Parenting a Teen with Special Needs: A Q&A with Adam J. Holstein, Psychoanalyst/Behavior Therapist: Interview by Melissa Couch Salim


In your work, you support children diagnosed with developmental disabilities and offer parent training.  Can you share what the most common challenges have been, and what has been the most prevalent concern from parents? The most common challenge for parents who contact me is how to parent their child who has special needs.  As the saying goes, “There is no manual that comes with your child.”  Most often parents draw on their experience being raised by their parent, to raise their child.  Many parents claim they do the opposite or better.  While this might be true, the parenting they had impacts how they parent.  Raising a child with special needs requires the parent adapt their style to the special needs of their child.  This is not easy.  Parents start out anxious wanting to be a good mother or father, and the stress and anxiety increases when they learn their child has special needs.

The families that bring their child to me need help addressing behavioral challenges ranging from, non-compliance, to verbal and/or physical aggression at home or school.  I then look at the parenting history mentioned above and develop a behavior program using applied behavior analysis.

You work with children of all ages.  Do teens with ADHD and/or on the spectrum have challenges processing the feelings of others, and if so, how can parents help them to grasp this? This question applies to children who can have a conversation, that is, express themselves and understand the meaning of abstract words related to feelings.  Certainly, not all children who have ASD have this ability.  Assuming the children with ADHD fall in the average range of cognitive functioning and have age-appropriate language skills, I will answer the question accordingly.

We as therapists and parents have to realize that all of us have difficulty accurately processing the feelings of others.  Most of us also have some difficulty honestly expressing our needs and desires as well.  If we can accept this, then we can normalize the conversation.  That is, all of us have problems understanding the thoughts and feelings communicated verbally and non-verbally by others.  By normalizing the conversation with a teen, they will not feel something is particularly wrong with them.  It is something everyone could/should be, working on.

If we can discuss our challenges with our teenager and question what challenges they might have, it can open the door to reflecting on themselves and others.

Ideally these types of conversations have been occurring before adolescence.  Depending on how accepting the parents and teen have been about the teen’s diagnosis and related symptoms, the discussion is just another life lesson dialogue.

Teens with ADHD do not necessarily have a difficult time processing / perceiving the feelings of others.  However, due to their attending difficulties, the challenge of responding to them might be greater.  Teens who have ADHD are very sensitive and know exactly what the parent or others are feeling and thinking.  They are generally also in tune to how they feel.  Their ability to respond might be compromised due to their impulsiveness.

Teens with ASD on the other hand have difficulty understanding other’s feelings and grasping non-verbal, or pragmatic, communication, of feelings.  Teaching children on the spectrum in many ways is an intellectual exercise.  Parents have to explain not only what sarcasm is for example, but when and why it is used.

It is quite known what the primary symptoms are with ADHD; what are some of the common secondary symptoms? Not all children who have ADHD have secondary symptoms that are any more significant than a neurotypical child.  ADHD is a more severe form of ADD.  The challenges of coping with the impulsivity can be overwhelming of any child.  They often start feeling like a failure if they cannot focus and stay on task.

In addition to their feelings of failure and often times the criticism that results from the inability to focus and stay on task, low self-esteem develops.  In more severe cases, other emotional disturbances can occur such as anxiety and depression.

If a teen with ADHD or another developmental disability doesn’t have the highest self-esteem, how can a parent best have a constructive conversation with them when they have done something wrong? Where a child has low self-esteem, the parent is going to want to ask their child questions about what they did wrong.  The parent should be curious rather than critical.  Ask; “What were you thinking?”,  What were you feeling?”, “ Were you trying to tell me something?”  Parents need to listen to the answers carefully, repeat the answer back to the child, even if does not make sense AT THE MOMENT.  The parent needs to validate any feelings or thoughts.  The answer might not come immediately after the question, but minutes or hours later.  Ask the child if in the end of doing what they did wrong, they got what they wanted?  Don’t give the child the answer, don’t fix it for them.  Help them work out a better way of getting what they wanted.

A quick example:  A mother reported her ADHD child was acting out in school with their 1:1 hitting, spitting, etc.  The mother asked; “Why did you do that?  The child responded;  “School is hard!”  The mom responded, but you have a 1:1 to help you!  In my consultation with the mother, I suggested she say some of the following; “I understand, school is hard work.”  “Mommy works, daddy works, it is hard.  We don’t like everything we have to do, but we do it anyway.”  “I understand, writing and math are hard for you. But, I know you can learn to do better on these hard tasks.”  Creating a positive expectation, having faith in your child’s ability is important.

How can parents help boost self- esteem and self confidence in their kids? Having a positive expectation and supporting the child related to their disability is vital.  Focusing on when the child is successful, playing their games and attending,  The way we talk about wearing eye glasses should be the way we talk about a child’s ADHD or ASD.  “Oh, you are having a difficult time sitting, let’s take a break and come back…” “Oh let’s adjust your medications, see if that helps.”  “I know this is a challenge how can WE work together so you can get the job done?”  I am so proud that you are controlling your body when we did…”

Parents have to be mindful of their feelings and thoughts when engaging with their child.  If a parent can find the positive when they are feeling critical of the child and communicate the positive, it goes a long way to building self-esteem.

How does ADHD impact their readiness for college and other adult responsibility? When a child has a disability, parents and schools are too often compelled to provide all the supports to make the child successful.  The child then becomes dependent.  If there was no long term effort to help them become independent, fade the supports, this adversely will impact on their ability to succeed in college and as an adult.

What advice can you offer parents to help their child cultivate executive functioning skills? I believe the precursors to executive functioning stem from schedules and routines in a child’s life.  Giving a child choices and letting them learn the consequences of good and bad choices is part of taking control of their life.  As the child matures, let them schedule their school work, play time, time with family and so on, all contribute to executive functioning as the child matures.

How can parents practice self-care so they can remain calm, patient and present for their kids who may require more than most?  This is such a good and important question.  I often use as an analogy the instructions given to passengers in an airplane in the event of an emergency.  “If the oxygen masks are needed, first put them on you the parent, then your child.”

If the parent(s) are not taking care of themselves, they are not going to be present for the child in a calm, caring and thoughtful manner.  Taking advantage of family and community resources to care for a child while a parent goes for a walk, does some work, is critical for their mental, emotional and physical health.  A parent who sacrifices of themselves certainly does not help a child to become independent or develop executive functioning as discussed above.

Have you had the experience working with families who reached the conclusion that their child might be best served in a residential environment?  Yes.  It is an extremely emotional and difficult conclusion to come to.  There are so many practical, logistical and financial decisions, short and long term that need to be made to ensure the child is well cared for in the long term.

What is the best piece of advice you have shared with families over the years? Parent child relationships are like fingerprints.  There is wide latitude when we define “Good enough” parenting.  Our goal should be to teach and love our children the best we can.  We need to understand and acknowledge their realities about us as parents and their world.  They need to be heard and validated.  If we can be reflective about ourselves, they will learn be reflective about themselves.

 

Adam J. Holstein has a master’s degree in Developmental Psychology from Yeshiva University and graduated from St. John’s University with a Professional Diploma in Clinical Child Psychology. He graduated of the Washington Square Institute for Psychoanalysis and Mental Health. He is a New York State Certified School Psychologist and a New York State Licensed Psychoanalyst. He is currently in private practice and works with adults, children and their families in New York City and Long Island. Teletherapy is also available. Visit www.behaviortherapists.org.

 

 

Tags: , , , ,

Post a Comment