Friday, May 19, 2017

101 Ways to Teach Social Skills - Neurodiversity Comments (Activities 45-59)

This is the third part of my review of 101 Ways to Teach Social Skills.

Section 4: Caring About Yourself And Others

The intro to this section demonstrates generational prejudice, reporting that 80% of adults believe children today are ruder and less respectful. They neither provide any references, nor question whether those adults' perceptions are accurate. Rudeness and respectfulness are subjective, and different norms may result in the perception of rudeness where none is intended. Just as different cultures have different standards, so do different generations - for example, it's no longer acceptable for an older person to insist on preferential treatment simply because of their age. Plus, many people are likely to try to present themselves in a more favourable light, including claiming they behaved better as a child than they actually did. More objective measures of caring actually suggest that people are getting nicer - crime rates, including violent crime rates, have declined dramatically in both Canada and the US over the past 50 years. It's simply not justified to make claims like this without evidence, especially if you plan on working with a younger generation.

Activities 45-46 are about asking adults for help and understanding how your actions impact others. These activities both look great.

Activity 47 is about understanding that others have reasons for their behavior and trying to figure these reasons out. This is a valuable lesson for everyone. In my opinion, many adults working with neuroatypical kids need to learn this possibly more than the kids do. Never assume the child is only acting a certain way because they don't know any better. Always consider whether there may be a more pressing reason, such as sensory issues, why they specifically behave in that particular way.

Activities 48-52 focus on showing empathy, showing interest in others and helping others. I have no problem with any of these activities - they all look great!

Activities 53-54 are about giving and getting advice. I have a big objection to their portrayal of unsolicited advice as a well-intentioned act that you shouldn't object to. Personally, I see unsolicited advice as often being harmful and used to enforce social conformity.

This is especially true for disabled people. Visibly disabled people get assumed to be incompetent and given advice on how to manage their disability and on regular everyday tasks. Invisibly disabled people get advice from people who don't know they're doing something unusual because of their disability, or in some cases flat out refuse to believe that this behavior is due to a disability even when told. And both kinds of disabled people get constant advice about quack cures they should try. Not only is this advice unwelcome and annoying, but it frequently reveals hurtful assumptions, such as that the disabled person is incompetent, inconsiderate or really desperate for a cure. In short, much of the unsolicited advice disabled people get end up being microaggressions. Good intentions don't mean your actions can't hurt others.

Instead of teaching kids that they should receive unsolicited advice positively and dish it out to others, children should be taught to only give advice if they have explicit consent or if there's an immediate risk of harm ("don't touch that - it's hot!"). If someone asks for advice, that's consent. You can also ask "would you like some advice?" and don't push it if they say no. Very often if someone is complaining, they don't want advice, they just want empathy. Comment about how it made them feel, not what they should do.

Obviously, many people these children will meet won't follow these rules. They should be taught to respond to unwanted advice two ways. If it's a stranger, or someone who has been a poor listener to them in the past, they should simply say a one-liner like "I will take that under consideration" or "I have my own reasons for doing it this way, which I'd rather not get into". If the person tries to push for more response, they should simply repeat that same line until the person gives up, or seek help from a supportive person. If the advice comes from someone they trust to listen and learn (everyone makes mistakes), on the other hand, they should explain why that advice isn't helpful to them, and possibly also challenge the hurtful underlying assumptions (for example, if someone I trust is offering me a quack cure for autism, I will explain that I don't want a cure because autism is part of my identity).

Activity 55 talks about being a good friend. Most of this advice is good, but I do have a concern with the item about keeping your friend's secrets. This is usually a good idea, but if your friend tells you about something that is hurting or could hurt you, your friend or someone else, you should tell a trusted adult. Many abused children, children with serious psychiatric issues such as eating disorders, or children contemplating violence either tell their friends or drop strong hints about what's going on. Breaking your friend's confidence in those situations can save lives, or prevent someone getting badly hurt. This lesson is especially important for teenagers, because they're more likely to face really big secret problems, but even younger children might know about abuse going on - or even be recipients of abuse from a 'friend'.

When he was about 8 or so, my brother was playing with a friend of his and one of her friends, and her friend talked him into letting them tie him up and try to French kiss him. He got uncomfortable and asked to be untied, and when they refused, he pulled free (he's always been extremely strong for his age) and ran home. He told us right away, and my Mom relayed the story to his friend's mother, who decided to limit her daughter's contact with this troubled friend. By telling, my brother did the right thing and enabled the adults to protect him and his friend from a girl who was engaging in mildly sexually abusive behavior.

In addition, the attached worksheet is not really suitable for a child who doesn't have any friends.

Activity 56 is about borrowing and lending. Their advice is fine for kids with normal executive functioning, but for children with executive dysfunction, borrowing and lending is a lot more challenging. Discuss strategies for making sure they remember to return a borrowed item (such as storing it in their backpack so it's handy when they next see that person), warning the owner before borrowing that they might forget and asking for a reminder, or using an electronic device to remind them. If they can't be certain of success using those strategies, they should avoid borrowing things.

Activity 57 talks about respecting others. This activity is pretty good, but it's important to keep in mind that "treat others the way you want them to treat you" doesn't always work out well for kids who have atypical desires in social situations. For example, just because you hate surprises doesn't mean you should tell someone else what their birthday present is!

Activity 58 is about offering people help, and it's great! I especially like that they listed asking if the person wants help as a crucial step before helping them. Unneeded help can be intrusive and problematic, especially for people with visible disabilities.

Activity 59 discuss asking others for help. This activity looks great to me.

Friday, May 12, 2017

101 Ways to Teach Social Skills - Neurodiversity Comments (Activities 22-44)

This is the second part of my review of 101 Ways to Teach Social Skills.

Section 3: Being Part of a Group.

Activities 22, 23, 24, 25 and 26 all sound pretty good. They teach a mix of basic conversation-starting skills and how to empathize and compromise with others.

