Employing Older Teens and Young Adults with Aspergers: 10 Tips for Employers

Teens and adults with Aspergers (high functioning autism) may experience some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary. Be aware that not all teens and adults with Aspergers will need accommodations to perform their jobs, and many others may only need a few accommodations.

Accommodation Ideas—

1. Employees with Aspergers may have difficulty communicating with co-workers or supervisors.

• Allow worker to have a friend or coworker attend meeting to reduce or eliminate the feeling of intimidation.
• Allow worker to provide written response in lieu of verbal response.
• Provide advance notice of date of meeting when worker is required to speak to reduce or eliminate anxiety.
• Provide advance notice of topics to be discussed in meetings to help facilitate communication.

2. Employees with Aspergers may experience difficulty managing time. This limitation can affect their ability to complete the task within a specified timeframe. It may also be difficult to prepare for, or to begin, work activities.

• Divide large assignments into several small tasks.
• Provide a checklist of assignments.
• Set a timer to make an alarm after assigning ample time to complete a task.
• Supply an electronic or handheld organizer, and train on how to use effectively.
• Use a wall calendar to emphasize due dates.

3. Employees with Aspergers may exhibit atypical body movements such as fidgeting. Atypical body movements are sometimes called stimulatory behavior, or "stimming." These body movements often help calm the person or assist them in concentrating on tasks, but can also disturb co-workers at times.

• Allow worker to use items such as hand-held squeeze balls and similar objects to provide sensory input or calming effect.
• Allow the worker to work from home.
• Provide private workspace where worker will have to room to move about and also not disturb other by movements such as fidgeting.
• Provide structured breaks to create an outlet for physical activity.
• Review conduct policy with worker.
• Schedule periodic rest breaks away from the workstation.

4. Employees with Aspergers may not be familiar with or understand abstract concepts like corporate structure, hierarchies of responsibility, reporting requirements, and other structural elements of the workplace.

• Adjust method of supervision to better prepare worker for feedback, disciplinary action, and other communication about job performance.
• xplain corporate structure to worker, using visual charts and clear descriptions of positions and reporting structure. Do not assume that worker will understand structure from a simple chart of job titles.
• Povide concrete examples to explain consequences of violating company policy.
• Provide concrete examples to explain expected conduct.
• Review conduct policy with worker.
• Use services of the Worker Assistance Program (EAP) if available.

5. Employees with Aspergers may have difficulty managing stress in the workplace. Situations that create stress can vary from person to person, but could likely involve heavy workloads, unrealistic timeframes, shortened deadlines, or conflict among coworkers.

• Allow worker to make telephone calls for support.
• Allow the presence and use of a support animal.
• Modify work schedule.
• Provide praise and positive reinforcement.
• Provide sensitivity training for workforce.
• Refer to EAP.

6. Employees with Aspergers may experience decreased concentration. They report intolerance to distractions such as office traffic, worker chatter, and common office noises such as fax tones and photocopying.

• To reduce tactile distractions: Instruct other workers to approach the Aspergers employee in a way that is not startling, such as approaching from behind, touching the worker, or other tactile interactions, if the worker is bothered by those interactions.

• To reduce auditory distractions:

1. Hang sound absorption panels
2. Provide a white noise machine
3. Purchase a noise canceling headset
4. Redesign worker's office space to minimize audible distractions
5. Relocate worker's office space away from audible distractions

• To reduce visual distractions:

1. Install space enclosures (cubicle walls)
2. Redesign worker's office space to minimize visual distractions
3. Reduce clutter in the worker's work environment
4. Relocate worker's office space away from visual distractions

7. Employees with Aspergers may have difficulty getting or staying organized, or have difficulty prioritizing tasks at work. The worker may need assistance with skills required to prepare and execute complex behavior like planning, goal setting, and task completion.

• Allow supervisor to prioritize tasks.
• Assign a mentor to help worker.
• Assign new project only when previous project is complete.
• Develop color-code system for files, projects, or activities.
• Provide a "cheat sheet" of high-priority activities, projects, people, etc.
• Use a job coach to teach/reinforce organization skills.
• Use the services of a professional organizer.
• Use weekly chart to identify daily work activities.

8. Employees with Aspergers may have difficulty exhibiting typical social skills on the job. This might manifest itself as interrupting others when working or talking, difficulty in listening, not making eye contact when communicating, or difficulty interpreting typical body language or nonverbal innuendo. This can affect the individual's ability to adhere to conduct standards, work effectively with supervisors, or interact with coworkers or customers.

• Social skills on the job:

1. Encourage all workers to use appropriate social skills.
2. Provide a job coach to help understand different social cues.
3. Provide concrete examples of accepted behaviors and consequences for all workers.
4. Use role-play scenarios to demonstrate appropriate social skills in workplace.
5. Use training videos to demonstrate appropriate social skills in workplace.

