ebooks since the library is closed, and a couple family movie nights a week. Plus, his reward for completing his day’s school work is… yep, you guessed it… a little screen time playing Pokemon or Minecraft.

It’s more screen time than we could have previously imagined. It’s certainly not optimal for development. But it is the current reality for many of us. So, rather than talking about “just say no to screen time”, I think we need to take more of a harm-reduction approach.

So, we’ll look first at how to keep young eyes and young bodies healthy while using screens, then we’ll take pointers from this approach, from the Media Policy Project:

We argue that this long-held focus on the quantity of digital media use is now obsolete, and that parents should instead ask themselves and their children questions about screen context (where, when and how digital media are accessed), content (what is being watched or used), and connections (whether and how relationships are facilitated or impeded).

Here are some tips, collated from lots of sources:

Improve “Screen Hygiene” During Use

For their eyes:

  • Screens should be 18 – 24 inches from eyes
  • Use screens in locations with good lighting without a lot of glare (or consider a matte screen filter)
  • Adjust brightness and contrast for comfort
  • Consider night mode or blue shade mode on devices after about 7 pm to shut out the blue light which can disrupt sleep
  • Remind your child to blink now and then to avoid dry eyes and eye strain
  • 20-20-20 breaks: Set a timer – every 20 minutes, they should look at something 20’ away for 20 seconds (plus spend some time outdoors every day, looking at a far distance)

For their body:

  • Use good posture – typical advice is to sit so there’s a 90 degree angle at your ankles, your knees, and your hips, and that your elbows are at a 90 degree angle as your hands rest on the keyboard. Start with that advice, but then adjust as needed for your child’s personal comfort.
  • Choose good furniture – if you don’t have furniture that fits your child for their screen use, perhaps look for inexpensive options to help their posture
  • Vary seating choices – if possible, have multiple work stations so they’re not putting weight on exactly the same parts of their body all day long every day, or have an exercise ball to sit on, or a standing-desk station
  • Stretch breaks – encourage your child to take breaks between activities… at the end of a chapter, after finishing a school assignment, every 20 minutes, whatever “signposts” make sense; dance breaks are also great (try gonoodle.com)

Context Matters

Think about when, where and how screens are being used. Establish daily routines. Make sure you’re clear on when and where screens can be used, and when and where they’re limited or off-limits.

Take Breaks from Screens

Try to create some screen-free times in your day and in your week.

  • No screens at mealtimes? Many families declare the table to be a screen free zone so you have a chance to connect as a family and practice social skills and casual conversation. (Also, screen use during meals is strongly associated with obesity.)
  • Screen free days? I know several families who declare one day a week (often a Saturday or Sunday) to be screen-free.
  • Consider screen curfews: the light from screen media and the high stimulation caused by screens can delay sleep onset, and shorten sleep duration (source). Avoid screens right before bedtime.
  • Consider no screens in the bedroom: even if they’re “just charging”, they can buzz or light up as notifications come in, and this can disrupt sleep, and tempt your child to return to the screen at any hour of the night.
  • Be sure to balance screen time with physical activity, and with social interaction between members of the household.
  • Be sure to include some time every day outdoors – even if the weather is dreadful. Do choose outdoor areas that are less populated, rather than crowded parks, so it’s easy to maintain social distancing.
    • When we are indoors and using screens, we’re triggering our sympathetic nervous system – adrenaline responses keep us intensely focused, which is helpful for work, but exhausting to our bodies.
    • When we are outdoors, we shift to our parasympathetic nervous system, which is about conserving energy while the body is at rest, so the body and mind can heal itself. After spending just a few minutes in nature, we have lower pulse rates, lower blood pressure, lower cortisol levels.
    • Read more about the benefits of outdoor time.

Content Matters

Not all screen time is created equal. Some is helpful and beneficial, especially in this time of social isolation. Screens offer opportunities for learning, connection, adventure, and entertainment.

Some screen time is less helpful. Let’s think about some categories of screen use, and for each, figure out how to increase the benefits, and reduce the downsides.

