How to Talk so Kids will Listen, and Listen so Kids will Talk

As a parent I like to expand my knowledge to its capacity with regards to the most beneficial rearing of kids. I'll assume that this is every parents goal: To get accustomed to ways of raising your kids for them to be productive members of society. Doesn't everyone want kids that'll make them and the larger public proud? That's my assumption anyway.

But in a world where there's books by the thousands that seemingly offer the newest and best ways to raise kids, how can we tell which way (if there is such a thing) is most beneficial? Some books focus on anecdotal evidence ('It worked for me, so why wouldn't it work for others?'). Other books bring in anecdotal evidence of parents coupled with effective methods and models of parenting and how they're implemented in the real world. Still other books and articles would focus purely on research models that have been backed by exhaustive empirical evidence and which are shown effective over the a longer period of time (i.e. longitudinal research on families).

But I'll ask again, where should we get our ideas of raising our kids from?

For me, I like to focus on both anecdotal and research-backed methods of parenting in order to best raise my son. Each child is an individual, and I can't rest on what people suggest me to do for my kid - methods that seemingly work for theirs. What I want is to see results. These results (albeit recognising the variability in different contexts) shape how I talk with my son, talk with my wife about great ways to raise my son, and work together with my wife to get the most out of parenting, and for our son to get the most out of his childhood and experience within our family unit.

Now, what do we want when we are parents? I'll propose we want to be able to talk with our kids about the important things in life. Now notice I emphasised with rather than the word 'to'. All dialogues should be two-way. We can't expect to say that we don't want our kid to do something 'because I said so!' Research has shown time and again that this authoritarian style of parenting creates kids that have little independence later in life, higher stress levels, lower self-esteem, and little sense of control over their lives (Buri, Louiselle, Misukanis, & Mueller, 1988; Loeb, Horst, & Horton, 1980; Steinberg et al., 1994; as cited in Burton, Westen, & Kowalski, 2009). 

'Tiger-momming' is argued to be an example of this authoritarian form of parenting. But we shouldn't forget cultural factors when we speak of authoritarian parenting styles (e.g. eastern european parenting styles seem to be authoritarian, along with many asian countries - and it's imperative we take these cultural factors in mind when we assess the responses kids have to these styles of parenting).

But let's get to the nitty gritty of the purpose of this post. I titled this How to Talk so Kids will Listen, and Listen so Kids will Talk because it's such a catchy title! It's the title of a parenting book that was originally published in 1982 by Adele Faber and Elaine Mazlish, and has been updated since. 

I was first introduced to this book while listening to psychologist Michael Britt's Psychology in Everyday Life (a higher education podcast that can be found free on iTunes). I loved the interview Britt had with Faber on the importance of communicating effectively with your kids.

So let's talk about it.

I've spoken in a prior post about the importance of Carl Rogers' approach to psychotherapy which was expanded to other forms of 'being' (e.g. being in the workplace, cross-cultural being, being in the family, etc.). 

This approach emphasises the relationship between people. This relationship must be such so that it allows the other person the potential to self-actualise (i.e. realise their ability to build themselves into the people they'd like to be). Given certain "core conditions" such as empathy (seeing the other person from his or her frame of reference), unconditional positive regard (always acknowledging that the other person without judging them as being 'good' or 'bad' according to what we think those concepts mean), and congruence (or realness of the person; Rogers, 1957).

What I love about the concepts in Faber and Mazlish's (1982) book are that they reinforce the importance of Rogers' hypothesis (albeit it was initially a hypothesis regarding the therapeutic relationship which was later applied to a whole number of other situations cross-culturally) that if the core conditions described can be emulated by a person that is trying to help another reach their full potential, there almost inevitably occurs constructive personality change (Cain 2002, p. 20; as cited in Corey, 2013).

So let's apply this with how we can talk with our kids so that they'll listen, and how to listen so they'll talk.

1. Make sure there is a two way dialogue

When we invite our kids to tell us what they're thinking and we share what we're thinking we can collaborate together to satisfy both our needs.

2. Give your kids options

Instead of telling your kids off for playing with the ball inside ('I said not to play with the ball inside!' What the child hears is 'Play with the ball inside!') you can say something like this: 'Jimmy, we can't play with the ball inside. Let's see, where can we play with the ball. I know, we can play in the front yard, the backyard, the park; play with all that you got!' (this of course depends on the age of the child and their comprehension).

When we give our kids options, or let them suggest their own options they're more likely to cooperate with the parent and end up getting what they want in the end anyway!

3. Share your feelings with the child

Many of us want to yell at our kid to 'toughen up', to say 'no that shouldn't hurt, it's only small', 'you're not sad, you gotta be happy!' or something along those lines.

When we say something like (and this is especially true in the case of fathers) 'Oh I didn't think something like that would hurt, but you seem really distressed. What can we do to make it better?' or 'I can see you're really sad at the moment. Would you like to talk about it? What can I do to help you get to being happy again?' we open up a two way dialogue (see step one) where the child feels acknowledged and understood. When we acknowledge their feelings it creates inside them a sense of empathy for others within them and this will aid them so much in their later development. It helps even well into their married life. When a child only hears for him to toughen up, or when their feelings aren't acknowledged and talked about when they're younger what stops them from turning to their wife and saying 'You shouldn't be upset. Just get over it.' We give the best in our children when we're able to talk to them about what they're feeling and where they want to go with that feeling.

