With holiday break approaching, we may feel our anxiety starting to rise; less structured time, no school, different schedules, etc. These changes can wreak havoc for kids with autism and other mental health challenges. Here are 5 quick tips to help break be a successful time that everyone can enjoy.

1. Provide advance notice. Let your child know that break is approaching and what s/he can expect to happen over break. Sometimes we use calendars to write in what activities will be happening each day. This advance notice lets a person know what is coming so they can begin to prepare mentally.
2. Schedule breaks. Sometimes there are lots of new and different sensory stimuli like cooking smells, new people, different sounds etc. Processing new stimuli takes additional energy and so scheduling frequent breaks may be helpful for your child. The trick is to remain within a window of calm and not letting our emotions get too big. Frequent breaks can help us get regulated throughout the day and increase the likelihood that we will stay within that window of calm.
3. Help others understand. Perhaps family that isn’t around often throughout the year may not know what to expect or how to interact most successfully with your child. Some advance training for them through an email or phone call with some key points about your child’s triggers as well as preferred items / activities can go a long way
4. Create structure. Kids with autism and other mental health challenges are usually most successful in situations which have structure. With school being on holiday, there may be less structure during the day. Reaching out to support providers (i.e. ABA, speech, OT) to see if there is an option for increased services during the break may help. Also, creating a daily schedule for your child can help create structure for him/her (and you!).
5. Enjoy the moment. Holidays can be times of additional stress and pressure. Remember that it is also a season aimed at spending time with those we love. Try to remain in the present moment and notice what is happening around you; the lights, the sounds, the smells, instead of thoughts about what must be done next or worries about what might happen in the future.

We’d love to hear any other tips that help your family enjoy this holiday season!

Warmly,

Dr. Becca

We have been working to get our new clinic location in Jacksonville, NC set up and we are pleased to announce that the clinic is officially open! 

Why have sessions in the clinic? This is a great question. And we understand that it is often most convenient to hold sessions in your home, for a variety of reasons. The clinic allows us to have access to new / different reinforcers which may not be an option in your home such as swings, trampolines, the Ball Bath, and other larger sensory items. Being in the clinic is also a newer / different environment for your child so it allows us to very naturally work on generalization of skills to a new environment with different distractions and stimuli. Clinic sessions also allow for you to drop your child off and our location off Western Blvd extension allows for convenience for you to run errands or get some “me time” while your child works towards his/her goals.

Do all sessions have to be in the clinic? We can customize a service schedule specifically for your needs. Some families have all sessions in the clinic, some have one per week, some  have two per week. It depends on your needs / goals.

Do I have to stay at the clinic during session? You are always welcome to stay at the clinic during session. We have an area with chairs and coffee and of course WiFi for your comfort. However, you are also free to drop your child off and come back at the end of his/her session. Our convenient location off Western Blvd extension makes it easy for you to run errands or get in some “me time” while your child is working towards his/her goals in the clinic.

Will other children be there? Great question. Depending upon the time of your child’s session, there may be other children, parents, and staff in the clinic setting. For any clinic sessions, we require a signed confidentiality agreement on file. This means that you will keep confidential any other children / families that you see in the clinic and that other families will keep confidential your presence at the clinic. This is aligned with HIPAA (Health Insurance Portability and Accountability Act) which ensures equal access to certain health and human services and protects the privacy and security of health information.

Here are some pictures of our Jacksonville, NC clinic. If you’re interested in starting sessions at the clinic, please talk to your BCBA or supervisor. If you’re a new client, please contact me at drbecca@delmarbehavioralhealth.com. Hope to see you there soon!

Dr. Becca

The Parent Handbook offered to you at every IEP meeting is your special education bible!

This document is not just some useless booklet. It’s technical name is the Procedural Safeguards and it’s a requirement under IDEA 2004 Section E. These safeguards are there to protect the parents and families of children with a disability. This document also gives very specific information about how any disputes or disagreements about services can be solved.

Just a few of the safeguards outlined include:

• The right of parents to receive a complete explanation of all the procedural safeguards available under IDEA and the procedures in the state for presenting complaints
• Confidentiality and the right of parents to inspect and review the educational records of their child
• The right of parents to participate in meetings related to the identification, evaluation, and placement of their child, and the provision of FAPE (a free appropriate public education) to their child
• The right of parents to obtain an independent educational evaluation (IEE) of their child
• The right of parents to receive “prior written notice” on matters relating to the identification, evaluation, or placement of their child, and the provision of FAPE to their child
• The right of parents to give or deny their consent before the school may take certain action with respect to their child
• The right of parents to disagree with decisions made by the school system on those issues
• The right of parents and schools to use IDEA’s mechanisms for resolving disputes, including the right to appeal determinations

As parents, you are in integral member of the IEP team. You know your child better than anyone else seated at that table. The law recognizes this and also acknowledges that as parents, you are your child’s best advocate. Next time you’re at an IEP meeting and the team offers you a copy of the handbook, accept it, review it, become familiar with your rights and the protections in place for your child with a disability.