Activity 27, about flexible and inflexible rules, is mostly fine, except for it's mention of "tell the truth" as a rule that "should always be followed". There are situations where it's accepted and even expected to lie (eg "Does this dress make me look fat?") as well as situations where lying to protect someone is a noble thing to do (a bully wants to beat up your friend and asks you where he is). Rather than just telling kids not to lie, kids with social issues should be taught about the different kinds of good and bad lies. If a child hates to lie, teach them how to 'elven lie' (say something true but misleading, like how elves and other magical beings incapable of lying tend to act). While you're at it, you could also discuss how to disclose a disability, and the different levels of disclosure (need only, need & general disability, needs & specific diagnosis, etc).

Activity 28, in which groups of kids are asked to brainstorm ideas and come to a unanimous agreement, is mostly good. However, it's very important to check in that kids aren't being bullied into agreeing (intentionally or not). A combination of a child who is a bit too pushy and a child who is a bit too submissive can easily result in false consensus, and the experience helps neither child. If you've already picked up on these tendencies in certain children, one solution would be to assign groups and pair pushy children with other pushy children and submissive children with other submissive children. However, you can also take the opportunity to teach the concept of 'checking in' (often discussed in the context of sexual consent), where the person who is pushing more learns to stop and specifically ask the other person if they are OK with what's happening.

Activity 29, about being a good sport, looks great. You may want to add in some basic mindfulness techniques such as counting breaths or noticing a sensation, if the children aren't able to control their reactions otherwise. You could also work in direct practice by having the children play games of chance (so each child is just as likely to win or lose) while you coach any child who seems frustrated on how to be a good sport.

Activity 30, about fostering a group identity by finding things each child has in common, looks mostly good, but if any child in the group has tactile issues then a secret handshake for the group should not be permitted, and a group uniform should be something that doesn't set off tactile issues. You could explicitly discuss the importance of being inclusive and respecting others' needs by choosing something that everyone can handle.

Activity 31, accepting differences, looks good. However, you should discuss neurodevelopmental disabilities as a form of diversity. This would be a great time to explain the concept of neurodiversity in kid-friendly terms. (for example "neurodiversity is about how everyone thinks and feels in their own unique way.")

Activities 32, 33 and 34 look great. However, activity 33 assumes the child has a friend, which is not a given in a social skills class. Some thought should be put into how to handle this activity for a child with no friends (maybe they could pick someone in their family?).

Section 4: Expressing Your Feelings

Activities 35 and 36, about identifying and talking about feelings, are very good. Keep in mind that children with alexithymia will find these activities extremely difficult. But these kids also have the most to benefit if they can master these skills. If a child seems to have no clue how they're feeling, ask them to pay attention to physiological signs of emotion and the behavioral impulses that emotions elicit. (For example, if they feel flushed and their heart is pounding and they want to punch someone, they might be angry. Or possibly scared.)

Activity 37 is about "I messages". I have mixed feelings about "I messages". They can be useful if you know the other person actually cares about how you feel but is feeling defensive when you complain. But in a genuinely hostile situation, such as a bullying or abuse situation, "I messages" are not really appropriate, in my opinion. You don't want to tell an abuser how you're feeling, just tell them that what they're doing is inappropriate, and then give a reasonable threat (eg telling a teacher, calling the police, etc).

Activity 38 is about "putting yourself in another person's shoes". The major problem with this idea is that not everyone feels the way you would feel in their situation. Gifts are a good example - one child might be happy to get a dollhouse, another child would be disappointed because they wanted a monster truck instead.

This is particularly important for neuroatypical kids (and the people around them) to figure out, because neuroatypical kids often have very atypical emotional reactions to situations. For example, they might feel scared when another child would feel excited, excited when another child would feel bored, bored when another child would feel relaxed, etc. Some kids on the autism spectrum have much less capacity for loneliness than neurotypical children, and so might not care if they are alone. Indeed, many neuroatypical people actually have better social skills than neurotypicals in this area, because they learn very quickly that many people don't react the way they would.

Activity 39, about mixed emotions, looks great. It might be too complicated for an alexithymic child, though. If the child struggled a great deal with identifying even one emotion at a time, they're probably not going to be ready for understanding mixed emotions yet.

Activity 40 is about thinking positively instead of negatively. The big problem here is that this activity assumes the presence of inner speech. Some children, especially those with past or ongoing language delays, may not have inner speech. (Both autistic people with VIQ and orally taught Deaf people tend to lack inner speech.) Some children may be able to do this task by speaking out loud and then gradually lowering the volume until it's only the barest whisper. Others may find it works better if they use visual images or other sensory representation instead of words.

In addition, some children may simply not be able to stop intrusive negative thoughts. They may get more benefit from mindfulness techniques such as taking deep breaths and counting your breaths or noticing details of an object. For children who show stimming behavior, you can harness stims for mindfulness purposes by asking them to focus all their attention on the sensations induced by their favorite stims. (This is one of the big reasons why you shouldn't suppress stims - they can often be extremely beneficial and adaptive.)

Activities 41-42 are about self-control and anger regulation. These activities look good, but these skills will not be mastered by most children simply through a single session. They will take ongoing practice. It may be useful to enlist parents' help in reminding their children how to do this. In addition, you could also show the children the Sesame Street Breathe, Think, Do app, available for both Android and Apple devices. The app has the children help a monster through a three-step process for handling strong feelings - first take three deep breaths, then think up some ideas to solve the problem, and then pick an idea and do it. However, it's aimed at preschoolers, so it might be a bit juvenile for older kids.

Activity 43 is about dealing with someone else's anger. This activity has some good aspects, but in the section about taking a break to discuss it later, it's important to discuss what to do if the person follows them or refuses to let them leave, or if they aren't allowed to leave (eg if their caregiver is angry at them in a public place).

Activity 44 is about handling change. This is a great activity, especially since some children in this group would likely struggle with even minor and positive changes.

Friday, May 05, 2017

101 Ways to Teach Social Skills - Neurodiversity Comments (Activities 1-21)

Recently I posted a list of neurodiversity-friendly ways to teach an autistic kid. Later, I came across this list of 101 activities for a social skills group, and was inspired to write up comments on how to modify those activities to be more respectful of neurodiversity and overall more useful to the children.