• Working effectively with supervisors:

1. Adjust supervisory method by modifying the manner in which conversations take place, meetings are conducted, or discipline is addressed
2. Establish long term and short term goals for worker
3. Give assignments verbally, in writing, or both, depending on what would be most beneficial to the worker (e.g., use of visual charts)
4. Identify areas of improvement for worker in a fair and consistent manner
5. Offer positive reinforcement
6. Provide clear expectations and the consequences of not meeting expectations
7. Provide detailed day-to-day guidance and feedback

• Interacting with co-workers:

1. Allow worker to transfer to another workgroup, shift, or department
2. Allow worker to work from home when feasible
3. Encourage workers to minimize personal conversation, or move personal conversation away from work areas
4. Help worker "learn the ropes" by providing a mentor
5. Make worker attendance at social functions optional
6. Provide sensitivity training to promote disability awareness

9. Employees with Aspergers may experience memory deficits that can affect their ability to complete tasks, remember job duties, or recall daily actions or activities. They also may have difficulty recognizing faces.

• Allow additional training time for new tasks.
• Allow worker to use voice activated recorder to record verbal instructions.
• Encourage worker to ask (or email) with work-related questions.
• Offer training refreshers.
• Prompt worker with verbal cues.
• Provide worker directory with pictures or use nametags and door/cubicle name markers to help worker remember coworkers' faces and names.
• Provide pictorial cues.
• Provide written instructions.
• Safely and securely maintain paper lists of crucial information such as passwords.
• Use a flowchart to describe the steps involved in a complicated task (such as powering up a system, closing down the facility, logging into a computer, etc.).
• Use post-it notes as reminders of important dates or tasks.

10. Employees with Aspergers may experience difficulty performing many tasks at one time. This difficulty could occur regardless of the similarity of tasks, the ease or complexity of the tasks, or the frequency of performing the tasks.

• Create a flow-chart of tasks that must be performed at the same time, carefully labeling or color-coding each task in sequential or preferential order.
• Explain performance standards such as completion time or accuracy rates.
• Identify tasks that must be performed simultaneously and tasks that can be performed individually.
• Provide individualized/specialized training to help worker learn techniques for multi-tasking (e.g., typing on computer while talking on phone).
• Provide specific feedback to help worker target areas of improvement.
• Remove or reduce distractions from work area.
• Separate tasks so that each can completed one at a time.
• Supply proper working equipment to complete multiple tasks at one time, such as workstation and chair, lighting, and office supplies.

Questions to Consider:

1. Can the worker with Aspergers provide information on possible accommodation solutions?
2. Do supervisory personnel and workers need training regarding Aspergers?
3. How do these limitations affect the worker's job performance?
4. Once accommodations are in place, would it be useful to meet with the worker to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
5. What accommodations are available to reduce or eliminate problems? 
6. Are all possible resources being used to determine accommodations?
7. What limitations does the worker with Aspergers experience?
8. What specific job tasks are problematic as a result of these limitations?

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

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

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Do you need the advice of a professional who specializes in parenting children and teens with Autism Spectrum Disorders?  Sign-up for Online Parent Coaching today.

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Aspergers Children and Seasonal Affective Disorder

Does your Aspergers (high functioning autistic) child or teen seem to have a change in mood as the seasons change?

A form of depression that follows a seasonal pattern, SEASONAL AFFECTIVE DISORDER (SAD) appears and disappears at the same times each year. Aspergers children with SEASONAL AFFECTIVE DISORDER usually have symptoms of depression as winter approaches and daylight hours become shorter. When spring returns and the days become longer again, they experience relief from the symptoms and a return to a fairly normal mood and energy level.

Signs and Symptoms—

Like other forms of depression, the symptoms of SEASONAL AFFECTIVE DISORDER can be mild, severe, or anywhere in between. Milder symptoms minimally interfere with the child’s ability to participate in everyday activities, while more severe symptoms can interfere much more.

The symptoms of SEASONAL AFFECTIVE DISORDER are the same as those of depression, but occur during a specific time of year. It's the seasonal pattern of SEASONAL AFFECTIVE DISORDER — the fact that symptoms occur only for a few months each winter (for at least 2 years in a row) but not during other seasons — that distinguishes it from other forms of depression.