Hopefully, you have a strong alliance with the school team and you’ll not need to use the dispute resolution process, however perhaps you’d like to get an advance copy of testing results before an IEP meeting or you want an IEE for your child. These are not unreasonable requests and are within your power. Reviewing this information regularly may also help to get more familiar with some of the terms used by school teams. All those acronyms can begin to swim through your mind during meetings

I’d love to hear how you use your Parent Handbook or what information you learned as you’ve gone through it that have helped you and your child move closer towards your goals.

Dr. Becca

Halloween can be an exciting and fun time for kids however all of the changes and sensory input may present challenges for kids with ASD. Here are some tips that may help Halloween be less scary and more spooky!

1. Try on your child’s costume before Halloween. This will give enough time to check on and fix any sensory issues with costume material, tags, or other sensory issues.
2. Create a social story about what to expect during Halloween and Trick-or-Treating and read it daily. This helps you child learn what to expect which helps to decrease anxiety.
3. Practice! Perhaps have your child ring your own doorbell, in costume, say trick-or-treat and receive candy or a small toy. Practice serves a similar purpose to the social story in that it helps the child know what to expect.
4. Only do what your child feels comfortable with. Some children may go to 3 or 4 neighborhoods trick-or-treating. Perhaps you know that your child can only handle 3 or 4 houses. That’s OK! It’s better to end on a calm and positive note which helps set the stage for successful Halloweens to come as your child will remember that s/he was successful this year.
5. Go with a group. For some children, friends and/or family of other children may help him/her feel more comfortable and supported. Additional adults may also help you, as parents, to have additional support should the need arise.
6. Hand out candy. If going out trick-or-treating feels overwhelming this year, stay home and hand out candy. Your child can hand out candy to the other children who come to the door. This allows him/her to participate in the holiday festivities in what feels more safe for him/her this year
7. Trunk or treat. Some areas have community events like Trunk-or-treat or trick or treating in a mall. This may be a good option for some children as it’s a place they may be familiar with and it is often not at night which can bring about different worries or sensory difficulties.
8. Remain positive. Remember that our children are barometers of our own emotions. Remaining calm and positive models that for your child and send him/her the message that you believe in them and are accepting of them.
9. Avoid comparison. Comparison is the thief of joy. Remember that your holiday may look different than those posted on Facebook by your friends. That’s OK! Whatever feels right for you and your child is the “right” kind of Halloween for you
10. Have fun! This is an opportunity to experience something new or different with your child and to potentially relive some of your own childhood. Enjoy it!

Holidays are meant to be fun events. Sometimes they can bring about some additional stress and/or worry however with preparation, they can be great opportunities to spend time with your child. I’d love to hear how you make Halloween work for you and your family!

Dr. Becca

Hurricane Matthew is starting to arrive here in Eastern North Carolina and bringing with him lots of sensory stimulation in the form of heavy rain, strong winds, and red alert alarms going off on cell phones and TVs. All of these are new and potentially scary things for kids. Families are also forced to stay indoors and may be without power which can further increase stress and anxiety in both kids and parents. Remember that all behavior is communication; your child is telling you something when s/he shows challenging behaviors. Most often in these situations it is anxiety and worry. Hurricanes and other storms can be made more manageable by following these tips:

1. Create a schedule. Remember that a schedule creates feelings of safety because it creates a sense of knowing what is coming next. Anxiety stems from not knowing what is going to happen next and when children have a basic schedule to follow it can be easier to deal with the anxiety of the storm because they have something that is predictable in the schedule. It can be written on paper or a white board or even have them help create the schedule. You can use pictures or written word, whatever is most appropriate for your child.
2. Music. Music or any other rhythmic sound has the power to influence our mood and energy level. Playing low levels of calming, soothing music can help set the stage of a calming environment. Perhaps find a classical music station on your battery operated radio if you have lost power or even sing lullabies or other calming songs with your child.
3. Model calm. We know that our own moods and actions has a huge effect on those around us, including our children. By keeping our voice calm and even and using reassuring statements, we can help our children feel more safe which can help them to relax.
4. Use heavy work. We know that feelings of exhaustion after a good workout. We can elicit those same feelings in our kids but instead of doing cardio activity which may wind some kids up, we can use “heavy work” activities that get their proprioceptive systems regulated. (More about the proprioceptive system here) This system can be activated by giving deep pressure massages or squeezes, wrapping your child up in a blanket like a burrito, chewing crunchy foods, sucking thick smoothies through a straw, or pushing or pulling heavy items like helping vacuum or moving boxes.
5. Talking about it. Give your child space to say they might be scared or worried. You can help give your child the language to use if verbal language isn’t a strong skill or have them draw a picture of their feelings or worry. Remember that the important part is for them to feel heard and understood so after sharing or drawing, be sure to repeat back to your child what you heard for example “Sounds like you’re worried Daddy won’t get home before the storm hits” or “Sounds like you’re mad that you have to miss the party planned for this weekend because of the storm”

Stay safe and dry!

Dr. Becca

Sleep is something that is absolutely imperative to living and yet it is also something that we so often skimp on when we are stressed. Adults typically need 7-9 hours of sleep per night. Take a moment and think – when was the last time that you got that amount of sleep per night for a few days in a row? How did you feel? Or maybe, it’s been so long that you can’t remember. How do you feel now? Research has shown that when we are sleep deprived we respond similarly to when we are intoxicated. And yet, we so often go about our days sleep deprived; driving around town, making decisions, and caring for others. We simply must create greater emphasis on getting more and better quality sleep! This applies for us and our children. Try these tips for a week and then compare how you feel.

1. Start powering down at least 60 minutes before bedtime. This means turn off electronic devices which stimulate our minds. Reducing the stimulation allows our brains to begin to power down for sleep which is a gradual process. So that when we get into bed, our mind is already in a closer to relaxed state.
2. Create a bedtime routine. We often do this for our children and yet not for ourselves. Perhaps its changing into pajamas then reading for 30 minutes then turning out the light. Or perhaps its wiping the counters, having a cup of tea then going to your room. Whatever works for you and is realistic. Sure, it’d be great to mediate every night but if it’s not realistic then let’s not put it as part of our routine or we’re just setting ourselves up. Having a routine let’s your mind know that sleep is coming soon when you begin the routine each night.
3. Avoid large meals before bed. It can be easy to snack on chips or ice cream or to even eat a late dinner some nights. Food equals calories which gives us energy. Taking in large amounts of calories will give us energy which is the opposite of what we want right before bed. Further, when we eat a lot we may become uncomfortable which can make it more difficult to get physically relaxed when we get into bed.
4. Calm your mind. Often, it isn’t our body that keeps us up, but rather our mind. Practicing mindfulness can be one way to learn how to become more aware of what is happening in our mind and to then be able to direct what happens. For example, if I frequently get into bed and then think about everything from the melting glaciers to my shortcomings from the day, I can be actually increasing my anxiety which is the opposite of becoming more relaxed. When I can remind myself that my thoughts are just thoughts and that I can choose to let them pass by my mind like clouds in the sky, I’m taking steps towards calm rather than activity and anxiety.
5. Put a pen and pad next to the bed. Sometimes we remember things when we’re laying in bed because the stimulation of the day has died down. When we have an idea we can write it down on the paper next to the bed which removes the feeling of anxiety about having to remember it the next day. We can write it down and then let it go. It will be there when we wake up.

I’d love to hear what works for you! Sweet dreams!

Dr. Becca

This is a question I’m asked often by school staff and parents alike. It can be very confusing when a person, child or adult, acts one way in one setting and another way in a different setting. However, this is a completely normal occurrence even for us as neurotypical individuals. For example, the way I act in a library, is very different than the way I might act at a Pittsburgh Steelers football game. This is a somewhat exaggerated example, but I mean it to help illustrate the point that there are different expectations across different environments which exhibit control over our behavior. Schools tend to be a more structured setting, with more consistent schedules, and also more expectations related to academic and social tasks. Home tends to be a more relaxed setting, with more unstructured time, and the expectations of social behavior are different and there is not much academic demand but rather daily living demands. Of course, this is a generalization as some educational environments are not very structured and some home environments are. The main idea is that there are different repertoires of behaviors that are required to be successful in each environment and it’s possible to have mastered cleaning one’s room while not yet having mastered reading comprehension. Further, the social demands in school are with same aged peers who may not be as understanding as family members and who may create anxiety in the individual because they are less predictable and when we are anxious, we act differently than when we are calm. School may have more environment stimuli such sounds, sights, smells which can be overwhelming and typically, homes are much less stimulating or the stimuli that are present are more familiar and therefore easier to manage. All of these differences across different environments help to explain why behavior may be different across those different settings.