Let them also see you acknowledge your feelings to your wife and them also. Exhaustive research shows that kids model what they see. When they see you emulate positive behaviour and acknowledge different feelings they're more likely to follow. Remember this also works with negative behaviour also.

4. Work with your kids imagination

Imagine your child wants to eat food other than that which you've cooked, or wants to wear makeup when you think they're a little too young. Let's create a hypothetical dialogue:

Child: I want Mcdonald's!

Parent: I'm sorry sweety we only have beef and brocolli tonight.

C: I want McDonald's!!!

P: Well I wish I had McD to give you. I wish we had it right in front of you. I wish this entire kitchen was filled with McD so we can have it all week! No, I wish we had McD stacked up really high in every room so we can see, smell, and eat it whenever we want. And only McD! We can get fat and eat. And do this for breakfast lunch and dinner! But I'm afraid you have parents that cooked you some nice and healthy food. I wish you had those parents that would just give you McD. I'm sorry son, but you're stuck with us.

Now in this example we can have the child potentially realising that he really doesn't want McD as much as he thought he did. When we recognise what they want, play with their imagination, we can hopefully disarm them rather than continually shutting them down from the get-go.

Let's look at another example:

Daughter: I really want to wear makeup mum!

Mum: I'm sorry but I really think you're still a bit to young to wear makeup at the moment.

D: Why can't I wear makeup?! You're nothing but bad to me!

Walks in room and slams door.

After following the daughter the mother knocks lightly on the door and the daughter opens it.

M: I really wish you could wear makeup honey. I wish you could lather it on. Eye shadow, lipstick, blush, bronzer, eyebrows! The whole lot! I wish you could wear it to bed and all day, every day. But I'm sorry that you have a mother that really loves your nice beautiful smooth skin the way it is. You'll have to give me a bit of time to think. Maybe we can talk about it in a while.

This example also might create the potential to have the daughter realise that she doesn't want to wear makeup as much as she thought. It also reinforces that to her mother, her skin is flawless and there's no need for makeup. Finally, it creates the potential for more dialogue rather than shutting the daughter down from the beginning.

Through imaginative dialogue there's the potential to tear down barriers rather than to erect them; to create opportunities for dialogue rather than satisfying the parents need for control.

Of course each situation must be considered on a case by case basis. And depending on the age and background of the child, he or she may react differently.

5. Use one word 'sentences'

What you can say in a whole book, say in a chapter. What you can say in a chapter, say in a page. What you can say in a page, say in a paragraph. What you can say in a paragraph, say in a sentence. And what you can say in a sentence, you can say in a word!

What's this mean? Well, when we use one word statements we allow the child to think about what we're talking about. Their executive functioning is at work and their problem solving skills activated. An example could be a parent seeing the kids school bag on the floor and shouting 'Bag!' (more in an alerting tone rather than a denigrating one). The child has to think about what the parent's saying. 'What does he mean bag? I know he told me to put my bag in my room. Oh, did I leave it on the floor. Where is it? I should get it and put it away.'

You see in the latter an example of the child's thinking processes in action. Rather than having to defend themselves to their parents they are given the chance to work out themselves what the parent is asking of them, and put their cognitions into action-oriented behaviour!

...

These little tips might work and they might not (though the latter is said with caution given the great results these tips seem to have in the life of children). I'm more convinced than not that when we create an environment where we nurture the child's ability to think for themselves, to create their own options, to use their imagination and executive functioning, and to acknowledge their own and others' emotions they're well on the way of shaping up to be a child that will benefit society and the family unit rather than work to tear it apart!

References

Burton, L., Westen, D., & Kowalski, R. (2009). Psychology. Milton, QLD: John Wiley & Sons.

Corey, G. (2013). Theory and practice of counseling and psychotherapy. Cengage Learning

Faber, A., & Mazlish, E. (1982). How to talk so kids will listen, and listen so kids will talk. New York, NY: Avon Books.

Rogers, C. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95-103.

What you need to know about Autism: An Essay

Such a colourful world
[http://www.health.am/psy/more/kids-with-autism-often-get/]

There is no question as to whether Autism Spectrum Disorders (ASD) cause stress within the family unit[1]. Studies have shown that families with a child (or children) with an ASD report increased vulnerability to depression, loneliness, psychological stress and cognitive impairment in mothers (Bromley, Hare, Davison & Emerson, 2004; Kapp & Brown, 2011; Koegel et al., 1992). Social isolation and anxiety in both parents and children (Guralnick, 2000); lower financial status and quality of life (Ghanizadeh, Alishahi & Ashkni, 2009; Sipos, Predescu, Muresan & Iftene, 2012); sleep problems in both parents and children (Australian Psychological Society [APS], 2012; Mayes & Calhoun, 2009); and escaping and distancing behaviours in parents (Sivberg, 2002) are also reported.

Coping styles among parents that contribute to the way stressors are handled in both positive and negative ways have also been explored among researchers. For example, Kapp and Brown (2011) identified several strategies that helped parents deal positively with stressors. These include: The introduction of practical routines for both the child dealing with an ASD and other family members; attendance in recreational activities; maintenance of internal control in parents in order to perceive the situation as controllable; and gaining knowledge about the disorder. Both, stressors involved with caring for a child with autism, and parental coping tactics contribute to the treatment methods selected, as well as the parent’s satisfaction with the treatment and progress of the child.

