What’s the Most Effective Treatment for Childhood Anxiety?

Up until recently the most studied and effective treatments for childhood anxiety have been medication and Cognitive Behavioral Therapy. Both of those treatments, however effective have serious shortcomings. Long-term fixes from medication especially for young children, are hampered in part because their use is not universally accepted as safe by parents. Cognitive Behavioral Therapy requires a professional and a child who is at least nominally receptive to treatment, willing to engage in change.

By it’s very nature, a child’s anxiety becomes a relational family system problem. Parents are wired to protect and help their children regulate.

When mammal babies are threatened they don’t look to fight off the danger, they signal the parent or caregiver for protection and regulation.  This is a critical bio-neurological loop of attunement between parents and their children.

In the case of anxiety disorder as opposed to real and imminent danger, when a parent accommodates a repetitive anxious behavior, he/she is sending the signal that the danger is real. This expands the child’s sense of insecurity and lessens the opportunities for the development of resilience.

The threat response disorder highjacks the system INCLUDING THE PARENT’s.  We’re wired to protect and soothe and help regulate. But since our systems are hooked to the child’s disregulation, ours becomes disrupted as well.  And we seek to soothe ourselves instead of healing the child.

Since the secondary language of childhood anxiety includes verbal and physical resistance, anger, swearing hitting etc. it’s easy to understand the need for parent training in order to avoid the pitfalls of over-reacting to those behaviors.

Without training most parents will be at an increased risk for feeling rejected by their own children, and will re experience their own childhood, feeling rejected or not fully seen by their parents. This is the meaning of getting re-triggered

Parent training and engaging in some therapy or personal growth work is critical and probably number 1 on the list of first steps to healing one’s child.

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Autism and Trauma Meet Comedy

Jill Greenberg/Courtesy of ID PR

We understand perhaps now more than ever, that humans are wired for connection. Whether we identify as introverted or extraverted we need each other. Feeling the protection of others, our family, our tribe, and our community holds important survival benefits. Those on the Autism Spectrum (ASD) have a primary struggle with social communication, both receiving and sending. No matter what other strengths someone on the autism spectrum may have, struggling to connect (in neurotypical ways) has significant and potentially traumatic consequences. An ever- present feeling of being the outsider, getting shunned, insulted and rejected is a terribly consequential wound. It’s the very definition of trauma in the making. In this NPR article, Autism Spectrum Diagnosis Helped Comic Hannah Gadsby ‘Be Kinder’ To Herself, the Australian comic describes how stand up comedy helps her through the struggle to connect.

“People on the spectrum … sort of feel like an alien being dropped in from outer space, and you can’t quite connect properly,” she says. “Being on stage and making a room full of people laugh, felt like a connection I hadn’t been able to establish in any other environment.”

“I was getting a lot of things wrong, and the most difficult was my interpersonal life, because on stage in interviews, the boundaries and the rules of engagement are very clear. But once you step out of these things and you’re talking to people, you’re building relationships with people, there’s so much more uncertainty, and I don’t read the room nearly as well. I’ve spent my whole life really trying to study the room — that is one of my one of my special subjects. So in many ways I appear very good at being social. But it’s an incredibly exhausting process for me.  So when I was diagnosed, it just gave me permission to be kinder to myself…”

In my new and upcoming book “A Light Within My Dyslexia” I write in the afterword and directly to kids:

“Everyone has a learning profile. It means we all have some strengths. Some are obvious and some are hidden. Having a learning profile also means we have areas that don’t come easily for us, are hard. Put these two things together and call them strengths and weaknesses, or strengths and challenges. I like to think of them as rockets and rocks.

Rockets are the things that help you rise up. They’re parts of you that give you a feeling of strength. Rocks on the other hand, can get in the way.

If your rocks, your struggles, are big enough especially when you’re going uphill, we sometimes feel defeated. Our rocks can seem like quite the obstacle. But they can be useful in the long run.

Everyone has some rockets and some rocks.”

As I have learned over the years, those of us who are more neurotypical have plenty of lessons we can learn from those with ASD. Curiosity, respect and compassion to name a few.

At Evoke Therapy Programs we are operationalizing this compassion and respect with a unique integration of Universal Design for Learning with mental health therapy for teens and young adults.

