Teaching Interpersonal Relationship Skills: Tips for Parents

Because your Aspergers youngster may have difficulty perceiving the “ins and outs” of typical social interactions, he may feel uncomfortable or be pegged as socially “awkward” when it comes to conversation with friends, family, teachers, etc. Navigating the “ebb and flow” of everyday interactions can be an art for anyone – but it can be especially precarious for a child with Aspergers. However, with parental support, Aspies can grow to learn ways to improvise and improve the quality of those interactions.

Some Aspergers kids appear shy and withdrawn, rarely speaking unless spoken to. Others may dominate the conversation with lengthy discussions about their special interests. Your Aspie may reflect these traits at different times, or generally fall somewhere in between. The social skills you teach your youngster now will have long-term benefit as he matures through the teenage years and into adulthood. Learning how to develop social circles and relationships that can lead to true friendship is important to your youngster's future successes and mental health stability.

The Aspergers youngster who appears shy and withdrawn often wants to “fit-in” and get along with others, but doesn't know where to begin. Similarly, the youngster who is overly verbal knows how to talk circles around a particular topic and may think that everyone has the same degree of interest such that they are spellbound. This youngster also doesn't realize the “give and take” of social interactions and needs some help with interpersonal relationship skills.

How Parents Can Teach Interpersonal Relationship Skills—

1. Use cartoons to teach relationship skills. Your Aspergers youngster may respond well to understanding social conversation when his favorite TV cartoon show is involved. It is best to record the cartoon on DVD so that you can start and stop the show and highlight “good versus inappropriate” conversation styles. Help your youngster to reinforce what he's just seen by drawing it out on paper. Suggest that you both modify the conversation a bit.

2. Teach “conversation-starters” and “conversation-enders.” Many Aspergers kids have terrific rote memories if they are able to create images of situations to best “match” the conversation “starter” or “ender.” To begin, partner with your youngster to break down, in writing and pictures, lists for each area. Here are a few sample conversation starters and enders:

• “Good morning Mr. Smith.”
• “Hello” or “Hi”
• “Hey!”
• “How's it going?”
• “What are you doing after school?”
• “What did you do over the weekend?”
• “What did you watch on TV last night?”
• “What's up?”
• “I gotta go now.”
• “I'll catch you later.”
• “I'll see you tomorrow.”
• “I'll talk to you after school.”
• “See ya Friday.”
• “Take it easy.”

Sit down with your Aspie and come up with additions to the list above. What do your child’s favorite cartoon or TV characters use as conversation starters or enders that are socially acceptable and fit well on the list? Talk about how no one “owns” these conversation starters or enders – anyone can use them!

3. Teach your child to provide “feedback” to the other person during conversations. Feedback is a response to conversation starters or enders initiated by someone else. Providing feedback may include responding with a question in order to elicit more information from the other person. Tell your child that providing feedback is like building a sky scraper. Each piece of the conversation adds layers to the foundation either person began. When the conversation changes topic, the process of building the sky scraper starts over. Providing feedback is always a useful tool to “fall back on” whenever your child is uncertain of what to say. For example:

• “Awesome!”
• “Cool!”
• “I don't know what that is – tell me more!”
• “I never heard of that before. Can you explain it to me?”
• “I'm sorry about that.”
• “That's interesting!”
• “That's really neat!”

4. Teach your child how to “interject” in an appropriate manner. Interjections are socially acceptable alternatives to interrupting conversation. Your youngster will need to appreciate, through words and images, that it is considered rude to interrupt in conversation, but there are ways to “interject” without being rude. You and your Aspie can identify when this works best (usually during a conversation lull or when someone has stopped talking). Interjections may include:

• “Can I say something now?”
• “Excuse me, please.”
• “May I add to what you're saying?”
• “Pardon me for interrupting, but…”
• “Can I tell you about something similar that happened to me?”

Some of these statements might be too formal for a young person and would be better suited for an older teenager. Perhaps you and your Aspie can come up with other statements to add to this list (ones that are more your child’s style).

Mistakes and unexpected circumstances are bound to occur, and these will require private and respectful debriefing to explain. With time, you and your youngster can modify and adapt his “bag of conversational tricks” to become adept in carrying on a good conversation.

5. Find opportunities that are available in your community by which you can support your youngster in making contacts to build on his special interests (e.g., passion for insects, astronomy, Japanese animation, etc.). If you are uncertain, start by pursuing the following:

• After-school activities sponsored by your school district
• Community classes such as arts and crafts, or martial arts
• Community projects or special celebration days
• Opportunities offered through local television and radio stations
• Opportunities offered through the newspaper or local circulars
• Programs and special events offered by your local historical society or museums
• Programs and special events offered by your local library
• Special events sponsored by local athletic leagues

One of the most powerful ways to connect with others with similar passions is through the Internet. The possibilities are endless. Your youngster may learn more about other children of the same age, beyond just the passion they share, by locating them on a map and learning about the local industry, economy, and more. The youngster passionate about Japanese animation may even have the chance to communicate with someone of that culture. They can compare notes and exchange ideas about the video games each is developing.

6. Consider forming a group for children with Aspergers in your community. These groups provide a forum for unconditional acceptance in a safe and comfortable environment. Such groups do not advocate exclusion from neurotypical kids; rather, they are an opportunity for some kids to learn social skills in a place where it's perfectly acceptable to mess-up as you learn and practice. Your local school district or county human service program may be able to tell you if any such group already exists in your town - or a neighboring town. Most likely, moms and dads previously unconnected will want to meet to discuss the similarities of their lives, but the focus should stay on supporting the kids to meet their individual needs in a comfortable atmosphere.

7. Don’t force your child to be more “social” and “conversational” than he is comfortably able. “Social” should be defined differently for each person, depending on that individual’s needs. You, as a neurotypical parent, may value many friends as a mark of being socially successful. Some Aspies, however, are content with just a few, select friends. Most Aspies are not social butterflies …don't wish to be …and never will be. Unless they want to become more out-going, such individuals may simply be completely comfortable with a small group of close-knit friends. As a mother or father, you can arrange to expose your youngster to a variety of people within a range of environments and circumstances. Your youngster will guide you to those with whom he feels connected and wishes to know better.

The Aspergers Comprehensive Handbook

Aspergers Teenagers and Problems with Depression

All teenagers experience depression from time to time due to the normal pressures faced during adolescents. Also, people with Aspergers experience depression occasionally due to dealing with the symptoms associated with the disorder. So, little wonder why a teenager WITH Aspergers may have more than his fair share of depression symptoms.

Depression in Aspergers teens is a serious condition – it affects emotions, thought and behaviors. Although adolescent depression isn't medically different from depression in grown-ups, Aspergers adolescents often have unique challenges and symptoms. Issues such as peer pressure, academic expectations and changing bodies can bring a lot of ups and downs for these adolescents. But, for some Aspies, the lows are more than just temporary feelings — they're a sign of depression.

Depression is Aspergers teens is not a weakness or something that can be overcome with willpower. Like depression in grown-ups, adolescent depression is a medical condition that can have serious consequences. However, for most Aspies, adolescent depression symptoms ease with treatment such as medication and psychological counseling.

Adolescent depression symptoms include:

• Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still
• Anxiety, preoccupation with body image and concerns about performance, particularly in girls
• Changes in appetite. Depression often causes decreased appetite and weight loss, but in some individuals it causes increased cravings for food and weight gain
• Crying spells for no apparent reason
• Disruptive behavioral problems, particularly in boys
• Fatigue, tiredness and loss of energy — even small tasks may seem to require a lot of effort
• Feelings of sadness
• Feelings of worthlessness or guilt, fixation on past failures or self-blame when things aren't going right
• Frequent thoughts of death, dying or suicide
• Insomnia or excessive sleeping
• Irritability, frustration or feelings of anger, even over small matters
• Loss of interest or pleasure in normal activities
• Slowed thinking, speaking or body movements
• Trouble thinking, concentrating, making decisions and remembering things
• Unexplained physical problems, such as back pain or headaches

Adolescent depression often occurs along with behavior problems and other mental health conditions, such as anxiety or attention-deficit/hyperactivity disorder (ADHD).

What's normal and what's not:

It can be difficult to tell the difference between the ups and downs that are just part of being an adolescent and adolescent depression. Talk with your adolescent. Try to determine whether he or she seems capable of handling his feelings without help, or if life seems overwhelming. If adolescent depression symptoms persist or begin to interfere in multiple areas of your adolescent's life, talk to a doctor or a mental health professional trained to work with adolescents. Your adolescent's family doctor or pediatrician is a good place to start. Or, your adolescent's school may have a recommendation.

Warning signs that your Aspergers adolescent could be struggling with depression:

• An ongoing sense that life and the future are grim and bleak
• Conflict with friends of family members
• Extreme sensitivity to rejection or failure
• Loss of interest in family and friends
• Neglected appearance — such as mismatched clothes and unkempt hair
• Poor school performance or frequent absences from school
• Reckless behavior
• Sadness, irritability or anger that goes on for two weeks or longer
• Talking about running away from home or attempting to do so
• Use of alcohol or drugs

When to see a doctor:

If you suspect your adolescent may be depressed, make a doctor's appointment as soon as you can. Depression symptoms may not get better on their own — and may get worse or lead to other problems if untreated. Adolescents who are depressed may be at risk of suicide, even if signs and symptoms don't appear to be severe.