The aim of this essay is to discuss a number of challenges evident in everyday life of families with a child suffering from autism. Of special focus shall be the source and access to relevant information available to parents; and the lack of funding for effective initiatives that assist parents, and how the latter affects the choice of treatment. It is important to stress that these challenges shall be investigated in light of the implications they have with regards to the choice of empirically based and non-empirically supported therapies – a very important dichotomy where therapy is concerned.

Psychiatric Symptomatology

The American Psychiatric Association (APA, 2007) describes ASDs as pervasive developmental disorders categorized in terms of Autistic Disorder, Rett’s Syndrome, Asperger’s Disorder, Pervasive Developmental Disorder Not Otherwise Specified, and Childhood Disintegrative Disorder. However, for the purposes of this essay, ASDs shall only be referred to with reference to autistic disorder.[2]

        

    The Diagnostic and Statistical Manual of Mental Disorders (at the time of this writing [mid-2012] in its fourth revised edition; DSM-IV-TR) describes the symptoms of ASD as follows: impairment in social communication (both verbal [e.g. delay in the onset of speech, and when speech is present it is not always comprehensible] and nonverbal [e.g. gestures]) and interaction (e.g. lack of development of interpersonal relationships); lack of shared enjoyment (e.g. interests and achievements) with others; lack of emotional expression; lack of imaginative play; preoccupation with unimportant objects (e.g. rocks); adherence to routines and rituals (e.g. lining up rocks in a certain order); repetitive motor mannerisms (e.g. waving arm around for an extended period of time); and a restricted range of interests (APA, 2000). Disturbance is marked in language used in social communication, social interaction, and imaginative play. Importantly, these symptoms must manifest themselves before the age of three years, and are not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

Epidemiology

The DSM reports the prevalence of autism to be between two to 20 cases per 10,000 individuals (APA, 2000); others report between 30 and 70 cases per 10,000 (Fombonne, 2005 as cited in Butcher, Mineka & Hooley, 2012; Woolfenden, Sarkozy, Ridley & Williams, 2012). The Australian Psychological Society (APS; 2012) reports a diagnosis of one in 160 children with the boy/girl ratio of 4:1. The APS’s approximation is in line with other research (Ghanizadeh et al., 2009; Glazzard & Overall, 2012; Sipos et al., 2012), and can be regarded as a fairly accurate prevalence for those suffering with autism.

Aetiology

Although there is no known cause of autism, a number of researchers have made inferences as to various risk factors and biological characteristics inherent with the disorder. For example, the DSM-IV-TR notes that there is a five percent chance of siblings having the disorder compared with only 0.05 percent in the general population (APA, 2000). Butcher et al. (2012) note that there is a general consensus among investigators that autism originates prenatally with impairment in perceptual-cognitive functioning. Girgis et al. (2007) found that autistic patients had decreased volume of gray matter in the orbifrontal cortex, suggesting disturbances in central nervous system functioning. Other factors are related to neurotransmission (e.g. elevated serotonin and dopamine levels; Sue, Sue & Sue, 2006), genetic predispositions that interact with environmental stressors in order to bring about an increased proclivity to the disorder (Sue et al.), birth complications (Comer, 2004), and organic damage (Durand & Barlow, 2003). Although no one of these factors alone is explicitly responsible for the causation of autism, they may play a vital role. Research is constantly undertaken and revised; therefore there is hope that in the future, aetiology shall be determined.

Is it difficult to take children with autism spectrum disorder to a family restaurant?
[http://www.sheknows.com/parenting/articles/804475/taking-your-autistic-child-to-a-restaurant-tips-on-dining-out-for-families-living-with-autism]

The Challenges of ASD on Parents

Kanner (1943) documented 11 cases of children that had autistic disturbances in affective contact. He was the first to recognize a unique set of symptoms (previously outlined) among children that had manifested in their behaviour. Kanner was the first to speak about autism as a distinct developmental disorder, and since his time there has been a vested interest among researchers to understand the etiology of the disorder and the way it affects both the diagnosed child as well as the family unit. There are a variety of challenges that present themselves within the family unit and each challenge implicates choice of treatment of the disorder, and ultimately the effectiveness of the treatment itself. Guralnick (2000) lists four categories of stressors that are present in families dealing with autistic children. These stressors are the source and access to information about autism and relevant treatments; stigma and interpersonal distress associated with ASDs; stress on resources; and the parenting style of children affected with autism (this stressor can be seen as a culmination of the three previous classes of stressors). What follows is a discussion of two of the most focused on challenges to the treatment of autism: The source and access to empirically based information for treatment of ASD; and the financial burden on family resources and how this affects treatment.

Source and Access to Information and Treatment

    

        According to Eikeseth (2001), in order for professionals and parents of those affected by autism to make informed decisions about the available treatment methods, these decisions must be founded by empirical evidence. Guralnick (2000) concurs, stating that in order to “fix” stressors associated with ASD and help children developmentally, an increase in relevant information is paramount. However, it has been found that in many cases evidence-based treatment is not the initial choice for many parents. Recent literature has elucidated the fact that parents are bombarded with the opinions of professionals and those of other parents suggesting which treatment is best for their child – what’s worse is that many of these treatments are regarded as pseudoscientific rather than backed by empirical support (Green, 2007; Green et al., 2006; Guralnick, 2000; Mackintosh, Goin-Kochel & Myers, 2012; Miller, Schreck, Mulick & Butter, 2012; Smith, 2005; Webster, Feiler, Webster & Lovell, 2004).