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The Glance of Mercy

My friend Dr.Brad Reedy describes good therapy or a good therapist as a place where you get to find yourself, and as part of that process, as the messy parts of you come into view, you find that your therapist simply nods their head as if to say, “it’s ok, you’re ok” and “this is part of being human, fallible.” This is true in an ideal sense of any other trusted relationship; teacher, partner, parent. By acknowledging and accepting a child’s feelings and perceptions of their struggles and the parts that feel like failures, a child is more able and willing to see their core gifts and strengths. This only means giving them understanding and a listening ear. It doesn’t mean that you have to agree or disagree with how they see their challenges, only that you hear them, that you get what they are saying. It means not moving too quickly from listening to fixing mode or smoothing out the rough edges by attempting to “put a positive spin” on whatever it is. Reframing can come later, but not first.

When children have struggles in school, do you as a parent want a teacher that’s a gifted technician of educational approaches but with little relationship skills and lacking that accepting and forgiving way? Or would you rather your child have a less skillful technician but blessed with relational excellence and who can give your child that “glance of mercy” that sees all sides of your child and says “you’re ok?”

For my money, why not both?

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Helping Children Cope With Stresses and Worries

Mostly what children need to start working through difficulties is to have a parent or a trusted someone really listen. Even when a child works with a clinically sophisticated therapist, no matter what technique or approach is used, the most important part is the listening. Listening in a way that makes it safe for the child to be in distress, to feel badly and to be able to show one’s self, messy parts included. A parent must have a self that’s able to bear their child’s struggles without taking it personally.  For a deeper dive into the wisdom of this I highly recommend my friend and colleague Brad Reedy’s work and notably his books, “The Journey of the Heroic Parent” and his latest “The Audacity to Be You”

In my upcoming children’s book “A Light Within My Dyslexia” two characters sit as one of them cries after a tough day in school. Beaver shows us that listening is all we really need. Not advice or even “cheering up.”

“When Beaver sat down next to her, she was crying softly. She was upset about her day in school. She told him about misplacing her homework, losing her place several times during class reading time, and how her teacher assumed she hadn’t studied enough because she only got 9 out of 20 correct on the spelling test…
…Beaver didn’t try and solve her problems. He couldn’t. And he didn’t attempt to say something to cheer her up right away. He’d learned from his own life that when he was feeling down or frustrated about school, he really didn’t want his mom to try and cheer him up. He just wanted her to listen and be there next to him.
So he sat there beside Sherry and nodded his head while she spoke. After a few minutes he gently put his arm around her shoulders and she didn’t seem to mind. They sat in silence for a few minutes, watching the passing birds overhead. They heard the buzz of a few bees. Beaver noticed that the sun was moving lower in the sky and towards the horizon. The air had cooled slightly.
Sherry’s tears dried up and her mood seemed lighter, less sad.”

Please also see my first children’s book, “A Light Within” aimed at helping younger kids through anxiety.

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Strong Backs Bending

Women like this one, a local Chola Cuencana, have strong backs, bending and bent. Years of collecting what they can, and what they need.

There is no “gift” of poverty. But living in a developing country like Ecuador, even in our beautiful modern city of Cuenca, it’s obvious that materials for building, clothing, and sources of food, are not taken for granted. Recycling is a way of life for most. There’s a sensibility especially among the many hard working poor, that “stuff” isn’t to be taken for granted and that the ebb and flow of earth’s resources is valued. Very little is wasted. This woman in the video is collecting earth-scraps and the shedding bark of the eucalyptus. And right at the end you can see the ever-present blue face mask (off her nose).

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15 Seconds of Life: Cow Therapy

Cuenca is a modern city high up in the mountains…

…of Ecuador. And one of the parts of this city we love is the mixing of modern urban and and rural countryside culture. Here on my walk to the very modern Mall del Rio, I encountered some of the more laid back ‘citizens.’

Finding peace where you can.

#CowTranquility #BovineTherapy #PastoralPandemica

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Can We Have Joy and Moments of Happiness During a Pandemic?