  • Social time with friends and family on screens – Skype, Facetime, etc.
    • Connection Matters. I believe that when we are physically distant, having interactive conversations with others, even if it’s on a screen, is truly essential for our mental health and for a child’s developing social skills.
    • If you as a parent need a break during your time home 24-7 with a child, this social screen time with someone else can offer that to you. Our 26 year old son “babysits” our 9 year old over a Skype call while my husband and I have a date night at home.
    • For young children, think about how to make it as interactive as you can. For little ones, it helps to add a physical component – have your child show grandma a favorite toy – grandma can show your child the steps they’re doing as they cook a meal. It may be easier for your child to pay attention if someone is reading them a book rather than trying to engage them in a conversation. (Note for those who might not have kid books at home: on YouTube, you can find LOTS of great kid book read-alouds – I share my screen on Zoom and show the video to a child with the sound muted and I read the words.)
    • For older kids, try playing games together online: charades? hangman? There’s lots of online gaming platforms, like Jackbox games, kahoot.it, Ravensburger jigsaw puzzles, and more.
    • If you want a break away from the screen, consider also trying phone calls while going for a walk.
  • School work on screens – lots of school work is now online
    • Think about whether any of it can be physical work. For example, is there anywhere you can print a worksheet and have your child write on it with a pencil rather than using a stylus on a screen? If the math book is showing pictures of blocks, can you pull out real blocks? Instead of writing a paper on the computer, can they hand-write it, scan it, and email it in?
    • For younger children, kindergarten through second grade, you may want to ask their teacher if you can opt out of some of the online learning and instead do hands-on learning at home.
    • Have your child talk to you (or a family member or friend) about the work they’ve done – that helps move it off the screen and into their interactive brain.
  • Online extra-curriculars and summer camps
    • As summer arrives, many parents (especially working parents) are wondering how to keep their kids occupied and engaged. And while I’d encourage lots of outdoor time, and art, and free play, if you turn to screens, consider something like Outschool, which offers interactive online classes with a teacher and a small group of kids.
  • TV, Movies, Videos
    • Ask yourself: Could you find books or audio books or podcasts that engage them as much in stories? (My son listens to story podcasts as he builds Lego.)
    • Can you watch together and make it a social activity instead of them watching alone? Or could they watch with a friend or family member using Zoom or Skype and sharing a screen, or using Amazon watch parties on Twitch?
    • Choose quality TV or video that teaches something, shows diverse people and experiences and reflects your family values. I really love Common Sense Media for researching our options.
    • Choose things that take you on an adventure outside your home. This is a great time for nature documentaries, or shows about foreign lands – anything with a touch of the exotic can be a welcome break!
    • Have your child watch where you can keep eyes and ears on what they’re watching.
    • If your child is using YouTube or other similar platforms, check their history now and then to make sure they’re making appropriate choices, and have conversations with them about what they’re consuming.
    • Set limits on what’s appropriate in your family and what’s not. If your child violates those limits, then impose consequences – take away entertainment screen time.
  • Video games – I’ve got a kid whose deepest passions are video games, so I get that they’re an easy motivator to get kids to do another thing they don’t want to do (i.e. if you finish your school work you can play Pokemon…). Just try not to over-use them.
    • Ask yourself: Is there something else they could do? Is there some other reward that would motivate them?
    • Can you play together and make it a social activity instead of them playing alone?
    • Choose games with challenges – instead of just mindless Candy Crush games or platforming games that only teach hand-eye coordination, look for games with some cognitive challenges too – perhaps puzzles to solve, or building challenges to pursue.
    • Minimize games with lots of violence or age-inappropriate language, sexuality, and situations. Again, check out reviews on Common Sense Media or elsewhere.
  • Escape / Zoning Out – Realistically, in our current quarantined life, sometimes we just want to escape into something, and screens offer an easy escape. If you catch yourself or your child doing this, think:
    • What else could we do – could we just go for a walk? Or exercise? Put on music and dance? Do some crafts, play some games? Choose things that emphasize social connections and emphasize physical movement as a balance for all that screen time.
    • Try to minimize background TV and mindless clicking through social media. If you need the occasional zoning out time, consider setting a timer to remind yourself to look up and ask yourself if you want to continue or if you’re ready to move on to another activity.