If you're an adolescent and you think you may be depressed — or you have a friend who may be depressed — don't wait to get help. Talk to a health care professional such as your doctor or school nurse. Share your concerns with a parent, a close friend, a faith leader, a teacher or someone else you trust.

Suicidal thoughts:

If your adolescent is having suicidal thoughts, get help right away. Here are some steps you can take:

• Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor or have your adolescent talk to someone.
• Contact a family member or friend for support.
• Contact a minister, spiritual leader or someone in your faith community for advice.
• Seek help from a doctor, a mental health provider or other health care professional.

When to get emergency help:

If you think your adolescent is in immediate danger of self-harm or attempting suicide, call 911 or your local emergency number immediately. Make sure someone stays with him or her until help arrives.

Causes—

It's not known exactly what causes depression. As with many mental illnesses, it appears a variety of factors may be involved. These include:

• Biological differences. Individuals with depression appear to have physical differences in their brains from individuals who aren't depressed. The significance of these changes is still uncertain but may eventually help pinpoint depression causes.
• Early childhood trauma. Traumatic events during childhood, such as abuse or loss of a parent, may cause changes in the brain that make a person more susceptible to depression.
• Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression.
• Inherited traits. Depression is more common in individuals whose biological family members also have the condition.
• Learned patterns of negative thinking. Adolescent depression may be linked to learning to feel helpless — rather than learning to feel capable of finding solutions for life's challenges.
• Life events. Events such as the death or loss of a loved one, financial problems, and high stress can trigger depression in some individuals.
• Neurotransmitters. These naturally occurring brain chemicals linked to mood are thought to play a direct role in depression.

Risk factors—

Although the precise cause of depression isn't known, factors that seem to increase the risk of developing or triggering adolescent depression include:

• Abusing alcohol, nicotine or other drugs
• Being a girl — depression occurs more often in females than in males
• Being attracted to members of the same sex — which can cause depression linked to negative social pressures and internal emotional conflicts
• Having a chronic medical illness such as diabetes or asthma
• Having a family member who committed suicide
• Having a parent, grandparent or other biological relative with depression
• Having an anxiety disorder
• Having been physically or sexually abused
• Having been the victim or witness of violence
• Having biological relatives with a history of alcoholism
• Having certain personality traits, such as low self-esteem or being overly dependent, self-critical or pessimistic
• Having experienced recent stressful life events, such as the death of a loved one
• Having few friends or other personal relationships
• Having strict moms and dads that are quick to blame or punish
• Obesity, which can lead to judgment by others and to low self-esteem
• Parental divorce

Complications—

Untreated depression can result in emotional, behavioral and health problems that affect every area of your adolescent's life. Complications associated with adolescent depression can include:

• Suicide
• Social isolation
• Relationship difficulties
• Family conflicts
• Anxiety
• Alcohol and drug abuse
• Academic problems

Preparing for an appointment—

You're likely to start by taking your adolescent to see his primary care doctor or pediatrician. However, when you call to set up an appointment, you may be referred directly to a psychiatrist or psychologist — mental health professionals who specialize in diagnosing and treating mental health conditions.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea for you and your adolescent to be well prepared for the appointment. Here's some information to help you get ready for your adolescent's appointment, and what to expect from the doctor.

What you can do:

• Make a list of all medications, vitamins or supplements that your adolescent is taking.
• Write down any symptoms your adolescent has had, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes your adolescent has experienced.
• Write down questions to ask your adolescent's doctor.

Your time with the doctor is limited, so preparing a list of questions ahead of time will help you and your adolescent make the most of your time. List your questions from most important to least important in case time runs out. For problems related to depression, some basic questions to ask the doctor include:

• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
• Are there any possible side effects or other issues I should be aware of with the medications you're recommending for my adolescent?
• Are there any restrictions that my adolescent needs to follow?
• Is depression the most likely cause of my youngster's symptoms?
• Is there a generic alternative to the medicine you're prescribing?
• My adolescent has these other health conditions. How can he or she best manage them together?
• Other than the most likely cause, what are other possible causes for my youngster's symptoms or condition?
• Should my adolescent see a psychiatrist or other mental health provider?
• What are the alternatives to the primary approach that you're suggesting?
• What kinds of tests will he or she need?
• What treatment is likely to work best?
• Will making changes in diet, in exercise or in other areas of my adolescent's life help ease depression?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions at any time during your adolescent's appointment.

What to expect from your adolescent's doctor:

The doctor is likely to ask your adolescent a number of questions. Making sure he or she is ready to answer them may reserve time to go over any points you or your adolescent wants to spend more time on. Your youngster's doctor may ask your adolescent:

• Do you ever have suicidal thoughts when you're feeling down?
• Do you have any biological relatives — such as a parent or grandparent — with depression or another mood disorder?
• Does your mood ever swing from feeling down to feeling extremely happy and full of energy?
• Have you experimented with alcohol or illegal drugs?
• How long have you felt depressed? Do you generally always feel down, or does your mood change?
• How much do you sleep at night? Does it change over time?
• How severe are your symptoms? Do they interfere with school, relationships or other day-to-day activities?
• What other mental or physical health conditions do you have?
• What, if anything, appears to worsen your symptoms?
• What, if anything, seems to improve your symptoms?
• When did your family members or your friends first notice your symptoms of depression?

Tests and diagnosis—

When a doctor suspects an adolescent has depression, he or she will generally ask a number of questions and may do medical and psychological tests. These can help rule out other problems that could be causing symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:

• Psychological evaluation. To check for signs of depression, your doctor or mental health provider will talk to your adolescent about his thoughts, feelings and behavior patterns. The doctor may have your adolescent fill out a written questionnaire to help answer these questions.

• A physical exam. This generally involves measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to the heart and lungs; and examining the abdomen.

Diagnostic criteria for depression:

To be diagnosed with depression, your adolescent must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

For a diagnosis of major depression, your adolescent must have five or more of the following symptoms over a two-week period. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure. Symptoms can be based on your adolescent's feelings or may be based on the observations of someone else. They include:

• Depressed mood most of the day, nearly every day, such as feeling sad, empty or tearful (in adolescents, depressed mood can appear as constant irritability)
• Diminished interest or feeling no pleasure in all — or almost all — activities most of the day, nearly every day
• Either restlessness or slowed behavior that can be observed by others
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness, or excessive or inappropriate guilt nearly every day
• Insomnia or increased desire to sleep nearly every day
• Recurrent thoughts of death or suicide, or a suicide attempt
• Significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day (in adolescents, failure to gain weight as expected can be a sign of depression)
• Trouble making decisions, or trouble thinking or concentrating nearly every day

To be considered major depression:

• Symptoms are not caused by grieving, such as temporary sadness after the loss of a loved one
• Symptoms are not due to the direct effects of something else, such as drug abuse, taking a medication or having a medical condition such as hypothyroidism
• Symptoms aren't due to a mixed episode — mania along with depression that sometimes occurs as a symptom of bipolar disorder
• Symptoms must be severe enough to cause noticeable problems in day-to-day activities, such as school, social activities or relationships with others

Other conditions that cause depression symptoms:

There are several other conditions with symptoms that can include depression. It's important to get an accurate diagnosis so your adolescent can get the appropriate treatment. Your doctor or mental health provider's evaluation will help determine if the symptoms of depression are caused by one of the following conditions:

• Seasonal affective disorder. This type of depression is related to changes in seasons and diminished exposure to sunlight.
• Schizoaffective disorder. Schizoaffective disorder is a condition in which a person meets the criteria for both schizophrenia and a mood disorder.
• Psychotic depression. This is severe depression accompanied by psychotic symptoms such as delusions or hallucinations.
• Postpartum depression. This is a common type of depression that occurs in new mothers. It often begins four to eight weeks after delivery and may last for months.
• Dysthymia. Dysthymia (dis-THI-me-uh) is a less severe but more chronic form of depression. While it's usually not disabling, dysthymia can prevent your adolescent from functioning normally in his daily routine and from living life to its fullest.
• Cyclothymia. Cyclothymia (si-klo-THI-me-uh), or cyclothymic disorder, is a milder form of bipolar disorder.
• Bipolar disorder. Bipolar disorder is characterized by mood swings that range from the highs of mania to the lows of depression. It's sometimes difficult to distinguish between bipolar disorder and depression, but it's important to get an accurate diagnosis because treatment for bipolar disorder is different from that for other types of depression.
• Adjustment disorder. An adjustment disorder is a severe emotional reaction to a difficult event in your life. It's a type of stress-related mental illness that may affect your feelings, thoughts and behavior.

Make sure that you understand what type of depression your adolescent has so that you can learn more about his specific situation and its treatments.

