Thursday, May 3, 2012
Need to Move
If you haven't already subscribed to this blog at the new location, please do so. I will no longer be posting on Blogger, and the blog has moved. Simply click here, and when you get there just enter your email address on the right side where it says "follow this blog." Thanks so much!
Tuesday, March 6, 2012
The Kindness of Thieves
It is easy to become overly focused on the painful, tragic aspects of the work we do. After all, we devote our lives to making things better, and as much as we strive to celebrate our victories, we are constantly facing the struggles that make life so difficult for those with autism and for their families. But it remains important that we keep ourselves light in the face of pain, laughing at the funny things and cuddling up to the positives.
Here is a story with a happy ending, and the hero of the story is a bank robber. It occurred over a decade ago in upstate New York, but I recently came across the story and thought it would be an important thing to share with you.
Mike Fitzpatrick was 48 years old at the time. He was a simple, gentle man who, despite his autism, was able to drive a car, do his own shopping, and hold down a job as a night janitor in Syracuse. Police looking into the robbery of the Ontario National Bank in Clifton Springs, N.Y., eyed Fitzpatrick as the chief suspect. It so happened that Fitzpatrick visited Clifton Springs two weeks after the robbery took place, and the police observed him wandering in front of another bank there. They, perhaps understandably, took this behavior as suspicious and thought he was casing another bank to rob.
They picked Mike up at his job one night and interrogated him. He told the
police that in fact, he did rob the bank.Mike’s mother Anne explained: “Mike tries to please people. He thought in his mind if he told them what they wanted to hear, they’d let him go. He didn’t know that would complicate things.”
Of course, it did complicate things. The police charged him with bank robbery, which would have carried a 25 year prison sentence had he been convicted.
In comes David Harrington, the real bank robber. Harrington was already in jail awaiting trial for a string of other bank robberies, and when he heard about an autistic man being charged for a crime he did not commit, Harrington confessed to the Ontario National Bank robbery as well, telling the police details only the actual robber could have known. Charges were dropped against Fitzpatrick, and he returned to his janitor’s job. He said that he was grateful to Harrington for clearing his name.
To borrow from Art Linkletter, people with autism, like children, will often do or say “the darndest things.” Sometimes they will tell you the naked truth, and sometimes they will say what they think might work best for the situation, but it is the inability to read the subtle social cues and demands of the situation that can lead them down a dangerous path. It is this social “blindness” that becomes the center of our work as we progress through various treatment stages. As we educate the public, it behooves us all to express our gratitude to those who understand this “invisible blindness,” and to those thieves, like Harrington, who risk a bit of themselves to do the right thing.
Saturday, February 11, 2012
The Waves
My grandmother tried to teach me to swim at the ocean. I don't remember if it was Far Rockaway or Coney Island, but I suppose it doesn't matter. Between instructions we would pause as the waves lifted us higher, and then resume as they passed. Once, as I turned away to face the shoreline from the water, Grandma became agitated.
"Never turn your back on a wave," she sternly cautioned.
I never learned how to swim, perhaps because the undertow of the Atlantic ocean pulled me downward toward suffocation such that the memory of that fear drove me to breathlessness ever since. But I also never forgot my Grandmother's cautionary words, and they too are emblazoned somewhere behind my eyes.
There are the waves that seem to come in some predictable rhythm, and then there are the rogue waves that seem to come from nowhere and really take you by surprise. But there are always waves.
Having a child with autism is like being hit by a rogue wave. Becoming a parent is always a bit like taking a dip into the ocean. We can keep our eyes out for the waves, but there are just those that we can't see coming. And getting hit can drag us under, whether or not we think we know how to swim. The challenge is to find a way back to the surface, to find our breath again, to recover and move on as best as we can.
Ask a parent of a child with autism if the pain ever goes away. It does not. They do their best to find new perspectives, new ways to remain appreciative, to fight becoming tired of swimming and giving in to the constant undertow, to let love and hope and gratitude carry them to the next day and then the next.
Until the moon finds its way out of orbit, the waves will keep coming. As my grandmother said, we must keep a watchful eye out for them. But life will also find a way to catch us off guard, and it will occasionally take our breath away. The longer we can hold our breath, the more likely we will eventually make it back to the surface. At some point, some rogue wave may do us in. But until then, we must do our best to ride the waves we can see in front of us, and, to borrow a wonderful phrase from my youth, keep on keeping on.
"Never turn your back on a wave," she sternly cautioned.
I never learned how to swim, perhaps because the undertow of the Atlantic ocean pulled me downward toward suffocation such that the memory of that fear drove me to breathlessness ever since. But I also never forgot my Grandmother's cautionary words, and they too are emblazoned somewhere behind my eyes.
There are the waves that seem to come in some predictable rhythm, and then there are the rogue waves that seem to come from nowhere and really take you by surprise. But there are always waves.
Having a child with autism is like being hit by a rogue wave. Becoming a parent is always a bit like taking a dip into the ocean. We can keep our eyes out for the waves, but there are just those that we can't see coming. And getting hit can drag us under, whether or not we think we know how to swim. The challenge is to find a way back to the surface, to find our breath again, to recover and move on as best as we can.
Ask a parent of a child with autism if the pain ever goes away. It does not. They do their best to find new perspectives, new ways to remain appreciative, to fight becoming tired of swimming and giving in to the constant undertow, to let love and hope and gratitude carry them to the next day and then the next.
Until the moon finds its way out of orbit, the waves will keep coming. As my grandmother said, we must keep a watchful eye out for them. But life will also find a way to catch us off guard, and it will occasionally take our breath away. The longer we can hold our breath, the more likely we will eventually make it back to the surface. At some point, some rogue wave may do us in. But until then, we must do our best to ride the waves we can see in front of us, and, to borrow a wonderful phrase from my youth, keep on keeping on.
Thursday, January 12, 2012
The Third Story
In one of my favorite musical satires, Tom Lehrer sings that during “National Brotherhood Week” (yes, there really was such a thing from the forties to the eighties) “to hate all but the right folks is an old established rule.”