So, next time you’re at a meeting and you hear someone else describing a child that sounds like the polar opposite of the one you see when the child is in your setting, think of it as an opportunity to learn what helps your child to be more successful. For example, if they are doing well at school, how can we make home a bit more like school? Can we add a schedule? Keep that schedule more consistent day-to-day? Or if the child is more successful at home, how can we make school more like home? Less environmental stimuli like breaks throughout the day? Shorter work sessions to keep him/her from getting overwhelmed by academic demands? More specially designed instruction?

Though open communication, we can learn what is working for each child and aim to replicate his/her most successful environment to help increase his/her success.

Dr. Becca

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological disorder that is characterized by difficulty with organization and attention. ADHD affects approximately 1 in 10 school-aged children and 1 in 25 adults. Boys tend to be 3 times more likely to develop ADHD and receive a diagnosis of ADHD than girls. Many individuals with ADHD may also have other mental health challenges such as anxiety, depression, speech or language disorders, a learning disability, or other behavioral disorders (i.e. Oppositional Defiant Disorder or Conduct Disorder). While it is normal for kids to display some of these symptoms, a comprehensive evaluation can determine whether the symptoms are typical childhood behaviors or indicators of ADHD. There are three different types of ADHD; predominantly inattentive type, predominantly hyperactive/impulsive type, and combined type. But what about ADD? This is an outdated term/diagnosis that is still used sometimes and that may be confusing. The DSM-5 lists the criteria for ADHD and the 3 subtypes and is used by psychologists during an evaluation to determine if a child or adult meets criteria for ADHD. ADHD can only be diagnosed if the symptoms are impairing the individual’s functioning. The symptoms of each are listed below.

ADHD, Impulsive/Hyperactivity Type: Often blurting out answers before a question has been completed, has difficulty waiting his/her turn, talking excessively, is often “on the go” as if driven by a motor, frequently fidgets with hands or feet and may squirm in his/her seat, frequently interrupts others, has difficulty remaining seated or in a specific area when directed to do so such as in school, and has difficulty playing or engaging in leisure activities quietly.

ADHD, Inattentive Type: Often does not follow through on directions and fails to complete tasks, has difficulty organizing tasks and activities, avoids or dislikes tasks that require sustained mental effort, often fails to pay attention to details which may lead to making careless mistakes, does not seem to be paying attention when spoken to directly, is easily distracted, may be frequently forgetful in daily activities, and often loses things necessary for daily activities.

ADHD, Combined Type: Just as the name suggests, this subtype of ADHD is used when an individual displays symptoms that fall into the Impulsive/Hyperactive type and the Inattentive type.

Look for our next blog which will talk more about how to more effectively work with children with ADHD and also descriptions of common ADHD treatment.

Dr. Becca

I’ve been thinking a lot about transitions lately as I’m in the process of moving from California to North Carolina. It’s common knowledge that individuals with ASD and other mental health disorders struggle with transitions. After just having gone through a major transition myself, I’m wondering if we all don’t have some level of difficulty with transitions. Our routines are off, we’re unsure what to expect, we may be in a new environment with new and sometimes overwhelming stimuli. And in many ways, isn’t it normal to have an adjustment period when things change? I know I’m certainly going through an adjustment period now. My house is new and has some residual construction smells leftover, my personal items haven’t arrived with the movers yet so I can’t find the things I want/need or I’m having to do without, I get lost driving around a new town, and I don’t yet know anyone so I don’t have physically present social supports. All of these things lead to increased anxiety and stress. Somewhere around the middle of central Arkansas, I had the thought that many of these feelings are likely ever present in our kids with ASD and that this experience has given me a greater glimpse at the discomfort caused by smaller transitions in their daily lives. I wonder then if for some of our kiddos, daily changes may feel like cross country moves? Remembering these feelings during moments when I’m asking a child to transition, may help me to connect with him or her more compassionately as I can recall the feelings of confusion, uncertainty, and being overwhelmed. Have you felt overwhelmed with a transition? How can you use that experience to help create more meaningful connections and supports for individuals who may be struggling with a transition?

Dr. Becca