Supported and Unsupported Methods of Treatment

    

        The parent’s concern for their autistic child which ultimately leads them to pursue an effective treatment is understandable; however the reason the aforementioned “information bombardment” can be considered a challenge to treatment is precisely due to the fact that various methods of treatment simply will not work. Green et al. (2006) found that within their experimental sample, parents were using up to seven treatments at one time, and most of these treatments lacked empirical support. Treatments referred to parents ranged from professionals such as psychologists, behaviour analysts, occupational, speech, and physical therapists, medical doctors, audiologists, educators, and dieticians (Miller et al., 2012). Among these professionals it was the physical, occupational, and speech therapists that were most likely to recommend therapy lacking empirical support, with behavioural analysts and psychologists most likely to recommend research-based therapy (Miller et al.).

       

        One of the reasons parents tend to lean toward unsupported methods such as megavitamin, speech, music, and relationship therapy, sensory integration, diets, and computer-software packages is that they are an “easier” method, and less labour and cost intensive than methods such as Applied Behavioural Analysis (ABA; which teaches children how to communicate, engage in activities, and take care of themselves), and medications (such as antidepressants, antipsychotics, and stimulants; Butcher et al., 2012; Green, 2007; Smith, 2005). For example, ABA requires 40 hours of intense treatment for up to two years; and with medications, though they tend to alleviate various unwanted symptoms such as aggression, commitment to routines and sleep problems, they usually carry a number of side effects (such as restlessness and headaches; Smith, 2005).

            Smith (2005) found that parents might be swayed into the decision of pseudoscientific therapy due to such methods’ claims for a “cure”. While ABA and some medications propose an incremental increase in positive behaviours and decrease in negative behaviours, methods such as those previously listed as unscientific strive for something more. This is where their appeal is, notes Smith, however unsupported methods forget that as there is no known cause of ASD, and without a known cause, how can one propose a cure? Ultimately, such claims are unjustified as well as unethical (Lovaas, 2000 as cited in Tews, 2007). These methods may also point out difficulties in supported treatments such as that ABA may not generalize to everyday settings, but generally works in clinical settings, and that medications carry with them a variety of side effects such as nausea, restlessness, tremors, and headaches (Smith, 2005). Therefore, in order to bypass these negative effects, the parent may insist on a treatment such a vitamin therapy.

            Also important is that, as previously noted, friends of the parents of the autistic child – who usually also have a child with autism – profoundly impact the parents perception of which treatment may or may not work (Green, 2007). Miller et al. (2012) reported that the most influential method among parents when choosing treatment options were word-of-mouth from both professionals (e.g. psychologists) and non-professionals (e.g. other parents). Mackintosh (2012) found that within their sample, 72% of parents went from the advice of other parents when deciding which method would be best for their child. Hall and Graff (2010) found that other parents saw themselves as experts and occasionally advocated for parents that had less information about the disorder, thereby influencing many aspects of the therapeutic process. Interesting are Green’s findings that regardless of the lack of empirical data of some treatments that are chosen in response to recommendations of others, parents may report on positive outcomes of these approaches when their expectations of success are high – a phenomenon known as the placebo effect. In other words, unjustified recommendations for specific treatments are passed on from parent to parent because of the expectancy that it works even though there is no evidence that it does.

            Therefore, as the source of information (e.g. recommendations from a psychologist as opposed to a occupational therapist), and the access to empirical methods of treatment are vital to treatment, it is important for parents to be better informed of their choices. The prognosis of the child is at stake, and if unsupported methods are constantly chosen, preferential progress is not achieved.

Lack of Funding and Implications for Treatment Information

            One final challenge for the family unit when faced with raising a child with autism, are the burdens on resources involved. The costs attributed to therapeutic methods for both the parent and the child limits the psychological and developmental progress of both. That is, stressors are observed in the family unit, and therefore therapy is not only beneficial for the child suffering with autism, but also for the parent in coping (Kapp & Brown, 2011). For the effects of treatment to be most profound one would assume that parental mental health should be at an optimal level. If parents were increasingly stressed, then this would adversely affect the quality of treatment, as well as the observed prognosis of the patient (Bromley, et al., 2004). Tonge et al. (2006) observed that when a counselling program was in effect, parents of children with autism benefitted in terms of mental health and wellbeing. This observation is in line with Kapp and Brown’s (2011) findings that when parents were in charge of their emotions and maintained internal control when faced with stress, they were able to function more effectively, and optimal functioning influenced the way the child developed and responded to various treatment methods. Similarly, Guralnick (2000) found that when parents maintained positive transactions with their child regardless of stressors, the parent’s confidence grew and in turn provided an ideal environment for improvement.