Symptoms of SEASONAL AFFECTIVE DISORDER may include:

• Changes in eating: craving simple carbohydrates (e.g., comfort foods and sugary foods); tendency to overeat (which could result in weight gain during the winter months)
• Changes in mood: irritability and/or feelings of hopelessness or worthlessness most of the time for at least 2 weeks; tendency to be more self-critical and more sensitive than usual to criticism; crying or getting upset more often or more easily
• Changes in sleep: sleeping much more than usual (which can make it difficult for children to get up and get ready for school in the morning)
• Difficulty concentrating: more trouble than usual completing assignments on time; lack of usual motivation (which can affect school performance and grades)
• Lack of enjoyment: loss of interest in things that are normally enjoyable; feeling like tasks can't be accomplished as well as before; feelings of dissatisfaction or guilt
• Less time socializing: spending less time with friends in social or extracurricular activities
• Low energy: unusual tiredness or unexplained fatigue

The problems caused by SEASONAL AFFECTIVE DISORDER — such as lower-than-usual grades or less energy for socializing with friends — can affect self-esteem and leave the Aspergers child feeling disappointed, isolated, and lonely, especially if he doesn’t realize what's causing the changes in energy, mood, and motivation.

Fall and Winter SEASONAL AFFECTIVE DISORDER—

Winter-onset seasonal affective disorder symptoms include:

• Anxiety
• Appetite changes, especially a craving for foods high in carbohydrates
• Depression
• Difficulty concentrating
• Heavy, "leaden" feeling in the arms or legs
• Hopelessness
• Loss of energy
• Loss of interest in activities you once enjoyed
• Oversleeping
• Social withdrawal
• Weight gain

Spring and Summer SEASONAL AFFECTIVE DISORDER—

Summer-onset seasonal affective disorder symptoms include:

• Agitation
• Anxiety
• Irritability
• Poor appetite
• Trouble sleeping (insomnia)
• Weight loss

Causes of SEASONAL AFFECTIVE DISORDER—

It's believed that with SEASONAL AFFECTIVE DISORDER, depression is somehow triggered by the brain's response to decreased daylight exposure. How and why this happens isn't yet fully understood. Current theories focus on the role of sunlight in the brain's production of certain key hormones that help regulate sleep-wake cycles, energy, and mood.

Two chemicals that occur naturally in the body are thought to be involved in SEASONAL AFFECTIVE DISORDER:

1. Melatonin, which is linked to sleep, is produced in greater quantities when it's dark or when days are shorter. Increased production of melatonin can cause sleepiness and lethargy.
2. Serotonin production increases with exposure to sunlight. Low levels of serotonin are associated with depression, so increasing the availability of serotonin helps to combat depression.

Shorter days and longer hours of darkness in fall and winter can increase melatonin levels and decrease serotonin levels, which may create the biological conditions for depression.

In addition, the child’s biological clock (circadian rhythm) is altered. The reduced level of sunlight in fall and winter may disrupt the body's internal clock, which lets you know when you should sleep or be awake. This disruption of your circadian rhythm may lead to feelings of depression.

Risk Factors—

Factors that may increase your risk of seasonal affective disorder include:

• Being female. Seasonal affective disorder is diagnosed more often in females than in males, but males may have symptoms that are more severe.
• Family history. As with other types of depression, those with seasonal affective disorder may be more likely to have blood relatives with the condition.
• Having clinical depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions.
• Living far from the equator. Seasonal affective disorder appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter, and longer days during the summer months.

Complications—

Take signs and symptoms of seasonal affective disorder seriously. As with other types of depression, seasonal affective disorder can get worse and lead to problems if it's not treated. These can include:

• School or work problems
• Social withdrawal
• Substance abuse
• Suicidal thoughts or behavior

Seeing the Doctor—

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• Is your child taking any medications, supplements or herbal remedies?
• Do any blood relatives have seasonal affective disorder or another mental health condition?
• Does your child have any other physical or mental health conditions?
• Have his symptoms been continuous or occasional?
• How severe are the symptoms?
• What are the symptoms?
• What, if anything, appears to worsen the symptoms?
• What, if anything, seems to improve the symptoms?
• When did your child first begin having symptoms?

Your doctor may also ask other questions depending on your individual situation.

Tests and Diagnosis—

To help diagnose seasonal affective disorder, your doctor or mental health provider will do a thorough evaluation, which generally includes:

• Physical exam. Your doctor or mental health provider may do a physical examination to check for any underlying physical issues that could be linked to your child’s depression.

• Medical tests. There's no medical test for seasonal affective disorder, but if your doctor suspects a physical condition may be causing or worsening the depression, your child may need blood tests or other tests to rule out an underlying problem.

• Detailed questions. Your doctor or mental health provider will ask about your child’s mood and seasonal changes in thoughts and behavior. The doc may also ask questions about your child’s sleeping and eating patterns, relationships, school, or other questions about his life. You may be asked to answer questions on a psychological questionnaire.

Seasonal affective disorder is considered a subtype of depression. Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health provider to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms.

To be diagnosed with seasonal affective disorder, your child must meet 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 professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

The following criteria must be met for a diagnosis of seasonal affective disorder:

• The periods of depression have been followed by periods without depression.
• There are no other explanations for the changes in your mood or behavior.
• The child has experienced depression and other symptoms for at least two consecutive years, during the same season every year.