The field of psychology has had more than its share of attitude polarization. As a graduate student, the humanistic psychologists were steadfastly at war with the behaviorists, the behaviorists poked fun at the Freudians, the systemic family therapists despised the psychoanalysts, and even the analysts fought deeply among themselves. Yet there were always those who struggled to build bridges, to find common ground. These were often the psychotherapy process researchers, looking for the ingredients common to successful outcomes among the various approaches.
In the field of autism, we have our own polarities: those who believe autism is caused by immunizations versus those who believe the cause is genetic; those who believe we are in the midst of an epidemic versus those who believe we are simply identifying and labeling more children; and those who believe the best treatment is behavioral versus those who believe the solution is psychodynamic or relationship based.
Although I proudly identify myself as a behaviorist, I suspect, like those who have identified the common ingredients of successful psychotherapy outcome, there is common ground to be had among all these apparent differences. In relationship to the question of whether or not the best treatment is either psychodynamic or behavioral, the data are apparently in, at least that’s what the surgeon general says, and that’s what the committees who agree on “best practices” would say. But here’s my personal story:
At my first "real job" out of graduate school, I was assigned two Special Ed classrooms to supervise, and a caseload of about ten children to see in individual, group and family therapy. Two of those children had been diagnosed with autism, and each of them had an interesting treatment pedigree. One of them had been a member of Lovaas' original research study, and had been designated as "cured" by his strictly behavioral methodology. The other child had a book written about the novel treatment approach taken, which turned out to be a very intensive form of psychodynamic play therapy in which the therapist essentially mirrored the child around the clock. The therapist, a woman named Rachel Pinney, also claimed this child was cured.
Both children were remarkably similar. They were highly intelligent, and each had savant qualities. The child treated by Pinney had memorized the entire LA bus system, along with time schedules, and could tell you how to get from anywhere to anywhere, including the best way to transfer. The child treated by Lovaas could build anything out of Legos, intricate jaw dropping structures. According to their parents, both children clearly made remarkable progress, despite the great differences in their treatment methods. Yet, both had many severe behavioral problems which necessitated them being in a special education setting.
Neither child had any friends, both were remarkably self centered, incapable or unwilling to consider another person's feelings, compulsive and prone to severe tantrums if they didn't get what they wanted.
At the time, I had been trained in both behavioral and psychodynamic methods. I primarily used behavioral methods in the classroom and psychodynamic methods in the therapy office. Eventually, I abandoned psychodynamic methods. After years of working "on the floor" with children, I frankly could see very little progress. The lack of progress was frustrating for parents, the children themselves, and for me.
Behavioral methods simply seemed to work better, although at the time they were receiving horrible press. The bad press was in a few cases warranted. There were places that used aversive methods, such as squirting water in children's faces, and even Lovaas himself was known to give an occasional slap or pinch under the table. But mostly, the bad press was unwarranted, and it was clear to me from my first two children with autism that the claim that behavioral intervention turned kids into robots was ridiculous. It was ridiculous because the robotic affect that does sometimes accompany autism was clearly a hallmark of the disease, and not a result of treatment. The child who was lovingly mirrored into psychodynamic health was just if not more robotic in his affect as the child who had been treated by Lovaas.
It has long been said that if you get three experienced clinicians together who approach their work from vastly different theoretical perspectives, and have them all observe the same therapy session, they will all agree on which therapists are most competent, and the extent to which the sessions represent "good therapy". They will, however, each describe the reasons for their determination with their own language, giving vastly different explanations.
The kind of therapy my first two children with autism received couldn't be more dissimilar. Yet both methods did share some common ingredients. Both were extremely intensive, which is to say that each child received over 40 hours a week of therapy. Their therapy was their lives. Both methods were quintessentially individualized. Behavioral protocols were designed specifically to meet the child's needs, and those protocols were changed frequently as the child mastered new skills, responded to some interventions and less to others. Psychodynamically, the child received the therapists' undivided attention, and the therapist did all she could to fulfill the rapidly changing wishes and needs of her client. Both children received attention that was no doubt caring in nature. And there can be no doubt that despite efforts to mirror and lead, it is unlikely that there weren’t subtle prompts occurring that pointed the way to progress.
These ingredients may contribute to the potency of all therapeutic interventions: the intensity of the treatment, the loving and caring attitude with which the interventions are delivered, and an individualized (as opposed to cookie-cutter) approach. One should never underestimate the power of these ingredients.
Perhaps it is natural to polarize. The Talmud states that there are three sides to every story. Those of us who work in any field are typically well-versed in our own story, and hopefully we are fairly well-versed in the stories our competitors tell. It behooves all of us, however, to become versed not just in the two competing stories, but also in the third story. It is through our knowledge of the third path that we are most likely to reach the greatest depth of understanding.
[By the way, you can watch a video of Tom Lehrer singing “National Brotherhood Week” on YouTube at http://youtu.be/CgASBVMyVFI, and Rachel Pinney’s book, titled “Bobby,” is available for under a dollar at Amazon.com.]
The field of psychology has had more than its share of attitude polarization. As a graduate student, the humanistic psychologists were steadfastly at war with the behaviorists, the behaviorists poked fun at the Freudians, the systemic family therapists despised the psychoanalysts, and even the analysts fought deeply among themselves. Yet there were always those who struggled to build bridges, to find common ground. These were often the psychotherapy process researchers, looking for the ingredients common to successful outcomes among the various approaches.
In the field of autism, we have our own polarities: those who believe autism is caused by immunizations versus those who believe the cause is genetic; those who believe we are in the midst of an epidemic versus those who believe we are simply identifying and labeling more children; and those who believe the best treatment is behavioral versus those who believe the solution is psychodynamic or relationship based.
Although I proudly identify myself as a behaviorist, I suspect, like those who have identified the common ingredients of successful psychotherapy outcome, there is common ground to be had among all these apparent differences. In relationship to the question of whether or not the best treatment is either psychodynamic or behavioral, the data are apparently in, at least that’s what the surgeon general says, and that’s what the committees who agree on “best practices” would say. But here’s my personal story:
At my first "real job" out of graduate school, I was assigned two Special Ed classrooms to supervise, and a caseload of about ten children to see in individual, group and family therapy. Two of those children had been diagnosed with autism, and each of them had an interesting treatment pedigree. One of them had been a member of Lovaas' original research study, and had been designated as "cured" by his strictly behavioral methodology. The other child had a book written about the novel treatment approach taken, which turned out to be a very intensive form of psychodynamic play therapy in which the therapist essentially mirrored the child around the clock. The therapist, a woman named Rachel Pinney, also claimed this child was cured.