Treatments and drugs—

Numerous treatments are available. Medications and psychological counseling (psychotherapy) are very effective for most adolescents with depression.

In some cases, a primary care doctor can prescribe medications that relieve depression symptoms. However, many adolescents need to see a doctor who specializes in diagnosing and treating mental health conditions (psychiatrist or psychologist). Some adolescents with depression also benefit from seeing other mental health counselors.

If your adolescent has severe depression or is in danger of hurting himself or herself, he or she may need a hospital stay or may need to participate in an outpatient treatment program until symptoms improve.

Medications:

A number of antidepressant medications are available to treat depression. There are several different types, categorized by how they affect the naturally occurring chemicals in the brain linked to mood.

Because studies on the effects of antidepressants in adolescents are limited, doctors rely mainly on adult research when prescribing medications. The Food and Drug Administration (FDA) has approved two medications for adolescent depression — fluoxetine (Prozac) and escitalopram (Lexapro). However, as with grown-ups, other medications may be prescribed at the doctor's discretion (off label).

Types of antidepressants include:

• Atypical antidepressants. These medications are called atypical because they don't fit neatly into another antidepressant category. They include trazodone and mirtazapine (Remeron). Both of these antidepressants are sedating and are usually taken in the evening. In some cases, one of these medications is added to another antidepressant to help with sleep.
• Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), isocarboxazid (Marplan) and phenelzine (Nardil) — are generally prescribed as a last resort, when other medications haven't worked. That's because MAOIs can have serious harmful side effects. They require a strict diet because they may cause life-threatening high blood pressure if combined with certain common foods such as aged cheeses, pickles and chocolate. They can also interact with some medications, including decongestants. MAOIs can be very dangerous in overdose. Selegiline (Emsam) is a newer MAOI that's applied to the skin as a patch rather than swallowed as a pill. It may cause fewer side effects than do other MAOIs.
• Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) falls into this category. At high doses, bupropion may increase the risk of having seizures.
• Selective serotonin reuptake inhibitors (SSRIs). Many doctors start depression treatment in adolescents by prescribing one of these medications. SSRIs are safer and generally cause fewer bothersome side effects than do other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). These medications can cause side effects. These may go away as the body adjusts to the medication. Side effects can include digestive problems, jitteriness, restlessness, headache and insomnia. These medications have a low risk of death in overdose.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq). Side effects are similar to those caused by SSRIs. In high doses these medications can cause increased sweating and dizziness. Individuals with liver disease shouldn't take duloxetine.
• Tricyclic antidepressants. These antidepressants have been used for years and are generally as effective as newer medications. Examples include amitriptyline, imipramine (Tofranil) and doxepin. Because they can have side effects, they generally aren't used in adolescents. Side effects can include low blood pressure, dry mouth, blurred vision, constipation, urinary retention, fast heartbeat and confusion. Tricyclic antidepressants are also known to cause weight gain. These medications can be very dangerous when taken in overdose.
• Other medications. If your adolescent's depression isn't getting better with one antidepressant, the doctor may recommend adding another antidepressants or another type of medication for better effect — such as a stimulant, mood-stabilizing medication, anti-anxiety medication or antipsychotic medication. This strategy is known as augmentation.

Managing medications:

Carefully monitor your adolescent's use of his medications. In order to work properly, antidepressants need to be taken consistently at the prescribed dose. Because overdose can be a risk for adolescents with depression, your adolescent's doctor may prescribe only small supplies of pills at a time, or recommend that you dole out your youngster's medication so that your adolescent does not have large amounts of pills available at once. Be especially careful if you think your adolescent is at risk of suicidal behavior and is taking a tricyclic antidepressant or an MAOI — these medications are more dangerous than other types of antidepressants when it comes to overdose.

Finding the right medication:

Everyone's different, so finding the right medication or dose of medication for your adolescent may take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as the body adjusts. If your adolescent has bothersome side effects, he or she shouldn't stop taking an antidepressant without talking to the doctor first. Some antidepressants can cause withdrawal symptoms unless the dose is slowly tapered down. Quitting suddenly may cause a sudden worsening of depression.

If antidepressant treatment doesn't seem to be working, your adolescent's doctor may recommend a blood test to check for specific genes that affect how his body processes antidepressants. The cytochrome P450 (CYP450) genotyping test is one example of this type of exam. Genetic testing of this kind can help predict how well the body can or can't process (metabolize) a medication. This may help identify which antidepressant might be a good choice for your adolescent. These genetic tests aren't widely available, so they're an option only for individuals who have access to a clinic that offers them.

Antidepressants and pregnancy:

If your adolescent is pregnant or breast-feeding, some antidepressants may pose a health risk to her unborn youngster or nursing youngster. If your adolescent becomes pregnant, make certain she talks to her doctor about antidepressant medications and managing depression during pregnancy.

Antidepressants and increased suicide risk:

Although antidepressants are generally safe when taken as directed, the Food and Drug Administration (FDA) warns that in some cases, kids, adolescents and young people ages 18 to 24 may have an increase in suicidal thoughts or behavior when taking antidepressants. This risk may be highest in the first few weeks after starting an antidepressant or when the dose is changed. Because of this risk, individuals in these age groups must be closely monitored by while taking antidepressants.

While this warning may seem alarming, for most adolescents the benefits of taking an antidepressant generally outweigh any possible risks. In the long run, antidepressants are likely to reduce suicidal thinking or behavior.

If your adolescent has suicidal thoughts when taking an antidepressant, immediately contact his doctor or get emergency help.

Again, make sure you understand the risks of the various antidepressants. Working together, you and your doctor can explore options to get depression symptoms under control.

Psychotherapy:

Psychological counseling (psychotherapy) is another key depression treatment. Psychotherapy is a general term for a way of treating depression by talking about depression and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy. Psychotherapy may be done one-on-one, with family members or in a group format.

Through these regular sessions, your adolescent can learn about the causes of depression so that he or she can better understand it. He or she will also learn how to identify and make changes in unhealthy behaviors or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals. Psychotherapy can help your adolescent regain a sense of happiness and control and help ease depression symptoms such as hopelessness and anger. It may also help your adolescent adjust to a crisis or other current difficulty.

Cognitive behavioral therapy is one of the most commonly used therapies for adolescent depression. It helps a person identify negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts — not other individuals or situations — determine how you feel or behave. Even if an unwanted situation doesn't change, you can change the way you think and behave in a positive way. Interpersonal therapy and psychodynamic psychotherapy are other examples of counseling commonly used to treat depression. There are a number of additional types of psychotherapy that can be effective. Many therapists use a combination of approaches.

Hospitalization and residential treatment programs:

In some adolescents, depression is so severe that a hospital stay is needed. Inpatient hospitalization may be necessary if your adolescent is in danger of self-harm or hurting someone else. Getting psychiatric treatment at a hospital can help keep your adolescent calm and safe until his mood improves. Partial hospitalization or day treatment programs also are helpful for some adolescents. These programs provide the support and counseling needed while your adolescent gets depression symptoms under control.

Lifestyle and home remedies—

Depression generally isn't an illness that you can treat on your own. But there are some steps you and your adolescent can take that may help:

• Pay attention to warning signs. Work with your adolescent's doctor or therapist to learn what might trigger depression symptoms. Make a plan so that you and your adolescent know what to do if symptoms get worse. Ask family members or friends to help watch for warning signs.
• Make sure your Aspergers adolescent gets plenty of sleep. Sleeping well is important for adolescents, especially adolescents with depression. If your adolescent is having trouble sleeping, talk to his doctor about what can be done.
• Make sure your adolescent gets exercise. Even light physical activity can help reduce depression symptoms.
• Learn about depression. Education about your adolescent's condition can empower your adolescent and motivate him or her to stick a treatment plan. It can also benefit you and other loved ones to learn about your adolescent's depression. Counseling that focuses on this is known as psycho-education.
• Help your adolescent avoid alcohol and other drugs. Your adolescent may feel like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat.
• Encourage your adolescent to stick to his treatment plan. Make sure your adolescent attends psychotherapy sessions or appointments, even if he or she doesn't feel like going. Even if your adolescent is feeling well, make sure he or she continues to take medications as prescribed. If your adolescent stops taking medications, depression symptoms may come back. Quitting suddenly may also cause withdrawal-like symptoms.

Alternative medicine—

Alternative medicine strategies for depression include supplements and mind-body techniques. Here are some common alternative treatments for depression.

Herbal remedies and supplements:

A number of herbal remedies and supplements have been used for depression. Examples include:

• Omega-3 fatty acids. Eating a diet rich in omega-3s or taking omega-3 supplements may help ease depression and also appears to have a number of other health benefits. Cold-water fish and fish oil supplements are good sources of omega-3s. Omega-3s are also found in flaxseed, walnuts and some other foods.
• SAMe. Pronounced "sam-EE," this is a synthetic form of a chemical that occurs naturally in the body. The name is short for S-adenosylmethionine. As with St. John's wort, SAMe isn't approved by the FDA to treat depression. However, it's used in Europe as a prescription drug to treat depression.
• St. John's wort. Known scientifically as Hypericum perforatum, this is an herb that's been used for centuries to treat a variety of ills, including depression. It's not approved by the Food and Drug Administration to treat depression in the United States. Rather, it's classified as a dietary supplement. However, it's a popular depression treatment in Europe.

