Helping your teenager stay physically active and healthy
Your adolescent is getting taller, eating more, and gaining weight. It happens parents, our kids grow and eat more while moving less. Between school and therapies who has time for the gym, right? Well, unfortunately, we tend to place fitness in the back burner when in reality it should be in the forefront.
Our health should have as much importance to us as education or physical therapy or speech therapy. Adolescence is a great time to begin incorporating health and fitness and I will be discussing some quick pointers to help with that transition.
Self advocacy is the action of representing oneself or one’s views or interests. This includes: learning how to speak up for yourself, make your own decisions, pursue your interests, find the people who will support you, know your rights and responsibilities, problem-solve, listen to others, and express agreement and disagreement in a calm manner.
Self advocacy helps you to:
Obtain what you need
Make your own choices
Learn to say no without feeling guilty
Express disagreements respectfully
How to be a self-advocate
Believe in Yourself
The first step of self advocacy is believing in yourself. That also means believing in your strengths. Know that your worthy and that you are willing to do whatever it takes to care for yourself. Many people with disabilities struggle with self-esteem and motivation. You have to find out what makes you happy, learn something you enjoy and be good at it.
It is often hard for people with disabilities to ask for what they want when they are treated poorly; I know from experience. This makes it difficult to practice self advocacy.
It is time to invest in yourself and your self-worth. Make it a point to believe in yourself daily: whether it’s looking in the mirror and saying “I’m a terrific, a great person,” or writing a post it on the wall to remind yourself how good you are, or a reflection letter with all of your strengths and obstacles you have overcome.
Assess: On a scale of 1 to 10 rate how you are feeling that day. If it’s a zero, then find a way to make yourself feel better; if it’s a ten, then keep doing what makes you happy. When you can’t decide, give yourself a 5 and remind yourself: “what can I do to make things better?”
Appreciate: Give yourself credit when credit is due. It’s hard to believe in yourself and give yourself credit because you feel you can do better or feel as if you not doing your best. We can be our own worst enemies. Practice forgiving yourself when you’re sad or hurt.
Give yourself credit for everything you do that is great, even if it’s small, like getting out of bed when you are depressed.
I’m emailing with Kris Jones, an eloquent writer on Linkedin about his Asperger’s Syndrome. We’re talking about the stressors he experiences that can create extremely self-limiting anxiety. We’re going to use several blogs to talk about different stressors. Kris’s first stressor was his lack of self–fulfillment. One of the causes of this lack of self-fulfillment was Kris’ social anxiety.
Tony Attwood, expert on Asperger’s Syndrome, suggests that around 65% of adolescents with Asperger Syndrome have a secondary mood or affective disorder (such as depression or anxiety); most have anxiety.
Kris describes his thoughts and feelings which I’m calling social anxiety like so: “No one likes you. No one wants to know you. You are not interesting. Stay where you feel most comfortable – inside your house and away from others. You are not fit to be out there amongst the human race.” He says that this is representative of how he feels and it is what keeps him from going out and mingling with others his age. Even though he knows these thoughts about himself aren’t true, he can’t get past the anxiety.
Let’s break this down into parts. What causes this social anxiety?
Why are there higher rates of depression in those with AS? There may be some genetic predisposition to depression for some, but this doesn’t explain most cases of depression. One reason for depression is isolation and loneliness. Despite the misconception that people with AS prefer being alone, research shows that many with AS want friends. Children and teens with AS are often lonely and feel their friendships aren’t “quality.” They’re looking for company, safety and acceptance to give them a sense of confidence. Those who have friends may have a lower tendency towards depression. However, many with AS who experience social anxiety or lack social skills in joining, starting, and maintaining friendships don’t have the tools to have the friends they want.
Another reason for depression is the experience of being bullied.
Studies have suggested that a majority of those with AS experience bullying. This isn’t surprising given the drive towards conformity and the emphasis on social status among middle school children in particular, but also among high school students and even older individuals.
There isn’t a cultural norm of tolerance of neurodiversity, or even of most kinds of diversity.
Qualities of those with AS that engender bullying are
lack of awareness of social cues;
interests or behavior labeled ‘odd’;
AS individuals have difficulty flexibily and astutely responding to bullies. Some with AS tend to be submissive and anxious in response, which empowers bullies to continue. Still others lash back, which gets them in trouble.
In my own practice, my Asperger’s teenagers and young adults have often been bullied and carry the wounds of bullying deeply ingrained in their sense of self-esteem.