What Else?

Several of my points above were “ask  yourself what else you could do.” I think that’s a key thing. If you consider what all your options are in the moment, and the screen solution is the best answer, then use the screen without feeling guilty. But, if you can think of other satisfying options, then choose those more often.

Now might be the time to try something new: Yes, you can be one of those folks who is telling everyone on social media about your families’ new hobbies – new musical instruments, your family’s first garden, your sourdough starter projects, roller blading adventures, art work, your new puppy, or the domino chain Rube Goldberg your child built!

As much as we love Lego in our family, I’ve previously resisted just having a bin out all the time. The clutter bugs me. But, in the midst of this quarantine-time, we’ve surrendered half of our dining table to a free-build Lego zone to encourage that hands-on play whenever possible. And this weekend, I think we’ll set up a tent in the living room, and toss a pile of books inside.

Read More:

I’ve written previously about the Benefits and Risks of Screen Time, and Making Screen Time Work for Your Family. It has a lot more tips about how to choose appropriate content, especially for toddlers and preschoolers.

The most helpful article I have found on the topic of coronavirus screen time is “Screen Time Recommendations For Parents: How Much Is Too Much For Kids?” from Child Development Institute https://childdevelopmentinfo.com/screen-time/screen-time-recommendations-for-parents-how-much-is-too-much-for-kids

My final piece of advice is be gentle on yourself – don’t feel guilty for using screens! We’re parenting in a situation unlike any other before us, and we’ll just have to do the best we can to make it through each day.

Autistic? Or Just “Quirky”?

As a parent educator, and as a parent of autistic children with ADHD, I’ve had multiple discussions with parents who are wondering whether their child is autistic, wondering whether they should have them tested, and receiving testing results of “well, we can’t say it’s autism, but we also can’t rule out autism.” I’ve also had conversations with colleagues about children in their classes, where they’ll wonder about a child’s unusual behavior, but also say “I see these symptoms, but I don’t think they’re autistic, because they don’t ______.”  [fill in the blank of a stereotyped assumption about how “all” autistic people behave].

It’s tricky to figure out what to do about these “maybe?” cases, and trickier still when parents see that their child has challenges, and think they would benefit from support (like occupational therapy or ABA – applied behavior analysis, or social groups) but their insurance won’t cover it unless they have the diagnosis.

The Autism Diagnosis

When I was a kid, we tended to think of autistic people as ones who showed significant impairment in multiple domains: non-verbal, developmentally delayed, frequently stimming (e.g. rocking). Then there were a bunch of other kids who were skilled in many areas, but had some unusual behaviors. We called them “quirky” or “odd ducks” or said they “march to the beat of their own drummer.”

Then the term Asperger’s syndrome appeared, and was often applied to kids who were gifted and “quirky.” And we would talk about people in terms of “where are they on the spectrum” or “are they low functioning or high functioning?”

Now, Asperger’s is no longer a distinct diagnosis. It’s been pulled back under the umbrella of Autism Spectrum Disorder (ASD).

The criteria for an ASD diagnosis in the DSM-V require showing symptoms in both of these categories:
A) Persistent deficits in social communication and social interaction (deficits in social-emotional reciprocity, in nonverbal communicative behaviors used for social interaction and in developing, maintaining, and understand relationships) and
B) Restricted, repetitive patterns of behavior, interests, or activities (as manifested by at least two of: S
tereotyped or repetitive motor movements, use of objects, or speech; Insistence on sameness, inflexible adherence to routines, or ritualized patterns of behavior; Highly restricted, fixated interests that are abnormal in intensity or focus; Hyper- or hypo-reactivity to sensory input.)

Or to put it in a less deficit-based language: A) challenges with social interaction and emotional interaction with neurotypical peers and B) strong preferences for predictable routines and specific interests.

But within these criteria, there’s a range of behaviors from subtle to blatant, and from minimal impact to major impacts on school and home

What is a spectrum disorder?