Some supplements — including St. John's wort and SAMe — can interfere with antidepressants.

Mind-body connections:

The connection between mind and body has been studied for centuries. Complementary and alternative medicine practitioners believe the mind and body must be in harmony for you to stay healthy.

Mind-body techniques used to improve depression symptoms include:

• Yoga
• Meditation
• Massage therapy
• Guided imagery
• Acupuncture

Make certain you understand risks as well as possible benefits before pursuing any therapy for your adolescent. To be safe, talk to your adolescent's doctor before he or she takes any herbal or dietary supplements — particularly St. John's wort or SAMe. Keep in mind, alternative treatments aren't a replacement for conventional medical treatment or psychotherapy.

Coping and support—

Showing interest and the desire to understand your adolescent's feelings lets him or her know you care. You may not understand why your adolescent feels that things are hopeless or why he or she has a sense of loss or failure. Listen to your adolescent without judging and try to put yourself in his position. Help build your adolescent's self-esteem by recognizing small successes and offering praise about his competence.

Encourage your Aspergers adolescent to:

• Ask for help. Adolescents may be reluctant to seek support when life seems overwhelming. Encourage your adolescent to talk to a family member or other trusted adult whenever needed.
• Connect with other adolescents who struggle with depression. Talking with other adolescents facing similar challenges can help your adolescent cope. So can learning skills to manage life's challenges. Local support groups for depression are available in many communities, and support groups for depression are offered online. One good place to start is the National Alliance on Mental Illness.
• Encourage your adolescent to keep a private journal. Journaling can improve mood by allowing your adolescent to express and work through pain, anger, fear or other emotions.
• Have realistic expectations. Many adolescents judge themselves when they aren't able to live up to unrealistic standards — academically, in athletics or in appearance, for example. Let your adolescent know that it's OK not to be perfect.
• Make and keep healthy friendships. Positive relationships can help boost your adolescent's confidence and stay connected with others. Encourage your adolescent to avoid relationships with individuals whose attitudes or behaviors could make depression worse.
• Simplify his life. Encourage your adolescent to carefully choose his obligations and commitments, and set reasonable goals. Let your adolescent know that it's OK to do less when he or she feels down.
• Stay active. Participation in sports, school activities or a job can help keep your adolescent focused on positive things — rather than negative feelings or behaviors.
• Stay healthy. Do your part to make sure your adolescent eats regular, healthy meals, gets regular exercise and gets plenty of sleep. These are priorities — encourage your adolescent not to avoid these things because of social activities, school responsibilities or other demands.
• Structure his time. Help your adolescent plan his activities by making lists or using a planner to stay organized.

Prevention—

There's no sure way to prevent depression. However, making sure your Aspergers adolescent takes steps to control stress, to increase resilience and to boost low self-esteem can help. Friendship and social support, especially in times of crisis, can help your adolescent cope. In addition, treatment at the earliest sign of a problem can help prevent depression from worsening. Some adolescents with Aspergers need to continue taking medications even after symptoms let up, or have regular therapy sessions to help prevent a relapse of depression symptoms.

Discipline for Defiant Aspergers Teens

Helping Your Child Cope with Frustration

Does your Aspergers child seem to experience more than his fair share of frustration? And does he often slip into a meltdown once he’s frustrated? If so, then read on…

Most Aspergers kids go through peaks of frustration throughout their childhood. Young Aspies often express their frustration in tantrums. At that point, many of them learn the word “frustrated,” and moms and dads and teachers help them to find compromises and alternatives and to develop at least some degree of “frustration tolerance.”

In the preschool years, further triggers for frustration emerge (e.g., comparisons with peers, new expectations, observations of older kids - especially siblings - and grown-ups, etc.). A youngster may be prone to frustration if he has minor delays in some developmental area, if he has easily succeeded at many things and does not remember the process of learning them, or if he is developing a somewhat perfectionistic personality style.

How your Aspergers child deals with frustration is influenced by how you react to it. If you model an unhealthy response to the frustration you experience in your life (e.g., with impatience, anger, etc.), your child may learn that this is an appropriate way to deal with frustration. If you are calm, positive, and look for solutions when you get frustrated, your child will likely adopt this approach to frustration.

Here's how parents can help Aspergers kids cope with frustration:

1. Explain that everyone, including grown-ups, feels frustrated sometimes. Talk about the process people go through of not being able to do something and then practicing and getting better at it.

2. Give lots of encouragement for small accomplishments. If a youngster reaches a plateau with a new task, celebrate how far he has come. Reassure him that, in his own time, frustration will diminish, reappearing occasionally as a signal of his hard work.

3. Help Aspergers kids develop a strategy of taking one small step at a time in approaching new things.

4. Identify how your child expresses frustration and the activities (or social situations) that tend to elicit it.

5. Instead of recognizing that failure is temporary, an Aspergers youngster often concludes, “I’ll never succeed.” That’s why encouragement is by far the most important gift you can give your frustrated Aspie. Take his dejection seriously, but help him look at his challenge differently: “Never,” you might reply, “is an awfully long time.” Eventually, he’ll learn from your encouraging words to talk himself out of giving up.

6. One of the first mistakes that many Aspergers kids make – and that moms and dads often encourage – when faced with frustration is to just increase their effort (i.e., do whatever they are doing - more and harder). But then they are violating the Law of Insanity: doing the same thing and expecting different results. When frustration first arises, rather than plowing ahead, your Aspie should do just the opposite (i.e., step back from the situation that is causing the frustration). For example, if your youngster can't solve a math problem or learn a new sports skill that he is practicing, he should set it aside and take a break. Stopping the activity creates emotional distance from the frustration, thus easing its grip on them.

7. Provide alternatives to unacceptable expressions of frustration. Since frustration is a form of pent-up energy, doing something physical to burn-off the negative energy often works quite well. Going for a brief - but brisk - walk, jumping up and down for a minute or two, or some other physical activity helps to semi-exhaust the child so that little energy is left over for tantrum-behavior (e.g., throwing things, yelling, hitting, etc.).

8. You can help your Aspergers child learn to soothe himself by demonstrating patience and self-control, and by suggesting self-calming strategies (e.g., cuddling with a favorite stuffed animal, singing a favorite song, taking a break and doing something fun, beginning the task again with a smaller step so that there is a first success to build on, etc.). Your long-term goal is for him to learn to recognize when he’s frustrated and what he can do about it on his own.

9. You can help your Aspie hold on to his sense of self-worth by helping him remember his past successes – and the struggles that preceded them. Put his current struggle into perspective by recalling other times that he thought he’d never succeed, until he did. Help him learn to notice the strengths that he can count on to help him triumph — guts, determination, endurance, careful observation (no matter how fledgling some of these qualities may still be).

10. You can help your youngster recognize that learning involves trial and error. Mastering a new skill takes patience, perseverance, practice, and the confidence that success will come. To a young person, achieving success, whether it’s writing his name or hitting a baseball for the first time, can seem monumental.

My Aspergers Child: Preventing Meltdowns and Tantrums

Aspergers in the Elderly

Although Aspergers has been around for many years, it was only classified as a distinct condition in 1992. This means that many elderly folks could not have been diagnosed as kids because the signs and symptoms were not recognized.

There is evidence that Aspergers can run in families, and elderly folks may become aware of their condition when a younger family member is diagnosed. Moms and dads normally read up on the signs and symptoms and may recognize the same signs in their older relatives.

Grown-ups with Aspergers present with similar signs of the condition as do children and teens. In some cases, the problems may not be quite as pronounced as the grown-up may have developed coping mechanisms.

Elderly folks with Aspergers normally display the following symptoms:

• Social interaction is difficult, and the Aspie is normally too detached or too intense. They struggle to understand the full meaning of relationships, and sexual issues may be a problem. Some are unable to distinguish between date rape and seduction.
• Obsessional interests are common, and the Aspie may work in a position that is related to this interest. Computers are frequently the focus of attention. Collectibles (e.g., stamps and coins) are also favored. Some elderly folks with Aspergers may also be obsessed with trains, airplanes or other forms of transport.
• Elderly folks often like routine, and Aspergers may magnify this to extremes. They may have rigid routines and become unsettled and difficult if they are pressed out of their comfort zones.
• Communication problems are common, and the Aspie often engages in long-winded, one-sided conversations, not realizing they are boring the other party. Information may be shared in a lecture-like manner and with little or no facial expressions. Body language is weak and eye contact poor.

While some older folks find a diagnosis helpful, others refuse to accept it and prefer to carry on as they have been for years. Accepting a diagnosis means the individual will often look back and examine past actions and decisions. For an elderly man or woman set in his/her ways, this may be an alarming prospect.