Both children were remarkably similar. They were highly intelligent, and each had savant qualities. The child treated by Pinney had memorized the entire LA bus system, along with time schedules, and could tell you how to get from anywhere to anywhere, including the best way to transfer. The child treated by Lovaas could build anything out of Legos, intricate jaw dropping structures. According to their parents, both children clearly made remarkable progress, despite the great differences in their treatment methods. Yet, both had many severe behavioral problems which necessitated them being in a special education setting.
Neither child had any friends, both were remarkably self centered, incapable or unwilling to consider another person's feelings, compulsive and prone to severe tantrums if they didn't get what they wanted.
At the time, I had been trained in both behavioral and psychodynamic methods. I primarily used behavioral methods in the classroom and psychodynamic methods in the therapy office. Eventually, I abandoned psychodynamic methods. After years of working "on the floor" with children, I frankly could see very little progress. The lack of progress was frustrating for parents, the children themselves, and for me.
Behavioral methods simply seemed to work better, although at the time they were receiving horrible press. The bad press was in a few cases warranted. There were places that used aversive methods, such as squirting water in children's faces, and even Lovaas himself was known to give an occasional slap or pinch under the table. But mostly, the bad press was unwarranted, and it was clear to me from my first two children with autism that the claim that behavioral intervention turned kids into robots was ridiculous. It was ridiculous because the robotic affect that does sometimes accompany autism was clearly a hallmark of the disease, and not a result of treatment. The child who was lovingly mirrored into psychodynamic health was just if not more robotic in his affect as the child who had been treated by Lovaas.
It has long been said that if you get three experienced clinicians together who approach their work from vastly different theoretical perspectives, and have them all observe the same therapy session, they will all agree on which therapists are most competent, and the extent to which the sessions represent "good therapy". They will, however, each describe the reasons for their determination with their own language, giving vastly different explanations.
The kind of therapy my first two children with autism received couldn't be more dissimilar. Yet both methods did share some common ingredients. Both were extremely intensive, which is to say that each child received over 40 hours a week of therapy. Their therapy was their lives. Both methods were quintessentially individualized. Behavioral protocols were designed specifically to meet the child's needs, and those protocols were changed frequently as the child mastered new skills, responded to some interventions and less to others. Psychodynamically, the child received the therapists' undivided attention, and the therapist did all she could to fulfill the rapidly changing wishes and needs of her client. Both children received attention that was no doubt caring in nature. And there can be no doubt that despite efforts to mirror and lead, it is unlikely that there weren’t subtle prompts occurring that pointed the way to progress.
These ingredients may contribute to the potency of all therapeutic interventions: the intensity of the treatment, the loving and caring attitude with which the interventions are delivered, and an individualized (as opposed to cookie-cutter) approach. One should never underestimate the power of these ingredients.
Perhaps it is natural to polarize. The Talmud states that there are three sides to every story. Those of us who work in any field are typically well-versed in our own story, and hopefully we are fairly well-versed in the stories our competitors tell. It behooves all of us, however, to become versed not just in the two competing stories, but also in the third story. It is through our knowledge of the third path that we are most likely to reach the greatest depth of understanding.
[By the way, you can watch a video of Tom Lehrer singing “National Brotherhood Week” on YouTube at http://youtu.be/CgASBVMyVFI, and Rachel Pinney’s book, titled “Bobby,” is available for under a dollar at Amazon.com.]
Sunday, January 1, 2012
Flying
I have spent most of my adulthood as a child psychologist. (That is probably because I spent most of my childhood as an adult psychologist, but that is another story.) In the last decade I have had the good fortune of indulging in a hobby that I had dreamed about most of my life—flying. The parallels between my vocation and avocation are at times striking.
As a pilot, the most important decision one often makes is whether or not to fly on a particular day: the decision to launch is often called the “go/no-go” decision, and one of the most important predictors of safety. It consists not just of checking the airplane, but also of checking all the circumstances surrounding the airplane, not the least of which is the weather. Airplanes have a way of doing exactly what you tell them to do: the weather doesn’t. What goes on around the airplane is equally as important as what goes on inside.
As a child psychologist and behavior analyst, what goes on around a child can be equally important to the successful outcome as what goes on inside. For those working with children, understanding the family environment is like understanding the weather for the pilot. It can predict the success or failure of your mission.
As a pilot, one must always be “ahead of the airplane,” a term that roughly translates to making sure that you have done the planning, practiced scenarios, and know how to operate the machinery so well that the airplane doesn’t lead you where it wants to go, but instead that you are in command of the direction and manner in which the airplane performs. As a behavior analyst, you always want to know where you are going, and it behooves a good behavior analyst to know what the goals are and be facile enough with one’s tools that one can react quickly to any deviation that may arise. While one should always have a plan, as both a pilot and a psychologist, one must be prepared at a moment’s notice to give it up and let it go should the unpredictable complexities of life demand an alternate course of action. But when an alternate course is necessary, both the pilot and the psychologist ought to have the tools and preparation to react swiftly and effectively.
Good pilots need to relax under pressure. It is well known that many accidents occur as a result of a pilot panicking under adversity and making nonsensical decisions. As a psychologist, children will sometimes surprise you by pressing buttons you didn’t even know you had, or raising the stakes with sometimes egregiously self- or other-destructive behavior. Thinking clearly and calmly under those circumstances (and remembering your training) can go a long way to positive outcomes.
And, as is true in nearly endeavor, practicing your skills and keeping current is essential. It is said in flying that experience is the thing you get as a result of not having any. And, of course for psychologists, it is no wonder that what we do is called “practicing”. We only get better by doing what we do over and over again, and constantly learning better and more effective ways of using our tools.
