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Showing posts sorted by relevance for query school behavior. Sort by date Show all posts

Aspergers Children and School Refusal

Question

My 14yr old boy dropped out of school 2 years ago. Our present psychologist is very dismissive of his diagnosis although 2 psychiatrists have diagnosed him as having Asperger's complicated by separation anxiety and severe generalised anxiety disorder. I think his refusal to go to school stem from his Asperger's and his disposition to anxiety but our psychologist is saying that it's pure defiance. I am so afraid that he will end up in a wrong residential setting that is not equipped to deal with his autism if we cannot get the HSE to see that it's not just behavioural. He was on Prozac and Seroquil to help with behavioural problems and I wonder should he go back on Prozac while trying to return to school?

He was placed in a residential school last year but unfortunately it was a bad placement and he had to be removed. He is high functioning with above average intelligence and they placed him (against my wishes) in a school for children with severe learning difficulties. I am so afraid that they are not listening to me again and I hope someone might have some suggestions or guidelines for me. I have another meeting this week on Thursday but I am not very hopeful that it will bring about any beneficial change for us.

Answer

Case Example 1: Kayla, an eight-year-old Aspergers girl, has always had difficulty attending school. Since she began third grade two months ago, her problems have significantly worsened. She constantly begs to stay home from school, having tantrums that cause delay in dressing and often result in her missing the bus. After arriving at school, Kayla frequently complains of stomachaches, headaches and a sore throat to her teacher and asks to visit the school nurse with whom she pleads to call her mother. Her mother typically picks her up early twice a week. When Kayla gets home she spends the remainder of the afternoon watching TV and playing with her toys. When her mother is unable to pick her up early, Kayla calls her mother's cell phone periodically throughout the afternoon to "check in" and reassure herself that nothing bad has happened. Kayla's teacher has expressed concern about her missing so much class time which has resulted in incomplete assignments and difficulty learning.

Case Example 2: Jake is a fourteen-year-old Aspergers boy who has missed forty-three days of school since beginning the eighth grade four months ago. When home from school, Jake spends most of the day online or playing video games. On the days he does attend school he is typically late for his first period which enables him to avoid hanging out with other kids before class. He always goes to the library during lunch. When he does go to class, he sits in the back of the classroom, never raises his hand and has difficulty working on group projects. Jake' teachers have noticed that he is always absent on days that tests or book reports are scheduled. His parents have already punished him after his first report card came home since he received D's in Math and Social Studies and failed Gym for cutting. Jake' parents have started to wonder if they should change his school placement and have asked the school to arrange home tutoring while this alternative is explored.

Prevalence and defining characteristics—

As much as 28% of school aged kids in America refuse school at some point during their education.1 School refusal behavior is as common among boys as girls. While any youngster aged 5-17 may refuse to attend school, most youths who refuse are 10-13 years old. Peaks in school refusal behavior are also seen at times of transition such as 5-6 and 14-15 years as kids enter new schools. Although the problem is considerably more prevalent in some urban areas, it is seen equally across socioeconomic levels.

Kayla and Jake are just two examples of how school refusal manifests in Aspergers youth. The hallmark of this behavior is its heterogeneity. Defined as substantial, child-motivated refusal to attend school and/or difficulties remaining in class for an entire day, the term "school refusal behavior" replaces obsolete terms such as "truancy" or "school phobia," because such labels do not adequately or accurately represent all youths who have difficulty attending school. School refusal behavior is seen as a continuum that includes youths who always miss school as well as those who rarely miss school but attend under duress. Hence, school refusal behavior is identified in youths aged 5-17 years who:

1. are entirely absent from school
2. attend school initially but leave during the course of the school day
3. exhibit unusual distress during school days that leads to pleas for future absenteeism.
4. go to school following crying, clinging, tantrums or other intense behavior problems

As evidenced by Kayla and Jake, there are varying degrees of school refusal behavior. Initial school refusal behavior for a brief period may resolve without intervention. Substantial school refusal behavior occurs for a minimum of two weeks. Acute school refusal behavior involves cases lasting two weeks to one year, being a consistent problem for the majority of that time. Chronic school refusal behavior interferes with two or more academic years as this refers to cases lasting more than one calendar year. Youths who are absent from school as a result of chronic physical illness, school withdrawal which is motivated by moms and dads or societal conditions such as homelessness, or running away to avoid abuse should not be included in the above definition of school refusal behavior as these factors are not youngster-initiated.

While some school-refusers exhibit a more heterogeneous presentation, typically these youths can be categorized into two main types of troublesome behavior -- internalizing or externalizing problems. The most prevalent internalizing problems are generalized worrying ("the worry-wart"), social anxiety and isolation, depression, fatigue, and physical complaints (e.g. stomachaches, nausea, tremors and headaches). The most prevalent externalizing problems are tantrums (including crying and screaming), verbal and physical aggression, and oppositional behavior.

The cause and maintenance of school refusal behavior—

Kayla had several physiological symptoms at school and went home to be with her mother and play. Jake on the other hand, avoided potentially distressing social and evaluative situations at school which negatively impacted his academic performance. Although many behaviors characterize youths who refuse school, there are a few variables that serve to cause and maintain this problem. School refusal behavior occurs for one or more of the following reasons:

1. To avoid school-related objects or situations that cause general distress such as anxiety, depression or physiological symptoms
2. To escape uncomfortable peer interactions and/or academic performance situations such as test-taking or oral presentations
3. To pursue tangible reinforcement outside of school
4. To receive attention from significant others outside of school

The above four reasons for school refusal behavior can be explained by principles of reinforcement. Any one youngster can refuse school for one or more of these reasons. The first two reasons characterize youths who refuse school to avoid or escape something unpleasant (negative reinforcement). For example, one of the reasons for Kayla's crying in the morning is her fear of riding the school bus. By tantruming she accomplishes her goal of avoiding the school-related object (the school bus) that causes her distress. Another example of negative reinforcement is when Jake escapes aversive peer interactions and exams by school refusing. The third and fourth reasons characterize youths who refuse school to gain rewards (positive reinforcement). Kayla, as is common with many younger kids, tries to avoid school as a means of having her mother provide her with excessive attention and closeness. Thus, Kayla's behavior in this situation may be associated with separation anxiety.