Currently, there is no single diagnostic tool for Aspergers that is universally recognized. A family member may read an article about Aspergers and the elderly and see the signs in an aged relative. If the subject is broached, it is possible the potential Aspie will visit a doctor for confirmation. An evaluation may include a review of childhood behavior, analysis of school reports if available, and a questionnaire. Even if medical opinion is not sought, the knowledge that signs and symptoms of Aspergers are apparent can bring relief and understanding in some areas.

A firm diagnosis of Aspergers in an elderly man or woman may be met with resistance - but can be helpful. Even if the Aspie does not want to change or alter his/her behavior and routines, it can be comforting to know there is a reason behind the behavior.

The Aspergers Comprehensive Handbook

Aspergers Teenagers and Feelings of Low Self-Worth

All teenagers suffer with low self-esteem from time to time. But, Aspergers teens have an especially difficult time with esteem issues due to the Aspergers traits that make “fitting-in” with their peer group extremely challenging (e.g., poor social skills).

Unfortunately, many teens with Aspergers have been permanently ostracized from the middle school or high school “in-crowd” – and some have been bullied to the point of becoming depressed.

Helping your Aspergers teen to cultivate high self-esteem provides a secondary bonus for parents: better behavior! If you have a child with poor self-esteem, you have a child with behavioral problems.

When we recognize that our Aspergers adolescents may be having feelings of low self-worth or other destructive issues with low self-esteem, there are many parenting techniques that we, as parents or caregivers, can use to intervene.

How to help your Aspergers teen overcome low self-esteem:

1. A poor self-esteem can lead to poor performance in multiple domains (academics, sports, etc.), which can “cycle” the negative feelings that Aspergers teens have about themselves. Over time, theses teens may develop a defeatist attitude that can lead to depression. If your teen is showing signs of depression, seek advice from a child and adolescent psychiatrist.

2. An adolescent who is not the star quarterback he wants to be may be able to set short-term goals for improvement instead of focusing on a long-term, lofty or out of reach goals.

3. As you work with your adolescent on changing those things that can be improved, continually reinforce the positive and encourage your adolescent to learn how to focus on developing his strengths while working to improve on the weaknesses.

4. Be kind and patient with your Aspergers teen – because she is probably not being kind and patient with herself.

5. Build on the understanding that each person has strong points. The main goal should be to focus on developing these strong points without getting bogged down in negativity.

6. Encourage your adolescents to focus on her areas of interest. Help her understand that it’s okay to be less than perfect, and help her create realistic, achievable personal goals. If there are traits that can be improved upon, help your adolescent if you can, or get her the help she needs to evoke a positive change.

7. Finding something that your Aspergers teen can really excel at can give him a genuine boost to his self-esteem. Help your adolescent be realistic about goals that aren’t within his reach based on unchangeable capabilities or physical limitations.

8. Getting your adolescent involved in a worthwhile activity can be a good complimentary service to counseling and talking. Sometimes being able to see the impact they really do have on the world around them can make a difference. Get them interested in volunteering for a cause. They may very well learn that while your actions don’t always cause an immediate effect, the effect they do carry can be quite rewarding.

9. Having an Aspergers adolescent with low self-esteem does not mean that you are a bad parent or that you did the wrong things when he was little. Every parent makes mistakes, and every youngster misinterprets information. Low self-esteem can come from various sources, including some that are outside the home.

10. Identify specific areas where she is feeling deficient, even if you don’t agree with her assessment. Listen carefully, and don’t criticize her feelings. You need to acknowledge how important each of the concerns she expresses is to her. Being open as you listen carefully to her concerns - and not judging them - is the first step in solving any issues for adolescents with low self-esteem.

11. If your adolescent feels she is not excelling in class or not performing well in a sport, and these are things well within her capabilities to develop, then you can work with your adolescent to get the help required to facilitate her improvement in these areas (e.g., tutor, life coach, mentor, etc.). For example, an adolescent who is not excelling in class can get tutors or extra assistance to enhance her grades. Making these changes will go a long way toward building her self-esteem.

12. It’s not unusual for an Aspergers adolescent to not really understand why he has been feeling the way he does. For some Aspies, they have grown used to it, having had these feeling for longer than even they realize. Others just aren’t able to articulate it. They are not purposefully trying to be evasive or secretive – they just honestly don’t know what’s going on with them.

13. Just like every other parenting issue, take it one day at a time - and one issue at a time. Raising strong and solidly-grounded Aspergers adolescents is not an easy task. Walk with him, and he will know that if nothing else, he matters to you.

14. Keep your youngster talking! Being interested in what he has to say is a good start in letting him know that his thoughts and feelings are valuable. Listen to his thoughts reflectively and offer feedback. You may not always agree with what he has to say, but he doesn’t agree with everything that you have to say, either.

15. Know that sometimes an adolescent who is suddenly remarkably helpful or trying with great determination to please everyone around them is actually suffering from a low self-esteem.

16. Self-esteem problems can be temporary and somewhat short lived, or they can often be deep rooted and be a lifelong battle. Either way, it is always advisable to seek out counseling for your adolescent. Taking your youngster to counseling doesn’t mean that there’s something wrong with him. It simply offers him the opportunity to talk about things that maybe he isn’t comfortable talking to a parent about. While adolescents typical turn to their friends for help and assistance in dealing with life’s issues, low self-esteem – and the depression that often comes with it – is one issue that really should involve a sensible professional.

17. Some Aspergers adolescents are quite willing to talk about how they really feel. They have simply been waiting for someone to ask. Others aren’t quite so eager to lay it out there and need to be approached in order to discover what has them feeling so bad about themselves.

18. The pressures to grow up fast and be an independent, well liked member of their peer group can lead adolescents to feelings of low self-esteem. There are many dangers associated with these negative feelings and the consequences that may result. However, feelings of low self-esteem can be changed for the better with a little effort and positive thinking. Tell your child that “feeling bad about yourself” is only a temporary situation.

19. We, as parents, do not usually ask our adolescents, “What is the level of your self-esteem.” It’s typically not dinner conversation. However, if we are paying attention, we can notice when their self-esteem level is drifting, or plummeting, downward. Adolescents will often reference themselves as stupid, fat, ugly, or incompetent. These are glaring red flags that are screaming out “my self-esteem is low!” There are less obvious signs such as commenting how “it doesn’t matter anyway,” when referencing themselves or their thoughts or feelings, or noting that “it’s not like it makes a difference” when noting the affect their behavior has on the world.

20. When dealing with an Aspie’s self-esteem, it is important to be sincere when dishing out the compliments and the positive reinforcement. If your adolescent gets the feeling that you are just trying to make them feel better, your efforts will be in vain.

21. When your adolescents struggles with issues (e.g., poor grades, social awkwardness, loss of friends during transition, adjustment to change, etc.), they often question themselves and their self-worth. Being adolescents, they tend to be more observant of the comments that people are making, and they use these comment to determine their worth in the world. Of course they are naturally looking for specific things to be said, and instead of asking the question, they hope to have these answers provided for them. Without direct communication, Aspergers adolescents often misinterpret the communication around them.

22. While hormonal functions do play a role in an adolescent’s emotions, it’s not really helpful to simply chalk it up to puberty and the onset of strong hormones. Their emotions are legitimate and real, and teaching them to ignore it will only compound the problem. It is reasonable that the intensity of their emotions may be triggered by hormonal issues, but certainly not the only cause.

23. Work with your Aspergers adolescent to identify the reasons for any feelings of low self-worth. Is it because he has a negative self-image? Is it because he is not excelling at school or sports? Is he feeling excluded from peer groups?

24. You and your adolescent need to recognize the reality of each situation. You both need to be realistic and identify which areas can and cannot be changed. For example, if your adolescent is upset because he’s too short to play basketball, assess the situation carefully. Does he have other skills that could be improved on to allow him to be competitive in basketball, or should he be encouraged to change his passion to a different sport or maybe something entirely different where he would have a better chance of excelling.

25. Involve your teenager in an activity that he enjoys – but that also involves other people. For example, if he spends a lot of time - alone - playing video games, encourage him to invite a couple friends over who also enjoy playing these games. If he enjoys World War II history, see if there is a history club at school that he could join.

A message to your Aspergers teen:

1. Can you help others feel good about themselves? Yes. Don't put others down. Be patient with your friends and family when they fall short. We all make mistakes from time to time.

2. Does self-esteem guarantee success …success on tests …success playing sports …success with friends? No, but if you keep trying and doing your best, you are a success. Remember, having positive self-esteem will help you to achieve what you want. But when you don't succeed, it helps to accept the situation and move on.

3. Does self-esteem mean being self-centered or stuck-up? No. Teens who act this way usually are trying to pretend they are something they are not. In fact, they often have low self-esteem.

4. How do you get high self-esteem? Be honest with yourself. Figure out your strengths and weaknesses. Don't beat yourself up over your weaknesses. Don't compare yourself to others. It's hard at times, but accept yourself. Celebrate your achievements, set realistic goals for yourself, take it one day at a time, and do your best each day. Also, trust your own feelings, and try to get the most out of your strengths and do your best, without demanding unrealistic results of yourself.