As a pilot, the most important decision one often makes is whether or not to fly on a particular day: the decision to launch is often called the “go/no-go” decision, and one of the most important predictors of safety. It consists not just of checking the airplane, but also of checking all the circumstances surrounding the airplane, not the least of which is the weather. Airplanes have a way of doing exactly what you tell them to do: the weather doesn’t. What goes on around the airplane is equally as important as what goes on inside.
As a child psychologist and behavior analyst, what goes on around a child can be equally important to the successful outcome as what goes on inside. For those working with children, understanding the family environment is like understanding the weather for the pilot. It can predict the success or failure of your mission.
As a pilot, one must always be “ahead of the airplane,” a term that roughly translates to making sure that you have done the planning, practiced scenarios, and know how to operate the machinery so well that the airplane doesn’t lead you where it wants to go, but instead that you are in command of the direction and manner in which the airplane performs. As a behavior analyst, you always want to know where you are going, and it behooves a good behavior analyst to know what the goals are and be facile enough with one’s tools that one can react quickly to any deviation that may arise. While one should always have a plan, as both a pilot and a psychologist, one must be prepared at a moment’s notice to give it up and let it go should the unpredictable complexities of life demand an alternate course of action. But when an alternate course is necessary, both the pilot and the psychologist ought to have the tools and preparation to react swiftly and effectively.
Good pilots need to relax under pressure. It is well known that many accidents occur as a result of a pilot panicking under adversity and making nonsensical decisions. As a psychologist, children will sometimes surprise you by pressing buttons you didn’t even know you had, or raising the stakes with sometimes egregiously self- or other-destructive behavior. Thinking clearly and calmly under those circumstances (and remembering your training) can go a long way to positive outcomes.
And, as is true in nearly endeavor, practicing your skills and keeping current is essential. It is said in flying that experience is the thing you get as a result of not having any. And, of course for psychologists, it is no wonder that what we do is called “practicing”. We only get better by doing what we do over and over again, and constantly learning better and more effective ways of using our tools.
Wednesday, November 23, 2011
Giving Thanks
This Thanksgiving, I would like to depart from my typical expression of gratitude to all of you who work with those with autism, and those of you who are parents of children with autism, and thank directly those of you who have an autism spectrum disorder. It has often been said that the best way to judge the level of civilization in a culture is how well they treat those with disabilities (in current parlance, how well we treat those with special needs.) In the mid nineteen-thirties, Adolf Hitler justified his wholesale slaughter of those with disabilities as freeing their tormented souls from their bodies. It was the first step in what eventually became the slaughter of trade unionists, certain Catholics, gypsies, and six million Jews.
Parents of children with autism often describe their eventual awakening to the belief that their children on the spectrum are truly a blessing. They bless their parents’ and siblings’ lives with a deeper understanding of the human condition, and deepen their ability to love. They bring new friends and new meaning to their lives.
Those of us who are blessed to work in this field know well about the souls of those with whom we work, because that is why we do what we do. We know because we feel touched by our children who have "special needs". They touch us with their love, their kindness, their honesty, their humor, and their efforts and strivings. We learn from them daily, how to love, how to appreciate our own blessings, how to take life seriously but not too seriously, how to give and how to let go.
So this Thanksgiving, let’s all pause for a moment, close our eyes and express our appreciation for those on the spectrum, each of whom have touched us in some way or another, each of whom have enrichened us with their precious souls.
Parents of children with autism often describe their eventual awakening to the belief that their children on the spectrum are truly a blessing. They bless their parents’ and siblings’ lives with a deeper understanding of the human condition, and deepen their ability to love. They bring new friends and new meaning to their lives.
Those of us who are blessed to work in this field know well about the souls of those with whom we work, because that is why we do what we do. We know because we feel touched by our children who have "special needs". They touch us with their love, their kindness, their honesty, their humor, and their efforts and strivings. We learn from them daily, how to love, how to appreciate our own blessings, how to take life seriously but not too seriously, how to give and how to let go.
So this Thanksgiving, let’s all pause for a moment, close our eyes and express our appreciation for those on the spectrum, each of whom have touched us in some way or another, each of whom have enrichened us with their precious souls.
Sunday, October 30, 2011
PCFA in Mexico
Recently returned from beautiful Queretaro, Mexico, where I was honored to be the keynote speaker at the second international conference on autism held there. I spoke on "Autism and the Family," highlighting the effects of having a child with autism on the family as a whole, as well as on siblings and marriages. I was also honored to be among three other Pacific Child speakers: Arpi Arabian, Marta Marquez, and Stefanie Finney. All gave very well-received speeches on various aspects of their expertise. If you can read Spanish, you can get more info on the conference, as well as view the amazing poster, at http://caadd.com.mx/.
Wednesday, August 10, 2011
Pacific Child, Children's Learning and Autism Services North Connect!
I am proud to announce that Pacific Child has formally joined forces with two great companies, moves that will help us achieve our goal of becoming the preeminent provider of behavior analytic services in the United States.
The first company to join the family is Children’s Learning Connection, based in Orange County, California. The company was started by Melanie Foshee and Kimberly Eissing, two licensed speech and language therapists with expertise in both autism and in bringing scientifically-validated approaches together in a comprehensive and unified way to maximally benefit those in need. Their company provides speech therapy, occupational therapy, physical therapy, and ABA therapy, as well as parent training, infant programs and social skills programs.
We believe that the expertise Kim and Melanie bring to the coordination of services will greatly assist us in developing a broader menu of services throughout Pacific Child.
The second company to join us is Autism Services North (ASN). ASN is headquartered in Pennsylvania, but the company, begun by Paul Eschbach, BCBA, contracts with BCBAs across 24 states. ASN provides superior behavioral care to the TriCare community and has an excellent reputation with parents and referral sources alike. ASN will allow Pacific Child to provide quality care to more children along the spectrum, particularly across the United States where we currently do not have a presence.
This marks an exciting time in the history of Pacific Child. We look forward to creating new, dynamic synergies among our companies.
The first company to join the family is Children’s Learning Connection, based in Orange County, California. The company was started by Melanie Foshee and Kimberly Eissing, two licensed speech and language therapists with expertise in both autism and in bringing scientifically-validated approaches together in a comprehensive and unified way to maximally benefit those in need. Their company provides speech therapy, occupational therapy, physical therapy, and ABA therapy, as well as parent training, infant programs and social skills programs.