I’ve been thinking about this question because I’ve had them, joy and moments of happiness.  Even as I’ve watched personal and collective fear take hold because of the virus,  I still experience small and longer periods of time when things are, and I am fine, even good-ish.  Of course I have relatives and friends who are on some of the front lines (love to niece Randie Scondotto Shapiro and like-family Kendall Rookey).  And I know people who are losing jobs and security and more.  I really get that ….. I read the news and am quite aware that these struggles and darkness are real, all over the world.  So what’s up with moments of happiness and even gratitude?  

Two caveats: 1. While this may sound somewhat analytical and while it does come from some reflection, these thoughts are also as a result of feeling other’s struggles and the world wide fear on a deeper level than ever before, not just cerebral.  The other day I listened to a podcast by a longtime respected western teacher of meditation Sylvia Boorstein.  And her insights, commentary and laughter helped integrate some of my impressions.

2.  While this may sound like I know what’s true for others, it’s not and I don’t.  The only thing I can say for certain is that occasionally I feel what’s right for me.  I hope that if anything I share is valuable to anyone else;  it’s reason enough to share.  

So, Is it disingenuous to even ask the title question?  People are struggling all over the world and most of us have never experienced this level of uncertainty anxiety and universal imbalance.  It feels like the economic, relational and political turmoil this pandemic has exposed would blot out any semblance of personal joy.

My current take on the question is that we  can absolutely experience happiness gratitude and even joy in the midst of this turmoil.  And as many others have said, it’s kind of necessary to strengthen our psychic and physical immune systems.

But how do you get to that place in this incredibly challenging time?  This isn’t some lovey dovey pie in the sky attempt at positivity.  

We’re often tricked by the things we hear and read; that it’s a simple thing to “choose joy over fear” or the proverbial ‘glass half full or half empty’ metaphor.  But especially these days, it’s not simply a matter of choosing.   Or maybe it is, but it takes work too and that choosing is more possible and real only as a result of not blocking the feelings that are sad, dark and challenging.  Happiness and sadness or even moments of despair come upon us like waves when we least expect it.  We sometimes have to ‘let it be’ as Lennon and McCartney said.

I’m starting to see (as many of you do) that there’s been an increase in generosity.  Even though there’s plenty of crappy behavior out there, we’ve also seen  the ‘better angels’ surfacing as well.   People, non profits and for profit companies are giving giving services and resources away or at greatly discounted prices.  Symphonies, plays, art work and operas are being offered online for free!  If people have information that’s helpful to the greater good they’re sharing it instead of hoarding.  I have given away my book A Light Within.  Others are doing the same thing and discounting prices, not out of some marketing strategy but out of a sense of “we’re in this together.”  

These are some of the things that can give us pause and the kind of connection worthy of joy and happiness.  Don’t you think?  

If you practice something call  ‘radical realism, which includes seeing even the darkest aspects of life,  it can ultimately lead to a fullness, and a sense of appreciation and gratitude.  Perhaps all of us, especially us boomers and those older, are seeing the end of this life more viscerally than ever before.  Many of us are having moments of sensing our own mortality that sometimes gives rise to a fear  of death, or at least a clarity of the certainty of earthly death.  And yet that can give rise to knowing more than ever before, the preciousness of our lives and the priority of love and relationships. Many of us are reconnecting with family members and friends with this appreciation.

When we look to our neighbor and ask how they’re doing or if they need anything, there is a growing sense that we really are in this together and that the things we used to look past far too often, the connections and (the genuine care) are coming back into sharper focus.  Our individual and collective attentions can be less and less focused on the petty judgments that usually take up psychic space, and more on things that matter.

It’s not that the drama and heaviness aren’t exceedingly real.  But  when we allow the happiness moments in, we understand that we’re  allowed to feel that too.  In fact in it lies our capacity to find solutions and so much more.

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When Giving “Positive Messages” to Children Can Harm

On an online support page for parents with children with dyslexia, one mom wrote in and shared a touching letter that her daughter had “written to God.”  In it the girl wrote of her shame of being different, “not normal.”   She pleaded with God to make her the same as everyone else.

Nearly all of the well-meaning advice from other parents were aimed at changing this little girl’s feelings and thinking by convincing her that “she is perfect” or that “her learning difference is really her superpower.”  Tragically these attempts to “make the child feel better” can short-circuit and interrupt real healing opportunities. Here was my response to the mom:  

“My advice is quite different from what you’re reading here and I want to express it tenderly and with compassion for both you and your daughter and the many folks who are offering  different well-intentioned suggestions that amount to “correcting her feelings and thoughts.  