5. Is it easy to change your self-esteem? No. It means taking some time to understand who you are -- what you like, don't like, feel comfortable with and what goals you have. This takes time and hard work. It's a lifelong process, but it's worth the effort!

6. Why is self-esteem important? As an adolescent, you now have more responsibility to choose between right and wrong. Your parents are no longer constantly by your side. Positive self-esteem gives you the courage to be your own person, believe in your own values, and make the right decision when the pressure is on.

7. Your friends can put a lot of pressure on you. You want to be part of a crowd. The crowd may be the "cool" crowd, the "jock" crowd, the "computer" crowd or the "brainy" crowd. Belonging to a crowd is a part of growing up – it helps you learn to be a friend and learn about the world around you. It's okay to want to be liked by others – but not when it means giving in to pressure. Your friends are now making many of their own decisions. And their decisions may or may not be good for you. It's never worth doing things that could hurt you or someone else. For instance, drinking alcohol or using other drugs, having sex before you are ready, joining a gang or quitting school can all lead to trouble.

Discipline for Defiant Aspergers Teens

Helping Your Child Deal with Stress

Aspergers kids and teens tend to experience more anxiety and stress relative to neurotypical children. Issues like school and social life can sometimes create pressures that can feel overwhelming for these children. As a mother or father, you can't protect your Aspergers child from stress — but you can help him develop healthy ways to cope with stress and solve everyday problems.

Here are some important parenting techniques to help your Aspie deal with stress:

1. Be patient. As a mother or father, it hurts to see your Aspie unhappy or stressed. But try to resist the urge to fix every problem. Instead, focus on helping him grow into a good problem-solver. A kid who knows how to roll with life's ups and downs, put feelings into words, calm down when needed, and bounce back to try again, is a child who will be happy and healthy through the adolescent years and on into adulthood.

2. Comment briefly on the feelings you think your Aspie was experiencing. For example, you might say "That must have been upsetting," "No wonder you felt mad when they wouldn't let you in the game," or "That must have seemed unfair to you." Doing this shows that you understand what he felt, why, and that you care. Feeling understood and listened to will help your son or daughter feel supported by you, and that is especially important in times of stress.

3. Having “pizza night” (or your child’s favorite food) to discuss the week’s trials and tribulations can be therapeutic for some stressed-out kids.

4. Help your Aspie think of things to do. If there's a specific problem that's causing stress, talk together about what to do. Encourage your youngster to think of a couple of ideas. You can get the brainstorm started if necessary, but don't do all the work. Your youngster's active participation will build confidence. Support the good ideas and add to them as needed. Ask, "How do you think this will work?"

5. Just be there. Aspergers children don't always feel like talking about what's bothering them. Sometimes that's OK. Let your child know you'll be there when he does feel like talking. Even when children don't want to talk, they usually don't want moms and dads to leave them alone. You can help your youngster feel better just by being there — keeping him company, spending time together. So if you notice that your youngster seems to be down in the dumps, stressed, or having a bad day — but doesn't feel like talking — initiate something you can do together (e.g., take a walk, watch a movie, shoot some hoops, bake some cookies, etc.). Your presence really counts!

6. Limit stress where possible. If certain situations are causing stress, see if there are ways to change things. For instance, if too many after-school activities consistently cause homework stress, it might be necessary to limit activities to leave time and energy for homework.

7. Listen and move on. Sometimes talking and listening and feeling understood is all that's needed to help an Aspergers youngster's frustrations begin to melt away. Afterwards, try changing the subject and moving on to something more positive and relaxing. Help your youngster think of something to do to feel better. Don't give the problem more attention than it deserves.

8. Listen to your youngster. Ask him to tell you what's wrong. Listen attentively and calmly — with interest, patience, openness, and caring. Avoid any urge to judge, blame, lecture, or say what you think he should have done instead. The idea is to let your youngster's concerns (and feelings) be heard. Try to get the whole story by asking questions like "And then what happened?" Take your time. And let your son or daughter take his or her time, too.

9. Notice out loud. Tell your Aspie when you notice that something's bothering her. If you can, name the feeling you think she is experiencing (e.g., "It seems like you're still mad about what happened at the playground."). This shouldn't sound like an accusation (e.g., "OK, what happened now? Are you still mad about that?"), or put the youngster on the spot. It's just a casual observation that you're interested in hearing more about her concern. Be sympathetic and show you care and want to understand.

10. Put a label on it. Most Aspergers children do not have words for their feelings. If your youngster seems angry or frustrated, use those words to help him learn to identify the emotions by name. Putting feelings into words helps these children communicate and develop emotional awareness — the ability to recognize their own emotional states. Aspies who can do so are less likely to reach the behavioral boiling point where strong emotions get demonstrated through behaviors rather than communicated with words.

Moms and dads can't solve every problem as their child goes through life. But by teaching healthy coping strategies, you'll prepare him or her to manage the stresses that come in the future.

The Aspergers Comprehensive Handbook

Revealing Your Child's Diagnosis To Extended Family

Disclosing your youngster's “Aspergers diagnosis” to other family members (e.g., grandparents, aunts and uncles, cousins, etc.) is a sensitive issue. Divulging this information should occur in partnership with your Aspie in order to determine how much - or how little – extended family members need to know. In weighing your decision, ask yourself the following:

• Can other family members be trusted to honor this disclosure?
• Can they treat the subject with sensitivity and respect?
• Can I foresee their reactions?
• How often do I see these relatives?
• If there's potential for misunderstanding and conflict, how will I handle it?
• If they are intrigued and interested, how will I handle that without breaching my youngster's trust about disclosure (i.e., sharing more than what we agreed on)?
• If I see them infrequently (e.g., only once or twice a year), is it important to say anything?

In the end, the pros of disclosure may outweigh the cons, but you and your youngster may decide that it's simply no one's business. Many Aspergers kids can skillfully “pass” and “blend in” for the duration of a day with extended family such that any differences may go completely unnoticed given all the other distractions.

If you decide it’s appropriate to share information about your youngster's diagnosis, you will want to be prepared to deal with the potential for other family members to show their ignorance (they may simply need to be educated about the condition), overcompensation, or discomfort. You will need to consider how best to control any situations that arise from over-reactions should they express concern about the entire family being stigmatized by the diagnosis. For example, they may:

• become increasingly distant due to their own issues in processing the information (e.g., they may only want to spend time with your other kids)
• confuse Aspergers with severe Autism or some other diagnosis
• exclude you and your youngster from future family get-togethers
• express excessive and unreasonable concern (e.g., they may think that Aspergers is life threatening, contagious, etc.)
• focus on a cure or a “quick fix”
• offer assurances and support
• be overly cautious (e.g., trying not to do or say the wrong thing)

So, be prepared for the full range of reactions from extended family.

Additional tips:

1. Agree on how long you will attend family gatherings – and stick to it!
2. Be certain to locate an area where your Aspie can retreat, undisturbed by others, to recuperate during much-needed “downtime.” Show your Aspie where this “safe place” is, and assure him that he may use it at will.
3. Check with your family members in advance to find out what materials your Aspie may access with their permission.
4. Ensure that your Aspie has some materials related to his special interest (e.g., iPod, iPad) to quietly indulge in if he feels overwhelmed.
5. Make sure your Aspie knows where books, TV or videos, crayons, pen or paper, and Internet access can be found for solitary downtime activities.
6. To help your Aspie in surviving a day or more with extended family, you will want to arm him with self-advocacy and coping skills prior to attending family get-togethers.

Sharing information about your youngster’s disorder with neighbors, acquaintances, or total strangers in your community is no different than the process of determining when, where, and how to share the same information with extended family. Weigh carefully the pros and cons that may come from disclosing this information. Ideally, your Aspie should be encouraged to be his own advocate as early as possible in order to decide how much or how little to tell others about his condition (if it's even necessary at all).

The Aspergers Comprehensive Handbook

How will your other children be affected by your Aspergers child?

An estimated seven million "typically developing" American kids have siblings with some type of “disorder” (e.g., ADHD, Autism Spectrum Disorders, depression, anxiety, etc.). These kids face many of the same challenges — and joys — as their moms and dads, but they also face other problems. Some resent the extra demands placed on them at an early age by the affected sibling, and many feel neglected by their often overburdened parents.

Some kids say they fear "catching" their sibling's disorder. Others may wish that they, too, had a disorder so that they could get all the attention their sibling does. And many suffer embarrassment about their sibling's inappropriate behavior or abnormal appearance, and then feel guilty about it.

On the other hand, some siblings welcome the early maturity and responsibility that come with having an Aspergers sibling. They are often well versed in the details of their sibling's behavioral traits and quirks, and they take pride in being able to explain them in sophisticated ways.

So, exactly how will your other children be affected by your Aspergers child? 