Another instance of positive reinforcement is exemplified by Jake, who basically has more fun being at home on the computer and listening to music than being in school. It is important to note that alcohol and drug use can occur among adolescents who school refuse for one or more of the reasons listed above. For example, a teenager who is extremely socially anxious may drink alcohol as a way of enduring distressing social or evaluative situations. Another youngster who avoids school may smoke marijuana during school hours as a means of gaining acceptance by peers or simply because it is more enjoyable than attending school. While all forms of school refusal can be equally debilitating, typically, mental health professionals receive fewer referrals for youths who have internalizing as opposed to externalizing behavior problems. In other words, the youth who exhibits anxiety is less likely to receive treatment than the youth who is disruptive.

Home Schooling and Aspergers Children—

A common strategy in dealing with school refusal in Aspergers children is to switch to a home school environment. However, home schooling a child with Aspergers is completely different than educating a non-Aspergers child. Here is a summary plan:

• Child can only grow to be fully functioning if he first experiences a fully functional home life. Fighting, crying and meltdowns do not positively contribute to a functional home. Child functions best when conflict is removed so ALWAYS remove conflict and remain flexible.

• Meltdowns are worse for the child than they are for you. Remain calm and use the child's logic, obsessive compulsiveness and anger as a learning experience. Shutting your ears is tantamount to saying you know everything and are a superior person.

• Nobody can accuse you of being a bad mother. By designing education around the need of your child you are being the best mother you can be. Most people will be grateful that their children do not have Aspergers.

• Nobody can read your mind. Think abusive thoughts but NEVER say them because they will destroy the child's confidence and reinforce further unacceptable behavior and school refusal.

• Short term goals are not time specific. They can be revisited and strengthened at any stage. Know that the goals can be re-met if you do things differently.

• Teachable moments are everywhere. School does not have to represent that which we know as beneficial for us. School is everywhere and Aspergers learning occurs best without stress.

• What I value as important is not important to the child or his development. Allow him to explore that which he is highly interested in, even if it has no recognizable educational value to you.

• When you reign in and block outsiders from coming to your home and adding over stimulus, remember that it will only be for a short time while the child reaches emotional and social equilibrium again. Email and on-line Aspergers support groups produce no over stimulus to the child and are there 24 hours per day. Use them.

• Work through obsessions. On days when the child is focused on issues not included in the home school learning areas, it is acceptable to investigate the child's obsessions. These are teachable moments that will otherwise be lost.

• You are a team, a package, a caring parent. Team work means working together to get the best result. Work with the child, not against him.

• You can only recognize a bad day because you have first had good days to measure against. Things do improve. Hasten improvement by reducing conflict and grabbing whatever teachable moments you can.


Highly Acclaimed Parenting Programs Offered by Online Parent Support, LLC:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism

"Emotionally Fragile" Children with Asperger's & High-Functioning Autism

"Any tips for dealing with a very fragile and overly sensitive child on the autism spectrum ...he's a chronic worrier to say the least and will go back and forth between being extremely shy or very aggressive?"

As some parents may have discovered, many young people with Asperger’s (AS) and High Functioning Autism (HFA) are “emotionally fragile” (to coin a term). In other words, these individuals have great difficulty coping with day-to-day stressors, and exhibit unusually withdrawn or aggressive behaviors as a defense mechanism.

Emotional fragility is most prevalent in school-age AS and HFA kids. It can manifest itself in many ways, all of which are challenging for the youngster, parents, and teachers. These young people often exhibit a variety of symptoms that cause school psychologists to misdiagnose them with depression, bipolar disorder, or some other disorder. A wrong diagnosis can often lead to the youngster being placed in inappropriate special education classes, or even being treated with the wrong medication.



Traits of Emotional Fragility —

1. An emotionally fragile AS or HFA youngster may become socially anxious and withdrawn in public. When faced with risks or decisions, however trivial, he may become tense and fearful. He may have extremely poor self-esteem, and may seem to have a distorted sense of reality, usually preferring to live in his own fantasy world. These kids will often internalize their feelings and emotions, and have difficulty talking about them when asked. Occasionally they may act out and hurt others out of fear and a desire to be left alone.

2. Emotional fragility often causes AS and HFA kids to regress developmentally. They may behave as though they were much younger, even to the point of seeming overly dependent on others. As these kids become older, they may be at risk for substance abuse, although due to their lack of social skills, they may be less likely to use drugs in a peer-group context.

3. An AS or HFA child with emotional fragility usually has some degree of difficulty at school. A “typical” child will be able to follow a teacher's instructions independently, and will have no problem asking for help if needed. The emotionally fragile youngster will have difficulty carrying out these same age-appropriate instructions, and may be fearful of asking for help. This can create an inability to learn on the same level as other peers of the same age, which causes the youngster to view school as a source of misery and confusion. This often leads to poor grades and excessive absences.

4. Emotional fragility can have detrimental effects on a youngster's ability to make friends and interact with others. A “typical” youngster will be able to approach a group of his peers, converse, and join in their activities. The emotionally fragile youngster will be consistently rejected or ignored by these peers due to a lack of appropriate social skills, and may even be taunted or called names. This youngster may be viewed as immature or "weird" by his peer group.

