Being someone who works in the field of children with special needs it’s hard to have a baby without thinking about the risks each and every day. While I am past the first stage my fears continue.

With my first pregnancy I thought about the risks all the time. It’s hard not to. With my last pregnancy not only did I think about all that could happen with my new baby, but I also spent a lot of time thinking about how it would affect my older daughter Maya who is now 3 years old.

Sibling relationships are most often the longest lasting relationships in a family. They will go on after we are gone. While the arrival of a new sibling can be difficult for any child this is especially true if the new baby has special needs.

Siblings of children with special needs require very special care and often do not get it. As a result they suffer the consequences.

Much research has been done on the impact on brothers and sisters when there is a child in the family with special needs.

These children often have feelings of loss and isolation. Parents will try to protect them and rarely share information with them. Parents try to talk about other topics not relating to the disabled child.

While this is done with good intentions it leaves the brother or sister with no one to talk to about his or her feelings or concerns. It almost feels taboo to them to bring it up.

Siblings often feel fearful that they could have caused the disability. While this is irrational it is common.

They also may be resentful when the child with a disability is able to act in a way that is not acceptable behavior for them. I also see a lot of embarrassed siblings in my waiting room. While they see certain behaviors all the time they still feel ashamed when they are in public settings.

Brothers and sisters also have care-giving demands that other children their age do not, especially sisters. In fact research has shown sisters spend more time caring for their disabled sibling than on their own activities.

While they feel a sense of duty and responsibility and take on tasks willingly, ultimately it is not a healthy scenario.

These brothers and sisters also feel pressure to over achieve whether it is in school or sports. It is apparent they are looking for extra attention.

It takes years before many parents of children with special needs realize how all the issues they have been facing are affecting their other children. Some parents never realize it. It’s hard to balance the needs of any siblings. This fact only magnifies when one of them has special needs. Parents are human, we are not perfect, and we often make wrong decisions.

While I seem to dwell on this, again I bring up communication. I can’t help it. It’s just how I think. While there is such a thing as TMI (Too Much Information) children need to be kept in the loop. It’s amazing what they can understand and how much it will help them make sense of their worlds.

While many parents miss the boat, there are many programs and groups available for siblings of children with special needs. In these groups siblings get to communicate their feelings and meet others who are in similar situations as them. Just talking can do wonders.

I tried hard to prepare Maya for her new baby brother. I told her on a daily basis that when her brother is born he will not be any fun. In fact all he will do is eat, poop, cry, poop, sleep, and poop some more. These conversations seemed to have prepared her well. In fact we have both gotten several laughs since he has come home from the hospital in regards to his current routine.

So as I always say, talk, talk, talk….they will listen.

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So, what is Theory of Mind? Theory of Mind is one of the main deficits in individuals on the Autistic Spectrum yet it is rarely known or understood by professionals who work with children with Autism. I know this because I ask them before they come to work with me. In order to work with a child with Autism you must understand what it means to not have Theory of Mind.

Most often parents of children with Autism do not know what Theory of Mind is either.

Why Is It Important?
It is important for them to know what this term means as it will give them a better understanding of why their children are having such difficulties. It also allows parents to predict situations that may be difficult for their children due to their absence of Theory of Mind.

Even the highest functioning children with Autism most often do not have Theory of Mind.

Theory of Mind is the ability to not only understand that people have different beliefs, motivations, knowledge and moods but also understand how that affects their actions and behavior.

What Studies Tell Us
Many experiments have been done over the years to demonstrate Theory of Mind. My favorite being the “Smarties test”. In this experiment typically developing children, and children with Autism were shown a closed container with a Smarties label on it. They were then asked “What do you think is in here?”

The children in both groups answered “Smarties”. They were then shown that the container contained pencils, not Smarties.

Then they were asked a couple of other questions. The first question being “When I first showed you this container, what did you think was in here?” The typically developing child answered “Smarties”.

The children were then asked “When the next child comes in what will he think is inside here?”

Again they responded with “Smarties”.

When these two questions were asked to children with Autism the majority answered pencils to both questions.

