So, you're worried about your child. He can't make friends, won't keep eye contact when talking with you and avoids social situations as if they were the scariest thing on the planet! You're worried he might be anxious, or worse still, maybe he is on the Autism Spectrum - perhaps with a diagnosis like Asperger's Syndrome. I'm going to use my experience as a lifespan Psychologist, to help you understand what you may be dealing with, and how best to help.
I assume if you're continuing to read, your child just doesn't play like other children you know. He may not connect when other people are upset, and when you tell him he'd better "pull his socks up", that's exactly what he does....literally! Are you also concerned about habits and routines? Perhaps you've tried to change something like the route to school, or the layout of the bedroom, and found it is simply intolerable to your child. What is going on?
If these are the symptoms you're seeing, it could be that you are dealing Asperger's Syndrome. You may have already received a diagnosis, but as is often the case, you're none the wiser in respect of what to do next. You may just be starting out with trying to make sense of a confusing picture. Is it normal, and he'll grow out of it? Why is he so different to your other children? Hopefully, this short blog can assist you.
Before the advice, let's firstly review the science - I'll be brief, I promise. Asperger's Syndrome is sometimes called high functioning Autism. It is a "triad of impairments", namely problems with social communication, social relating and imagination / imaginative play. Problems with change, need for routines and extreme anxiety when they are compromised, are also common features.. Further signs may be difficulties with reciprocal (two way) conversation and difficulties with empathic responses to others (i.e. lacking emotional understanding).
Usually, a person with Asperger's Syndrome (or one suspected of being a candidate for the diagnosis) can be supported to find ways of adapting to the challenges they face. They tend to progress within a context where pro-social activity (i.e. activities, visits and games that encourage time in relationship with others) and peer relationship building can be gently encouraged, over their developing years.
So here is the advice I've been promising;
1 If you have not already done so, talk to your health visitor or visit your GP and chat the issues through. A good GP will refer you to local CAMHS (Child and Adolescent Mental Health Services), some of whom will have a specialist neurodevelopment service, who can help in making an assessment. Expect some considerable waits - NHS services are extremely stretched, but you know that already. In the meantime, read on...
2 Help your child with lots of opportunities to practice how to play/share with siblings, other children in the extended family or neighbourhood. Try not to feel embarrassed by your child's behaviour. The last thing to do is to isolate your child so that no-one visits, and you stay at home. This might provide a temporary comfort zone, but it won't help further along.
3 Your child will need encouragement to play with others, rather than spend time playing alone. If your child is of pre-school age, small playgroups may support him to meet peers and persist in socialising behaviour. Your health visitor would be a good person to ask for local groups.
4 If your child is older, consider social groups at school or in the local community. Ask his teacher about "nurture", or "circle of friends" groups. These kinds of groups help your child learn how to establish, maintain and (where required) repair friendship situations. Where this occurs as part of a group of children with similar social needs (not necessarily having ASD diagnoses), this can be most helpful. Being in a group situation with caring adults, your child can be supported with learning how to co-operate and take turns. Thought should be given to make free time at school feel like a more enjoyable experience.
5 When your child behaves in a hurtful manner towards others, or shows a lack of empathy or understanding, see this as an opportunity to gently coach him. In short, simple sentences, share your understanding of how the hurt person may be feeling, and what would help make them feel better. You could model a hug, or holding of hands, or just the question - "Are you ok? Can I do anything to help?". Your child will make these responses a part of their own skill-set, although it may take much practice and consistent coaching. It really is worth the time and patience.
6 If your child actually hurts another directly, it could be that they are controlling the situation due to underlying anxiety. Lashing out physically or verbally can be very effective in getting others to leave you alone, which a child with social challenges may seek out. If this is happening offer a consistent consequence, such as removing a toy or game they are playing with for 10 minutes, and allow it back after they have apologised to the hurt party. Act during or soon after the hurtful behaviours is observed. Also, always remember to make your attention, care and concern for the hurt child apparent.
7 Any time your child behaves in a more sociable manner, no matter how small, this should be praised and rewarded. Your child may not understand all the 'ins and outs' of why you are so pleased, but his behaviour and interaction with others will be influenced going forwards, nonetheless. The child will associate the pro-social behaviour with his parents being happy with him.
8 On a similar point, you can explain to your child what is desirable behaviour and what is unacceptable behaviour. By using rewards and sanctions, with pictorial targets (simply, a chart that has pictures of what you want your child to do, such as playing with another child, sharing toys, consoling someone who is hurt etc), desirable behaviour can be shaped, and unwanted behaviour can be reduced. Such boundaries and rules often help your child feel less anxious, and by extension, help him behave in a calmer manner. Each time your child succeeds with a target on the picture chart, give him a gold star to add to the chart! It's very visual, and soon your child will pair good feelings, with certain behaviours.
9 Children with Asperger's (or Asperger's traits) can also benefit from anxiety management training, and guidance in terms of how to develop and use what are called "self-soothing" strategies, at times of distress. Self soothing just means doing something that you can control, which calms you down or helps you feel less angry or anxious. Relaxation tracks with soothing melodies and sounds are readily available in bookshops on the high street. Youtube is an easy and free resource for such materials, through the internet. Do take a look. You can also seek out anxiety management groups in the local community (e.g. through an organisation like Barnados, Relate or other charitable groups), through NHS CAMHS or independent providers in the private sector.
10 Skills training in the recognition and expression of emotions (particularly hurt feelings, anxious feelings and angry feelings) can also be greatly beneficial. Books and posters with feelings faces, can be an invaluable aide. By asking your child to point at a face that shows how he feels, emotional communication and language can be encouraged. Practice, practice, practice! If your child struggles, help him out, and over time, he will learn to match faces to feelings, even if it's just enough to get by.
11 Your child can be prompted to maintain eye contact during conversation, whilst giving or receiving information. A gentle hand on his shoulder, or calling him in a reassuring manner to look towards you as you speak, can be helpful. Repeating this consistently, will lead to change over time. There is no harm in you saying to your child in a calm and inviting manner, "would you look at me please...I need you to look at me..." before you share, or before you are prepared to listen.
12 You should access the National Autistic Society for further information, or to be placed in contact with local support groups. It can be very helpful to know that you are not alone, and learn from other parents how they have managed to get help, and what to avoid.
13 Above all, remember your child is uniquely special. He may have certain challenges, but there will also be a number of hidden strengths and formidable talents. In my experience, I have come across many scientists, engineers, mathematicians and business strategists who have Asperger's, or present with traits of the condition. Logical processing and seeing patterns that others are often oblivious to, can be an exceptional quality in your child. In the right environment, and at the right life stage, these qualities can be expressed and lived. Be hopeful, and cherish your child.
Dr Bobby Sura
Consultant Clinical Psychologist
Dr Bobby Sura is a Consultant Clinical Psychologist specialising within the field of lifespan and family based mental health needs. He works both in the public (NHS) and private sector, being the proprietor of Clinical Psychology Direct and Partner for Solihull Well Being Clinic. Dr Sura is Chartered with the British Psychological Society (BPS), Division of Clinical Psychology (DCP), Health and Care Professions Council (HCPC) with eligibility for registration with the United Kingdom Council for Psychotherapy (UKCP) and
Association of Family Therapy (AFT).