Prevention—

There's no known way to prevent the development of seasonal affective disorder. However, if you take steps early on to manage your child’s symptoms, you may be able to prevent them from getting worse over time. Some parents find it helpful to begin treating their child before symptoms would normally start in the fall or winter, and then continue treatment past the time symptoms would normally go away. If you can get control of your child’s symptoms before they get worse, you may be able to head off serious changes in mood, appetite and energy levels.

Treatment—

Treatment for SEASONAL AFFECTIVE DISORDER, which varies depending on the severity of the symptoms, includes:

1. Talk therapy (psychotherapy). Helping to ease the sense of isolation or loneliness, talk therapy focuses on revising the negative thoughts and feelings associated with depression. It also can help children understand their condition and learn ways to prevent or minimize future bouts.

2. Medication (pharmacotherapy). Medications, which might be used in combination with talk therapy and light therapy, may be prescribed for a youngster or adolescent with SEASONAL AFFECTIVE DISORDER and should be monitored by a doctor. Antidepressant medications help to regulate the balance of serotonin and other neurotransmitters in the brain that affect mood and energy. Tell your doctor about any other medications your youngster takes, including over-the-counter or herbal medicines, which could interfere with prescription medications.

3. Light therapy (phototherapy). More troublesome symptoms may be treated with a stronger light that simulates daylight. A special light-box or panel is placed on a tabletop or desk, and the person sits in front of it briefly every day (45 minutes or so, usually in the morning) with eyes open, glancing — not staring — occasionally at the light (to work, the light has to be absorbed through the retinas). Symptoms tend to improve within a few days or weeks. Generally, light therapy is used until enough sunlight is available outdoors. Mild side effects of phototherapy might include headache or eyestrain. Lights used for SEASONAL AFFECTIVE DISORDER phototherapy must filter out harmful UV rays. Tanning beds or booths should not be used to relieve symptoms of SEASONAL AFFECTIVE DISORDER. Their ultraviolet rays can damage skin and cause wrinkles and age spots, and even lead to skin cancer such as melanoma. Phototherapy should be used with caution if someone has another type of depressive disorder, skin that's sensitive to light, or medical conditions that may make the eyes vulnerable to light damage. Like any treatment, phototherapy should be used under a doctor's supervision.

4. Increased light exposure. Because the symptoms of SEASONAL AFFECTIVE DISORDER are triggered by lack of exposure to light and tend to go away on their own when available light increases, treatment for SEASONAL AFFECTIVE DISORDER often involves increased exposure to light during winter months. For someone with mild symptoms, it may be enough to spend more time outside during the daylight hours, perhaps by exercising outdoors or taking a daily walk. Full-spectrum (daylight) light bulbs that fit in regular lamps can help bring a bit more daylight into winter months and might help with mild symptoms.

Lifestyle and Home Remedies—

If the symptoms are severe, your child may need medications, light therapy or other treatments to manage seasonal affective disorder. However, there are some measures your child can take on his own that may help. Try the following:

• Exercise regularly. Physical exercise helps relieve stress and anxiety, both of which can increase seasonal affective disorder symptoms. Being more fit can make your child feel better about himself, too, which can lift his mood.

• Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help — especially if your child spends some time outside within two hours of getting up in the morning.

• Make the environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or school.

Alternative Medicine—

Several herbal remedies, supplements and mind-body techniques are commonly used to relieve depression symptoms. It's not clear how effective these treatments are for seasonal affective disorder, but there are several that may help. Keep in mind, alternative treatments alone may not be enough to relieve symptoms. Some alternative treatments may not be safe if your child has other health conditions or takes certain medications.

Supplements used to treat depression include:

• Melatonin. This natural hormone helps regulate mood. A change in the season may change the level of melatonin in the body.
• Omega-3 fatty acids. Omega-3 fatty acid supplements may help relieve depression symptoms and have other health benefits. Sources of omega-3s include fish such as salmon, mackerel and herring. Omega-3s are also found in certain nuts and grains and in other vegetarian sources, but it isn't clear whether they have the same effect as fish oil.
• SAMe. This is a synthetic form of a chemical that occurs naturally in the body. SAMe hasn't been approved by the Food and Drug Administration to treat depression in the United States. However, it's used in Europe as a prescription drug to treat depression.
• St. John's wort. This herb has traditionally been used to treat a variety of problems, including depression. It may be helpful if your child has mild or moderate depression.