We believe that the expertise Kim and Melanie bring to the coordination of services will greatly assist us in developing a broader menu of services throughout Pacific Child.
The second company to join us is Autism Services North (ASN). ASN is headquartered in Pennsylvania, but the company, begun by Paul Eschbach, BCBA, contracts with BCBAs across 24 states. ASN provides superior behavioral care to the TriCare community and has an excellent reputation with parents and referral sources alike. ASN will allow Pacific Child to provide quality care to more children along the spectrum, particularly across the United States where we currently do not have a presence.
This marks an exciting time in the history of Pacific Child. We look forward to creating new, dynamic synergies among our companies.
Monday, August 8, 2011
Minority Bias
It has been known for some time that minorities, in most walks of life, often do not receive their fair share of services. We know that autism appears in nearly the same proportions throughout all races, nationalities and cultures. But in order to receive the diagnosis, one must be identified by some sort of professional. That is typically a physician.
Several studies have reported that Hispanics have a lower incidence of autism than non-Hispanic Caucasians. Most studies that report these results suggest that this is likely due to the fact that most Hispanics studied have lower income levels, and thus cannot afford the health care required for the diagnosis to be made. This makes sense to me. One study, however, looked at 1184 schools in 254 Texas counties, and counted the number of children in kindergarten through 12th grade in each district who had been diagnosed with autism. In this study, socioeconomic status was in fact controlled for, and the researchers still found fewer Hispanic schoolchildren were diagnosed with autism.
What was fascinating in this study, however, was that that for every 10 percent increase in Hispanic children in a district, the prevalence of autism decreased by 11 percent, while the prevalence of children with intellectual or learning disabilities increased by about 10 percent. Interestingly, the reverse pattern was seen among non-Hispanic Caucasian kids. As their percentage of autism in a district increased by 9 percent, the prevalence of intellectual and learning disabilities fell by about 13 percent.
It appears from these results that Hispanic children may, regardless of their socioeconomic status, be seen as learning disabled, cognitively or intellectually lacking (instead of autistic), while the non-Hispanic children were seen instead as having autism.
Is that surprising?
Several studies have reported that Hispanics have a lower incidence of autism than non-Hispanic Caucasians. Most studies that report these results suggest that this is likely due to the fact that most Hispanics studied have lower income levels, and thus cannot afford the health care required for the diagnosis to be made. This makes sense to me. One study, however, looked at 1184 schools in 254 Texas counties, and counted the number of children in kindergarten through 12th grade in each district who had been diagnosed with autism. In this study, socioeconomic status was in fact controlled for, and the researchers still found fewer Hispanic schoolchildren were diagnosed with autism.
What was fascinating in this study, however, was that that for every 10 percent increase in Hispanic children in a district, the prevalence of autism decreased by 11 percent, while the prevalence of children with intellectual or learning disabilities increased by about 10 percent. Interestingly, the reverse pattern was seen among non-Hispanic Caucasian kids. As their percentage of autism in a district increased by 9 percent, the prevalence of intellectual and learning disabilities fell by about 13 percent.
It appears from these results that Hispanic children may, regardless of their socioeconomic status, be seen as learning disabled, cognitively or intellectually lacking (instead of autistic), while the non-Hispanic children were seen instead as having autism.
Is that surprising?
Wednesday, August 3, 2011
Congrats to our new BCBA's!
Just wanting to send congratulations to our newest BCBAs-- Daniella Putnam, Robin Palm, Zsuzsanna Fodor and Danielle Christner. This is a great milestone, and well-deserved!
Wednesday, June 1, 2011
Going Home
Of the original psychoanalytic triumvirate of Freud, Adler, and Jung, perhaps the most forgotten was Alfred Adler. Adler was best known for the creation of the term “inferiority complex”, but perhaps his greatest contributions were his founding of the child guidance movement, community mental health centers, and his humanistic approach to psychopathology in general.
Adler died suddenly and unexpectedly, most likely of a heart attack, while on a speaking tour in Scotland. He was cremated there, but oddly, his ashes disappeared, perhaps in the chaotic runup to the Second World War. The ashes were just recently found on a shelf just a few hundred yards from the crematorium in Edinburgh, and are being returned to Vienna to be buried in an honored place in the central cemetery.
I am writing these words in a hotel in New York, not far from the hospital where I was born almost six decades ago. Yesterday a cab driver took me down Park Avenue, to a writer’s bar in Greenwich Village I wanted to see. As you travel south from midtown, you drive through a tunnel carved not out of a mountain, but under a building—the Metropolitan Life building (now the Helmsley building). It is an interesting way to build something, and the road itself takes a sharp carve just after you go through the building.
I have not lived in New York for more than half a century, so the experience seemed new to me. But tonight, as I let the thick air of Manhattan surround me as I walked, I remembered it. As a child I would often perch myself on the ledge behind the back seat that most cars had then. I could stare straight up at the world through the back window. That odd sensation of driving down a central street in Manhattan, entering the mouth of a big building, the sky disappearing, and then quickly entering a curve, like a horizontal roller coaster, just came back to me. I remember the strangeness of it, the slight dizziness, not unlike I felt last night in the taxi.
I am not terribly nostalgic about coming home. Life was not good when I lived here. In fact, it was mostly horrible. But it is a touchstone, something that makes one remember who one is. Of course, it is a silly cliché that we all end up going home eventually; we start as ashes and dust and end as ashes and dust.
But there is still something compelling about going back to that original nest, the comfort and safety of the womb, or at least the illusion of that safety.
I left New York and moved to California in high school. Neil Diamond, who went to my high school in New York and had the same music teacher, wrote “L.A.’s fine but it ain’t home, New York’s home but it ain’t mine no more.” What then, is it?
“Home” becomes a touchstone, that which we touch to remind us that we are still alive. It is an anchor, of sorts, a mooring whenever the seas get rough.
Pacific Child began as a dream of independence from the mental health clinics where I had worked previously. Yet it has been my home for 23 years now. As my connection to the heartbeat of PCFA moves closer and more distant, it is my touchstone, my home, my illusion of safety, yet still just a stopover somewhere between ashes and ashes.