            However, although there are prescribed benefits to the development and response to therapy for children when parents adapt to the situation and are internally controlled, these benefits can only be experienced when appropriate initiatives are in place. In other words, if various initiatives that benefit parents in coping are not funded by an external source, then the mental health of the parents would be affected, and this in turn would affect the development of the affected child (Guralnick, 2000; Kapp & Brown). Alternatively, not only important is the problem of funding with regards to parents mental health, but also the engagement in early intervention initiatives for children.[3]

            Dissanayake (2012) argues that early identification, diagnosis and intervention promote better long term effects for children suffering with autism – an understanding congruent with the findings of other researchers (Eikeseth, Klintwall, Jahr & Karlsson, 2012; Green, 2007; Guralnick, 2000; Kovshoff, Hastings & Remington, 2012; Marquez-Caraveo & Albores-Gallo, 2011; Matson & Tureck, 2012; Webster, et al., 2004). However, early intervention[4] is not always achieved, as the majority of diagnoses occur at the age of approximately four years (Dissanayake, 2012). Dissanayake argues that in order to get the best results, funding is needed in order to aid early diagnosis, and therefore earlier treatment (APS, 2012). Although this may be viewed as an external problem rather than one that presents significant challenges for the family, the two are interrelated. That is, if an external source does not initiate funding for an early diagnosis, then financial pressures are on the family as they receive a later diagnosis and pursue other methods of treatment that may adversely affect their child. The latter is in accordance with Glazzard and Overall’s (2012) findings that parents of children with autism receive less financial support than that of parents of children with Down syndrome and other disorders; parents are left “on their own”, and this in turn leads to increased vulnerability to psychopathology.

            However, although Dissanayake argues from an Australian context, the Australian Government has an initiative in place (which began in 2008) entitled Helping Children With Autism (HCWA). This initiative has been used widely across the country, and aims to put strategies in place for early intervention, as well as provide support for family members. It has yielded good results with four of every five affected children showing a marked improvement in communication skills, social skills, behaviour and transition to school (ARTD Consultants, 2012) – however, the initiative does have a few drawbacks. One of these drawbacks is that children in remote areas, and children from culturally and linguistically diverse backgrounds, as well as Indigenous Australians seem to be underrepresented in the client-base (ARTD Consultants; Wilson & Watson, 2011). Another more important drawback however is that this initiative does not do enough to facilitate earlier intervention. Dissanayake (2012) stresses that earlier diagnosis aids to protect from emotional and financial stress for families, and in turn provides better long-term outcomes. When families have access to early intervention before the age of three years (as opposed to the current diagnosis of four years), there is less stress on the parents as well as the child – therefore, funding (as Dissanayake argues) is paramount for the earlier diagnosis of autism.

Image retrieved from:
[http://www.tomatis.com.au/autism.php]

Summary and Implications

            The aim of this essay was to identify various challenges that present significant implications for treatment of ASDs. ASDs were referred to in terms of autism, and the diagnostic symptomatology was identified, including the epidemiology. Of vital focus in terms of challenges inherent in families of children with autism was the access and source of information available to parents of children with autism. Also discussed was the problem of funding initiatives for families and how this implicates treatment and early intervention. These were identified as challenges to the family unit as they stood in the way of either early diagnosis of the disorder and/or access to empirically based treatment options.

            Where children lack opportunities for early diagnosis, this in turn creates stress on the parents, as they have to wait for an extended period of time before treatment options were available. Furthermore, if a lack of funding pertaining to initiatives for early intervention of autism was experienced then the onus was on the parents to provide funding to help their children, as well as help themselves deal with problems with their mental health – thereby leading to increased psychopathology and strain on resources. Also vitally important was the access and source of information pertaining to various treatment methods. It was seen that parents were bombarded with a plethora of treatment options from a variety of professionals, and the majority of treatments that were referred were not empirically supported. Therefore, in order for parents to select the most effective treatment options, initiatives and funding must be in order to deal with this problem.

            In summary, three challenges were identified and expanded upon dealing with why exactly they were considered challenges and how they affected the treatment of autism. However, it was beyond the scope of this essay to go into extended depth about viable options to reduce the challenges in the first place thereby reducing the implications of these challenges.

References

American Psychiatric Association. (2007). APA dictionary of psychology (1^st Ed.), Washington, DC: American Psychiatric Association.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4^th Ed. – Text Revision), Washington, DC: American Psychiatric Association.

ARTD Consultants (2012). Final evaluation of the helping children with autism package (FaHCSIA components). Retrieved from http://www.fahcsia.gov.au/sites/default/files/documents/07_2012/hcwa_evaluation_summary_report.pdf

Australian Psychological Society (2012). Autism shows first signs in under-twos but more funding needed to aid diagnosis. Retrieved from http://www.psychology.org.au/news/media_releases2012/25June/

Australian Psychological Society (2012). Understanding and managing autism spectrum disorder. Retrieved from http://www.psychology.org.au/publications/tip_sheets/autism/

            Bromley, J., Hare, D. J., Davison, K., & Emerson, E. (2004). Mothers supporting children with autistic spectrum disorders: Social support, mental health status and satisfaction with services. Autism, 8, 409-423. doi: 10.1177/1362361304047224

Butcher, J. N., Mineka, S., & Hooley, J. M. (Eds.). (2012). Abnormal Psychology (15^th Ed.). New Jersey: Pearson.

Comer, R. J. (Ed.). (2004). Abnormal Psychology (5^th Ed.). New York: Worth Publishers.

Crowe, S., & Littlefield, L. (2012). A submission to the American psychiatric association by the Australian psychological society on DSM-5 draft criteria: 15 June 2012. Australian Psychological Society. Retrieved from http://www.psychology.org.au/Assets/Files/APS-DSM-5-submission.pdf

Dissanayake, C., & Crossley, S. A. (1997). Autistic children’s responses to separation and reunion with their mothers. Journal of Autism & Developmental Disorders, 27, 295-312.