Warning Signs—

Some of the most common warning signs of emotional fragility are a loss of interest in school, depression, social withdrawal, hyperactivity, sleep problems or fatigue. However, these are just a few of the most common warning signs. It is also important to keep in mind that just because a youngster has some of these behaviors doesn't necessarily mean that she is emotionally fragile. All kids experience these things at different points in their lives. Parents should only be concerned if their youngster is displaying any of the associated behaviors over a prolonged period of time.

The most difficult part of determining eligibility for special education services is deciding if the child is emotionally fragile, or has a behavior disorder (one can often look like the other).

Let’s draw a distinction between the two along the following domains:
  1. Affective Reactions— Emotional Fragility: disproportionate reactions, but not under child’s control. Behavior Disorder: intentional with features of anger and rage; explosive.
  2. Aggression— Emotional Fragility: hurts self and others as an end. Behavior Disorder: hurts others as a means to an end.
  3. Anxiety— Emotional Fragility: tense; fearful. Behavior Disorder: appears relaxed; cool.
  4. Attitude toward School— Emotional Fragility: school is a source of confusion or angst; does much better with structure. Behavior Disorder: dislikes school, except as a social outlet; rebels against rules and structure.
  5. Conscience— Emotional Fragility: remorseful; self-critical; overly serious. Behavior Disorder: little remorse; blaming; non-empathetic.
  6. Developmental Appropriateness— Emotional Fragility: immature; regressive. Behavior Disorder: age appropriate or above.
  7. Educational Performance— Emotional Fragility: uneven achievement; impaired by anxiety, depression, or emotions. Behavior Disorder: achievement influenced by truancy, negative attitude toward school, avoidance.
  8. Interpersonal Dynamics— Emotional Fragility: poor self-concept; overly dependent; anxious; fearful; mood swings; distorts reality. Behavior Disorder: inflated self-concept; independent; underdeveloped conscience; blames others; excessive bravado.
  9. Interpersonal Relations— Emotional Fragility: inability to establish or maintain relationships; withdrawn; social anxiety. Behavior Disorder: many relations within select peer group; manipulative; lack of honesty in relationships.
  10. Locus of Disorder— Emotional Fragility: affective disorder; internalizing. Behavior Disorder: conduct disorder, externalizing.
  11. Peer Relations and Friendships— Emotional Fragility: difficulty making friends; ignored or rejected. Behavior Disorder: accepted by a same delinquent or socio-cultural subgroup.
  12. Perceptions of Peers— Emotional Fragility: perceived as bizarre or odd; often ridiculed. Behavior Disorder: perceived as cool, tough, charismatic.
  13. Risk Taking— Emotional Fragility: avoids risks; resists making choices. Behavior Disorder: risk-taker; daredevil.
  14. School Attendance— Emotional Fragility: misses school due to emotional or psychosomatic issues. Behavior Disorder: misses school due to choice.
  15. School Behavior— Emotional Fragility: unable to comply with teacher requests; needy or has difficulty asking for help. Behavior Disorder: unwilling to comply with teacher requests; truancy; rejects help.
  16. Sense of Reality— Emotional Fragility: fantasy; naïve; gullible; thought disorders. Behavior Disorder: street-wise; manipulates facts and rules for own benefit.
  17. Social Skills— Emotional Fragility: poorly developed; immature; difficulty reading social cues; difficulty entering groups. Behavior Disorder: well developed; well attuned to social cues.
  18. Substance Abuse— Emotional Fragility: less likely; may use individually. Behavior Disorder: more likely; peer involvement.


Accommodations for Emotionally Fragile AS and HFA Children: Tips for Parents and Teachers—

1. AS and HFA kids with emotional fragility are often achieving academically below their “typical” peers in reading, writing, and arithmetic. Accommodation: early detection and intervention is the best strategy; set up personalized goals and strategies so that the youngster can find success.

2. Kids with emotional fragility may appear easily distracted, less attentive, and have poor concentration. Accommodation: by setting up an environment and materials that are stimulating, these kids can stay more engaged and interested; set clear rules and expectations with visual stimulating material.

3. Some young people with emotional fragility may be blame others, manipulate situations, and even bully others. Accommodation: use behavior contracts; use a highly structured environment; stay consistent in expectations; set limits and boundaries; develop a cue word for the youngster to note inappropriate behavior; clearly post rules.

4. AS and HFA kids who are emotionally fragile often have skewed views of their long term possibilities and desires. Accommodation: include these children in the planning process and IEP so they can visualize and voice their goals; it can also be helpful for them to note the goals it will take to get there.

5. Youngsters with emotional fragility may present extra challenges to parents in the form of outbursts and disobedience. Accommodation: parents should not give into this as it only validates the youngster’s behavior; instead parents need to challenge their child to keep him learning new skills.

6. Children with emotional fragility may have difficulty establishing a variety of relationships. Accommodation: use seating arrangement to encourage social interaction; use role-playing situations; set up goals aimed at social interactions.

7. Children with emotional fragility often have low self-esteem, high stress points, and may engage in self-injurious behaviors. Accommodation: be aware of your speech and non-verbal cues when talking to the child; establish a quiet cool off area; provide time for relaxation techniques; teach and put in place self-monitoring and self-control techniques; teach self-talk to relieve stress and anxiety.

8. AS and HFA children with emotional fragility are often truant from school and disruptive when present. Accommodation: communicate with moms and dads so similar strategies and expectations are used at home.




Additional Strategies to Assist Emotionally Fragile AS and HFA Children—

1. Create a new behavior to replace the behavior you want to change. If the AS/HFA youngster is aggressive toward others while working in a group, you may want him to take turns or talk in a quiet tone of voice while in a group. Remember to create an alternative behavior that is directly observable.