Adler died suddenly and unexpectedly, most likely of a heart attack, while on a speaking tour in Scotland. He was cremated there, but oddly, his ashes disappeared, perhaps in the chaotic runup to the Second World War. The ashes were just recently found on a shelf just a few hundred yards from the crematorium in Edinburgh, and are being returned to Vienna to be buried in an honored place in the central cemetery.
I am writing these words in a hotel in New York, not far from the hospital where I was born almost six decades ago. Yesterday a cab driver took me down Park Avenue, to a writer’s bar in Greenwich Village I wanted to see. As you travel south from midtown, you drive through a tunnel carved not out of a mountain, but under a building—the Metropolitan Life building (now the Helmsley building). It is an interesting way to build something, and the road itself takes a sharp carve just after you go through the building.
I have not lived in New York for more than half a century, so the experience seemed new to me. But tonight, as I let the thick air of Manhattan surround me as I walked, I remembered it. As a child I would often perch myself on the ledge behind the back seat that most cars had then. I could stare straight up at the world through the back window. That odd sensation of driving down a central street in Manhattan, entering the mouth of a big building, the sky disappearing, and then quickly entering a curve, like a horizontal roller coaster, just came back to me. I remember the strangeness of it, the slight dizziness, not unlike I felt last night in the taxi.
I am not terribly nostalgic about coming home. Life was not good when I lived here. In fact, it was mostly horrible. But it is a touchstone, something that makes one remember who one is. Of course, it is a silly cliché that we all end up going home eventually; we start as ashes and dust and end as ashes and dust.
But there is still something compelling about going back to that original nest, the comfort and safety of the womb, or at least the illusion of that safety.
I left New York and moved to California in high school. Neil Diamond, who went to my high school in New York and had the same music teacher, wrote “L.A.’s fine but it ain’t home, New York’s home but it ain’t mine no more.” What then, is it?
“Home” becomes a touchstone, that which we touch to remind us that we are still alive. It is an anchor, of sorts, a mooring whenever the seas get rough.
Pacific Child began as a dream of independence from the mental health clinics where I had worked previously. Yet it has been my home for 23 years now. As my connection to the heartbeat of PCFA moves closer and more distant, it is my touchstone, my home, my illusion of safety, yet still just a stopover somewhere between ashes and ashes.
Thursday, April 14, 2011
Welcome to our New Clinical Director
I am thrilled to announce the hiring of our new agency-wide clinical director, Michael Cameron, Ph.D., BCBA-D. Dr. Cameron has been serving in his new post since March 1st, and has already made a great impression on all those with whom he has come in contact. Dr. Cameron's hiring followed an extensive, nationwide search. Prior to joining PCFA, Dr. Cameron was associate professor and founding chair of the Department of Behavior Analysis at Simmons College in Boston. Dr. Cameron brings a breadth of knowledge and experience to PCFA. His fields of expertise include assessing and treating people with autism spectrum disorder, the evaluation of public and private school-based programs for children and adults with ASD, staff traininhg, and direct supervision of evidence-based behavior analytic services. He also has special interests in health and behavioral medicine. He serves on the editorial boards of the Behavior Analyst Today and the Journal of Speech-language Pathology and Applied Behavior Analysis. He has held positions as clinical director, and vice-president of research and development with behavior analysis agencies in Massachusetts, as well as maintaining a private clinical practice. Dr. Cameron chose to join PCFA because he shares our core values: the client always comes first, and our commitment to providing scientifically validated services built on a solid foundation of respect for those we serve. As agency clinical director, Dr. Cameron is responsible for ensuring the quality, viability and expansion of services of PCFA's offices. He also oversees training and the overall clinical direction of the agency. You can reach Dr. Cameron via our toll-free number: 888-805-0759. His direct extension is 204.
Thursday, February 24, 2011
Congrats in Order
Congratulations to our newest BCBAs! Holly Park from our Los Angeles office and Kim Altic from the Redwood Coast office successfully crossed the finish line after completing their marathon requirements toward receiving their board certification. Needless to say, I am so proud of their accomplishments. Both are extraordinarily talented people deeply committed to the work they are doing. We are blessed to have them on our team.
Thursday, January 27, 2011
Waiting
I don’t read much fiction, a fact of which I am not proud, but a few years ago I read a book that haunts me. The book was a best-seller by the Chinese author Ha Jin, called “Waiting,” in which a Chinese physician was caught in an arranged marriage and, because divorce was not legal, spent 18 years of his life waiting to marry a nurse with whom he fell in love.
In these modern times and in this western world, we are used to things happening quickly. It is difficult to wait for anything. We want our fast food, our fast cars, and, well…. And as I recognize the person staring back at me in the mirror less and less, waiting seems even more difficult. Time is a limited commodity, and there is simply less of it left in the bottle to drink.
But time is only experience; it is nothing more. And “waiting” is nothing more than wishing or imagining we were somewhere other than where we are now. So, we suffer from our imagination. We suffer from wishing our hands were doing something else, our eyes were feasting on a different sight.
So let us breathe in patience, and appreciate each moment to the extent our neuroses allow. In the Midwest there is a saying: if wishes were horses, beggars would ride. So, let’s let wishes be horses, and let’s let them ride off into the sunset with empty saddles.
Friday, December 31, 2010
Just a Little Bit Better
Ten years after Braulio Montalvo succeeded Salvador Minuchin at the reins of the Philadelphia Child Guidance Clinic, an interviewer asked him what the biggest difference was in his impressions of family therapy from the early days. He stated that he learned to expect less, that families didn't change as radically as what was hoped for when family therapy was nascent. Yet, what became clear to me after practicing family therapy for two decades, was that small changes in families were often perceived by family members as big.
As a couples and family therapist, I learned to ask a simple question. What is the smallest change that needs to happen in order for you to know that things are getting better?
When people were able to focus on making small changes, they felt better. Change did not have to be daunting, and they could see their accomplishments and feel good about their success.
As behavior analysts, we know this well. We are taught to shape behavior by breaking down complex behavior chains into their smallest parts, and we teach "successive approximations" until the complex behavior becomes seamless.