Dissanayake, C. (2012). The trouble with autism: Delays in early identification and diagnosis. Australian Psychological Society. Retrieved from http://www.psychology.org.au/inpsych/2012/june/dissanayake/     

Durand, V. M., & Barlow, D. H. (Eds.). (2003). Essentials of Abnormal Psychology (3^rd Ed.). Toronto: Nelson Thomson Learning.

Eikeseth, S., Klintwall, L., Jahr, E., & Karlsson, P. (2012). Outcome for children with autism receiving early and intensive behavioural intervention in mainstream preschool and kindergarten settings. Research in Autism Spectrum Disorders, 6, 829-835. doi: 10.1016/j.rasd.2011.09.002

Eikeseth, S. (2001). Recent critiques of the UCLA young autism project. Behavioral Interventions, 16, 249-264. doi: 10.1002/bin.095

Ghanizadeh, A., Alishahi, M. J., & Ashkani, H. (2009). Helping families for caring children with autistic spectrum disorders. Archives of Iranian Medicine, 12, 478-482.

Girgis, R.R., Minshew, N. J., Melham, N. M., Nutche, J. J., Keshavan, M. S., & Hardan, A. Y. (2007). Volumetric alterations of the orbitofrontal cortex in autism. Progress in Neuropharmacology & Biological Psychiatry, 31, 41-45.

            Glazzard, J., & Overall, K. (2012). Living with autistic spectrum disorder: Parental experiences of raising a child with autistic spectrum disorder (ASD). Support for Learning, 27, 37-45.

Green, V. A., Pituch, K. A., Itchon, J., Choi, A., O’Reilly, M., & Sigafoos, J. (2006). Internet survey of treatments used by parents of children with autism. Research in Developmental Disabilities, 27, 70-84. doi: 10.1016/j.ridd.2004.12.002

Green, V. A. (2007). Parental experience with treatments for autism. Journal of Developmental & Physical Disability, 19, 91-101. doi: 10.1007/s10882-007-9035-y

Hall, H. R., & Graff, J. C. (2010). Parenting challenges in families of children with autism: A pilot study. Issues in Comprehensive Pediatric Nursing, 33, 187-204. doi: 10.3109/01460862.2010.528644

Hare, D. J., Pratt, C., Burton, M., Bromley, J., & Emerson, E. (2004). The health and social care needs of family carers supporting adults with autistic spectrum disorders. Autism, 8, 425-444. doi: 10.1177/1262361304047225

Hedenbro, M., & Tjus, T. (2007). A case study of parent-child interactions of a child with autistic spectrum disorder (3-48 months) and a comparison with typically-developing peers. Child Language Teaching & Therapy, 23, 201-222. doi: 10.1177/0265659007076294

Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217-250.

Kapp, L., & Brown, O. (2011). Resilience in families adapting to autism spectrum disorder. Journal of Psychology in Africa, 21, 459-464.

            Koegel, R. L., Schreibman, L., Loos, L. M., Dirlich-Wilhelm, H., Dunlap, G., Robbins, F. R., & Plienis, A. J. (1992). Consistent stress profiles in mothers of children with autism. Journal of Autism & Developmental Disorders, 22, 205-216. doi: 10.1007/BF-1-58151

            Kovshoff, H., Hastings, R. P., & Remington, B. (2012). Two-year outcomes for children with autism after the cessation of early intensive behavioral intervention. Behavior Modification, 35, 427-450. doi: 10.1177/0145445511405513

            Mackintosh, V. H., Goin-Kochel, R. P., & Myers, B. J. (2012). “What do you like/dislike about the treatments you’re currently using?” : A qualitative study of parents of children with autistic spectrum disorders. Focus on Autism & Other Developmental Disabilities, 27, 51-60. doi: 10.1177/1088357611423542

Marquez-Caraveo, M. E., & Albores-Gallo, L. (2011). Autistic spectrum disorders: Diagnostic and therapeutic challenges in Mexico. Salud Mental, 34, 435-441.

Matson, J. L., & Tureck, K. (2012). Early diagnosis of autism: Current status of the baby and infant screen for children with autism traits (BISCUIT – Parts 1, 2, and 3). Research in Autism Spectrum Disorders, 6, 1135-1141. doi: 10.1016/j.rasd.2012.02.009

Wilson, K., & Watson, L. (2011). Autism spectrum disorder in Australian Indigenous families: Issues of diagnosis, support and funding. Aboriginal & Islander Health Worker Journal, 35, 17-18.

Mayes, S. D., & Calhoun, S. L. (2009). Variables related to sleep problems in children with autism. Research in Autism Spectrum Disorders, 3, 931-941. doi: 10.1016/j.rasd.2009.04.002

Miller, V. A., Schreck, K. A., Mulick, J. A., & Butter, E. (2012). Factors related to parent’ choices of treatments for their children with autism spectrum disorders. Research in Autism Spectrum Disorders, 6, 87-95. doi: 10.1016/j.rasd.2011.03.008

            Phetrasuwan, S., & Miles, M. S. (2009). Parenting stress in mothers of children with autism spectrum disorders. JSPN, 14, 157-165.

            Sipos, R., Predescu, E., Muresan, G., & Iftene, F. (2012). The evaluation of family quality of life of children with autism spectrum disorder and attention deficit hyperactive disorder. Applied Medical Informatics, 30, 1-8.