2. Establish rewards and/or consequences for behaviors. Overall, it's more effective to reward the positive behavior that you are trying to increase than to punish the behavior you are trying to decrease. If the behavior does not pose an immediate threat to you, the AS/HFA youngster or other kids, or does not disrupt the entire group lesson, try to ignore the disruptive behavior while rewarding the positive behavior.

3. Identify the behavior you want to change. Keep a written record of the behaviors the AS/HFA youngster exhibits during social and independent play and academic activity (e.g., "I want Julie to play without pushing other kids …or to remain quiet during a test …or to stay seated during a lesson"). Once you describe the youngster's behavior in terms of observable actions, you will be able to monitor and mediate the behavior.

4. Provide plenty of opportunities to practice new behaviors. AS and HFA children with emotional fragility usually have difficulty working with others whether they are aggressive or withdrawn. You will want to set up social situations where the youngster can practice taking turns in a group or with a partner, and sharing and talking appropriately.

5. Role-play and hold conflict-resolution meetings so the AS/HFA youngster can practice and discuss alternative responses to social situations.

6. Teach the youngster to monitor progress independently. Have charts in folders, in a locker, or at home where she can document progress in achieving a particular behavioral goal. Have her write or verbally explain why a certain behavior is unacceptable and what behavior she can do to change it.

Services—

Children with emotional fragility often have an early diagnosis among school districts. This is because educators initiate the referral process among concerns over behavior in class. Often, the DSM is used by a school psychologist, whom may conduct interviews and distribute surveys as part of the social-emotional evaluation.

When it is determined that the child is emotionally fragile, he should receive an Individualized Education Plan (IEP). Children can also receive specific behavioral plans such as a 504 in the state of California. This often includes goals towards appropriate behavior, productive coping strategies and academic skills. Effective services should focus on these, and can mandate an educational assistant for support in regular education classes, access to a resource room for individualized instruction, medication management provided by a mental health professional, as well as individual counseling.

Emotionally fragile children are often considered at-risk for dropping out of school, suicide, criminal activity, as well as being diagnosed with a learning disability. Nonetheless, with the appropriate supports in place, these young people have been shown to have enormous potential to succeed.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book


==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism

Anxiety-Based Absenteeism and School-Refusal in Kids on the Autism Spectrum

Some youngsters with ASD level 1, or High-Functioning Autism (HFA), experience fear or panic when they think about going to school in the morning. These kids may tell their moms and dads that they feel nauseous or have a headache, or may exaggerate minor physical complaints as an excuse not to go to school.

When the HFA youngster exhibits a developmentally inappropriate and excessive anxiety concerning separation from their home or from those to whom they are attached, they may be experiencing a Separation Anxiety Disorder. This disorder is characterized by the youngster exhibiting three or more of the following for a period of more than four weeks: 
  1. persistent and excessive worry about losing, or about possible harm befalling, major attachment figures
  2. persistent and excessive worry that a troublesome event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)
  3. persistent reluctance or refusal to go to school or elsewhere because of fear of separation
  4. persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home
  5. persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings
  6. recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated
  7. repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated
  8. repeated nightmares involving the theme of separation



In addition to the symptoms described above, HFA kids with an unreasonable fear of school may also:
  • display clinging behavior
  • fear being alone in the dark
  • feel unsafe staying in a room by themselves and frequently go check to find their parent or have a need to be able to see their parent (e.g., a child in a shopping mall who feels a lot of distress if he can't always see his parent may be exhibiting a symptom of separation anxiety)
  • have difficulty going to sleep
  • have exaggerated, unrealistic fears of animals, monsters, burglars, etc.
  • have nightmares about being separated from their parent(s)
  • have severe tantrums when forced to go to school

School-Refusal versus School-Refusal Behavior—

There is a significant difference between “school-refusal” and “school-refusal behavior.” The child who ditches school to hang out with his buddies is exhibiting school refusal behavior. Often, this is nothing more than a phase brought on by a sense of rebellion. On the other hand, the youngster who clings to his mom’s leg, screaming at the thought of having to enter the school building, is showing signs of school refusal (also called "anxiety-based absenteeism"). However, the label doesn't matter nearly as much as getting your youngster back in school. Working with school officials (and in serious cases, a therapist) to create a plan is a necessary step. 
 
==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

Is your child refusing to go to school due to real separation anxiety issues, or is he or she simply being defiant? Answers to the following questions may help to determine the motivation behind school-refusal or school-refusal behavior:
  • Are symptoms of school-refusal evident on weekends and holidays?
  • Are there any non-school situations where anxiety or attention-seeking behavior occurs?
  • Have recent or traumatic home or school events influenced your youngster’s school-refusal?
  • How did your youngster’s school-refusal develop over time?
  • Is your youngster willing to attend school if incentives are provided for attendance?
  • Is your youngster willing to attend school if you accompany him or her?
  • Is your youngster’s refusal to attend school legitimate or understandable in some way (e.g., due to a school-based threat, bullying, inadequate school environment, etc.)?
  • Is your youngster’s school-refusal relatively acute or chronic in nature? 
  • What are your youngster’s specific forms of absenteeism, and how do these forms change daily?
  • What comorbid conditions (e.g., anxiety, depression, sensory sensitivities, etc.) occur with your youngster’s school-refusal?
  • What family disruption or conflict has occurred as a result of your youngster’s school-refusal?
  • What is your youngster’s academic and social status? (This would include a review of academic records, formal evaluation reports, attendance records, and IEP or 504 plans.)
  • What is your youngster’s degree of anxiety or misbehavior upon entering school?
  • What specific problematic behaviors are present in the morning before school?
  • What specific school-related stimuli are provoking your youngster’s concern about going to school?
  • What specific social situations at school are avoided?
  • What specific tangible rewards does your youngster pursue outside of school that cause him or her to miss school?