The findings of this experiment revealed that most children with Autism do not have the ability to understand other people’s different beliefs. Typically developing children will have this understanding at 3-4 years of age.

Another Core Deficit
Perspective taking while sometimes used interchangeably with Theory of Mind is also very important to understand when involved in the lives of children with Autism.

While Theory of Mind is a necessary component of perspective taking I do like to differentiate between the two.

Perspective taking refers to our ability to relate to others. It is our ability to perceive someone else’s thoughts, feelings, and motivations. In other words it refers to our ability to empathize with someone else and see things from their perspective.

Most people can intuitively tell how someone else feels in a conversation. When they speak to someone who’s looking around and not paying attention, they perceive the person is not interested in the conversation or is distracted for some reason. They know if they see tears in the person’s eyes that the person is upset.

Experience From A Social Skills Class
In my social skills classes I often do an activity in which the children decide what gifts would be appropriate or inappropriate for their peers, family members and other people in general. This activity shows clearly who has difficulty with Theory of Mind and Perspective Taking.

In a recent class of 5 children with one being on the Autistic Spectrum the deficit was clearly evident. I went around the table and asked each child what they would buy their parents, grandparents and even a baby for the holidays. The one little girl who was on the Autistic Spectrum answered a Barbie Doll for everyone.

It was clear that this was what she wanted for a holiday gift however she was unable to get inside anyone else’s thoughts and decide what might be a good gift for them. You can see how these deficits will significantly impact social functioning of these children.

It is very important to note that lack of Theory of Mind and Perspective Taking is not a sign of intelligence. One can be of gifted intelligence and not have Theory of Mind or Perspective Taking skills.

So What Can Be Done?
I am often asked if these deficits can be overcome and/or taught. The answer is both yes and no. With intervention some people with Autism will develop a basic level of Theory of Mind which helps them function better in the situation they are currently in. In other words we can teach skills that are situation dependent. If you read any of the writings of Temple Grandin she explains this in more detail.

Also when pretend play and joint attention* is addressed early on the deficits may be less severe later in life.

It is in the best interest of both parents and professionals who work and live with individuals with Autistic Spectrum Disorders to learn as much as you can on this topic. It will be very eye opening for you as it was for me when I first learned about it. Learning leads to understanding. Understanding leads to progress.

* Joint Attention refers to sharing the experience of observing an object or event via non-verbal communication such as pointing or following a gaze. For example if I look at something and you then look to see what I’m looking at without being verbally told to. This skill should be present in babies by the age of 12 months.

Note: If you are concerned about your child’s social development you should call 914.488.5282 to set up a confidential consultation.

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Bullying is an issue that affects many children, especially those with special needs. It’s no secret that children who are different from the norm are often subjected to taunts, and tormenting by other children. This is an issue that is being discussed on a global level. From Australia to England to the US there are frequent newspaper reports about bullying.

A frequent question is “What do we do?”

Some argue that we should do nothing. They believe that bullying is a natural part of growing up. However, it would seem a majority disagree.

Anti-Bully Legislation The Answer?
In the United States alone thirty-five states have passed some form of “anti-bully” legislation. I have mixed emotions about this. On the one hand bullying is a problem in many schools. On the other hand, laws have a funny way of causing unintended consequences.

Connecticut seems to be trying to head off one unintended consequence, false labeling. The idea is that the accused bully and his/her family would have a chance to make their case against the charges. I’m shocked that there is even a question about that. Connecticut’s effort stems from a case in which a ten year old boy was officially labeled a bully. He and his family denied the charges and said he should not have been labeled. They claim he was retaliating against someone who was bullying him.

I don’t know if he is guilty or not, but he should have had a chance to make his case.

Labels Lead To Problems
I also question the judgment of giving children an “official label”.

Anyone who’s been in our practice knows we don’t believe in rushing to labels. You can treat something “as if” without making it official. Labels put our children into boxes. Once that is done it is difficult to see alternatives that don’t fit nicely into the box. To put it another way labels often do more to prohibit change than they do to encourage it.

Kids have a funny way of living up to their labels. Also, when a child is labeled their reputation precedes them. The other children and the adults have a tendency to not let them live it down. In other words, they reinforce the child’s label and therefore they encourage the labeled behavior.

