I work with all kinds of patients at my full time job at a small community hospital. From fluency to brain injury, I need to be prepared to support anyone who comes through the door. Every once in a while I get a referral for a child with autism. Usually these individuals are very "high functioning," meaning that their communication and cognitive skills are relatively strong when measured on the autism spectrum. And generally I am providing supplemental therapy for older children (age 10-15) because their parents and teachers feel they need extra support. Most of these kids have access to great treatment in their public school, with therapists who specialize in working with children of their developmental level and often with extra training and experience working with autism.
I'd like to take this opportunity to give a big shout out to the amazing school SLPs out there. They manage big caseloads, lots of budget and policy red tape, and sometimes less than ideal conditions, but boy do they make a difference in these kids academic lives. I will be frank: autism is not an area of specialty for me. However, I feel confident that I can support these kids and their families. I love each of my kiddos and I learn so much from working with them.
A primary area of focus for nearly all of the children with autism that I have worked with is Social Skills. Well, to be fair, it is an area of focus for these children's parents, not for the children themselves per say. Social skills include things like eye contact, topic maintenance in conversations, and "saying nice things to people (and here is the part that gets me most) even if you don't mean it." Though we call them skills in the speech therapy world, these socially acceptable ways of behaving and interacting are really more like "rules." Typically developing kids learn these rules easily, without having to be explicitly taught, because blows to self esteem, fear of being rejected, and being policed and judged by peers are common occurrences in our interactions from a very young age. Children with autism often seem to be immune to these methods of learning. This is sometimes a source of frustration for their families and peers. I hear them say "he doesn't notice when our eyes glaze over because we are ready to talk about something other than scorpions." Or "he doesn't wait for everyone to be ready before he puts away the game."
Here is my dilemma. I have actually spend these first few years of my adult life trying to unlearn many of these rules, or at least free myself from letting them dictate my every interaction. I am trying so hard to learn and internalize the TRUTH which is: the only person I need to take care of is myself, and by doing that I am serving the highest good of all around me. I don't need to manage other people's feelings or make them happy (this is called people pleasing). I don't need to say things I don't mean in order to be liked. I don't need to do anything I don't feel like doing! Of course it's complicated, because some aspects of these unhealthy ways of being have actually skyrocketed me to where I am today. I probably couldn't have scored glowing letters of recommendation, aced the job interviews, and occasionally schmoozed my way out of speeding tickets if I wasn't paying attention and using social skills like those mentioned above. But I just feel so wrong drilling these children to be hypervigilant people pleasers, when I know in my heart of hearts that they are ok just the way they are. In fact I envy them at times. Oh, to be completely free of social anxiety!
I suppose one answer is to show and teach these kiddos about all the different ways we can be in relationship, so they can make the choice about whether and when they want to "play the game." Show them the tools and let them reach for them if they want to. And always to be learning from them as much as they are learning from me.
I welcome your comments, especially those of you who work with people with autism and see the benefits of treating social skills. I trust that we are striving to improve people's quality of life, and not just teach them "the right way." And I encourage you to learn from my friends with autism. If you want to talk about scorpions till the cows come home, do it!
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