Mind-body therapies that may help relieve depression symptoms include:

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

What Parents Can Do—

Talk to your doctor if you suspect your youngster has SEASONAL AFFECTIVE DISORDER. Doctors and mental health professionals make a diagnosis of SEASONAL AFFECTIVE DISORDER after a careful evaluation and a checkup to ensure that symptoms aren't due to a medical condition that needs treatment. Tiredness, fatigue, changes in appetite and sleep, and low energy can be signs of other medical problems, such as hypothyroidism, hypoglycemia, or mononucleosis.

When symptoms of SEASONAL AFFECTIVE DISORDER first develop, moms and dads might attribute low motivation, energy, and interest to an intentional poor attitude. Learning about SEASONAL AFFECTIVE DISORDER can help them understand another possible reason for the changes, easing feelings of blame or impatience with their youngster or adolescent.

Moms and dads sometimes are unsure about how to discuss their concerns and observations. The best approach is usually one that's supportive and nonjudgmental. Try opening the discussion with something like, "You haven't seemed yourself lately — you've been so sad and grouchy and tired, and you don't seem to be having much fun or getting enough sleep. So, I've made an appointment for you to get a checkup. I want to help you to feel better and get back to doing your best and enjoying yourself again."

Here are a few things you can do if your Aspergers youngster or adolescent has been diagnosed with SEASONAL AFFECTIVE DISORDER:

1. Be patient. Don't expect symptoms to go away immediately. Remember that low motivation, low energy, and low mood are part of SEASONAL AFFECTIVE DISORDER — it's unlikely that your youngster will respond cheerfully to your efforts to help.

2. Encourage your youngster to get plenty of exercise and to spend time outdoors. Take a daily walk together.

3. Establish a sleep routine. Encourage your youngster to stick to a regular bedtime every day to reap the mental health benefits of daytime light.

4. Find quality time. Spend a little extra time with your youngster — nothing special, just something low-key that doesn't require much energy. Bring home a movie you might enjoy or share a snack together. Your company and caring are important and provide personal contact and a sense of connection.

5. Help with homework. You may have to temporarily provide hands-on assistance to help your youngster organize assignments or complete work. Explain that concentration problems are part of SEASONAL AFFECTIVE DISORDER and that things will get better again. Children and adolescents with SEASONAL AFFECTIVE DISORDER may not realize this and worry that they're incapable of doing the schoolwork. You may also want to talk to the teachers and ask for extensions on assignments until things get better with treatment.

6. Help your youngster to eat right. Encourage your youngster to avoid loading up on simple carbohydrates and sugary snacks. Provide plenty of whole grains, vegetables, and fruits.

7. Help your youngster understand SEASONAL AFFECTIVE DISORDER. Learn about the disorder and provide simple explanations. Remember, concentration might be difficult, so it's unlikely your youngster will want to read or study much about SEASONAL AFFECTIVE DISORDER — if so, just recap the main points.

8. Participate in your youngster's treatment. Ask the doctor how you can best help your youngster.

9. Take it seriously. Don't put off evaluation if you suspect your youngster has SEASONAL AFFECTIVE DISORDER. If diagnosed, your youngster should learn about the seasonal pattern of the depression. Talk often about what's happening, and offer reassurance that things will get better, even though that may seem impossible right now.

Coping and Support—

Following these steps can help your child manage seasonal affective disorder:

• Practice stress management. Learn techniques to manage stress better. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors
• Socialize. When your child is feeling down, it can be hard to be social. Help him make an effort to connect with friends he enjoys being around. They can offer support, a shoulder to cry on, or a joke to give your Aspie a little boost.
• Stick to the treatment plan. Take medications as directed and attend therapy appointments as scheduled.
• Take a trip. If possible, take winter vacations in sunny, warm locations if your child has winter seasonal affective disorder – or to cooler locations if he has summer seasonal affective disorder.
• Help your Aspie to take care of himself. Get enough rest and take time to relax. Participate in a regular exercise program. Eat regular, healthy meals.

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

==> Preventing Meltdowns and Tantrums in Asperger's Children

==> Discipline for Defiant Asperger's Teens

==> Teaching Social Skills and Emotion Management

==> Launching Adult Children with Asperger's: How to Promote Self-Reliance 

==> Everything You'll Ever Need to Know About Parenting Asperger's Children

==> Parenting Children and Teens with High-Functioning Autism

==> AudioBook: Unraveling The Mystery Behind Asperger’s and High-Functioning Autism

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

Misbehavior or Food Allergy? Tips for Parents of Kids on the Autism Spectrum

Is your Aspergers (AS) or high functioning autistic (HFA) child "acting-out"?  If so, the behavioral problems may be symptomatic of a deeper issue...

Digestive function is the key to physical and emotional health. If your youngster has gluten intolerance and/or autistic symptoms, chances are he has something called “leaky gut syndrome.” In a youngster with leaky gut, the stomach lining is more porous than it should be, allowing protein molecules to slip through the gut and enter the blood stream where it causes an autoimmune and behavioral response.