Sivberg, B. (2002). Family system and coping behaviors: A comparison between parents of children with autistic spectrum disorders and parents with non-autistic children. Autism, 6, 397-409. doi: 10.1177/1362361302006004006         

Skokauskas, N., & Gallagher, L. (2012). Mental health aspects of autistic spectrum disorders in children. Journal of Intellectual Disability Research, 56, 248-257. doi: 10.1111/j.1365-2788.2011.01423.x

Smith, T. (2005) The appeal of unvalidated treatments. In J. W. Jacobson, R. M. Foxx, & J. A. Mulick (Eds.), Controversial therapies for developmental disabilities: Fads, fashion, & science in professional practice (pp. 45-56). New Jersey, NJ: Lawrence Erlbaum Associates.

Sue, D., Sue, D., & Sue, S. (Eds.). (2006). Understanding Abnormal Behavior (8^th Ed.). Boston: Houghton Mifflin Company.

            Tews, L. (2007). Early intervention for children with autism: Methodologies critique. Developmental Disabilities Bulletin, 35, 148-168.

            Webster, A., Feiler, A., Webster, V., & Lovell, C. (2004). Parental perspectives on early intensive intervention for children diagnosed with autistic spectrum disorder. Journal of Early Childhood Research, 2, 25-49. doi: 10.1177/1476718X0421002

            Woolfenden, S., Sarkozy, V., Ridley, G., & Williams, K. (2012). A systematic review of the diagnostic stability of autism spectrum disorder. Research in Autism Spectrum Disorder, 6, 345-354.

---

[1] I use the term family unit to describe the individuals present within the “family”: that is, mothers and fathers as well as siblings – the latter however not discussed for the purpose of this essay. During the course of this essay I focus on the effects of stressors associated with parents of children (foregoing adults) with ASDs.

[2] This is in line with the most recent draft of the DSM-5, which proposes to eliminate the subtypes of ASD (i.e., Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified), as they are more similar than different. It is recognized that ASDs have homogeneity in core symptoms and heterogeneity in severity. This observation is supported by literature and creates the ability to simplify the diagnostic process by discussing ASDs in terms of mutually exclusive categories of the same disorder rather than distinct disorders, thus increasing diagnostic reliability (Crowe & Littlefield, 2012). One final note is that in the course of this essay, the terms ASD(s) and autism shall be used interchangeably.

[3] I shall spend a small amount of time on the problems in funding for both initiatives for parents, as well as initiatives for children suffering with autism – the latter being discussed in primacy. Then I shall discuss what has been done to correct this problem, and the challenges inherent within the initiative to overcome financial barriers.

[4] In the context of ASD, early intervention leads to the best results when initiated by the age of three years.

PTSD and the Military

"The War Room" by Robert Bridgens
[https://www.stockvault.net/blog/photography/30-war-and-suffering-themed-photographs/]

Picture this:

A man in his mid-twenties hesitates when his girlfriend asks him to take out the trash. He feels his heart racing, his hands get sweaty, and he feels like he should tell her something. He doesn't though.

She looks at him closely, watching and waiting for his response. It comes quietly, "Um. Okay. No worries."

She's relieved. She never really understood why he was so anxious when asked to take out the trash. Ever since he came back from Afghanistan he seemed on edge, but he never wanted to talk about it...

What's he thinking? Well it could be that improvised explosive devices (IED's) were hidden near or inside trash cans when he was on tour. It could be that his anxiety, although useful for him when he was in combat because it kept him on edge and alert, was becoming to be a burden when he found himself back home. Little things like taking out the trash, driving under bridges (given the anxiety of an insurgent marking his car with his AK-47), or any other such seemingly everyday circumstance that we take for granted as doing without any hint of anxiety, are riling him up. He doesn't want to be this way, and upon his arrival he really didn't get as much information as he would've liked - or maybe he was ignoring the information he was given - on management and treatment options of post-traumatic stress disorder (PTSD).

IS that what he's got? He doesn't know. He's heard a little about it, but not enough to inform him that he could be a prime candidate for this diagnosis. But even if he was diagnosed, wouldn't that just make others label him negatively? Or feel sorry for him? No. He wasn't going to go there. 'It's not like anybody understands?' 

The above is just one of the circumstances many (but not all) of our veterans find themselves in after returning from a military tour (or two, or three, or more) in a war zone. Circumstances that trigger symptoms that could fall into the ever so complicated syndrome identified in the Diagnostic and Statistical Manual of Mental Disorders (or DSM, currently in its fifth edition) as PTSD. What are these symptoms? In what sense is it a disorder? And what can they and we do to help those that have fought, died, and suffered for the country we live in?

This is what this post is about.

People that find themselves diagnosed with PTSD have suffered or witnessed singular or multiple traumatic events at some point in their life (the DSM-5 distinguishes between children, aged under six years, and adults suffering from PTSD). It is a very complex disorder where a person relives, in a sense, the trauma experienced in a number of identifiable ways.

Be it recollections of the event that are accompanied by emotional, sensory or physiological components (such as we have seen in the example above); dissociating from lived experience only to relive the traumatic events in the form of flashbacks; avoiding certain places or stimuli (say, discussion about the event) so that the person does their best to rid themselves of potential confrontation; negative thoughts that can affect day-to-day functioning related to the traumatic event; exaggeration; detachment from others; losing interest in things they once loved; and despondence. These symptoms are some of those present in someone that has been diagnosed with PTSD and can be quite debilitating for some people. 