When autism is described as a spectrum, it doesn’t mean this. (source)

continuum labeled not autistic at one end, and very autistic at the other end

Or this (source)

continuum, labelled "a little quirky" on the left, "definitely autistic" in the middle, and "tragic" on the right

Autism is a more complex way of interacting with the world that can’t be described on a simple numeric scale, and can’t be simplified to “not a problem” to “tragic”.

I’ll share with you here a few different ways that it has been illustrated, so you can find the one the best resonates with your experience.

The autism spectrum can look something more like this:

An illustration of a circle where the "pie pieces" are labeled language, executive function, etc. and dots indicate where the person might have more strengths vs. more difficulties

(That image comes from this great comic on “Understanding the Spectrum” by Rebecca Burgess – I highly recommend reading it.)

This graphic (source) breaks the spectrum into five categories, similar to Burgess, though the colors and the way they break things out are a little different:

GAO

And says that “the type and severity of characteristics varies from person to person.”

Picture1

C.L. Lynch on theaspergian.com uses this illustration

spectrum

Then gives a few examples of how this would apply for an individual person.

spectrum 2

I don’t know which one of these graphics might be helpful for you, but I find it very helpful to think of these more nuanced descriptions rather than a single axis of “a little quirky” to “tragic.”

I know that if someone asks me if my son is “high functioning” or “low” or asked “how autistic is he”, I would find it difficult to answer those questions. It’s much easier to tell you – “here are the things he’s good at, here are some behaviors he does that might seem odd to you but don’t harm anyone or anything, and here are some challenges he has and some accommodations you could make that might help him to manage them.”

To Test or Not to Test

I have been a childbirth educator for over 20 years. In that field, we often say – before you get a test, think what you will do with the results and whether it will be helpful to you to have the results.

If you are a parent deciding whether to test, or an early childhood professional deciding whether to refer for testing, it’s worth asking that same question.

If there are services that you believe that your child would benefit from that they can only access if they have a diagnosis, then you should get your child tested. If it would be helpful to you as a parent to have a “label” that helps you better understand your child and learn more about what they need, then it’s worth getting them tested to learn more from a professional, whether that’s a diagnosis or just resources for more ideas and support. (My daughter chose to pursue a diagnosis at age 20, during her sophomore year of college. For her, the diagnosis came as a relief, because in the past, it was easy for her to think her “quirks” were her fault and that she should be able to fix them herself. Once she had the diagnosis of autism, she was better able to accept that this is just who she is and it’s OK to ask for the accommodations she needs to be successful.)

I can share my own experiences about decision making for my youngest: As a parent, I suspected something was unusual about him from when he was about six months old – signs like when he got overstimulated, he’d bump his head into things or have meltdowns. When he was a toddler, he would perseverate on things – like during one gymnastics class where he told his coach “I am an ankylosaurus” at least 20 times. He had singular obsessions – like the month where he wanted nothing but Cat in the Hat, or the periods where he only wanted to talk about the planets and could easily be calmed out of a meltdown by just handing him 8 objects and asking him to decide which one was Mercury, which was Venus, and putting them all in order.

However, he didn’t fit some key stereotypes of autism: he’s very verbal, OK at eye contact, and seeks out social connections. So no professional ever told us that we should seek an autism diagnosis, but I suspected that was where we would be someday.

I learned  about autism and sensory processing disorders, and what accommodations help kids with those challenges, and I just did all those things for him. We chose preschools and activities that were a good fit for him, not ones that we knew would push his buttons. We didn’t have him tested yet, because having results wouldn’t have changed anything about what we were doing.

However, when he started kindergarten, things got more challenging. Luckily his kindergarten teacher was fabulous with him and just naturally did the accommodations he needed. But all of school didn’t accommodate as well. So, at that point, we had the testing done, and received an autism diagnosis, and that has made it easier for us to access the services he needs. For school, he has an IEP which ensures he gets extra support. And now our insurance will cover OT treatment and therapeutic social groups for him. Having access to therapies and supports are the upsides of having the official diagnosis. (There is a downside… some summer camps and other programs say they can’t take children with autism or can only take a limited number, so there are some programs that are no longer an option for him.)