As most teens and adults with Asperger syndrome know, people with Asperger syndrome can be significantly depressed. The rates of diagnoses of depression vary among studies, from 18% to 22%. The most commonly quoted rate of a depression in the general population of the US is 6.7%. Most of the research shows both genders have these high rates of depression.
Studies focused on males and females and not those who are transgender. There are more people who identify as transgender in the AS population than in the general population and transgender people have a higher rate of depression. One would guess that someone who is both AS and transgender might have a high tendency towards depression.
Interestingly, non-autistic full siblings and half-siblings of individuals with ASD (not just Asperger syndrome) also had higher rates of depression than the general population, although at half the rate of those with ASD. Studies of suicide attempts are also very troubling. In studies of suicide, the rate of suicidal thoughts and attempts are prevalent, especially in adolescence and young adulthood.
It’s critical to identify depression, since it can be treated.
It’s obviously important to understand why rates of depression and suicidal thoughts are so high. One factor, given the findings in siblings, is that there is an increased genetic vulnerability to depression, although large studies haven’t supported a common genetic overlap. We have to look to other factors to account for these high rates of depression.
It’s important to diagnose clinical depression for anyone for a simple reason – depression is treatable with a variety of modalities:
Mindfulness, meditation and self-talk are important ways of helping yourself when you’re depressed, stressed out, anxious or emotional. They’ve been shown to help handle feelings and are actually often used as components of the most helpful forms of therapy, cognitive therapy.
Why is it important to talk about these three techniques, especially for those with Asperger’s?
Two typical traits for those with Asperger’s are black and white thinking and a tendency to ruminate, to stew thinking about something. With black and white thinking, we see things in extremes, all bad or all good. When we’re depressed, that tends to be all bad.
All bad isn’t realistic; life is always a mix. Things don’t always go wrong. People aren’t always hostile or rejecting. Ruminating means dwelling on something, usually negative when we’re depressed. As we dwell on our thoughts, they tend to become more dramatic, more overwhelming, more conclusive of our negativity. It’s like a downward spiral.
Both black and white thinking and rumination focus on the past, revisiting what has happened, or in the future, anticipating what might happen. We’re rarely in the present. Most often, at this exact moment, nothing too stressful is happening.
The point of mindfulness as an outlook, a way of being, is that it focuses on the present moment – our awareness of what’s happening right now.
Mindfulness exercises include activities that force us to focus on the here and now. Focus can be on attending to our breath, what we hear, bodily sensations, or what we’re doing, like the feelings of washing dishes, the soap on our hands, the feeling of the water, the texture of the plate and glass. This pulls us out of the past and future into the present, which tends to be calmer.
Meditation is a practice for both the body and mind.
When we’re emotionally aroused or stressed, our entire autonomic nervous system is activated. Blood pressure goes up, breathing changes, stress hormones race through our bodies, and every system is affected.
We can be stressed in this way both by what goes on in the moment and by what goes on in our minds – thinking about something can trigger the same physical stress response as being in that moment. Emotionally we’re at a high level of arousal, regardless of what’s happening in the moment. Meditation turns off the stress response, and teaches our bodies what Herbert Benson of Harvard calls the “relaxation response.” Meditation has actually been scientifically proven to structurally change the brain to be more stress-resilient.
If you have: lost interest in your usual activities; trouble sleeping, wake up early or sleep all the time; a change in appetite (more or less); withdrawn from people with a down mood (for Aspies it might be sad, irritable or a sense of hopelessness – whatever negative mood or thoughts you recognize), you have what we call major depression.
For this, you probably need professional help. Things are not hopeless but being depressed is like looking through dark glasses. While people with Asperger’s are prone to depression because of challenging life experiences, clinical depression is not part of Asperger’s Syndrome and usually responds to treatment. For those struggling with lower level depression, you might still consider therapy to look at ways to make life changes and feel better.
For finding professional help and other resources, Autismsource.orgis a gold mine of resources including lists of local therapists in your area.
Psychologists, social workers, psychiatrists, advanced practice registered nurses (APRN), and other specialties all can provide therapy. Individuals should be licensed providers in their states. You can find this information by looking at their websites.
Only psychiatrists, other MDs (medical doctors), and APRNs can provide medication. Medication has been demonstrated to be effective in treating depression. Often a combination of medication and therapy are most useful. The form of therapy most recommended is CBT (cognitive behavioral therapy). MBCT (mindfulness-based cognitive therapy) has been shown to be effective for depression although there isn’t research on it with people on the spectrum. Most therapists specializing in working with those with ASD know how to modify traditional CBT to best work with those on the spectrum.
It can be very challenging, certainly in parts of the US, to find therapists who take insurance.