One way of conceptualizing absenteeism involves reinforcers. For example:
  1. to pursue tangible reinforcers outside of school (e.g., sleeping late, watching television, playing with peers, engaging in delinquent behavior or substance use, etc.)
  2. to pursue attention from significant others (e.g., wanting to stay home or go to work with the parent)
  3. to escape aversive social situations (e.g., conversing or interacting with classmates, performing before others in class presentations, etc.)
  4. to avoid school-based stimuli that creates anxiety, frustration, or despondency (e.g., interactions with educators and/or classmates, bus, cafeteria, classroom, transitions between classes, etc.)

Issues 1 and 2 above are maintained by positive reinforcement, or a desire to pursue rewards outside of school. Issues 3 and 4 above are maintained by negative reinforcement or a desire to leave anxiety-provoking stimuli. HFA students may also refuse school for a combination of these reasons. In the case of one young female with Asperger’s, she was initially anxious about school in general. But, after her parents allowed her to stay home for a few days, she was refusing school to enjoy playing video games.

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

School-refusal Warning Signs—

While one student may complain of headaches or stomachaches, another may refuse to get out of bed, while a third repeatedly gets "sick" and calls home during the school day. Symptoms can run the gamut and may even include combinations of behaviors. Here are some typical warning signs that an HFA youngster is suffering from Separation Anxiety Disorder:
  • Anxiety or panic attacks
  • Depression
  • Drug/alcohol use
  • Failing grades
  • Fatigue
  • Frequent physical complaints (e.g., headaches, stomachaches, etc.)
  • Physical aggression or threats
  • Risk-taking behavior
  • Social problems

Many symptoms, particularly physical complaints, can mimic other disorders. When these occur in combination with a pattern of not attending school, a complete evaluation should be made by qualified professionals to determine whether the child has Separation Anxiety Disorder or another psychological or physical disorder.

Separation Anxiety Disorder can be exhausting and frustrating for moms and dads to deal with, but it is worse for the HFA youngster who feels such intense fear and discomfort about going to school. If parents are unable to get the youngster to school, he may develop serious educational, emotional, and social problems.

Because the anxiety is about separating from the parent (or attachment object), once the youngster gets to school, he usually calms down and can function. It's getting him there that is the real challenge.

School avoidance may serve different functions in different kids. For some, it may be the avoidance of specific fears or phobias triggered in the school setting (e.g., fear of school bathrooms due to contamination or other fears associated with Obsessive-Compulsive Disorder, fear of noisy and crowed hallways, fear of test-taking, etc.). For other kids, it may serve to help them avoid or escape negative social situations (e.g., being bullied by peers, being teased, having a critical teacher, etc.). 
 

When school-refusal is anxiety-related, allowing the HFA youngster to stay home only worsens the symptoms over time. Getting her back into school as quickly as possible is one of the factors that is associated with more positive outcomes. However, this requires a multimodal approach that involves the student's physician, a mental health professional, the mom and/or dad, the student, and school officials. The same therapeutic modalities that are effective with Panic Disorder and Obsessive-Compulsive Disorder are also effective for school-refusal, namely, “exposure-response prevention” (i.e., a form of cognitive-behavior therapy that may include relaxation training, cognitive alterations, and a graded hierarchy of steps towards the goal).

There is some research that suggests that education support therapy may be as effective as exposure therapy for treating school-refusal. Working with the school psychologist, the student talks about his fears and is educated in the differences between fear, anxiety, and phobias. He learns to recognize the physical symptoms that are associated with each of these states and is given information to help him overcome his fears about attending school. 
 
The student is usually asked to keep a daily diary where he records his fears, thoughts, strategies, and feelings about going to school. The time of day that he arrived at school is also recorded, and the record is reviewed each morning with a school psychologist. Although it may seem like a good idea to incorporate positive reinforcement for school attendance, that may backfire and simply increase the student's stress levels and anxiety.

Parent training in strategies to work with the HFA youngster in the home is also an important piece of any school-based plan to deal with the student with school-refusal.




When it comes to school-refusal and school-refusal behavior, accommodating the HFA youngster by letting her stay home is generally contraindicated (unless there are other issues). So, what can moms and dads do to address this dilemma? Here are some tips:

1. Try to find ways to empower the HFA youngster to go to school. For example, a youngster is likely to feel reassured if times are set for him or her to call the mother from school. In extreme cases, mothers may stay with the youngster in school, but for a specified length of time (which is gradually reduced).

2. Punishment does not work. Kind, consistent, rational pressure and encouragement do.

3. Investigate what's going on at school. If it's bullying, parents need to find out who the perpetrator is. Once they know whether their youngster’s complaint is a valid one, it's easier to work with him around the issue, both in and outside of school.

4. It is most important to tell the HFA youngster exactly what she is to expect. There should be no "tricks" or surprises. For example, if the youngster is told that she should try to stay in school for only one hour, but after the hour, she is asked to stay longer either by the teacher or parent, this WILL backfire! The youngster will eventually refuse future arrangements for fear that they will be modified arbitrarily. Part of being anxious is anxiety about the unknown and the “what if?”
 

5. Prevent “secondary gain.” Some parents frequently – yet unintentionally – reinforce separation anxiety symptoms in their HFA child. For instance, when parents get a divorce and the youngster expresses refusal to leave the custodial parent (who may be distraught or saddened by the divorce), the youngster may not be firmly encouraged to appropriately separate and instead is rewarded either overtly or covertly for refusal to separate (e.g., when the youngster who refuses to attend school is excused by the parent). In this case, the parent does not clearly give the youngster the task of developing strategies to adapt to the divorce.