When your daughter or any child writes such a vulnerable letter to God it’s important NOT to immediately try and convince her that her thinking and feelings are wrong.  When she feels so very broken, telling her that the conditions that led to her very real feelings of hurt and self doubt are really “gifts” or “a superpower” can further drive her wounding down, hidden away (only to resurface later and in different forms).  That’s when trauma turns inward from legitimate pain.  Believe me I totally understand the desire to protect our children and to try and help them reframe struggle into triumph.  But educational trauma is a vey real thing.  Our attempts to help our kids feel better is often a result of our own struggle and uncomfortableness with their pain.

It’s important that her feelings are allowed to be validated; and to hold space for them as a parent is difficult.  The most psychologically damaging habit we as parents can do with our kids is to try and convince them their feelings are wrong.  It’s a slower process but more beneficial to first acknowledge her thoughts and feelings of pain, frustration and of imperfection or “not being good enough.”  The most important first step is simply allow the child to have the space and relationship to express the hurt. Later, one can share compassion and empathy with stories from our own lives where we felt some similar things.  Messages of positivity or even examples of great and truly creative thinkers with learning differences can’t fit where’s there’s no psychological room. Timing is everything.”

Only then do we stand a chance of helping children reframe struggle and real challenge and experiences with an ill-equipped or insensitive school system towards resiliency and hope and self-worth.

Years ago a study examined the traits of successful adults who also had Learning Disabilities.  One of the traits was “self-awareness,” which was described as being aware of the realities of the struggle without over-identifying with them and the diagnosis.  You can’t supersede one for the other with children. 

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15 Seconds of Life: Cuenca Shoeshine

Cuenca Shoeshine

I’ve heard it said that life is made up of individual moments and those that connect in waves. I’ve started using my old iPhone 6s and with clunky hand-held-ness to capture scenes here and there. Not sure if these will hold any interest but I hope so. Maybe a life’s moment in Cuenca will spark something in someone else’s.

Growing up in Brooklyn and NYC shoeshiners were always around in subways. As a kid I always thought of them as in the province of businessmen who seemed fancy or sophisticated. Or, maybe they were for the WW2 generation. Guys like my dad, working guys who’d occasionally get one, though more likely they’d shine and buff at home.

Here in Cuenca young kids are often trying to earn some coins shining shoes. They populate some of the downtown parks.

In my neighborhood and in this quick vid, there’s always one or two regular shoeshine guys at the mercado de veinte siete de febrero, my local open air market. They charge the usual going rate of 50cents. This guys has some classic skills. I’ve used him.

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“Nature, meet Nurture.” Attachment and Autism

Photo Credit: Nature vs. Nurture/Philosophy Talk

In general, infants with autism spectrum have eye gazes that focus more on objects than faces.

And that impacts the mechanisms of attunement between mother/father/ and child.  Less oxytocin, the “love chemical,” and less “feel-goods.”  

Unfortunately this dynamic can trigger the wounds of the parent. All parents are wounded because no parent is perfect because no parent was raised perfectly. Wounding is part of the human condition. It’s nothing to feel guilty about; it’s something to be aware of.

 Without the usual and expected validations from smiles, giggles, gurgles and reciprocal eye gazes (joint attention), the risk increases for parents to feel rejected by their own child. The result is often a subtle but very real moment-by-moment withdrawal by the parent from the child in an attempt to avoid painful feelings.  And round and round we go. 

“Nature, meet Nuture.”

What’s needed is for the parent to build a solidity and resilience of self that supports persevering through the hurt.  A great new book on what it means to develop your healthy self as the greatest gift to your child and partner is Brad Reedy’s new book “The Audacity To Be You.”Continued touching and gazing and talking to their baby will build attunement and foster self-soothing and repair when needed.  Studies show that when this happens babies and their parents increase the chemical oxytocin in their brains and with it, the feelings of healthier attachment and relationship.

There was a time when Autism was considered purely in psychological terms. At one point autism was thought to be a result of repressed emotions caused by poor parenting. Of course now we know that it’s an organic, neurobiological condition with struggles in social communication and sensory differences as primary markers. Most all efforts focus on the child and how to stimulate social learning skills. Applied Behavioral Analysis (ABA) and Social thinking and perspective taking curriculums are two examples of evidenced practices.

