Monday, June 20, 2016

Identity formation in children with ASD: are you a cat or a horse?

Today’s blog is in answer to a query received by me regarding how to facilitate identity formation in a 13 year old with autism.The teenager in question, lets call her Penny, has severe challenges with theory of mind i.e. relating to/understanding another persons state of mind and responding to it appropriately. Hence Penny frequently misreads tonal variations in others speech, such as when she says to me, “ Ms. Huma why are you screaming” and/ or “don’t make fun of me”, when I am only trying to explain something to her in a deliberate tone. Another example of Penny’s struggle with appropriate social skills is when she made a loud comment about a child’s oversized teeth and called him ‘bugs bunny’ on his face, not realising how he would feel. On being told that her comment had been hurtful she insisted that she was only telling the truth. This is also referred to as ‘mind blindness' and is typical feature of the Autism Spectrum Disorders found in varying degrees in individuals with autism.

Penny goes to a mainstream school where owing to her brash and self-focused attitude, forming friendships with other children is a struggle. She has expressed her loneliness in school and helplessness in relating to others through her artwork in the art therapy sessions that she comes to me for once a week. Judging by my communication with her, it is evident that just as Penny lacks insight into others, she has very limited awareness of herself as well. 

Penny is at the cusp of what Erik Erikson, in his theory of psychosocial development,  calls the stage of ‘identity vs role confusion’. According to Erikson’s lifespan theory of development this stage lasts from 12-18 years of age (adolescence) and is crucial for identity formtaion. During this time, youngsters are trying to gain independence, relationships with peers become very important, and fitting in with others are the main goals of this period.

But in Penny’s case, her diagnoses of autism puts her in a very precarious situation where  her chances of achieving success in the aforementioned psychosocial stage of her life are hugely challenged by her condition. Failure to develop a healthy sense of identity may put Penny in danger of developing a low-self esteem and lack of confidence which can lead to a sense of failure, isolation and perhaps even depression.

So how to help Penny develop: self-awareness (who am I?), acceptance of the self (I have challenges that many others don’t) and goals for her future (I also have many strengths that I can build on).

Below are a few ideas that I would like to share with you. As an *art therapist I would incorporate the following in my sessions but the idea behind each directive can be adapted to other modes of interaction such as  games, social stories and role playing etc.

  •       Draw yourself as an animal/animals. What qualities or weaknesses within the animal/s do you associate with?

  •       Divide a paper in quarters. Draw yourself as a child in one1/4, as you are now in the next,  how you see yourself after 10 years and then 25 and so on.

  •       Draw a self portrait of yourself on one side of the paper and on the other how you think others see you.

  •       Draw yourself as an animal, plant or object in an environment.

  •       Draw all the things you like about yourself in a circle and the ones that you don’t like outside the circle. Now transform one of the things that you don’t like into something that you like.

 The above directives could help Penny gain some insight into herself by tapping into her subconscious through her artwork and then analysing it with her to help her with self-awareness. Frankly, these exercises could work for anyone, you and me including but especially for Penny who may be more visual than auditory as most children on the spectrum are.

All stages of life are interdependent and we hope that all our children pass through each successfully, but as parents of special needs children, we know that the effort that we need to put in is significantly more at each stage. Hence, educate yourself  in order to empower yourself and your child to conquer each and every stage. Penny or your child or mine may never fit in with others or have friends to hang out with,  but  they can face all of these difficulties if they are proud of and believe in who they are . Instead of changing them to become ‘us’ let’s celebrate their differences. Yes, we must equip them with skills that we all humans need to live in society but let’s love them for who they are right now and not what we want them to become.

*Art therapy can only be conducted by a qualified art therapist.

Monday, June 6, 2016

"It's a long story..."

Osman and I have decided that Mo will come back home to Singapore next year after he finishes school in England. I apprised him of this plan during his May holidays. Mo on the other hand, wants to go to college in England as according to him his classmates are going to go. However, I told him that we, his parents, felt strongly it was in his best interest to return to Singapore, find a job and settle down. The idea of a job  in Singapore was the carrot that I dangled knowing full well that Mo would acquiesce fairly easily  to the plan. And he did, so much so that he declared with pride, "my friends at school are going to be so jealous because I will have a job". When I reminded him that they too would eventually find jobs he declared "yes I suppose so, but first they will go to college. I can't go to college because I am more special needs than they are". Taken aback by his comment I probed Mo for an explanation to which he replied, "it is a long story", meaning I had reached a dead end and was not going to get my answer. That same day he told me,"I am tired of being surrounded by autistic people, I want to be around normal people". This is not the first time he has said that. In fact a couple of days ago he saw two blind people in the London underground and declared, " I don't like seeing people with disabilities, they give me the creeps"!

Mo's attitude pained me immensely. I began to question myself and my upbringing of my children. I, who claimed to be an advocate of special needs individuals, could I possibly have passed down the 'wrong' ideals to Mo? If not consciously then sub-consciously had I or Osman  encouraged a dichotomy between 'normal' vs' 'abnormal' in his mind? Looking for answers, I rewound my memory over the past 15 years and all I could remember telling my kids was that there is no such thing as 'normal'. Everyone is 'different' and we all have our challenges. Differences must be celebrated and not scorned. So then what had gone wrong and where?!

As I teetered between reflection and hypothesis I came to a possible conclusion. Although Mo gives the impression that he has a significant degree of awareness about his diagnosis of autism, he openly says that he is autistic,  I don't think he sees himself as any different from stereotypical's. He acknowledges that he has difficulties  but as far as his self concept is concerned he believes that he is no different from his brothers. Does it mean that he is in self denial? Or is it that he is not able to perceive himself from another's point of view? Whatever the case should it be viewed as a good thing or not such a good thing? Also could this be a contributory factor to his attitude towards people with disabilities?

Here are my thoughts on the above. Given that Mo is autistic, there is a very high probability that he lacks self awareness and by default is in denial. His teachers are working on his self concept but it is a goal in progress. I believe it is critical for him to accept that he is different, embrace the difference and celebrate it. Once he is able to do that he may become more accepting of others who are different from the norm by virtue of association or empathy.

I believe that Mo's early schooling has a big role to play in his perception of himself and others. Till grade 6 he was in mainstream school where he was pretty much the only special needs child in his class. Inclusion benefitted him in many ways but the lack of exposure to kids similar to him probably created a template of what is normal and not normal in his mind. Henceforth he began to categorise people into normal and abnormal categories based on that template. Had he mixed with both stereotypical and special kids in his primary years this distinction may not have been so black and white. He may have grown up accepting the differences as a norm rather than having to label them.

It boils down to the fact that exposure and integration are key elements to an inclusive society for individual with special needs. If our children grow up amongst individuals who are different physically or mentally, they will embrace the differences and not shun them. Then labels for mental illnesses and disabilities will perhaps only be use to define  symptoms and not a be viewed as a stigma. Just my thoughts on the subject...