It’s not too early to think about ways to help your youngsters get prepared for school. It’s sooner than we think, and children who are on the autism spectrum face great challenges. I spend a great deal of my time lately trying to get the kids and parents adjusted. Disruptions include changes to their schedule, new students, sometimes new teachers, a strange environment and academic pursuits. Any or all of these things could be said of neurotypical children, so imagine how tough it is when there are developmental issues. Plus, there are still all of the therapies that many children still require.

“So,” I ask the parents, “is it anxiety or focus that you are most concerned about?” Dad says the child is always worried about mistakes and getting things perfect, Mom is uneasy because the child daydreams and can’t stay on task, and sometimes they switch after a bit of time, and often they finally agree that it is both. This is an important discussion. Parents are the experts about their children and assembling an accurate description of the child’s strengths and weaknesses can help shape how the new school year progresses.

The problem is, in medical parlance, anxiety is treated with anti-anxiety medications and focus is addressed by the use of stimulant medication. Often, parents do not wish to enter into that arena. Should they decide to go that route, pharmacologically treating either ‘symptom’ is not very satisfactory. Choices that need to be considered are anti-pschotics vs. stimulants vs. blood pressure meds vs. reuptake inhibitors vs. benzodiazepans and further multiple selections within each category. There are numerous side effects, it takes time to see improvement and frequently there are negative behaviors that make this a less-than-optimal option. To the traditional medical community, except for the stimulant products, “The latest studies have not shown efficacy in most cases.”

Here’s the catch – anxiety or focus – it’s neither and both. Because the main problems that I observe in most of the children revolve around their immaturity. What are the symptoms? First, whether the child has friends; and then,  if they are much younger, older, the opposite sex or cousins. Such playmates are ‘safe’, they aren’t as aggressive and more tolerant if the child goes off-task. The books and videos that patients choose are less than age-apropriate, usually by several years. Imaginative play may often be limited to the toys of much younger children. The patient has a ‘short fuse’ and suffers meltdowns or other disruptive behaviors that the situation does not warrant. When the parent exclaims that, “He/She is acting like a baby,” I know what you mean.

By thinking in terms of tracking maturity, parents can record their child’s true progress. Each year brings new milestones, even if it is not neuro-typical. Improvements can continue to advance at a given pace (for example,  the 7 year-old who acts like he’s 5 in some areas – especially social), so that by the late teenage years there is a smoothing of the disparity. Some eighteen year-olds are very immature and some 16 year-olds are quite advanced. The question is, “Has your child continued to make progress?” If not, is it because the symptoms are related to anxiety or focus and could they really be helped by using medication? If so, then the interventions that you are applying are succeeding.

There isn’t a pill for maturity, so what is a parent to do? How can self esteem be supported through these difficult years? True, corporal punishment may occasionally diminish disruptive behaviors, but at what expense? This may not be the most popular advice, but I believe that the focus should be on social skills with less emphasis on academics – the FCAT (or whatever State exam your offspring must endure) notwithstanding. Holding back a grade, especially in first and third can be beneficial. Positive reinforcement through desired activities, not to excess, of course. Continuously keeping ABA and other therapies is paramount, so that acceptable behaviors come from within, even when the parents are no longer present.  A psychologist may assist with family issues. Neurofeedback has been shown to improve symptoms. Once in a while medications do work. The most successful Dad I ever knew advised, “You’ve got to bring the child into our world, and not go into his.”

Finally, I often say, “If there were a medication for maturity, my wife would have given it to me already!”

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      Functional and Integrative Children’s Care

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