6. Do not quiz your child about why he feels scared. The youngster often does not know why. By not being able to provide an explanation, in addition to being anxious, he may feel guilty about not making sense of what is happening. It’s better to acknowledge that the fears are inflated (e.g., a child’s fear that the parent may die while he is at school) and that the youngster has to fight them.

7. Coordinate with school officials. Parents shouldn’t try to address this situation alone. Whether it's arranging to have someone meet you on the playground to escort your youngster into school, or trying to ease the amount of makeup work due to missed school days, it's critical that the school plays a role in integrating your youngster into the classroom.

8. Do not deny or minimize your youngster's anxiety or worries. Instead, acknowledge them and reassure her (e.g., "I know you're worried that I won't be there to pick you up, but there's no reason to worry. I'll be there.").

9. Set a baseline expectation. Having your youngster in school for any amount of time is better than having her at home. Even though your youngster may only come to school for a couple hours or sit in the library all day, it is much easier to get her back into the regular classroom from that point.

10. Be open to hearing about how your youngster feels. However, lengthy discussions about his problems are not always helpful and can be experienced as a burden by the youngster. The focus must always be that you want to help him be free of worries and fears.

11. Make it less inviting to stay home. If your youngster knows she can sit at home and watch TV during the school day, the incentive to stay home is greater than the incentive to be at school. Create a contract, set some boundaries, and make it more worth her while to go to school.

12. An HFA youngster's reluctance to go to school can be irritating to moms and dads. Expressing resentment and anger is counterproductive though. You won't feel the urge to do so if you adopt specific strategies to assist your youngster.

School-refusal can be viewed along a spectrum of absenteeism, and a child on the spectrum may exhibit all forms of absenteeism at one time or another (e.g., the child could be anxious during school on Monday, arrive late to school on Tuesday, skip afternoon classes on Wednesday, and fail to attend school completely on Thursday). When you have identified the issue, make a plan and stick to your guns. Once your youngster has overcome the fear of school, he or she will probably thank you.


 
 
More articles for parents of children and teens on the autism spectrum:
 
Social rejection has devastating effects in many areas of functioning. Because the ASD child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

Click here to read the full article…

---------------------------------------------------------------

Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

Click here for the full article...

--------------------------------------------------------------

Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

Click here to read the full article…

------------------------------------------------------------

Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with ASD face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

Click here to read the full article…

------------------------------------------------------------

Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

Click here
to read the full article...

------------------------------------------------------------

Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

Click here for the full article...
 
------------------------------------------------------------
 
A child with High-Functioning Autism (HFA) can have difficulty in school because, since he fits in so well, many adults may miss the fact that he has a diagnosis. When these children display symptoms of their disorder, they may be seen as defiant or disruptive.

Click here for the full article...

Dealing with Children on the Autism Spectrum Who Refuse to Go to School

Has your ASD (high functioning autistic) child given you some indication that he is nervous about starting back to school?  He may have even said, “I’m not going!!!

What youngster hasn't dreaded September, the end of summer and the return to school – but for many ASD students, the prospect of school produces a level of fear so intense that it is immobilizing, resulting in what's known as school-refusal behavior. Some children with autism spectrum disorder have been known to be absent for weeks or months. 

Some may cry or scream for hours every morning in an effort to resist leaving home. Others may hide out in the nurse's office. Some children who miss school are simply truant (i.e., they'd just rather be doing something else), but sometimes there are genuine reasons to fear school (e.g., bullying, teasing).

Anywhere from 5% to 28% of kids will exhibit some degree of school-refusal behavior at some point, including truancy. For children with anxiety-fueled school refusal, the fear is real and can take time to overcome. Families may struggle for months to help an autistic youngster get back into the classroom. Ignoring the problem or failing to deal with it completely can lead to more-serious problems later on. Individuals who experience school-refusal behavior and anxiety disorders in childhood may face serious ramifications in adulthood.

Psychologists say and studies show the following:
  • Alcohol, drug use: A study of kids ages 9 to 13 with an anxiety disorder showed that those who still had the disorder seven years after treatment drank alcohol more often and were more likely to use marijuana than those whose disorders had resolved.
  • Depression: Teens and young adults ages 14 to 24 that had social anxiety were almost three times as likely to develop depression later on than those without the anxiety disorder.
  • Different life choices: Psychologists say they've seen young people with persistent anxiety make fear-fueled choices that can have long term effects, such as selecting a less-rigorous college or a less challenging career.
  • Psychiatric treatment: A study of school-refusing kids showed that about 20 to 29 years later they received more psychiatric treatment than the general population.

School refusal affects the entire family. If a child doesn't go to school, it may be hard for a parent to keep her job. Children are at heightened risk when starting a new school, and especially when entering middle school. It is the perfect storm with the onset of puberty, a huge transition and a chaotic academic environment.

Well-meaning moms and dads can make things worse by allowing an anxious youngster to miss school. Such an accommodation sends the message that school is too scary for the youngster to handle and the fear is justified. Overprotective moms and dads rush in way too quickly to shield their Aspie from any experience that creates distress.

Untreated, a youngster on the spectrum with school-refusal behavior is likely to fall behind academically, which can then lead to more anxiety. And there may be longer-term consequences. A 1997 study followed 35 students (ages 7-12) treated for school refusal. Twenty years later they were found to have had more psychiatric treatment and to have lived with their parents more often than a comparison group.

Some ASD teens with unresolved anxiety may go on to self-medicate with alcohol and drugs. A 2004 study followed 9- to 13-year-olds who were treated for an anxiety disorder. Seven years after treatment, those who still had the disorder drank alcohol more days per month and were more likely to use marijuana than those whose disorder had resolved.