In second and third grade, when kids are expected to sit still and pay attention for longer periods, he was having challenges with that, so we then learned more and had him evaluated for ADHD. That diagnosis gave us access to medication which has been helpful for him and also allowed us to adjust his IEP for more accommodations which are helpful. So, doing each of those evaluations when we did worked out for us. Your needs may be different.

To refer or not to refer

As a parent educator, I observe the kids in my class. I had one toddler where I had no doubt she was on the autism spectrum and would benefit from early and intensive services. I spoke to that parent early in the year, encouraged her to seek testing, and got her connected to services.

I’ve had lots of other students who were “quirky.” I do developmental screenings in my toddler classes (here’s how you can do your own screening), and this can start the conversation with parents about developmental issues. If there’s a minor delay in one area, I just talk about ways to enhance learning in that area, but if I see more delays, we have a broader conversation about what might be going on there. So far, I have not had another child that I told the parents specifically that they should ‘have them tested now’ for autism. But, I have shared “here are some things about your child that are a little different than what we see in other kids their age. It could just be a temperament thing or just where they are in their development, but it does make me wonder a bit, so it’s something you could keep an eye on, and check in with me again if it becomes a concern.” I do mention the word autism, because I’ve spoken to parents of 7 year olds who have said things like “I can’t believe no professional we worked with ever mentioned the word autism to us before last  month or told us that those behaviors might be signs of autism. If anyone had the courage to have that conversation with us, we could have learned more about accommodations that would have helped us parent him more successfully and access services earlier.”

In my classes, I share my story of having two kids with an autism diagnosis (My older daughter was not diagnosed till age 20, because autism is different in girls and more difficult to diagnose especially for gifted girls). I hope to help people learn more about what autism looks like and how to interact effectively with autistic people.

I also talk about autism differently than the common dialogue. Autism is often treated as a tragic thing. I think it’s better to just think about it as a developmental difference which creates some challenges but can also be accommodated. If a child is blind, or deaf, we don’t expect them to be able to change that, just by “choosing to behave better.” We don’t assume that “learning to act normal” will “cure” them. We figure out what accommodations they need to move through the world, and to maximize their potential for a successful life. It’s an accessibility issue. The same is true for autism accommodations.

Autistic people also have unique strengths. For example, many have intense attention to detail, a high degree of persistence, and ability to analyze data. And “Sometimes being autistic means that you get to be incredibly happy. And then you get to flap. You get to perseverate. You get to have just about the coolest obsessions.” (Source)

The Autism Self-Advocacy Network recognizes Autism Acceptance Month, which “promotes acceptance and celebration of autistic people… making valuable contributions to our world. Autism is a natural variation of the human experience, and we can all create a world which values, includes, and celebrates all kinds of minds.”

A Note on Co-Morbidity and Social Issues

Autism also has several co-morbidities: conditions that often occur with autism.  “Over half of autistic youth [also had] attention deficit disorder (53 percent) or anxiety (51 percent), nearly one quarter had depression, and 60 percent had at least two comorbid conditions. Other common comorbid conditions include sleep disorders, intellectual disability, seizure disorders, and gastrointestinal ailments.” (Source) Many of the challenges we think of as being due to autism actually come from these co-morbidities. We should think of them as separate issues and handle them separately.

And many of the “challenges” of autism actually come from societal attitudes toward autism. For example, if a child jumps up and down with excitement, is that really a problem behavior that needs to be corrected? If a teenager gets overwhelmed by noises, so chooses to wear noise-canceling headphones in many situations, is there a reason anyone else should care about this? If someone can’t stand it when the different foods on their plates touch each other, isn’t it easy to use just a little extra care when dishing them up instead of using a lot of energy telling them that “you just have to learn to cope with that”? If the neurotypical community understood more about neurodiverse people, it would greatly reduce the “challenges of autism.”