The most common causes of leaky gut are parasites, low stomach acid, prolonged chronic antibiotic use and food additives and preservatives. Gluten is the protein found in wheat, barley, rye and oats. AS and HFA kids with undiagnosed and untreated gluten intolerance commonly show these symptoms:

1. Difficulty in group games or sports: Your youngster may appear to be “cheating” on a board game or sport when, in fact, he can’t figure out the rules despite repeated explanations.

2. Inability to read tones of voice and body language: Your youngster doesn’t seem to “get it” until you’ve reached the end of your rope and begin yelling or punishing. This is because he is not picking up on your more subtle attempts at correction. After your repeated reprimands have been ignored, you finally yell to get through to your child.

3. Non-sense talk: Your child’s attempt to communicate with you comes out in a string of unintelligible sentences, causing frustration and anger in both the youngster and parent.

4. Obsessions: Your youngster may go on and on and on about the same subject for hours.

5. Physical symptoms: Stomach pain, diarrhea, constipation, chronic burping and/or passing of gas, chronic nasal congestion and/or postnasal drip, allergies and or “vague” or “drugged” look in the eyes are all common symptoms in a youngster with food allergies.

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

6. Poor coordination: Your youngster may bump into and/or break things, but when this is pointed out, he insists he didn’t do it. This is true for your youngster as he may lack body awareness due to the brain fog caused by gluten allergy. He literally doesn’t notice his arm or leg hitting that priceless vase that is now smashed to pieces on the floor.

7. Self-destructive behavior: Frustration with being misunderstood and/or not understanding others may cause the youngster to hit or cut himself.

8. Social difficulties (e.g., lack of eye contact, inability to read social cues, nonsense talk, etc.) can be symptoms of gluten intolerance.

9. Staring off into space: Gluten has an “opiate” effect on the system of an allergic or intolerant person causing open-mouthed staring and disassociation. You may notice this is especially true a couple of hours after eating.

10. Trouble communicating: Your youngster may become frustrated when he can’t find the right words to describe something and needs to resort to pointing to an object he is talking about.

How your child's doctor can test for food allergies:

I. Obtain a detailed history and perform a complete physical examination

A. Formulate suspicion of food allergy based on history and physical findings

B. Rule out other causes of symptoms

II. Evaluate for IgE-mediated food allergy with skin prick-puncture tests or radioallergosorbent tests

A. Test are negative

1. Reintroduce the food to the diet

2. If the child has a history of significant reaction or a non¬IgE-mediated reaction is suspected, reintroduce the food to the diet in a physician-supervised or challenge setting

B. Tests are positive

1. Eliminate food

2. If the child has multiple sensitivities or an unclear history, perform open or single-blind food challenges

a. If the challenge test is negative, reintroduce food

b. If the challenge test is positive, challenge

1. Eliminate foods (if only a few foods)

2. If multiple foods are implicated, consider double-blind, placebo-controlled food challenges

a. If the challenge is positive, eliminate food

b. If the challenge is negative, reintroduce food

III. Diagnosis established

A. Educate parents about treatment and avoidance

B. Re-evaluate at appropriate intervals if tolerance is likely

How parents can eliminate the cause:

Get your youngster on an elimination diet. An elimination diet is an easy method of figuring out what foods your youngster is reacting to.

For one week, serve only:

• Bottled or distilled water
• Brown rice (not enriched white rice which has wheat flour in it), Quinoa or Amaranth
• Fresh fruit (excluding citrus and any fruit that is eaten more than twice per week)
• Fresh vegetables (excluding corn, peas and beans)
• Organic chicken and turkey

For one week, avoid:

• All dairy products (use rice milk instead)
• All processed foods
• Bacon, sausages, tuna and any “prepared meat”
• Caffeine in any form
• Chocolate
• Citrus fruit
• Eggs
• Food colorings and dyes
• MSG
• Nuts
• Peas, beans and corn
• Soda or cola
• Sugar and sugar substitutes of any kind
• Wheat, oats, rye or barley

It is very important that there is no “cheating” during this one-week period. The culprit food has to be completely eliminated from the body and chances are, if your youngster has a compromised digestive system, it will take longer for allergens to fully exit the body so you’re left with a “clean slate” on which to reintroduce foods.

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

The best way to find the foods that will get you through this challenging diet change is to consult your local health-food store. Most specialize in gluten-free diets and will prove most helpful in this process. Once the one-week period is over, you’ll want to reintroduce foods. Remember to do this one at a time.

Continue to follow the elimination diet but now, reintroduce a food such as cheese and make a list of any symptoms your youngster has exhibited. If none, good deal! Two days later, introduce another food, say, wheat and note the reaction, if any. Then, try eggs. A couple of days later try nuts and so on. When you find the problem food, you’ll KNOW. The symptoms will return with a vengeance.