Can we apply our own methods to ourselves? What if we told ourselves, "what is the smallest change I can make in order to know things are getting better?" Would we choose not to focus on losing 20 pounds, but instead on 2? Would we choose to finally pick up the musical instrument that sits dormant, and practice for just five minutes a day? Would we choose to write one page of our dissertation or that article we have been intending to tackle, instead of focusing on completing the entire project?
I am a sixties (that's 1960's, not 1860's) musical fanatic. I can't help but think of Peter Noone singing the chorus of one of Herman's Hermits great songs: Now ain't that just a little bit better?
Thursday, December 30, 2010
Happy Kaizen New Year!
Those of you who have recently been meandering around the hallowed halls of Pacific Child and Family Associates have heard me muttering the word "kaizen" repeatedly under my breath. This is my new mantra. I have been trying to implement this American-born and Japanese-bred management style at Pacific Child, in true kaizen style, little by little over the last couple of months. Things are going great here, and I do believe this approach is a very cozy bedfellow for those of us who call ourselves behavior analysts. It is a method that encourages personal initiative. It is interactive and flexible, creating cycles of creative progress which ultimately lead onward and upward.
So, in the next few blogs, I intend to clue you in on the principles of kaizen and how they apply to what we do.
There are several facets of the kaizen approach, some big ones and some not so big ones. One key element is the focus on making small, measurable change, as opposed to large, radical shifts. Sounds like ABA, yes? We take our baseline, assess the problem, make a plan, measure the outcome, and memorialize the results if they are positive. It is the classic A-B design.
But in this entry, I want to focus on another piece of kaizen philosophy. That is the piece having to do with the importance of taking care of oneself. It is about working hard at what we do, but not so hard that we allow ourselves to get burned out.
In this holiday season let’s pause and consider how self-care gives us more energy to care for others as well. Self care doesn’t mean self-indulgence, or being self-centered. And it’s much more than finally taking that long, slow bath or treating yourself to a massage. Nurturing oneself can also mean embracing the kaizen principle of ‘personal discipline’ as a daily practice. That type of self-care helps us reduce from our lives those things which waste time, energy, space and resources. We find we have more time and more energy.
It’s not about expecting more from oneself than is reasonable. Rather, recognizing that the kaizen elements of effort and quality and can be applied to our own lives as well as our work. Underlying it all is the willingness to change.
Research has shown that the majority of New Year’s resolutions are broken very quickly. The one-shot, sudden approach, no matter how well-intentioned, can fail us. I’m going to look toward 2011 as the beginning of a fresh personal philosophy, inspired by the kaizen method of sustained change which is aimed at gradual improvement in a humane, people-oriented way. I hope to take better care of myself and in so doing take better care of our employees and our clients. Happy New Year.
So, in the next few blogs, I intend to clue you in on the principles of kaizen and how they apply to what we do.
There are several facets of the kaizen approach, some big ones and some not so big ones. One key element is the focus on making small, measurable change, as opposed to large, radical shifts. Sounds like ABA, yes? We take our baseline, assess the problem, make a plan, measure the outcome, and memorialize the results if they are positive. It is the classic A-B design.
But in this entry, I want to focus on another piece of kaizen philosophy. That is the piece having to do with the importance of taking care of oneself. It is about working hard at what we do, but not so hard that we allow ourselves to get burned out.
In this holiday season let’s pause and consider how self-care gives us more energy to care for others as well. Self care doesn’t mean self-indulgence, or being self-centered. And it’s much more than finally taking that long, slow bath or treating yourself to a massage. Nurturing oneself can also mean embracing the kaizen principle of ‘personal discipline’ as a daily practice. That type of self-care helps us reduce from our lives those things which waste time, energy, space and resources. We find we have more time and more energy.
It’s not about expecting more from oneself than is reasonable. Rather, recognizing that the kaizen elements of effort and quality and can be applied to our own lives as well as our work. Underlying it all is the willingness to change.
Research has shown that the majority of New Year’s resolutions are broken very quickly. The one-shot, sudden approach, no matter how well-intentioned, can fail us. I’m going to look toward 2011 as the beginning of a fresh personal philosophy, inspired by the kaizen method of sustained change which is aimed at gradual improvement in a humane, people-oriented way. I hope to take better care of myself and in so doing take better care of our employees and our clients. Happy New Year.
Tuesday, November 23, 2010
Rising Stars
Just some words of congratulations on some of Pacific Child's rising stars. Marta Marquez and Hilary Zeller are our newest BCBAs! Congratulations on leaping the final hurdle. Also, I want to congratulate LaDonna Haltom, one of our senior therapists in the Southern California office, for being promoted to a supervisor position. Also, I want to welcome aboard two new supervisors. A warm welcome goes to Laura Simpson, our newest supervisor in the East Bay office, and Andria Hernandez, our newest supervisor in the Inland Empire office. We welcome your commitment and passion and your dedication to providing the highest quality ABA services to our clients. Congratulations to you all, and welcome aboard.
Sunday, September 19, 2010
"Go East!"
“Go West, Young Man, Go West!” were the famous words written by Horace Greeley in support of Manifest Destiny. For Pacific Child, this is a difficult calling, because we have been born and bred in the west. So for Pacific Child, our most recent calling is to “Go East!”
I am thrilled to announce that Pacific Child is opening its first office in the Midwest, which to us in California is really the East. Deb Ewen Miller, who has shepherded our Eureka, California office so brilliantly in the last several years, will be running our first office in Duluth, Minnesota. We hope to serve the entire Minnesota area out of this office.
As we embark on our Easterly expansion, I want to thank Deb Miller for her extraordinary work among the redwoods of Northern California. We are truly blessed to have her continue her work with PCFA, and brave the bitter winters, in Minnesota.
I am thrilled to announce that Pacific Child is opening its first office in the Midwest, which to us in California is really the East. Deb Ewen Miller, who has shepherded our Eureka, California office so brilliantly in the last several years, will be running our first office in Duluth, Minnesota. We hope to serve the entire Minnesota area out of this office.
As we embark on our Easterly expansion, I want to thank Deb Miller for her extraordinary work among the redwoods of Northern California. We are truly blessed to have her continue her work with PCFA, and brave the bitter winters, in Minnesota.