This isn't to say that all people that have experienced combat will present with these symptoms, and it isn't to say that people that haven't experienced combat won't experience these symptoms (e.g. take the case of Mr. Yates in the DSM-5 Clinical Cases Handbook where he was a transporter in Iraq and although he didn't experience any combat he was still diagnosed with PTSD given his fulfilment of certain criteria such as avoidance of bridges (given the potential for conflict at such a location while he was in Iraq), hyperarousal, and other symptoms; Barnhill, 2013).

"Off to War" by Steve Hill
[https://www.stockvault.net/blog/photography/30-war-and-suffering-themed-photographs/]

What we as the general population must understand is that we must be there to help our veterans when they return from their deployment rather than expect them to re-integrate into society without the slightest fuss. For example, in a 2013 news article by the ABC, the voices of frustrated Australian veterans were heard in that they did not receive enough support in their reintegration, especially in terms of counselling. 

Just last week the Minister for Veterans Affairs, the Hon. Michael Ronaldson declared that the Government is attempting to prioritise mental health services for veterans right now and into the future. What shall come out of it remains to be seen, but it's comforting to see that in Australia this issue is a priority.

Listening to the "Military PTSD" podcast of Psychology in Seattle (which can be found free of charge on iTunes) it was interesting to hear that when we juxtapose warrior tribal reintegration from around the world (presumably from years ago) there is a very apparent contrast to how we reintegrate veterans in various western countries today.

It was said that upon returning from combat, tribal members would have to undertake intensive re-initiation and therefore certain rites and purification rituals were performed upon their arrival. These were done away from the tribe. Only after these rites and rituals were performed were they re-integrated back into the tribe. Upon their return to their home tribe, each member was given the opportunity to tell their story. This story was now not their own story, but the tribe's story.

What an encouraging situation!

We today are often disengaged from the experiences of those that join the military and return broken people. Obviously we can bring into focus the difference in culture between collectivist cultures and individualist cultures and how these factors might influence our response, but that'll make this post much longer than it needs to be... What we can make reference to however is the part that we can play as a people to those that have returned from combat

What can we do?

1. Instead of seeking to understand all the 'juicy' details of the veteran's deployment we should meet them where they are. Provide a supporting environment where they can discuss what is on their mind and let them tell their story. This, in turn, can help us understand that although there are many stories individual to be told overall, there is a metanarrative that needs to be understood. We are all part of this metanarrative and we'll do well to understand that.

2. Don't be quick to label a veteran as having PTSD and asking them to go get help. Assigning a diagnosis will do little to the esteem (self and other) of that person and could potentially make them unwilling to seek help. Seeking help must ultimately stem from him. It can be guided by the loving concerns of the family and loved ones, but it's only when help is sought by the client that the therapeutic process is most advantageous.

3. Don't be afraid to be involved in the process. When we tell our veterans that they need to go and see someone and remain disengaged from this process, we are creating an environment for there to be dips and flows, and sporadic increases and decreases in their reintegration. Just as when a drug addict relapses after he's attended rehab and came back clean to an unchanged environment, a veteran can feel as though he's on his own when his environment hasn't changed. We must change along with our veterans for the process of healing to take place.

4. Familiarise ourselves with PTSD and do our best to understand treatment methods. As stated before, it's not beneficial to label somebody and then ask them to see someone; it's a much better strategy to talk to the person in such a way to allow them to be honest about what they went through (along with our own understanding of any disorders that could accompany that person) and go on from there.

Treatment Opportunities?

A U.S. soldier trying out VRET
[http://www.fastcompany.com/1728656/virtual-iraq-helps-soldiers-overcome-ptsd]

I'm not going to dwell on this section long, because there are many other places that can run through interventions much better than I can in a brief blog post. What I will say is that there are great initiatives around the world which provide potential for helping the veteran in the long-term. One of these is virtual reality exposure treatment (VRET). Many veterans are hesitant to engage in therapy for any number of reasons. As one Marine put it, "I didn't want it put on my military record that I was crazy" (Halpern, 2008, as cited in Butcher, Mineka & Hooley 2013). When engaging treatment methods are formulated, there can be a higher willingness for veterans to actually initiate the search for personal growth.

VRET works by simulating battle conditions. The veteran experiences "trauma related cues such as vibrations of the ground, the smell of smoke, and the sound of AK-47 fire." (Butcher et al., 2013). Treatment is usually short-term (roughly a months duration) and the veteran undertakes up to six 90-minute individual sessions.

This type of therapy significantly reduces PTSD treatment and improves overall functioning (Gerardi et al., 2008; Reger & Gahm, 2008, as cited in Butcher et al., 2013).

This is a great method, among others, that caught my attention and thought I would share...

End Thoughts

So one thing we have to realise is that it's up to us to support those that have returned from combat and are suffering from the psychological wounds that go with the territory. Only through psychoeducation, a loving and caring environment, and if the need be, therapeutic measures can we hope to best assist our veterans.

...

Lest We Forget!

References

Barnhill, J. W. (2013). DSM-5 Clinical Cases. Arlington, VA: American Psychiatric Publishing.

Butcher, J. N., Mineka, S., & Hooley, J. M. (2013). Abnormal Psychology. New Jersey, NY: Pearson Education.

Other references are linked throughout the body of the blog post.