First, a few general principles:

It's important to keep in mind remediation, compensation and accommodation. If a child struggles with a certain skill, there are three main ways to help them. You can target weak skills directly, target strengths in alternative skills to accomplish the same purpose, or teach them to modify their environment or use an external tool to help them get around that skill they lack. It's important not to overemphasize remediation alone.

Secondly, self-advocacy is crucial, especially if the child needs accommodation. It's important to build their confidence and feelings of self-worth, and to help them understand what they need and how to communicate that to others.

Thirdly, examine the reasons behind a behavior. Sometimes, it's simply that the child hasn't learnt the typical behavior (eg, a child might grab objects because they don't know how to ask nicely). But other times, the kid has a very pressing reason to act the way they do, such as compensating for a sensory issue (eg overload triggered by eye contact), a motor problem (eg poor balance can cause strange posture), or other issue. If a Deaf child insisted on you looking at them while talking to them, it would be pretty easy to understand why. Just because neurological differences are harder to understand doesn't make the needs that result any less real.

Lastly, we tend to think of poor social skills as a generalized difficulty with all things involving figuring out other people. However, my reading of the research suggests that there are a pile of separable skills under that general category. Among adults with brain injuries, distinctions can be found between theory of mind and social perceptual skills, between cognitive theory of mind (inferring what someone believes by their experiences) and emotional theory of mind (inferring how someone feels by their experiences), between facial expressions, body posture, gestures and vocal cues, between reading emotions in the forehead versus the mouth, and even between specific emotions such as sadness, fear and anger.

Although studies of autistic people as a group find difficulties in all of those areas, this doesn't necessarily mean each individual autistic person has the same level of difficulty in each area. When we look at other developmental disabilities, they definitely don't have uniform difficulty in all of those areas. This uneven performance is useful for compensation strategies, since we could build on their strengths.

Lastly, keep an eye on the future. What's fine for an 8 year old may not be fine for a 16 year old. Conversely, some things are not really necessary for adults but may be expected of children (eg, eating what someone else tells you to eat). Children who are slower to learn social skills will also be slower to adapt to changes. And there's no real point in teaching a child something you'll have to un-teach later, especially if it's something they find really difficult.

And now, I'll start discussing each activity.

Section 1: Communicating

Activities 1, 2 and 3 sound like great activities. They focus on helping kids show off to the group what makes them unique - sharing interests, values and strengths with the group. All of these activities are great as they are, but activity #1 could be made even better if you worked in a body positivity exercise (sadly, body image concerns are extremely common even in young children) by asking them to list appearance traits they like about themselves, rather than choosing appearance traits at random. Be prepared to help a child if they have a lot of difficulty finding good things to say about themselves.

Activity #4 teaches polite greeting. This one is problematic because it requires eye contact. As I found in my recent survey, a substantial subgroup of autistic people have problems with eye contact, ranging from increased difficulty concentrating while making eye contact to feeling anxious even when someone else looks at them. Impairing one child's ability to concentrate or causing them acute anxiety isn't worth the benefits of making eye contact while greeting someone new. Therefore, eye contact should be optional.

If you notice a child avoiding eye contact in this activity, explore with them whether they can handle looking elsewhere on the person's face (such as at their mouth). My Mom and I tested it out, and at a normal conversational distance, she couldn't tell if I was looking at her eyes or her mouth. However, some kids can't handle even looking at someone's face, and that should be respected. One warning, though: adolescent boys who struggle with eye contact should be warned to avoid looking at a girl's chest instead!

In addition, activity #4 mentions the option of a handshake. This can be a problem for kids with tactile sensitivity. If you choose to suggest handshakes, model how a child can politely refuse to shake hands while still offering a friendly greeting.

As the first activity with sensory concerns, it would be a good idea to take this time to introduce the idea that you want them to tell you if you ask them to do something they aren't comfortable with. It's possible you may be helping children who have previously been pressured into ignoring sensory needs for the sake of appropriate behavior, so some children may assume they have no option but to do it regardless of the discomfort it causes.

Activity #5 revolves around having each child introduce themselves to the class so they can learn each other's names. I see no major problems with this activity, but it's important to remember that for children with prosopagnosia or other similar difficulties, learning to recognize classmates by name may not be a realistic expectation. In severe cases, prosopagnosic individuals can fail to recognize immediate family members, or even their own reflection. Even in milder cases, it can take years of regular interaction before a prosopagnosic child can reliably recognize an individual.

It may be useful to give the child advice on compensatory strategies such as noticing hair, movement patterns or voices. They could learn to listen for a person being called by name and take note of who responds and what they are wearing. For milder prosopagnosia, taking a little extra time to study a person right after being introduced can help, so you could ask the child, after putting their name on the board, to pause and wait for a moment in front of the class. (Although some children might find being the center of attention anxiety-provoking, so flexibility is important.) Nametags can be a big help, though some children may have sensory issues with wearing nametags. Assigned seating can also be helpful.

In addition, children with prosopagnosia should be taught to warn others when it's likely that they might need to recognize them. For example, if they're planning to meet someone in a public place, or are being introduced to someone they will probably meet again. I've found that warning people I will have trouble recognizing them makes things go a lot more smoothly.

Activity #6 involves each person greeting the person next to them and giving a detail about themselves. It has handshakes and eye contact, which as described above should be optional. It could also be extremely challenging for a prosopagnosic child. Consistent seating will help a great deal here.

Activities 7 & 8, which both involve figuring out stuff about other children, both look great to me. I have no concerns with them.

Activities 9 & 10, giving and receiving compliments, are mostly fine, except for the mention of appearance. There are a number of problems with appearance compliments. First, for children with body image issues, receiving or overhearing appearance compliments can potentially be triggering. Secondly, once children reach adolescence, complimenting the opposite sex on appearance is considered inappropriate in non-intimate circumstances (especially a boy complimenting a girl). Complimenting secondary sexual characteristics such as breasts is especially inappropriate. Even if children are nowhere near adolescence, it's better not to teach a behavior you'll have to un-teach later on.