Screening and Diagnostic Testing

If you’re wondering about your child, or a child you know, start with this list of symptoms, or red flags to watch for. https://www.cdc.gov/ncbddd/autism/signs.html

If you’re still concerned about possible signs of autism, use a screening tool:

If you’re still concerned, talk to your child’s health care provider, and/or contact your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. If your child is under three years old, look at the ECTA website. If your child is 3 years old or older, contact your local public school system.

In King County, Washington, some resources for diagnostic testing include: Kindering (especially for kids under age 3), UW Autism Center (this is where my daughter was tested at age 20), and Seattle Children’s Autism Center. Some private practice psychologists also offer testing. For example, our son was tested by Heather Davis at Brook Powers Group, who had worked with him in their Incredible Years program.

Here is a podcast with tips for what to do when you’re waiting for an autism diagnosis or a PDF on the same topic.

What if they’re NOT diagnosed as autistic?

If your child has been tested for autism, and the diagnosis was “we can’t say it’s autism but we can’t rule it out” you’re in a bit of a bind.

If you feel your child needs services now and you can only access them if you have a diagnosis, you may have to do a fair amount of advocacy. Know that some clinics will refuse families who have already had an evaluation elsewhere – they worry that some parents may just be shopping around for someone who will give them the diagnosis they want. That wouldn’t be in the best interest of the child.

If it is possible for you to wait to pursue a diagnosis, that may work out better. A few months or a few years down the road, you may discover that they moved through a phase, and are now doing well in school and social occasions. Or, you may discover that things have gotten more challenging for them, and more professionals are on board with a diagnosis, given more evidence.

In the meantime, you can learn more about autism, sensory processing disorder, ADHD and other issues. You may discover that there is a description that is a better fit for your child. It doesn’t help though, to be overly focused on finding a label – an answer to “WHY is my kid different than other kids.” Instead, you may find it more helpful to think: “given that my kid is who they are, what can I do to support them?” Learn how you can accommodate them so they’re not under continuous stress and pressure, while still giving them appropriate challenges so they learn and grow and reach their potential.

What was the Cause? Is there a Cure?

It can be tempting to ask “what causes autism” and for many parents, that’s a quest to understand whether they “did something wrong” that led their child to be autistic. There’s no one cause for autism. There may be genetic factors, or environmental factors, or a combination of environmental factors with genetic susceptibility. Personally, I have not found it helpful to look backwards and wonder about the cause – it’s better to focus on what we need to do to move forward into the future.

I also do not seek a “cure” for autism. (Partially because that implies it is a problem that needs to be fixed rather than just a different way of being in the world which benefits from accommodations.) Some parents spend a great deal of time and energy seeking a way to fix their child. There are some effective treatments which can help make things more manageable for the family, but there are also some “treatments” you’ll find on YouTube videos or random people’s blogs that can either cause harm, or simply just take more time, energy and money than they are worth.

For example, many parents have reported significant improvements in behavior problems with dietary changes. If you find diet changes that are generally considered nutritionally sound and they prove helpful for you, then hurray! But if a special diet is prohibitively expensive, or if it deviates from mainstream nutritional advice and might cause nutritional deficits, or if your kid is just a super picky eater and it’s a huge battle, it’s worth knowing that there’s not a lot of research that proves this is essential.

Resources on Autism

General Resource Guides

There are lots of resource guides from various organizations. Try these from the Seattle Children’s Autism Center, Autism Parenting Magazine, and the AAP. Plus these communication resources. Note: I have not vetted all these resources. If you discover materials that approach autism as a terrible disease to be cured, or focus on ways to “fix” autistic kids, you may choose to set those aside. I personally choose materials that talk about autism as a neurological difference that shapes who they are and how they interact with the world, and talks about ways we can increase accessibility for them. 

Autism Navigator has a free online class (approx 3 hours) on Autism in Toddlers. They have handouts you can print on everyday learning activities, how parents can support language and emotional skills, and Q&A for parents.