Just remember, your youngster may be allergic or intolerant to several different foods so when you notice a reaction, remove that food from the diet, wait a day or two more and reintroduce the next food. The most common food allergies/intolerances are wheat/gluten, diary, eggs, soy, nuts, citrus, sulfites and fish so you may want to reintroduce those foods first.

The elimination of food proteins is a difficult task. In a milk-free diet, for example, parents must be instructed not only to avoid all obvious milk products, but also to read food product ingredient labels for key words that may indicate the presence of cow's-milk protein, including "casein," "whey," "lactalbumin," "caramel color" and "nougat." When vague terms such as "high protein flavor" or "natural flavorings" are used, it may be necessary to call the manufacturer to determine if the offending protein, such as milk protein, is an ingredient.

Parents must also be made aware that the food protein, as opposed to sugar or fat, is the ingredient being eliminated. For example, lactose-free milk contains cow's milk-protein, and many egg substitutes contain chicken-egg proteins. Conversely, peanut oil and soy oil generally do not contain the food protein unless the processing method is one in which the protein is not completely eliminated (as with cold-pressed or "extruded" oil).

Elimination of a particular food can be tricky. For example, a spatula used to serve cookies both with and without peanut butter can contaminate the peanut-free cookie with enough protein to cause a reaction. Similarly, contamination can occur when chocolate candies without peanuts are processed on the same equipment used for making peanut-containing candy. Hidden ingredients can also cause a problem. For example, egg white may be used to glaze pretzels, or peanut butter may be used to seal the ends of egg rolls.

Fortunately, kids on the autism spectrum often lose their sensitivity to most of the common allergenic foods (egg, milk, wheat, soy) in a few years, particularly with avoidance of the foods. However, positive skin tests may persist despite the development of clinical tolerance. Serial diagnostic food challenges over time are often helpful in managing these food-allergic kids. Unfortunately, sensitivity to certain foods, such as peanuts, tree nuts, fish and shellfish, is rarely lost, and sensitivity persists into adulthood.

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

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

Comments:

•    Anonymous said... I am a firm believer that diet affects our Aspies. I have had mine on a low- gluten diet for 2 months now & he is a very different child!!! He is happy, more attentive & is interacting well w/ peers. Temper is also MUCH better & easier to control. I opted for low-gluten because he is only 6, and ADHD med he is on decreases his appetite already, making him very small for his age. Even this small change in his diet has helped tremendously!!
 

•    Anonymous said... I am still stuck on how to get my child to eat...anything. He gags on both textures and tastes. He has the classic beige diet going, but even that is very limited (and so very unhealthy, as I am painfully aware!) pizza, chicken nuggets (of any variety), cheerios, yogurt, mac n cheese is about all my child will eat. He has never liked vegies/fruit (gagged as an infant even) thus I have him drinking v8 fushion (out of desperation). I know the "what" of gluten-casein free, but how does one go about the "how"? advise welcome =)
 

•    Anonymous said... My sister has full custody of her children (4 total, 2 of which are out of the house and married) the issues are with the younger 2 (Boy 13) and (Girl 16). We will start with the older one who is in need of help but not as much as her younger brother. The 16 year old was expelled from school the first week due to a drug related issue, she has since been enrolled in PASS and goes to school every day and is showing signs of understanding the repercussions of her actions. She is not fully there yet but I think she has grown up a lot over the past 2 months and accepts her punishment from a “school” perspective. At home on the other hand my sister struggles with maintaining boundaries and enforcing her discipline decisions. My niece was suppose to have certain privileges revoked for a period of time as part of the consequence of this action however that only lasted one day as my niece has the uncanny ability to wear my sister down into submission. My question for her is if I were to purchase your program would if provide my sister the tools she needs to stand behind her own convictions and/or point her in a direction that will help her to be successful? Next is my Nephew. He has been in either ISS or suspended for 42 of the 60 days school has been in session this year. Not only is he rebelling at school by being defiant and throwing temper tantrums he is pulling pranks like letting off stink bombs in the lunchroom which resulted in a 10 day suspension. He also struggles outside of school as he has been caught shoplifting by me and forced to return the items to the store. His attitude during this is not remorseful for being caught it is anger and frustration. He tells my sister he hates living in Missouri and wants to go back home to Michigan (they moved here 3 years ago) where his dad is. He has become increasingly violent recently and has been challenging my sister by getting into her personal space and asking her “what are you going to do?”. He also does things like grabbing knives and banging his head against walls. I do not fear for the safety of my sister so I want to make sure I do not paint that picture but I do see it getting worse. The kicker is they live with me and I have 3 small children of my own which I get to see 2 days a week and every other weekend as I was divorced earlier this year. My Nephews father and my sister have both asked that I step in to control him however I do not see that fixing the problem. My opinion is that my sister needs the tools to be able to do this on her own and as for me I need to focus my attention on my own children. So I guess after writing all this the questions are the same, if I were to purchase your program would if provide her the tools she needs to correct these behavioral issues.
 