Section 2: Nonverbal Communication

Activity #11 focuses on tone of voice. This is generally a good activity, however for some children, this will be an insurmountable challenge. It may be useful for a child to learn to warn people that they have trouble reading tone of voice. In addition, if a child has a particular weakness in reading tone of voice, but other nonverbal cues are easier, it may be more effective to focus practice on their strongest nonverbal cue reading, because most messages are communicated multimodally. Just like Deaf people learn to focus on facial expressions, and blind people on tone of voice, people with specific difficulties with certain nonverbal cues may learn to compensate.

Activity #12 looks good, but actually controlling the volume of their voice may take a lot of intensive one-on-one practice in realistic contexts for some kids.

Activity #13, teaching eye contact, is terrible. Instead, children who struggle with eye contact should be taught to look elsewhere on their face if possible, or if not possible (do not pressure the child!) they should be taught other ways to show they are paying attention, such as nodding or saying ‘uh huh’ periodically, and to respond to requests for eye contact with self-advocacy. In addition, some children may find eye contact from others uncomfortable, so the activity of having someone stare nonstop at them may provoke intolerable anxiety even if they aren't looking back. Tying eye contact to caring could be emotionally damaging if the child needs to avoid eye contact for their own well-being. Essentially, to be appropriate for children who avoid eye contact, this activity would have to be modified to the point of being unrecognizable.

Activity #14 is mostly good, but looking at their face should be optional. Some children can follow facial expressions with brief glances or peripheral vision, so training them on facial expressions is still beneficial. Some individuals find even looking at pictures of eyes anxiety-provoking (in this Wrongplanet thread, one respondent found the Mind in the Eyes test stressful for this reason). However, cartoon faces are probably fine for the majority of kids with eye contact issues.

As described above, some kids may also find this insurmountably difficult. Children with prosopagnosia may be especially likely to have face-specific emotion recognition issues, since facial identity recognition and facial expression recognition are controlled by closely interconnected brain systems. For these kids with general face processing issues, it may be useful to teach them to focus on non-facial cues a lot more.

Activity #15, teaching children to recognize common gestures, looks completely fine to me.

Activity #16, focusing on the concept of personal space, looks good. Keep in mind that children with tactile sensitivity may need a larger personal bubble (and self-advocacy skills regarding their bubble). In addition, children with depth perception difficulties may not be able to judge their distance from another person. They could use external cues such as floor tiles or wall fixtures (make sure to teach generalization for multiple situations), or else simply avoid “chasing” if the person moves away.

Activity #17, teaching children when it's okay to touch others and when it's not, looks great. I especially like the questionnaire on the accompanying worksheet, which could be quite educational for understanding a child with tactile issues. I would prefer if this activity also included some instruction on how the children can defend their boundaries if touched in a way that makes them uncomfortable. Not only is this a valuable self-advocacy skill for children with tactile issues, it's also an important sexual abuse prevention strategy for all children. Since children with disabilities are at higher risk of abuse, this is a very important lesson to learn.

Activity #18, teaching children the meaning of various postures, looks fairly good. However, it's important to remember that hypotonia, balance problems and other motor difficulties are common among kids with social disabilities, and can make certain posture uncomfortable or unsustainable for the child. Remind the class to let you know if certain poses are a problem for them, and work with them to find an alternative that conveys the same message. If you can't find something workable, it's time to teach self-advocacy skills.

Activity #19 discusses body language in general. I have concerns about telling children that "93% of communication is nonverbal". Firstly, I seriously doubt that's true - if a person is unable to speak (or doesn't share a common language with their communication partner), does it seem likely that they could get across 93% of their message anyway? And more importantly, for a child who knows they struggle with nonverbal communication, telling them that is very disheartening.

Activity #20 reviews the various ways that people communicate emotions nonverbally. It's a great activity, and since you call upon children to provide each component, you could strategically call upon any child with significant skill scatter in these skills so they get to show off their strengths rather than their weaknesses.

Activity #21 discusses clothing choices. It's good information to know, but it's important to note that sensory issues (particularly tactile sensitivity) and motor issues (fine motor struggles, needing shoes they can walk safely in, needing to cross their legs or lift them up, etc) can constrain clothing choices as well. It may be useful to discuss these practical concerns in class.

That marks the end of section 2. I'm going to take a break now. The next post will start with section 3: being part of a group.

Monday, May 01, 2017

Aromanticism, Asexuality and Parenthood

This is the April 2017 issue of the Carnival of Aces. I only got two submissions, so I think instead of just listing them, I'll write up a bunch of my thoughts on these submissions and the topic of this carnival.

Soul Riser writes about respecting children and having opinions about parenting despite not wanting to have any children of their own.

When I first got their entry, I wrote a big long response to them, saying the following.

It's interesting - your comment about the attitude that only parents should have an opinion on parenting. I feel like that started because the early parenting advice books were all written by men, in a time when childcare was done overwhelmingly by women, and were pretty clueless. (I know I was not impressed when I read Dr Dobson's book and he commented about 'babysitting' his own children occasionally.) So I can see where they're getting at. And certainly parents need to be a big part of the conversation about parenting.

But I do think people have gone too far in the other direction. There are lots of ways to get expertise in parenting. If you spend a lot of time reflecting on your own childhood and how you were raised, as it sounds like you have, that gives you a kind of expertise. If you're a child development researcher and have read and/or performed studies on how children are affected by parenting, that's also a kind of expertise. If you're a teacher, childcare provider, closely involved aunt/uncle, or otherwise spend a lot of time with children, that's also a kind of expertise.

And it gets messy, too. Firstly, not everyone who wants to be a parent can be, and for reasons that are often linked to privilege. A blogger I follow, David Hingsburger, wrote about getting faced with the attitude that not being a parent means he shouldn't have an opinion on parenting, and in reaction, he shared on his blog a story about a little boy that he and his partner Joe wanted to adopt, many years ago, and how the boy was returned to his biological parents and died because the adoption agency didn't think it would be a good thing for a child to have gay dads.