That depends on how you, the parent, deal with this challenge. Your neurotypical (i.e., non-Aspergers) kids will take their cues from you and your husband/wife. The attitudes and actions you model will be reflected in them. They will not only project the values about their Aspergers sibling's differences within the family, they will demonstrate these beliefs in school, the community, and the world at large. Thus, parents need to work toward setting a positive tone when first presenting their youngster's Aspergers condition to his siblings. It not only influences the quality of your immediate family relationships, but it also affects the ways in which all your kids perceive all people with differences for the rest of their lives.

When you introduce the topic of Aspergers to your Aspie’s siblings, consider these points:

1. Allow for process time and questions.

2. Begin by highlighting the ways in which individuals are more alike than different.

3. Decide if it's best to share the information with each sibling in privacy or if it should be done with the family as a group.

4. Discuss the gifts and talents of your other kids first and then discuss those of your Aspie.

5. Discuss the ways in which the entire family is going to strive toward being more sensitive to the needs of your Aspie — needs previously unacknowledged or unrecognized.

6. Don't play the pity card — you want your children to be children and to maintain their typical relationships as siblings, not walk on eggshells.

7. Don't put unfair or unrealistic expectations on your Aspie’s siblings about increased responsibilities or the burden of future caretaking.

8. Emphasize Aspergers as a natural experience, and dispel fears about it being a contagious disease or something that can suddenly happen to just anyone.

9. Partner with your Aspie about the issue of disclosure to agree on how much or how little to reveal.

10. Talk about respecting your Aspie’s ownership of confidentiality, discretion, and disclosure.

11. Wherever possible, try to engage all your kids in any activities that can include them all. Are there games and routines that your entire family can engage in? This will work toward family bonding, patience and tolerance – and it will make learning fun for your Aspie.

12. The more you treat your Aspie’s way of being as “natural” and “no big deal,” the more his siblings will automatically pitch in, help out, and pick up the slack without thinking or complaining beyond typical sibling rivalry.

There will be occasions when your Aspie’s siblings require some strong parental support when they are unable to manage internal and/or external pressures.  

Some pitfalls to be mindful of in observing your Aspie’s siblings may include coping with:

• Becoming weary and worn out from constantly defending their Aspergers sibling
• Being ostracized by their friends who don't want to hang around them or come over to your house because of the Aspie
• Feeling guilty when they want to go places and do things alone
• Feeling perpetually pressured to “parent” or protect their Aspergers brother/sister
• Feeling pressured by peers to reject their Aspergers brother/sister
• Mental health issues due to the stress associated with having an Aspergers sibling, especially in older daughters who may develop depression or an eating disorder
• Perceived embarrassment caused by their Aspergers sibling's behavior, especially in public

If you recognize problems in any of these areas, it will be important to have a private "family meeting" with your Aspie’s siblings to offer your love, praise and reassurances. Are there ways that you can compensate in partnership with your neurotypical kids, especially if they've been feeling left out? Be willing to admit it's true if you have unintentionally been neglectful, and plan some quality time with your Aspie’s siblings apart from the rest of the family.

The Aspergers Comprehensive Handbook

Aspergers Children and Social Impairment

Question

I’m a family therapist who is in the beginning stages of learning how to counsel Aspergers clients, specifically children between the ages of 5 and 12. What is the main thing I need to look for in working with these children.


Answer

One main issue that comes up routinely in therapy for Aspergers children and teens is "social skills deficits." There are three broad categories into which we can classify social deficits:

1. Social awkwardness -- Socially awkward Aspergers kids are typically higher functioning children who may try very hard to gain and keep friends, but are hindered due to:

• focusing on their favorite topic or topics to the exclusion of most everything else
• an inability to learn social skills and taboos by observing others
• a lack of reciprocity in conversation and interest

2. Social avoidance -- Children who would fall into the category of socially avoidant might be those who tantrum, shy away from, or attempt to escape from social situations. Often, children that are this avoidant of social situations are doing so because they have some hypersensitivity to certain sensory stimuli. Consequently, those sensory needs must be addressed prior to attempts at teaching social skills. A kid who is constantly overwhelmed by his environment is likely not going to be successful in many interventions.

3. Social indifference -- Social indifference is the social impairment common to the majority of Aspergers kids. Kids who are socially indifferent are those who do not actively seek social interaction, but at the same time, do not aggressively avoid such interaction.

So, in addressing social skills deficits, it is helpful to know the child's social style (i.e., awkwardness, avoidance, indifference).

The Aspergers Comprehensive Handbook

When Aspergers Runs In The Family

Aspergers is often an invisible disability. Because it is so subtle, it can go undetected. It is very likely that there many adults with Aspergers living and working in your community who are undiagnosed.

It is hypothesized that certain types of individuals with “Aspergers-like” traits (e.g., smart, but antisocial) attract one another, leading to such couples having kids with the same traits – but magnified due to an overload of genes. It is estimated that Aspergers correlates with a genetic component more apparent than even autism. About 33% of fathers of kids with Aspergers show signs of Aspergers themselves – and there appear to be maternal connections as well. This information increases the likelihood that Aspergers may be present in your own family. Think about your youngster's lineage. Are there - or were there - brilliant and creative, but blatantly eccentric, family members?

Depending on your personality and the strength of your coping skills, this may be either a relieving or a disturbing revelation to ponder. If the diagnosis is received with a negative outlook, you may slip into a period of guilt or self-condemnation. You may even find yourself unjustly bearing the brunt of blame induced by your partner. Moms and dads of Aspergers kids do tend to reflect more stress tied to anxiety and depression when compared with moms and dads of neurotypical kids. But never forget that Aspergers is a naturally occurring phenomenon – and it is no one's fault. So, avoid believing pessimistic, self-defeating “Aspergers stereotypes” in favor of focusing on the positives associated with this challenge.

One father reported that learning of his son’s diagnosis was “liberating,” because it wasn't until then that he realized he, too, had Aspergers. He defined the experience as “reaching the end of a race to be normal.” At long last, he came to a point of acceptance, and was now in a position to voice his “quirks” using the framework of Aspergers. This father’s journey was challenging, but fortunately, his wife was very supportive throughout. However, not all families deal the experience of uncovering Aspergers in themselves as well as this.

There are married couples that simply don’t do well under real (or perceived) pressures of raising a youngster with a different way of being. Families of kids with Aspergers are no exception. Educate and inform yourself - and your husband or wife - early on. Connecting with other moms and dads in similar situations can help cast out destructive, stigmatizing myths and stereotypes.

If your child has been diagnosed with Aspergers, and you suspect that you or your partner also has Aspergers, consider the following suggestions:

1. Arm yourself with knowledge and gather as much information as you can from the Internet or the resources.
2. Avoid the “blame game” (e.g., “It's your fault our son is this way.”).
3. Avoid the “guilt game” (e.g., “It must be my fault.”).
4. Because you are both still assimilating your youngster's experience, allow yourself and your partner time to process this new twist on the situation.
5. Broach the subject with your partner by asking leading questions that will provide opportunity for reflection (e.g., “Do you think our son gets his love of history from your side of the family or mine?”).
6. Discuss marriage counseling or other professional supports with your partner.
7. Offer to research Aspergers with your partner or to provide your partner with whatever literature you've already gathered.
8. The conversations you have about Aspergers in the family should build slowly and incrementally.

Understanding Aspergers as a probability for you and your partner will be a learning experience for the both of you. It can create marital stress and chaos, or it can be an opportunity to strengthen and enhance your relationship. It’s your choice!

Living With Aspergers: Help for Couples

Pet Therapy for Aspergers Kids

Man’s best friend can truly be your Aspie’s best friend, according to some studies on the interaction between pets and Aspergers kids.

Many moms and dads are surprised to see the connection between their youngster and pets. You might see it happening spontaneously — just when you are wondering how to help improve your child’s communication and social skills, you notice that he acts playful, happier, and more focused when around a friend's pet. Or perhaps you have heard about the profound impact pets can have on some Aspergers kids from another parent. Whatever prompts you, it may be time to introduce your Aspie to the world of pets.

Being around household pets or having structured contact with pets can be a great addition to treatment for kids with Aspergers. There are many reports from both parents and clinicians that interacting with pets, formally called animal-assisted therapy, can offer both physical and emotional benefits to these kids.

Animal-assisted therapy can be as simple as bringing a family pet into the household - or as structured as programs that offer horseback riding or swimming with dolphins. Interaction with pets can help Aspergers kids become more physically developed and improve their strength, coordination, and physical abilities. More importantly, many of these children derive much joy from their relationship with pets, which can help them have a better sense of well-being and more self-confidence. Pets can relate to Aspergers kids – and Aspergers kids (who have a hard time relating to peers) can really relate to pets.

While more research is still needed to determine the effects and confirm the benefits of animal-assisted therapy specifically for kids on the spectrum, a number of studies have suggested it can help. In the 1970s, researchers began studying how interactions with dolphins affected kids with Autism Spectrum Disorders (ASD). They found that being around dolphins increased the children’s attention, enhanced their thinking, helped them learn faster – and retain information longer.

More recently, one study looked at the effects of ASD children interacting with dogs. For this particular study, kids were exposed to a ball, a stuffed dog, or a live dog under the supervision of a therapist. The kids who played with the live dog were in a better mood and more aware of their surroundings than the kids who were exposed to the ball or stuffed dog.