The prevailing cost of therapy varies widely across the country. Some therapists (usually psychologists) offer sliding scale fees or have some lower fee slots, so it’s worth calling and asking. Clinics generally take insurance but you want to be sure that the therapist is familiar with ASD. The first thing you should do is call the number for patient or customer service on your insurance card and ask for a list of providers (psychologists/psychiatrists/social workers) in your area. This way you can know all the providers near you who are in network with your insurance plan before you call around clinics. In network providers have more affordable rates than out of network providers. It is important to inform yourself about your insurance plan and coverage before you begin the search.
Also, check providers with Medicaid if you have it. Any MD or APRN will know about treating depression with medication. Some therapists who accept Medicaid might be experienced with ASD even if they’re not on a directory for ASD.
Depression is most common in adolescents and young adults with Asperger’s, and particularly in those with stronger intellectual and verbal skills. That means college students with Asperger’s are at a very high risk for depression. This is particularly true for freshmen, who are transitioning to the college experience. Although I’ve seen this in later years as well when students are dealing with more challenging classes, social issues, and upcoming graduation as triggers.
Let me tell you about one college student’s experience with depression:
Franklin went off to a good college based on his excellent academics in high school. However, he’d been provided with executive function scaffolding all through high school. His parents and a teacher had helped him organize his time and initiate his work. The school counselor and his parents had feedback from teachers if he was falling behind on assignments.
In college, he was on his own.
He was supposed to check in with the disability office, but he resisted being seen as needing help. Franklin had challenging classes and had taken on a very full load of five classes; he had always set his standards and expectations of himself very high. Franklin began falling behind in writing papers for his English literature class because writing was difficult and he wrote slowly. His effort was going into writing, so he fell behind on the reading. He tended to procrastinate as the pile of work grew. Franklin was embarrassed at being behind, so he stopped going to English. He also was stressed by feeling at a loss in terms of the 24/7 social demands.
As you might expect, all of this stress was a trigger for depression. In Franklin’s mind, one was either a success or a failure, and he was a complete failure.
Depression is more frequent in those with AS than the general population, and the struggles of those with AS often contribute to the development of depression. The obvious question is, what resources are available and what do we do? First, we should not accept depression as just a normal part of AS, especially if it’s interfering with everyday life. Secondly, we need to recognize the symptoms to help as early as possible. And lastly, we need to research the supports that are available – how you can help yourself or others right now – and what resources still need much improvement so that you can call upon action in your community.
Being aware of the symptoms of depression is critical:
sleep difficulties, either sleeping more or less (insomnia, early morning waking);
changes in appetite (either more or less hunger);
weight gain or loss;
a failure to enjoy normal sources of pleasure;
sadness, guilt or hopelessness;
crying or unusual irritability.
Someone who is clinically depressed sees the world in the above ways each day. It’s important for the individual or those around to seek professional help.
Medication can help many with depression, as can Cognitive Behavioral Therapy. Although CBT is a slower process with AS individuals and needs to be adapted to their thought process. Some studies suggest neurobiofeedback can be helpful with depression and there are a few early studies of its use with ASD patients. For those who prefer to avoid medication, this is certainly worth exploring. It is best to come to your medical sessions with the knowledge of various treatments so that you can be prepared to discuss what is best for you.
It’s important to think about addressing the factors that can result in depression.
Having Autism is tough as it is already because you may come across many people who do not understand or care about you. You may often be made fun of because of the way you look, walk or anything you do or say. It’s a continuous battle that I deal with every day and unfortunately there exists people who will talk and make fun of you no matter what. Know that you are not alone. I have 2 simple idea on how to enhance your emotional intelligence (or Emotional Quotient, EQ) to counteract this negative feedback and restore your mind with positive thoughts.
As has previously been discussed on Aspergers101, emotional intelligence is a crucial skill to learn and practice that can greatly benefit you in many areas of your life. But how exactly do we get there? The steps below should help guide you towards building your emotional intelligence and self-awareness.
How can we enhance our emotional intelligence (EQ)?
Listen to your body:
A gut feeling you have about a particular situation such as quitting your job is a sign that something is not right either about the situation, or something is not right about quitting your job. If your body gives you an alert signal about a certain situation, pay heed because it may save you from a dangerous outcome. Listening to these signals and the root feelings of the sensations in your body will process your power of reason.
Always ask yourself, how do you feel?:
From a score of 0-10, with 10 being the best and most positive and 0 being the lowest and least confident, write it down in a journal to record how you feel each day overall. If you’re having a bad day, examine how or what caused you to feel this. Explore what transpired that day that made you feel down and how it connects with your overall feelings.