And then there's the situation where the child is part of a minority group that the parent isn't. In a situation like that, it's very important that the parent seek out the voices of people who are like their child, whether or not they happen to be parents as well. And yet so many parents actively resist advice from people who've been like their kids. (As an autistic person, I've seen this a lot from 'autism parents'.)
I'd also like to comment about the assumption that not wanting kids means hating kids. I personally feel like I've experienced a related assumption - the assumption that finding kids tiring or overloading means you must hate kids. There seems to be this stereotype of the childfree child-hater who is bothered by disruptive children in public, never wants to have kids or even see kids around, and has derogatory views of parents as 'breeders' or whatever. I fit one piece of that stereotype and SoulWolf fits another piece, but neither of us fit the stereotype as a whole.

Isaac writes about his reaction to a Spanish news article about young people choosing not to be parents, and explores the nature of his lack of desire for parenthood and how that interacts with his aromantic asexual identity. He also discusses his perception of societal progress in making both marriage and parenthood more optional.

Not speaking Spanish myself (except for a tiny amount), I found it interesting to get a window into how Spanish people are approaching the generational shift away from the standard heteronormative lifestyle - a shift that I feel is also happening in many English-speaking countries (and, from what I've heard, also in Japan and Denmark - Gaijin Goomba discusses it here for Japan, and the Danish tourist board proposed an unconventional solution here.)

Certainly, it can be threatening for the older generation when birth rates drop, because elderly people typically depend on young people to care for them, and declining birth rates make it more difficult to get enough providers of elder care.

And the desire to be a grandparent is a significant desire, and one that you ultimately have no control over its fulfillment. (My own mother has talked a lot about how much she wants to be a grandmother, and I've seen the pride and joy in the faces of people at my church as they show off pictures of their grandchildren.) I can tell that it would be tough being someone who really wants grandchildren, and not having children who want kids.

I also feel that both the article Isaac reviews and Gaijin Goomba's video also draw attention to the fact that generational differences in marriage and parenthood aren't always a choice. Societal pressures and cultural shifts lead many people to have fewer opportunities to fit the heteronormative ideal, even if they want it.

But Isaac also makes a valuable point about how it's getting easier to forge your own path, if you so choose, and I see that in Canada and the US as well. As someone who wants a child without a partner, I see more and more women (and a few men) getting the chance to choose the same lifestyle I want. It used to be that becoming a single mother was a recipe for lifelong stigma (and being a single father got you pity and condescension). The idea of actually choosing to be a single parent was unimaginable. Now, single parents by choice are everywhere, and they're speaking out and being heard. The same is happening with non-romantic coparenting families.

Similarly, unconventional relationship designs are becoming more accepted, too. Same-gender relationships are at the forefront of this. The heteronormative ideal isn't just 'hetero', it also expects strict gender roles, which are not applicable to most same-gender relationships. Parenthood is more available, too, for those who want it, leading to what has been termed the 'gayby boom'. (If David and Joe were looking to adopt Christopher today, they'd almost certainly have gotten custody.)

Polyamorous relationships are also starting to become more accepted, though more gradually. And in the ace/aro community, people are starting to redefine relationships to suit a-spec people, talking about romance without sex, lifelong commitments to friends, sexual partners you care deeply for but aren't romantically involved with, and relationships that blur the line between romantic and platonic.

Meanwhile, sexual education and availability of contraception are making unplanned pregnancy less likely, and those who do have unplanned pregnancies have more options - not just closed adoption, abortion or unplanned marriage, but also coparenting, single parenting, open adoption, and so forth. There are even some people choosing to be sterilized at a young age, where previously sterilization was only available for people who already had kids or imposed on people society thought should never be parents.

In addition, in Canada and the US at least, there's an added twist. Declining birth rates are mostly a white phenomenon, and many ethnic minorities are having a population increase instead. In Canada, 28% of Aboriginal people are under 15, compared with 16.5% of non-Aboriginal people. A similar shift is happening in the US as well. If this trend continues, many ethnic 'minorities' will soon no longer be minorities.

We're headed for interesting times, indeed.

[inserted later:]

It turns out that I missed some submissions. Oops!

Laura at (Purr)ple (L)ace wrote about her journey to realizing that she wants to be pregnant and have a child as a single teacher. I can relate a lot with her feelings, despite not being a teacher. I think it's interesting how she has come up against a lot more social pressure now that she's definitely wanting to be a parent - I've experienced the same thing.

Emily at From Fandom to Family wrote an update to a post she wrote a year and a half ago, in which she expressed a desire for foster or adoptive parenthood, connected with her own adverse childhood experiences. In this post, she discusses how this desire for parenthood has influenced her desire for a queerplatonic relationship, and how her queerplatonic partner has had to explore his own feelings regarding foster/adoptive parenthood.

Isaac has also written a second entry, explaining why he is childfree, and contradicting the stereotype of childfree people as selfish.

Friday, April 21, 2017

The Baby and the Bathwater: Concepts That Are Flawed But Still Useful

I think there's an important distinction between "this concept is being used in a flawed and damaging way" and "this concept is inherently useless and damaging". But too often, I see people confusing the two, and assuming that if there are valid criticisms of a concept, it's an entirely useless concept that can only be harmful.

Here are some concepts I think still have some use, despite their flaws.

Mental Age

Mental age is the idea that if you compare an atypically developing child's scores on a cognitive test to the results of NT children of varying ages, very often their pattern of functioning will be similar to that of most NT children at a particular age. This age at which responses are similar to the atypical child's responses is termed that atypical person's "mental age".

This has traditionally been taken to mean that atypical children should be like NT children with the same mental age in all sorts of ways, including ways not actually assessed by the test used. For example, a 15 year old with a cognitive mental age of 5 years is assumed to also have the emotional maturity of a 5 year old, the interests of a 5 year old, the academic abilities of a 5 year old and the level of independence of a 5 year old. This can result in unfair restrictions on this person, missed opportunities to do things a 5 year old wouldn't be ready to do, and generally treating this person like a small child when he or she would rather be treated like a teenager.

For an added wrinkle, some atypical people have skills that are not standard for any age of NT. For example, an autistic child who communicates through complex echolalic but mostly situationally appropriate sentences has a language profile that is not typical of NT children at any age, so assigning a mental age to that child's language abilities is fairly arbitrary.