Friday, September 17, 2010
Lifelong Learning
There was a phrase I heard constantly throughout my childhood. In the Bronx accent I usually heard it, it sounded like this: “You live and you loyn.” Translation: You live and you learn. It was most often uttered as a way of comforting someone when something happened that wasn’t quite right, kind of like, well, you won’t make that mistake again and it will be alright.
But, as is typical with phrases that hang around for a lifetime, there was a lot more to it than that. Do we, in fact, “live and learn”?
In “The Once and Future King,” T.H. White writes (through the character of Merlyn):
The best thing for being sad… is to learn something. That is the only thing that never fails. You may grow old and trembling in your anatomies, you may lie awake at night listening to the disorder of your veins,… you may see the world around you devastated by evil lunatics, or know your honor trampled in the sewers of baser minds. There is only one thing for it then—to learn. Learn why the world wags and what wags it. That is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust, and never dream of regretting. Learning is the thing for you.
For many of us, the product of our education system in the U.S. is to see learning as a chore. It is something we have to do to go from here to there, like an uncomfortable bus ride over pot-holed streets. But in Merlyn’s comforting words learning takes a different form. It is a kind of therapy, a comfort and a solace. It is to some degree a place away from the hectic world of business and rumor, but it is also a powerful tool with which to engage life. Perhaps most importantly it is an antidote to “fear and distrust.” Learning, the pursuit of the truth, guided by a moral compass, leads to compassionate understanding and is a powerful weapon against those “evil lunatics” who, in reality, fail to understand or see the deeper truths.
But, as is typical with phrases that hang around for a lifetime, there was a lot more to it than that. Do we, in fact, “live and learn”?
In “The Once and Future King,” T.H. White writes (through the character of Merlyn):
The best thing for being sad… is to learn something. That is the only thing that never fails. You may grow old and trembling in your anatomies, you may lie awake at night listening to the disorder of your veins,… you may see the world around you devastated by evil lunatics, or know your honor trampled in the sewers of baser minds. There is only one thing for it then—to learn. Learn why the world wags and what wags it. That is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust, and never dream of regretting. Learning is the thing for you.
For many of us, the product of our education system in the U.S. is to see learning as a chore. It is something we have to do to go from here to there, like an uncomfortable bus ride over pot-holed streets. But in Merlyn’s comforting words learning takes a different form. It is a kind of therapy, a comfort and a solace. It is to some degree a place away from the hectic world of business and rumor, but it is also a powerful tool with which to engage life. Perhaps most importantly it is an antidote to “fear and distrust.” Learning, the pursuit of the truth, guided by a moral compass, leads to compassionate understanding and is a powerful weapon against those “evil lunatics” who, in reality, fail to understand or see the deeper truths.
Monday, August 9, 2010
A Great Loss
O. Ivar Lovaas died just over a week ago at a hospital in Lancaster. He was 83 years old. I did not know him personally, although I spoke with him on a couple of occasions and attended a lecture of his at Cal-ABA on self-stimulatory behavior. To say that Lovaas was an icon is an understatement. Although he was not the originator of the methods that eventually became so associated with him that for many years they were called “Lovaas therapy,” his contributions as a researcher and tireless promoter were huge.
In reality, the methods he used to treat children with autism and others were developed by his mentors at the University of Washington—Don Baer, Todd Risley, Montrose Wolf, and others—methods that eventually came to be called applied behavior analysis. Lovaas was a graduate student at the University of Washington who had been trained in classical psychoanalytic methods, and although he became perhaps the most well-known advocate for behavioral methods for children with autism, he never swayed completely from his psychoanalytic roots. In fact he was probably the only behavioral researcher who gave Rorschach tests to his subjects.
Lovaas was a controversial figure, revered by many and reviled by many others. In his early work, he occasionally used aversive procedures, which he defended adamantly although he eventually abandoned them in favor of non-aversive procedures. He claimed for some time that the only way to achieve the formidable results he achieved was to be trained only by him or those authorized by him, thereby giving a proprietary flair to his methods. In true scientific fashion, many academicians looked askance at anything proprietary, capitalism and science being the awkward bedfellows they can sometimes be.
Those who knew him and were close to him have told me that he was often sweet and charming, but definitely genuine. You knew where you stood with him. In my view, his responses to those who criticized him occasionally lacked sensitivity; he did joke at times that his Norwegian farmer roots led him to say things simply and directly. There can be no doubt that without his contributions, many thousands of children would not have received the help they needed.
In the last few years, he had been diagnosed with Alzheimer’s, and he did not lecture or appear in large public forums. He eventually died of an infection following hip surgery. He was a giant and we will miss him. Most importantly, those of us in the field of helping children with autism owe him a deep debt of gratitude.
In reality, the methods he used to treat children with autism and others were developed by his mentors at the University of Washington—Don Baer, Todd Risley, Montrose Wolf, and others—methods that eventually came to be called applied behavior analysis. Lovaas was a graduate student at the University of Washington who had been trained in classical psychoanalytic methods, and although he became perhaps the most well-known advocate for behavioral methods for children with autism, he never swayed completely from his psychoanalytic roots. In fact he was probably the only behavioral researcher who gave Rorschach tests to his subjects.
Lovaas was a controversial figure, revered by many and reviled by many others. In his early work, he occasionally used aversive procedures, which he defended adamantly although he eventually abandoned them in favor of non-aversive procedures. He claimed for some time that the only way to achieve the formidable results he achieved was to be trained only by him or those authorized by him, thereby giving a proprietary flair to his methods. In true scientific fashion, many academicians looked askance at anything proprietary, capitalism and science being the awkward bedfellows they can sometimes be.
Those who knew him and were close to him have told me that he was often sweet and charming, but definitely genuine. You knew where you stood with him. In my view, his responses to those who criticized him occasionally lacked sensitivity; he did joke at times that his Norwegian farmer roots led him to say things simply and directly. There can be no doubt that without his contributions, many thousands of children would not have received the help they needed.
In the last few years, he had been diagnosed with Alzheimer’s, and he did not lecture or appear in large public forums. He eventually died of an infection following hip surgery. He was a giant and we will miss him. Most importantly, those of us in the field of helping children with autism owe him a deep debt of gratitude.
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