post

Autism And Mental Health

I'm Blogging for Mental Health 2015.

My son George hops off the yellow school bus and bounds up the driveway with his fingers in his ears – a throwback to last summer, when the sound of the tree-feller’s chainsaw hurt his ears. He shucks off his backpack, removes the hoodie that he will not abandon even during the height of the summer, and kicks off his shoes. Then, and only then, am I permitted to talk to him.

“How was school?” I ask him, as I always do.

“School was fine,” he says, as he always does.

“What did you do today?”

He doesn’t reply. Instead he starts peering at the brim of his hat, or running a finger along the edge of the door frame.

“George?” I ask, needing to engage him before he gets too far into his own head. “What did you do at school today?”

“School was fine,” he mutters.

“Tell me one thing you did today.”

“Played outside,” he says, after a pause.

“And what did you do outside?” I ask, hoping I’m accomplishing the tone of gentle persistence that I’m going for. He cannot feel forced, but he needs to know that I’m not giving up on this conversation. It’s a delicate balance some days.

“Kicked the soccer ball,” he says.

“Wow, that sounds like fun!” I say effusively.

Sensing that he’s fulfilled his obligation to talk, he runs off to turn on his computer. I sit on the stairs for a moment, feeling both exhausted and elated by the fact that I actually had a conversation – albeit a brief one – with my son. For most kids, this kind of exchange would not be a big deal. For George, it is.

George, now eleven years old, was diagnosed with autism when he was three. We had him assessed because he wasn’t talking, and even though he has come a long way since then, his speech and communication skills are far below those of his typically developing peers. This comes with a number of challenges, but there is one challenge in particular that I have never really spoken about.

How do I know if he’s OK?

I’m not talking about “OK” in the physical sense. George is able to tell me when he feels sick, or when a part of his body is hurting. He has even started to identify emotions, telling me when he’s sad or angry.

What I’m talking about is whether he’s “OK” from a mental health perspective. With my younger son, who is typically developing, it’s fairly simple. I have conversations with him, I talk to him about how he’s feeling, and from his natural expressiveness I can get a sense of whether everything is all right or not. I am well aware that childhood depression is a very real problem, I know what signs to look out for, and I have a reasonable degree of certainty that I would recognize it in my younger son.

With George, it’s a little more complicated, and from a statistical standpoint, it’s more of a concern. Individuals with developmental disabilities are more likely than the general population to experience mental illness, but they are less likely to be diagnosed, because it’s less likely that the people around them will realize that something is wrong. George, with his speech delays, does not have the words or the cognitive functioning to describe depression in a way that would enable me to recognize it.

Even the behavioural cues present in typically developing children may be different for those with special needs. It is easy – far too easy – to blame everything on autism. When a child with autism has a meltdown, or starts to cry for no reason, or gets lost inside his or her own head, everyone assumes it’s because of the autism. That is not unreasonable: in many cases, it is because of the autism.

But what about those times when it isn’t? What about the times when a child is banging his head against the wall because his mind is in a dark, desolate place and he doesn’t know how to express it? What if the other-worldliness is not symptomatic of autism, but of withdrawal? What if no-one realizes that depression has become the child’s companion, because in their well-meaning attempts to manage the autism, they just haven’t thought to consider anything else?

These concerns are part of what drives me to try to have conversations with George. Every single thing he can tell me Рno matter how small it might seem Рis like a golden nugget that I treasure. I lavishly praise his attempts to communicate, and every day, I encourage him to tell me something Рanything Рthat happened to him that day. It is my hope that if, at some point, anything is going on in his life or in his mind that he needs help with, that will be the thing he tells me about that day.

This is an original post by Kirsten Doyle, written for APA’s Mental Health Blog Day. Picture attributed to the American Psychological Association.

 

 

 

post

What Do You Tell A Child When Another Child Dies?

 

Luke

Luke

Last weekend, I received word that a friend’s seven-year-old son, Luke, was in ICU after a near-drowning incident. I kept near-constant vigil at my computer during my waking hours, anxiously waiting for updates, and when I got the news that Luke had died, I took it very hard. As a human being, as a parent, as the mother of a seven-year-old boy – this tragedy hit very close to home.

As I have tried to make sense of the emotions that have been swilling around in my head all week, I have grappled with the question of what to tell my younger son, James.

The concept of death is not new to James. He got a rude introduction to it in Kindergarten, when his teacher died of pneumonia. The teacher had been very popular among the kids; James had absolutely adored him, and had a hard time understanding that he’d never see him again.

In the three years since then, he has developed a reasonably healthy attitude to the fact that people die. He asks about his grandfathers and how they died, and he talks about angels and souls and stuff like that. He is sad when people close to us die, but he accepts that it is part of the circle of life.

This is different, though. Old people dying is part of the circle of life. Children dying is an idea that just doesn’t fit. The mere thought of it has a jarring effect, as if you’re listening to soft classical music and hear a sudden blast of ear-splitting heavy metal. I wasn’t sure if James was ready to be introduced to this concept, especially since he had never met Luke.

Just as I had decided not to tell him, he came up to me as I was looking at a picture of Luke that his mother had posted on her Facebook wall. He asked me about the little boy in the picture, and I found myself telling him that Luke was now an angel. This led to a discussion that was hard for both of us.

For all his bull-in-a-china-shop approach to life, James is a sensitive child with a natural sense of empathy, and he was genuinely sad as he looked at Luke’s picture. He talked about how he’d never get to play with Luke, and he expressed concern for Luke’s mother.

“She must be so sad,” he said. “Is she going to be OK?”

I told him that yes, Luke’s mother was very sad, and I assured him that she had lots of people around her who would make sure she was OK.

There was a pause, and then he said, “Mommy, if I died, would you be OK?”

I couldn’t answer him. I was too busy trying to hold my rapidly dissolving composure. I just held him as close to me as I possibly could.

A few minutes later, his little voice piped up again.

“Mommy, I’m scared. Kids can die, and there are so many ways to die.”

This was a tough one. How was I going to strike the balance between realism and reassurance? I couldn’t say, “Don’t worry, it won’t happen to you or your brother”, especially since this whole discussion had arisen from an unexpected tragedy. And I couldn’t say, “Yes, accidents can happen at any time”, because that would freak the poor child out and make him afraid of leaving the house.

And so I decided to focus on probabilities. If we only cross the street when the pedestrian light is green, there’s far less chance of being hit by a car. If we don’t answer the door to strangers, they won’t kidnap us. If we eat the right foods and run around in the back yard every day, we will get sick less often and we’ll get better faster.

In other words, staying safe and healthy does not guarantee that something won’t happen, but it does vastly improve our chances. It’s good to be cautious and mindful of potential danger, but we have to live our lives.

As I spoke to James, his fears seemed to ease. Since then, he has returned to the topic a few times, and as hard as it is, I am glad that the original discussion opened a door for him to talk about a subject that is important.

Later on that day, James came up to me and said, “Mommy, I’m still sad for Luke’s mommy, but I’m not so worried about her anymore.”

“Why is that?” I asked.

“Because Luke is still alive in her heart, and he can hug her from the inside.”

This is an original post by Kirsten Doyle. The picture of Luke is reproduced with the kind permission of Janice Zimmerman.