Children with school-refusal behavior may have (a) separation anxiety (i.e., a fear of being away from their moms and dads), (b) a social phobia (i.e., an inordinate fear of being judged), or (c) a fear of being called-on in class or being teased. A specific phobia (e.g., riding the bus, walking past a dog, being out in a storm, etc.) may be present as well. Other kids are depressed, in some cases unable to get out of bed.

Because many children complain of headaches, stomachaches or other physical symptoms, it can be difficult to tell whether anxiety, or a physical illness, is to blame. (Note: Anxiety-fueled ailments tend to disappear magically on weekends.)

Autistic kids with school refusal may complain of physical symptoms shortly before it is time to leave for school or repeatedly ask to visit the school nurse. If the youngster is allowed to stay home, the symptoms quickly disappear, only to reappear the next morning. In some cases, the child  may refuse to leave the house. Common physical symptoms include headaches, stomachaches, nausea, or diarrhea. Tantrums, inflexibility, separation anxiety, avoidance, and defiance may show up, too.

Starting school, moving, and other stressful life events may trigger the onset of school refusal. Other reasons include the youngster’s fear that something will happen to a parent after he is in school, fear that she won’t do well in school, or fear of another student. Often a symptom of a deeper problem, anxiety-based school refusal affects 2 to 5 percent of school-age kids. It commonly takes place between the ages of five and six and between ten and eleven, and at times of transition, such as entering middle and high school. Kids who suffer from school refusal tend to have average or above-average intelligence. But they may develop serious educational or social problems if their fears and anxiety keep them away from school and friends for any length of time.

What Can Parents Do?

The most important thing a mother or father can do is obtain a comprehensive evaluation from a mental health professional. That evaluation will reveal the reasons behind the school refusal and can help determine what kind of treatment will be best. Your youngster’s pediatrician should be able to recommend a mental health professional in your area who works with kids on the spectrum.

The following tips will help you and your Aspie develop coping strategies for school anxieties and other stressful situations:
  • Arrange an informal meeting with your youngster’s teacher away from the classroom.
  • Emphasize the positive aspects of going to school: being with friends, learning a favorite subject, and playing at recess.
  • Encourage hobbies and interests. Fun is relaxation, and hobbies are good distractions that help build self-confidence.
  • Expose kids to school in small degrees, increasing exposure slowly over time. Eventually this will help them realize there is nothing to fear and that nothing bad will happen.
  • Help your Aspie establish a support system. A variety of people should be in your youngster’s life—other kids as well as family members or educators who are willing to talk with your youngster should the occasion arise.
  • Learn about your Aspie’s anxiety disorder and treatment options. For more information about school refusal and kid’s anxiety disorders, type "anxiety" and/or "school problems" in the search box at the top of this page.
  • Meet with the school guidance counselor for extra support and direction.
  • Talk with your Aspie about feelings and fears, which helps reduce them.
  • Try self-help methods with your Aspie. In addition to a therapist’s recommendations, a good self-help book will provide relaxation techniques. Be open to new ideas so that your youngster is, too.

Treatment—

Cognitive behavioral therapy (CBT), in which clients learn to change negative thoughts and behavior, is the main treatment for school-refusal behavior and the anxiety disorders that often underlie it. The primary technique is exposure therapy, where children gradually face and master their fears.

CBT is very effective. Recent studies have shown that about half to 70% of children with anxiety disorders treated with CBT will have a significant improvement in function and decrease in their symptoms. Some specialized school-refusal clinics have success rates that are even higher.

Antidepressants such as Zoloft (sertraline) or Prozac (fluoxetine) are often prescribed for kids with anxiety disorders, although their use in kids is controversial.

Psychologists stress the importance of seeking treatment quickly—after as little as two weeks of missed school. The longer they've been out of school, the poorer the prognosis.

Resolving School Behavior Problems in Kids on the Autism Spectrum

Question

"Mark, I have a daughter age 6 who was diagnosed with an autism spectrum disorder at age two. She received intensive therapy, 40 hours plus, per week utilizing various techniques. She is now 6. She is extremely friendly to even strangers, her IQ is 133… she is great with the exception of some behavioral problems. She is in first grade and is getting in trouble and being punished regularly for things such a marking on things she should not mark on, refusing to write. I need help."

Answer

You need to have a functional behavior assessment performed. Consider the following scenarios: 
 
A child with ASD has a behavior meltdown, in the school hall way. He begins to scream and hit other child. A grown-up is able to redirect the child and thus eliminate the behavior. Afterward, the team meets to discuss behavioral approaches for the future and to try to find out what led to this behavioral incident. 
 
As the team discusses potential reasons for the behavior, they discover that the child has been the victim of intense bullying and teasing. In response, the team questions what they can do in the future to eliminate behavioral difficulties. The issue of dealing with the bullies is never discussed.

Another child has a history of behavioral challenges that were minimal during elementary school, but have intensified in middle school. The team realizes that middle school presents special challenges because of changing classes and working with multiple staff. 
 

Accommodations are discussed that may assist the child in making numerous transitions throughout the school day. Despite these efforts, behavior incidents continue to occur. The behaviors are most likely to occur in the cafeteria or in hallways, which are incredibly noisy. It is suggested that in the future, in-school suspension be considered when there is a behavioral challenge. 
 
This is the approach used with other child, and the school has a strong zero-tolerance policy. The child is warned repeatedly. Despite these warnings, behaviors continue and actually escalate, resulting in removal from the educational setting.

Responding to Problematic Behavior—

When a youngster with ASD engages in problematic behavior, a typical response includes trying to identify what is going on within the youngster that leads to this behavior crisis. Questions are asked, such as, “Why is he exhibiting this behavior?” “Why is she hitting others?” or “What will stop this behavior?” 
 
All too often, this last question keeps us focused on consequence procedures that are child specific. However, simply focusing on the child as the sole source of the behavior provides limited insight into potential solutions and problems. In these situations, there are multiple issues to consider.