Discipline and Behavior Challenges

  • This article is short and helpful: 15 Behavior Strategies to Help Children with Autism.
  • There are tons of helpful resources at challengingbehavior.org: visual schedules, tip sheets on making daily routines easier, handouts on teaching emotional IQ, addressing behavior like hitting or biting.
  • If it’s available in your area, I highly recommend the Incredible Years program. (We worked with Shanna Alvarez in Seattle, who was fabulous.) While the parents meet, the kids attend “Dinosaur School” which teaches social and emotional skills. Note: my Discipline Toolbox is highly influenced by what we learned at Incredible Years.
  • Ross Greene has some really helpful tools, summarized as “Kids Want to Do Well – If they’re not doing well, ask yourself what skill or resources they are lacking.”
  • If emotional regulation is a challenge for your child, check out my post on Big Feelings and the Zones of Regulation approach.

Building Connections with Your Child

Floor Time, or Child Directed Play, is a powerful way to connect with any child, but especially children who have challenges with social-emotional connections. Click her eto learn about Floor Time: child-directed play. On Autism Navigator, learn how to support social communication development, and transactional supports to promote learning.

More resources

There are helpful resources at https://brightandquirky.com which has webinars with leading experts on how to support kids who are gifted AND autistic (or have other behavioral issues).

And for your child, here’s my list of Children’s Picture Books about Autism and other “quirky kids” stories. Seeing themselves reflected in a book might be helpful for them.

Wait for it…

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As a parent educator, I often tell my students: we can’t make our children do something before they’re developmentally ready. We can encourage them, provide opportunities to try a new skill, model behavior, try praise and punishment to motivate them, and create an environment that encourages them to master that skill. But sometimes, we just have to wait for them to be ready.

Sometimes when it comes to raising my own kids, the advice I give to other parents just flies out of my head…

Just 4 weeks ago, I was despairing that my child would ever want to write or draw anything. He is five years old, and was about to start kindergarten. Yet, I could count on one hand the number of times he’d attempted to draw a picture. The only time he would write was if we made him do it to earn something. “Want a chocolate Kiss? OK, write the word kiss and you can have it.” His grandma started paying him a penny for every letter he writes for her, and despite that, he didn’t write much.

This is in stark contrast to my older kids, but especially to my daughter who started drawing and trying to write when she was less than 18 months! And in contrast to one of his buddies, Jelly Bean, who sent him a lovely card covered with flowers and butterflies she had drawn when she was 3 and he was 4 and didn’t want to draw a straight line.

Any time your child seems developmentally behind where you feel he should be, or behind other children, it’s always worth checking into. Look up developmental newsletters and checklists to check whether your expectations are reasonable. It could be you’re expecting too much, too early. If he’s not meeting the exact questions on a checklist, ask yourself whether he is doing other tasks which show that same developmental capability.

For example, with my son, he was generally right on track developmentally. When it came to writing, I knew that the issue wasn’t that he didn’t understand letters, or the power of the written word. He was an early reader – beginning to read words at age 3, and reading chapter books by age 5. The issue wasn’t small motor skills – he could easily manipulate small lego pieces and small pieces in “experiments” he was working on. He just truly had no internal motivation to draw or write or paint.

From time to time I’d suggest it. I would show him the fully stocked cabinet of art supplies, and he would walk away and do something else. He even took an arts enrichment class, called Creative Development Lab for a full year, and managed to never paint or draw a thing.

So, there we were, on the brink of starting kindergarten and wondering if he’d even be willing to write his name.

Then, overnight, for no external reason, he started drawing. And writing. A lot! And talking about how exciting it was that he had his own “art studio” (the art supply cabinet). And producing drawing after drawing. We went to the meet-the-teacher session at kindergarten and she asked him to draw a picture of himself. My husband and I looked at each other with doubt – what would he do? He happily sat down, drew a stick figure drawing (his first!) and wrote his full name next to it. Now, one week into kindergarten, every day he brings home pictures he’s drawn, coloring pages he’s completed (mostly coloring inside of the lines when he chooses to do so), worksheets where he’s traced every letter carefully and well, and craft projects where he’s easily mimicked the teacher’s sample project.

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Over and over, we wondered whether he’d ever be willing to write or draw. But then, when he was ready, he leaped right into the deep end of non-stop creative work. It reminds me of the validity of the advice… sometimes you just have to wait for a child to be developmentally ready to make that leap in skills.