And lastly, not all NT kids are actually taught to their full potential. For example, there is evidence that under the right circumstances, NT 1 year olds can actually be toilet-trained. In addition, no real effort is usually made to teach reading to children under 6 years old, but some children have learned to read much younger with direct instruction. This means that even if most NT kids at the same 'mental age' aren't being taught a skill yet, direct teaching might enable a delayed child to master that skill.

But despite all this, I think mental age is still a useful concept, provided you a) confirm that they are actually showing a normal pattern of development at a different rate, and b) remember that the mental age given by a test only applies to the skills assessed by test.

For example, on most cognitive tests, adult non-human great apes score similarly to human preschoolers. Social cognition is similar to a typical human 3 year old, language is more like a 2 year old (in language-trained apes), while folk physics understanding is more at around a 5-6 year level. (Working memory, meanwhile, is better than most human adults.)

This data pretty reliably predicts what cognitive toolkit a typical non-human great ape has for solving problems.  For example, when it comes to social problems (eg "how do I keep that guy who's bigger and stronger than me from taking away this snack I just found?" or "how do I do this thing I want to do and not get in trouble for it?") non-human apes solve these problems about as skillfully as 3 year old humans do. For example Koko, a sign-language trained gorilla, when asked who ripped the sink off the wall, blamed her cat All Ball - about as plausible a lie as the ones many 3 year old humans make.

And yet, if you left a group of 2-6 year old children in a rainforest by themselves - even if they'd grown up in that forest from birth - I doubt they'd survive very well. This is a challenge that suitably prepared non-human apes can easily manage. Indeed, some non-human apes grow to be very wise and experienced leaders in their societies, guiding the younger generations.

If you take mental age as 'the age they really are inside', you're doing it wrong. But if you take mental age as 'they will probably be able to do X task in skill area Y because typical kids with the same mental age in skill Y can', then it's a pretty useful concept.

IQ Score

This is a closely related concept to mental age. In fact, originally IQ scores were derived by dividing 100 by the person's actual age and then multiplying by their mental age. Now, they're usually determined more by the percentage of same-age peers who score higher or lower, but the link still applies, and IQ can be misused in the same way that mental age is.

However, there are also some misuses that are more directly associated with IQ. Since IQ is always determined by standardized testing (while mental age can be determined in lots of different ways), many of the criticisms of IQ relate to problems with standardized testing.

The biggest problem is underestimating performance. If a person fails to answer a question on an IQ test correctly, did they really not understand the concept? Or did something else interfere? If they didn't understand the instructions, weren't physically capable of responding correctly, interpreted the question in an unusual way or just plain decided not to answer correctly, their IQ score will be an underestimate of their true cognitive ability. This is the main reason why ABA can increase IQ in autistic children - it doesn't make them smarter, but it does make them more compliant, better at understanding commands, and teaches them what kind of behavior is expected in a testing situation. (Basically discrete trial training is like non-stop testing with the correct answers being given to the child until the child learns them.) In other words, they become more 'testable', and so their IQ goes up.

Another criticism of IQ comes from the myth that IQ should predict adult performance. Many people express skepticism about the idea that a person with a genius-level IQ could be working at McDonalds instead of revolutionizing some field of study. But IQ was never intended as a fortune telling device, and there's a lot that determines success apart from IQ - socioeconomic status, disability, motivation, resilience, educational opportunities, and pure luck and timing. Einstein wasn't just smart. He had supportive parents, he was fascinated by physics and mathematics, he had enough mental resilience to withstand a bad school experience, and he entered the field at a time when the conditions were ripe for the discovery of relativity.

There are people who are every bit as smart as Einstein, but these other factors haven't come together as much. Torey Hayden's books One Child and Tiger's Child feature a girl with an IQ of 182, which is higher than the common estimate of 160 for Einstein. But at the age of 6, she was in a special education class as a last resort before going into a state institution. Why? Because she was from a poor, neglectful and severely abusive home (she was hospitalized once because her uncle stuck a knife in her vagina), and had severe emotional problems (she poked out the eyes of the classroom fish). Given her struggles, the fact that, as an adult, she was able to live independently, stay out of trouble and be employed was remarkable. Could she have revolutionized a scientific field? Maybe, if she'd had the opportunity. But it's not really surprising that she didn't, given how much the tables were stacked against her.

Friday, April 14, 2017

Does Your Identity Reinforce The Gender Binary?

An ongoing debate seems to be raging about whether people who are attracted to multiple genders should identify as bisexual or pansexual. The argument is that bisexual, because it has the Latin prefix for two, means someone attracted to two genders, and therefore people who identify as bisexual and feel attraction for nonbinary people are invalidating the nonbinary people's identities. Many bisexual people have responded saying that the 'bi' in bisexual refers to being both heterosexual (attracted to people with gender(s) different from your own) and homosexual (attracted to the same gender).

First, I'd like to acknowledge that I'm weighing in as an outsider. As a cisgender aromantic asexual, none of the labels I'm discussing here relate to me personally. The closest I come to identifying as any of these labels is ticking 'bisexual' in surveys that provide only three sexuality options, because my own attraction is equally nonexistent for all genders.

But it's interesting to me that I don't see the same furor over lesbian-identified women dating trans men. (Or the reverse, though I don't see that very often at all.) While some women choose to change their identification because of the realisation that they're also attracted to trans men, others don't, and it seems to be recognized as a personal choice and not necessarily a political one.

And I agree with that stance, by the way. After all, there are women who identify as lesbians despite experiencing some attraction to cis men, too. A woman who is Kinsey 5 may feel that lesbian is the best descriptor for her identity, despite her potential to be attracted to men. Or a woman who is biromantic homosexual or bisexual homoromantic may identify as lesbian because she only feels both attraction types together in relationships with other women, or because her attractions counted together result in a significant preference for women. If a woman can have attraction for cis men and still be lesbian, certainly a woman can have attraction to trans men and still be lesbian.

Personally, I don't think you can judge from someone's label, or their label plus their romantic and sexual choices, whether they support binarism or transphobia. It's the reasoning behind their label choice, and their overall behavior and attitudes towards transgender and nonbinary people, which really determine whether they're binarist and/or transphobic.