If you are interested in animal-assisted therapy for your Aspie, talk with your child’s doctor. There may be horseback-riding, dolphin-therapy, or other animal-therapy programs in your area that the doctor could refer you to.

If you are ready to make the commitment of bringing a pet into your home, you may want to consider a service dog that has been specially trained to work with ASD kids. These dogs can be wonderful additions to families and can even accompany kids when they are away from home (e.g., school), helping to keep them calm and comforted.

Pets quickly become a treasured member of the family, offering love and companionship. And for the family that includes an Aspergers boy or girl, the rewards can be even greater.

The Aspergers Comprehensive Handbook

Aspergers Children and Sibling Aggression

Question

My son is an 8 yr old fraternal twin. He was diagnosed with ADHD and generalized anxiety disorder in the summer of 2010 and was diagnosed with Aspergers in the summer of 2011. He is the oldest of 5 boys ranging from 8 to 14 months. My question is: How do I keep him from physically attacking the baby when he gets frustrated? This has only been happening physically since school started back in September, but verbally has always said he hates the baby, wants the baby to die, etc. since he was born in July of 2010. I know it has to do with him feeling he's not getting the attention he wants, but with 5 kids, the youngest being of an age that is very demanding, I don't always get to focus on the 8-yrear-old as much as he would like.

Answer

Parents of a large family (i.e., 3 or more children) have to deal with personality clashes, attention tactics, and multiple mini-battles, and eventually come to realize that sibling rivalry is one of the inevitable annoyances of having kids. Moms and dads must learn that the degree of sibling rivalry, and whether or not it has long-term positive or negative consequences, depends on what they do about it. Here are several ways that you can help your older child be friends with the younger ones:

1. If possible, start most days with "special time" with your oldest child. Often times, starting the day with 15 minutes of “special time” can ward off angry feelings in the child toward the new baby – and it is a good investment for the rest of the day.

2. When your older child says things like, “I hate the baby!” …always come back with the comment, “The baby loves you – and he looks up to you because you’re his BIG brother” (emphasis on “big”).

3. Promoting sibling harmony requires a bit of parental marketing. You may think that your older youngster should be thrilled to have gained a live-in friend, but kids are often preoccupied with what they've lost. They're not so keen on sharing their toys, their room, and most importantly, their mom and dad with someone else. Turn this around to help the normally egocentric youngster to imagine, "what's in it for me?" Use the term "special time" (you'll get a lot of marketing mileage out of the word "special"). The attention your older youngster apparently has lost from mom, he gains from dad. Arrange a lot of one-on-one outings for your older youngster (e.g., time at the park), so the youngster realizes that even though he's lost some time with mom, he's gets more special time with dad, grandparents, or other caregivers.

4. What bothers your older child the most is sharing you with the new baby. Since the concept of sharing is foreign to the child (as mom is his most important "possession"), it's unlikely that you'll be able to sell him on the concept of “sharing mother.” It sounds good to say that you'll give your older youngster equal amounts of your time, but in practice that's sometimes unrealistic. New babies require a lot of maintenance, and you don't have 200 percent of yourself to give. So what can you do? Wear your infant in a baby sling, which will give you two free hands to play a game with the older one. While feeding baby, you can read a book to the older sibling. Spending a lot of time sitting on the floor increases your availability to your child while your baby is in-arms or at-breast. As baby gets older, place him in an infant seat, or on a blanket on the floor to watch you play one-on-one with his big brother. This entertains two children with one parent.

5. While kids are created equally, it's impossible to treat them that way all the time. In their desire to prevent sibling squabbles, moms and dads strive to do everything the same way for all their kids, whether it's buying pajamas or selecting a college. Kids aren't the same; you don't need to behave as if they are. Make moment-by-moment decisions, and don't worry about the long-term consequences if you give one youngster more strokes than the other on any particular day.

6. In the future, as much as you can, try to divide chores equally among kids according to their ages and capabilities, yet don't beat yourself up trying to be 100 percent fair. You can't be. Remember, you are preparing your kids for life, and life does not treat people fairly and equally.

7. It's unrealistic for moms and dads to claim they never play favorites. Some parents and some kids have personalities that clash – others mesh. Some kids bring out the best in their parents – others push the wrong buttons. The key is to not let your kids perceive this as favoritism. Better yet, make them all feel special. If your youngster asks you a question, "Who do you love more – me or Johnny?" …give the politically correct answer: "I love you both in special ways."

8. Children are so caught up in their own emotions that they don't hear what you're saying. Show that you understand what your oldest child is going through by echoing his feelings (e.g., "Bobby, you feel like Jimmy is getting too much attention and that I love him more than you. But that’s not true. I love all my children equally.”).

9. Just for future reference (in case you have another child), get your older youngster acquainted with the new baby before birth. Show him pictures of a baby growing in mommy's belly. Let him pat the baby beneath the bulge, talk to baby, and feel baby kick. Replay the older youngster's babyhood. Sit down with your youngster and page through his baby photo album. Show him what he looked like right after birth, coming home from the hospital, nursing, and having his diaper changed. By replaying the older youngster's baby events, he will be prepared for a replay of his new brother or sister.

10. Make the older sibling feel important. Savvy visitors to your home (who themselves have survived sibling rivalry) may bring along a gift for the older youngster when visiting the new baby. In case this doesn't happen, keep a few small gifts in reserve for the older child when friends lavish presents and attention on the new baby. Let him be the one to unwrap the baby gifts and test the rattles. Give him a job in the family organization.

11. As the children grow up, minimize comparisons. This is also the basis for feelings of inferiority, which encourages undesirable behavior among siblings. Praise your older youngster for accomplishments in relation to himself and not in comparison to a sibling. Each youngster can feel he is special in the eyes of his parents. Kids are constantly being compared. Most of their life they will be rated on their performance (e.g., grades in school, batting order on the baseball team, races, games among themselves, etc.). The home is the only organization left that values a youngster for himself and not in comparison with others. So, avoid comments like, "Why can't you behave like your brother?"

12. “Disciplining” siblings is not “punishment,” rather it is giving them the tools to succeed in life, and one of the most important tools that will have life-long social implications is the quality of empathy. Help your kids learn how to get behind the eyes of another person and think first how their behavior is going to affect that other person. You want your kids to think through what they're about to do. A lack of empathy is the hallmark of sociopathic relationships between adult siblings.

13. It's hard to hate - and hit - a person you care about and who cares about you. Siblings are not born adversaries, certainly not unless moms and dads permit it. You can nurture patterns of life-long friendship among your kids by helping them find constructive ways to be sensitive to each other. Learning to live with a sibling is a youngster's first lesson in getting along with other kids. Your job is not to control how siblings relate, but rather to shape these relationships.

14. When to step in as a referee and when to remain a bystander is a round-by-round judgment call. Sometimes “letting kids be kids” or giving them reminders is all that is necessary. One parent’s immediate fight-stopper was, "You're disturbing my peace." This worked because she had already planted the idea that, in crowds, one respects the peace of others.

15. Sometimes you're too tired to play amateur psychologist and you just want to switch into “police mode.” Do it and don't worry about permanently damaging your youngster's psyche. Give clear messages about how you expect your children to behave toward one another before arguments become a way of life. Offer calm verbal reminders (e.g., "that's a put-down") as one sibling belittles the other, or issue a look that says "don't even think about it!" Head off fights at the first squabble, before they get out of hand.

16. Be watchful for aggressor-victim roles. Your job is to protect your kids, even from one another. How siblings behave toward one another is their first social lesson in how to behave in a group. In your family, set certain "maximum allowable limits," which are behaviors that you insist upon – and the kids are taught to respect these.

17. When one of the younger siblings gets hurt, ask the older one to help attend to the injury. Even give him a job title (e.g., "Dr. Billy, you hold Michael’s leg while I wrap it" …or "Please be my assistant and help me put the bandage on Johnny's cut"). The "doctor" will most likely muster up compassion for the "patient."

18. If your older child is a born clown, capitalize on that asset and encourage the clown to entertain the baby, such as the older youngster humoring the baby while you get ready for work.

19. When the kids get a little older (which will happen sooner than you think), encourage your oldest youngster to teach a skill he is proficient in to his siblings (e.g., get your older son, who may be an avid baseball player, to show his younger brother how to hit and catch a ball).

20. Since your kids are several years apart, give the older youngster some supervised responsibility for the younger ones. This will motivate the older brother to care, and the younger sibling will sense this.

21. Sometime during middle childhood (ages 5 through 10), impress upon your kids what "brother" really means. Kids sense that "blood is thicker than water." Brothers are a sort of live-in support system. Here's the message to give your kids: "Your brothers will ultimately be your best friends. Once your other friends have moved or drifted away, your family friends will always be there when you need them. Friends come and go, but siblings are forever."

22. Try sleeping together occasionally. Kids who sleep together at night usually play more peacefully together during the day.

My Aspergers Child: Preventing Meltdowns and Tantrums