Findings – by Ami Klin and Warren Jones of Atlanta’s Marcus Autism Center and Emory University, appeared online in the journal Nature.

“In a ground-breaking report (2013), researchers describe measurable decreases in in eye contact between 2 and 6 months of age in babies who went on to develop autism spectrum disorder (ASD). The babies actually started out with typical eye-gaze patterns. But month by month, they showed steady decreases in the amount of time they looked at a caregiver’s eyes in a video. Baby sibs who did not develop ASD showed the opposite pattern – with eye contact increasing month by month.”

Jones, W., Klin, A. Attention to eyes is present but in decline in 2–6-month-old infants later diagnosed with autism. Nature 504, 427–431 (2013). doi.org/10.1038/nature12715

“Such an early decline in eye contact would represent one of the earliest signs of autism identified to date,” emphasizes developmental pediatrician Paul Wang, Autism Speaks senior vice president for medical research. “It may also suggest a new window of opportunity for effective early intervention, as eye contact is so crucial for learning and the normal development of social skills.”

#CognitiveScienceinParenting. #AudacityToBeYou

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Learning Differences and Oppression

The Many Faces of Educational and Racial Oppression

The racialized reality black students experience every day in American schools mirrors bias and the unequal application of justice and resources that is psychologically and institutionally ingrained.

Even when displaying the same behaviors as white children, “black boys are almost three times as likely to be suspended than white boys, and black girls are four times as likely to be suspended than white girls. Black students’ (mis)behavior is more often criminalized compared to other students.”

Studies and experience shows that oppression looks and feels like:

varying levels of self-hatred (including one’s own group) and isolation from the system one finds oneself in

disengagement when few people in authority look like you

lack of self accountability and self worth

separation of language

shame and hiding who you are

disruption of identity formation

I’m quite certain that the same or similar issues exist in most all communities of color most especially brown and Native Americans.

Now imagine being a black boy or girl AND you have a Learning Difference, such as Dyslexia, another group that, independent of race, is already being miseducated. These children, our children are shamed and learn the behaviors of toxic shame.

Learn to go beneath the behaviors; to hear what these children are telling us. Our children need multi-sensory and multicultural education and therapy.

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Are Children and Teens with Learning Disabilities Potential Geniuses, or Victims of Educational Neglect?

Senators, Inventors, Entrepreneurs, Nobel and Pulitzer Prize Winners have all been people with Dyslexia.  So are kids with Learning Differences budding geniuses and leaders, or  are they victims of metastasized educational neglect?

Both are true.

Carol Mosely Brown, African American former Senator and US Ambassador, Philip Schultz, Pulitzer Prize winning poet, Dr. Carol Grieder Nobel Prize recipient, and Charles Schwab all belong to the first prestigious group.

Photo Credit, Richard Ross

However on the underside, up to 80 percent of incarcerated juveniles suffer from learning disabilities, and belong to the second group. (Center for Substance Abuse at Columbia University)

 A metastasized growth is defined as “the development of secondary malignant growths at a distance from a primary site of illness/cancer.” Having known and lost family and friends to stage four cancer I don’t use this term lightly when referring to the effects of educational neglect.

Children with learning differences such as dyslexia are misunderstood, often poorly educated and are victimized daily from the shame of feeling the very real protective need to hide their struggles. To hide who you are diminishes a healthy self. Daily trauma and wounding leads to a type of helplessness and hopelessness that can later metastasize into depression, anxiety, self-harm and addiction. Often the success stories we often (and thankfully) hear about, are the result of achievement “in spite” of one’s education or because a kid’s been fortunate enough to be born into a family that can afford the right private school or expensive educational therapists.

FACT: Individuals in substance abuse treatment have a higher incidence of learning disabilities than the general population.  One study revealed that 40 percent of people in substance abuse treatment have a learning disability, while another indicated that in residential substance abuse treatment programs, the percentage of people  with LD has been found to be as high as 60 percent.

Educational Traumas like these result in behaviors mentioned above, that get the treatment attention, but we need to acknowledge and treat the underlying wounds.

Hidden Reality: Educational Trauma and Wounding happen on a regular basis to students with Learning and Developmental Differences

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