For example, there was a straight man I heard of who dated a trans woman, but insisted that she had to allow him to have casual sex with cis women in order to meet his sexual 'needs' because he was 'not gay' and therefore not satisfied by sex with his non-op partner. His labelling himself straight while dating a trans woman superficially sounds accepting, but the fact that he insisted that she couldn't satisfy him sexually because he wasn't attracted to men belies his apparent acceptance of her identity, and suggests that he really did see her as a man on some level.

In contrast, my brother has a male friend who started dating someone he believed was female. His partner then came out first as FtM, and then they came out again as nonbinary. In response, he shifted his own identity from straight to bisexual. Although I haven't asked him about his feelings in depth, from my understanding, he has never been attracted to cis men. His identity as bisexual appears to be based on his potential to be attracted to cis women and transgender/nonbinary individuals, in which case he clearly demonstrates a willingness to acknowledge trans and nonbinary identities using a label commonly stereotyped as binarist.

I have also heard of bisexual-identified people who say "I have never knowingly met a nonbinary person, so how can I tell if I'm attracted to them?" Exposure to cis males and cis females is pretty much universal, so a questioning person can readily collect data on how their sexuality reacts to these people. Transgender and/or nonbinary people are a lot harder to find, and may not be out when you encounter them.

There are also nonbinary and transgender people who identify as bisexual. And there are nonbinary and/or transgender AFAB who identify as lesbians, and AMAB who identify as gay, despite those labels implying a gender they don't identify with. (This seems especially likely for nonbinary people who exist in the spectrum between cis and gender neutral, such as AFAB demigirls, but there are FtMs who consider themselves lesbians despite identifying completely as male.)

In conclusion, don't judge from the label they choose. Judge from their reasoning and attitudes around actual transgender/nonbinary people. And in that respect, it's important to remember that bi/pan/multisexual people, on average, have a better track record for accepting transgender and nonbinary people than gays and lesbians do.

Friday, April 07, 2017

Why Self-Diagnosis is Important - A Response to kellyann-graceful-warrior

(Note: I don't actually know which pronouns either of the people I'm discussing here actually use. I'm guessing both (Purr)ple (L)ace and kellyann-graceful-warrior use she/her pronouns, but if I've guessed wrong, just let me know and I'll edit this.)

I was browsing (Purr)ple (L)ace recently, and came across this thread. (Note: I made the mistake of thinking she agreed with it, because I didn't realize that she responded in her tags rather than in text. She doesn't.)

But in any case, I feel a strong desire to respond to this, so I will.

Kellyann's first argument seems to be that self-diagnosis is prone to error. Which is true. But a) so are official diagnoses, b) misindentifying yourself doesn't mean that you shouldn't have been looking for answers at all (imagine if we took the same attitude to gender and sexual orientation?), and c) just because you've misidentified doesn't mean you can't find stuff that helps you aimed at people with that diagnosis. I'm autistic, not ADHD (seriously, I've had dozens of psychologists say I'm not ADHD, because my school really really wanted me to get that diagnosis). But I've found a pile of ADHD advice that has helped me too, because ADHD and autism overlap.

Her next argument is that badly behaved people who use self-diagnoses as excuses give actually diagnosed people a bad name. To which I point out that actually diagnosed people can behave badly and use their diagnoses as excuses too. And that "you're giving us a bad name" places the blame on the wrong target - the real problem lies with people who assume that one member of [insert minority X] must represent every single person belonging to that minority group. If someone goes "I met a really shitty person with BPD who used it to excuse abuse, ergo all BPDs are shitty abusers", that's pretty much the same thing as saying "I met a transphobic and homophobic asexual who slut-shamed and considered themselves superior, ergo all asexuals are transphobic homophobic sult-shamers who think they're superior". Essentially it doesn't even matter if the person they met was accurately identified or not - the problem lies with the person who stereotypes a whole group based on one person.

Secondly, she talks about how complicated it is for psychologists and psychiatrists to actually diagnose someone. As a psych major, I can tell you - it's really not as complicated as people think. It's nothing like physical medicine, because the vast majority of diagnoseable mental conditions aren't based on running tests or determining causes or anything other than just, yes, checking the person against a checklist. (Yes, there are a few diagnoses that are more complicated, such as MR, which requires an IQ test. But those are the minority.) The DSM is designed so that you can use it to diagnose someone and know you're using the same definition of that condition as someone else is using, even if you come from very different backgrounds (i.e. a psychologist who regularly does outpatient treatment should use the same diagnostic standards as a pediatrician whose only experience with mental health came from their mandatory psychiatry rotation during medical school). It doesn't always work as intended, but that's what it's for. And as such, it's really not that big of a stretch to consider an untrained but well-read person using the same criteria and coming up with a similar level of accuracy.

Next, she complains about people diagnosing things that shouldn't be possible or are very unlikely, such as mutually exclusive diagnoses, extremely rare ones, or conditions that have age restrictions.

First, she makes a factual error here. The only personality disorder with an age restriction is antisocial personality disorder, and that's because ASPD and conduct disorder are basically the exact same condition at different ages, and someone under 18 with the symptoms of ASPD should be diagnosed with CD instead. (ASPD also requires that you met CD criteria before you turned 18.) All other personality disorders can be diagnosed in teenagers according to DSM rules, although many clinicians refuse to do so out of fear of stigma or because they overextended the ASPD rules by mistake. I did a couple papers for one of my classes on teenage BPD recently, and I know for a fact that the research finds the exact same validity and stability for BPD criteria in teens as in adults. What little I've read suggests similar findings for other PDs, too, except for ASPD. (There's a major subgroup of CD individuals who have CD/ASPD symptoms only in their teens and early twenties and transition to completely different symptoms with age, which is one big reason why ASPD has an age restriction.) So, yes, teenagers can absolutely have personality disorders.