•    Anonymous said... Hi all, I am looking for some insight from those of you who have survived the preschool years...my son with AS is 4 and attends a typical preschool 3 mornings a week. He has ongoing problems with hitting the other kids, but now he has targeted one little girl whom he has decided is a "troublemaker". He has been going out of his way to hit her, push her down, and throw sand on her - completely unprovoked, by his own account. I seriously doubt that this girl is really a troublemaker (and of course we have told our son that enforcing rules is the teacher's job, not his), but really the facts don't matter, because he has decided that she is. He makes up a lot of rules in his head (like he says that if he is mad, the rule is he has to hit), and they are really hard to break him of. There was a similar problem at preschool last year, when my son decided that another child was a "bad boy" (no one could ever figure out why he thought that) and spent the whole year hitting and kicking him. The only thing that stopped it was the school year ending, and now that my son and his target from last year are in different classes, they are actually getting along very well on the playground. I certainly do not want my son to keep targeting this little girl until school ends next May - to make matters worse, she is the smallest child in his class, really tiny for her age, and of course it bothers me that he is picking on a girl. Before this started with this particular girl, my son's teachers had already asked us to start picking him up a little early because the end of day playground time is the hardest for him and that is when he hits the most. Today when we went to pick him up, the director of the preschool was sitting with my son outside of the playground, because his behavior towards the little girl had been so bad he needed to be removed. Any suggestions on how to deal with an Asperger's child targeting a kid they think is bad would be very helpful!
 

•    Anonymous said... I feel your pain! My 10-yr old aspie has also chosen through the years to "pick on" one particular individual each school year. Looking back, I regret that I did not nip this in the bud earlier. I'm not exactly sure why it occurs, but it seems to work as a defense mechanism of some sort. At the preschool level, administrators are more likely to treat it as a normal stage of development and with a certain degree of tolerance for the diagnosis. As they get older, however, this becomes more difficult for them to do. We are facing possible expulsion and are now taking this very seriously. My advice is to NOT WAIT. Make sure you protect your child by documenting the diagnosis and including a behavior plan to address this issue specifically. Looking back, I wish I would have scheduled supervised play dates (consider it a social group) with the particular child in question. Never leave the children alone, and try to moderate the play to find common interests. One of my son's targets from Kindergarten became one of his closest friends in second grade! This happened all by itself when they discovered a common interest in Pokemon. There's often no telling what set them off...This particular kid smushed a bug, something that my son adores! Don't wait....make it a priority and make sure you communicate openly with the teachers at his school. It might also help to inform and educate the other parents of his diagnosis. We waited until third grade to describe and explain his diagnosis to the class, but it was by far the best thing we ever did.

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15 Ways to Bully-Proof Your Child

Over 25% of public schools report that bullying among students occurs on a daily basis. Also, one in five middle school students with Aspergers (high-functioning autism) report being bullied in the past 3 months.

 

Click here for full article...

Teaching Interpersonal Relationship Skills: Tips for Parents of Kids on the Spectrum

"In any type of social setting, my daughter (high functioning) is very withdrawn and will rarely speak to anyone unless they speak to her. How can I teach her to be just a bit more social in a way that fits her comfort level?"

Because Aspergers and high-functioning autistic (HFA) youngsters often have difficulty perceiving the “ins and outs” of typical social interactions, your daughter 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 on the autism spectrum. However, with parental support, these young people can grow to learn ways to improvise and improve the quality of those interactions.

Some Aspergers and HFA kids appear shy and withdrawn, rarely speaking unless spoken to. Others may dominate the conversation with lengthy discussions about their special interests. Your youngster 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 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 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 kids on the spectrum 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 youngster 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 child 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 son or daughter 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 kids on the spectrum 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.

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

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 (high functioning autism) 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.

Click here for the full article...

Helping Your Child on the Autism Spectrum to Cope with Frustration

"If things are not the way my son (high functioning) wants/needs them, we often hear swearing or he will just ignore me when i ask what is wrong (like he expects me to mind read)....i think he finds it difficult to put his feelings into words, so it often pours out in yelling and abusive names. Any suggestions?!"

Does your high-functioning autistic (HFA) or Asperger's 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 kids on the autism spectrum go through peaks of frustration throughout their childhood. Younger ones 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 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 HFA and Asperger's 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 them 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 youngster on he autism spectrum often concludes, “I’ll never succeed.” That’s why encouragement is by far the most important gift you can give your frustrated youngster. 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 kids on the spectrum 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 youngster 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 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 youngster 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