First, the federal law guiding special education services, the 2004 Individuals with Disabilities Education Improvement Act (IDEIA), requires special procedures and safeguards to be used when considering discipline for child with disabilities. These IDEIA provisions regarding discipline were designed to ensure that kids with disabilities maintain their ability to receive an appropriate education, even though the symptoms of their disability may include behaviors that require interventions. 
 
These provisions consider the amount of time a child may be removed from class or school due to behavior, and require the school team to analyze whether the behavior is related to the child’s disability. This process is called manifestation determination. If the behavior is determined to be due to the disability, the law requires that a functional behavior assessment be conducted that results in an individually designed behavior support plan. This plan should use positive behavioral interventions, strategies and supports to address the behavior and teach alternative ways of responding.

When conducting a functional behavior assessment, professionals and family members examine setting events or triggers that may increase the probability of these behaviors. These setting events may not be readily apparent. For example, a child with ASD is ill, has had a difficult morning ride on the bus or has not slept. These conditions will increase the likelihood that a behavior incident will occur. For most of us, stresses in life, changes in morning routines or skipping our morning coffee may set us up to be moody and agitated. These are setting events. 
 
Setting events that we often do not consider are related to the culture of the school. Schools that struggle with bullying, high rates of suspension or expulsion, or even high staff turnover may be settings that promote problematic behaviors. If this is the case, then schools should take a systematic approach in creating a school culture that is responsive to child and staff.


Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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Best Comment:

Well, I guess it’s time for me to tell our school administration about my son. I initially wanted to wait on this as I was trying to grasp what ASD was, make sure he really has this and really understand it. I feel I have the tools to do this now, two diagnoses from two professionals, a neurologist and a psychologist and after the two incidents that happened at school, I must say something.

First incident: I received a call from the school that my son was doubled over in pain in the office because he said his stomach hurt. I arrived at the school to pick him up in the office. The secretary said that he was in the bathroom (I told her to encourage him to go over the phone as he has had this problem/ his 8 yrs of life) Well, I waited and waited and waited...I told her he was taking too long. I then decided to knock on the bathroom door. He was not there. I walked over to his classroom and looked into the window and there he was! I went back into the office and told them that he was in his classroom. 
 
The office called him back so I could assess the situation. He now felt fine and wanted to stay at school. He loves school and could have easily pretended he was sick or just come home but that is not how he is. The office had no clue their student went m.i.a on him and if they had looked him in the eye and told him to make sure he came back and check on him after 3 min he would have been back. In his mind, he was ok and went back or just forgot and had his mind on one idea.

Second incident: My son was called into the office (he never gets called to the office!) because he spelled out loud an inappropriate word at school. The note said that he said the F word for which he does NOT know nor ever heard. I was in shock, tears, you know it! They said he heard this from a kid at camp over the summer. I asked him what he said. He said "mom, I spelled Sucker" When he went to the office, the administrator asked him to spell what he spelled out on the playground and the admin said he spelled it with a F. My son told me that spelling that with an F is NOT a word and does NOT make sense. I know in my heart that the admin heard it wrong. An F and an F sound alike when said out loud. What really bothered me was that the admin thought my son was lying or changing his stories in the office. 
 
When he said to the admin, I did not spell that, I spelled sucker. the admin said "you know what you spelled!" that is just wrong and then after being questioned my son started to get confused and cry and told the admin...uuhh I forget, which he does! It was not the admins fault. I blame myself. They need to know my so does not lie. He is a truth teller! I told my son that he has a detention for spelling sucker and that is not a good word. I’m hurt and angry because now he has been exposed to the F word because the admin. Thought that is what he said. It’s so unfair! I did not bring up ASD etc when I was in the office crying and trying to make sense of all this. I did not want to use that as an excuse. I called for the impromptu meeting in the office, they did not.

My son is also going through testing for an auditory processing disorder (on Wed) and other language issues. His speech is unclear at times, slurs words (may have been why the admin thought he used an F) and had a hard time expressing himself at times. The school does not know this. The only teachers that know of his diagnosis are his current teacher, teacher from last year and the music teacher. I will now be setting up an appointment with the administration.

My son told me that he did hear the word sucker from a kid at camp and that the boy did not get into trouble for it but he somehow knew it was bad. He said "Mom, it is a bad word to say and that is why I SPELLED it!" From the mind of a child with ASD. Thank you, God that he did not say the F word even though the guy in admin thought so. I know what he said...they can believe what they want.

I wrote a letter stating that for the record, my son did not spell what they thought he spelled, but I stand by the school 100% and YES, he should have a 20 min. detention for spelling the word SUCKER.I do not allow that word in our home and as a matter of fact the word Stupid is a bad word in our home. Stating the facts and supporting the school at the same time, shows the school I’m not a crazy parent without a brain.

My son attends a private school that we love! The admin who heard him wrong, is an amazing individual. I respect him but I think his "hearing aid" needed to be turned up that day! Ahhhh, I need to laugh.

Thanks for listening, my eyes are swollen! ( :
 
 
More articles for parents of children and teens on the autism spectrum:
 
Social rejection has devastating effects in many areas of functioning. Because the ASD child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

Click here to read the full article…

---------------------------------------------------------------

Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

Click here for the full article...

--------------------------------------------------------------

Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

Click here to read the full article…

------------------------------------------------------------

Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with ASD face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

Click here to read the full article…

------------------------------------------------------------

Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

Click here
to read the full article...

------------------------------------------------------------

Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

Click here for the full article...

Navigating the Journey: Parenting a Child with Both ASD and ADHD

Parenting is often described as one of the most rewarding yet challenging experiences in life. The joy of watching a child grow and develop ...