Secondly, not all mutual exclusions in the DSM actually are warranted. For example, up until DSM 5, ADHD couldn't be diagnosed in autistic people, because it was assumed that ADHD symptoms could be explained by autism. However, research showed that children who had both ADHD and autism symptoms were different from autistic kids without ADHD, in similar ways to how allistic ADHD kids differed from NTs, and that ADHD symptoms in autistic kids were helped by ADHD treatments just as much as in allistic kids. For example, stimulant meds do nothing to help autistic kids without ADHD, but were just as beneficial in autistic ADHD kids as in allistic ADHD kids. Based on those findings, the DSM 5 removed that restriction. Before this happened, I knew several autistic people with self-diagnosed ADHD, or ADHD diagnosed by clinicians who ignored that restriction, who were benefiting from knowing why they differed from non-ADHD autistic people. Similarly, I'd support ignoring the mutually exclusion rule for reactive attachment disorder and autism, because the research really doesn't support the idea that it's impossible to tell if someone has RAD when they're autistic. Even bipolar disorder and depression could potentially co-occur, judging from cases where a person with well-controlled BP continued to have depressive episodes and then responded well to having an antidepressant or CBT added to their existing mood-stabilizer. (Note: Clinicians should never give a BP person an antidepressant if they aren't already responding well to a mood stabilizer, because it can trigger manic episodes.) And as for the schizophrenia/schizoaffective/bipolar mess, that's mostly historical, and schizoaffective is basically just a fancy name for someone with both schizophrenia and bipolar disorder.

Thirdly, regarding rare conditions (like early-onset schizophrenia), rare doesn't mean nonexistent. There's certainly at least some people with early-onset schizophrenia online, and that random Tumblr user could be among them. You really can't tell.

And fourthly, controversial conditions are still diagnosed. Maybe some of them should be scrapped (personally I don't think histrionic PD is meaningfully distinct from BPD and narcissistic PD, for example), but that doesn't mean that people can't find something useful from identifying themselves in those criteria.

Next, she points out that you can learn to understand yourself, help yourself, and advocate for yourself without self-diagnosing. Which is true. I certainly have benefited from recognizing that I have BPD traits and adopting strategies that people with BPD use, such as DBT, even though I don't actually meet the criteria for BPD. But labels, even self-applied labels, do have a purpose, for several reasons:

a) They remind you that you're not alone, and help you find people like you. If I didn't know that I'm autistic, I might still know that I can't handle loud noises, have trouble reading people, can't look after myself as well as most adults, and so forth. But how would I go about finding people like me? How would I input that mess of traits into a search engine? Having a single label that covers all that stuff is really useful.

b) They can be used to communicate to others. When I was a kid saying "I can't do that, I don't know why", no one listened. Now, when I say "I can't do that because I'm autistic", people listen. Not everyone, because ableism, but a whole lot more than they used to. I've had people literally shut up and apologize as soon as I invoked autism as an explanation for the thing they didn't like about me. Can this be misused? Sure. But it can also be used appropriately, and it can be very empowering and useful.

c) They can help you accept yourself. When I just "thought I might be autistic", there was always this doubt in the back of my mind, telling me "you're not autistic, you're just lazy/stupid/inconsiderate". Getting my official diagnosis silenced that voice, and self-diagnosis can do that too. Whatever lets you trip the line from uncertainty to certainty, that's a powerful cure for the Imposter Syndrome.

d) They can help you plan. Realizing I'm autistic was instrumental in realizing that me being able to live independently as an adult was not a given. I've heard horror stories from autistics with similar difficulties to me, who jumped into adult life without any idea that they wouldn't just figure it out on their own like NTs do. There are autistic people who have starved, who have ended up homeless, who've had homes so messy they were unsafe to live in, etc, all because they were expected to function as well in adaptive living as they do cognitively. If I hadn't heard those stories as a teenager, that could have been me. I could have jumped into independent living assuming I could do it, when I really can't, and ended up in dangerous circumstances as a result. Instead, because I know I'm autistic, I'm planning it out carefully, assessing my own abilities regularly, and working on safety nets so my first forays into independent living don't end in disaster. I'm also planning for the possibility that I might never live independently, and figuring out what I'll do when I outlive my parents.

Essentially, self-diagnosed labels can be useful for all the same reasons that gender and orientation labels are. So you can find people like you, communicate who you are to others, accept yourself, and plan for future possibilities that diverge from the normative path.

Next, she says it's unhealthy to self-diagnose. I'm not sure exactly why - this section seems to throw out a bunch of facts without really tying them together into a real argument, as far as I can tell. I can say that I don't really get what self-diagnosis has to do with denial, or why teenagers searching for identity means they can't figure out something real about themselves. (After all, many people correctly identify gender and orientation in their teens.)

Then, she returns to the "giving us a bad name" argument, which I've already responded to, and also claims that self-diagnosed people are spreading mockery. It's not entirely clear to me whether she's complaining about people mocking self-diagnosed people (which really isn't their fault - being mocked by someone else is never your fault) or claiming the self-diagnosed people themselves are mocking people who actually have that condition. The latter would be a bad thing, if it was actually that person's motivation, but I'm not convinced that it really applies to more than a tiny minority of self-diagnosed people. Just as people who claim to sexually identify as "attack helicopters" are a tiny minority among people who claim nonbinary identities, and shouldn't be taken as representative of actual nonbinary people, people who claim a self-diagnosis purely to mock people should also not be taken as representative of actual officially diagnosed or self-diagnosed people.

Lastly, she comments on arguments regarding access to diagnostic services by claiming that similar barriers have applied to her in the past. Which really doesn't negate that argument, any more than a rich person who grew up poor and thinks other poor people should do what they did negates the argument that poverty is a real problem that restricts people's opportunities. And while the resources she linked to do sound useful, they're not necessarily accessible to everyone - eg teenagers with unsupportive parents and no means of independent transport, people who live in rural areas or cities that lack those resources, people who need a kind of help that isn't what their local free clinics provide (for example a lot of free counseling centers only provide CBT, which doesn't work for everyone), people who get turned away or put on waiting lists, people who've been saddled with incompetent clinicians, and many others. Access to treatment is a tricky problem and it's not solved just by having a few free clinics.

And then there are people who don't want an official diagnosis. Maybe they risk facing stigma, or being barred access or having reduced access to something important to them. (For example, military service or adopting a child.) Maybe they don't want to see a clinician. Maybe they don't actually need help, or don't want to change what makes them different from others. Those can all be perfectly valid reasons not to seek a diagnosis, and none of those necessarily mean the person can't benefit from a self-diagnosis.