I have seen this first hand because I was labeled. Not for bullying and not for anything that’s relevant to this story other than to say I lived up to the expectations of my label from the 6th grade until after I left home.

Instead of labeling children we need to look for solutions to the causes of bullying. The reality of bullying is that it is a symptom. What it is a symptom of varies. It could be a symptom of the local culture, problems at home or even of some sort of special need. Children who bully are doing it for a reason.

The Core reasons
Unless we address the reasons children bully we are only putting a band-aid on the problem. We are not fixing it. It will not go away. It may even become worse or create an even greater set of problems due to unintended consequences.

I don’t deny that bullying needs to be addressed. Children who are bullied suffer all sorts of problems ranging from becoming bullies themselves to committing suicide. I have personally known people who did both. Bullying is a problem. The complexity of the issue and the space limitations here prohibit a real discussion of what the solution may be. However there are alternatives to new laws and giving children negative labels.

The Federal Center for Mental Health Services recommends teaching children how to resolve problems, ignore routine teasing and how to respond to bullies.

If you read their list, almost every item is related to improving your child’s social skills. The reason is because both the victims and the perpetrators of bullying typically have social skills deficits.

Effective social skills give children the ability to interact in constructive ways and not resort to bullying. They also give children the ability to deflect the attempts of a bully when needed.

States that prohibit bullying and harassment in schools based on sexual orientation and gender identity: California, Iowa, Maine, Maryland, New Jersey, Oregon, Vermont, States that prohibit bullying and harassment in schools based on sexual orientation: Massachusetts, Washington, Wisconsin. States with school anti-bullying and harassment laws that do not list categories: Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Kentucky, Louisiana, Minnesota, Missouri, New Hampshire, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Tennessee, Texas, Utah, West Virginia.

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Have you ever been in a situation where everyone was different from you? If so you have some concept of what it must be like to have a social skills disorder. I’ve been in that situation many times, most of those times I have been by myself. While it is not the same as actually having a social skills disorder being in an environment that made me feel alone and like an outsider made acutely aware of how important having good social skills is. That’s why I spend so much time talking about this issue.

I can’t imagine where I would be if I had not been able to pick up on the unwritten social rules around me. I certainly would not be writing this to you today.
We all take these social rules for granted. We don’t even notice them unless we’re put in a situation in which we don’t know them. When that happens feelings ranged from isolation and anxiety to circus freak. Being the odd man out is never fun. It’s just too easy to do something wrong. That is exactly what happened the first time my family met Isa’s.

Social Lessons From My Wedding
Isa and I are from very different backgrounds. To say they are different is a massive understatement. Culturally the only way they could be more different is if they didn’t share the same language.

Isa has a liberal Jewish family from New York. I have a conservative Christian family from New Mexico. Her family grew up in the suburbs and the city. My family grew up on farms and ranches in the desert. Her family came here in the last century. Mine was here pre-revolution. You get the point, very different people.

As you can imagine, the first time they met was not comfortable. It was the afternoon before Isa and I were to get married. Everyone was doing their best to not commit a social faux pas. They were all very reserved in their behavior and trying to figure out what was acceptable and what was not. Personally I was sitting in a different room avoiding the whole ordeal.

A Social Rule Gets Violated
Anyway, after what seemed like an eternity my family and I headed out to the car to go back to the hotel. As my brother Greg stepped down from the front steps my then soon to be father-in-law, Jerry, grabbed him and kissed him on both cheeks. Greg promptly became stiff as a board and white as a ghost.

Had I not warned my family that they might get kissed, it may have been a far more uncomfortable situation.

You see my father-in-law had violated an unwritten social rule of our culture. Where I come from kissing is only shared between lovers. Hugging isn’t even accepted by everyone there. So a kiss on both cheeks by another man really shocked my brother.

If it’s difficult for the average adult to follow the unwritten social rules imagine how difficult it must be for a child who has a social skills disorder. For them every day is like trying to understand a different culture. It’s like a pop quiz that they’re not prepared for. Imagine how stressful that must be.

Social Skills Must Be Learned
It is a mistake to assume that just because a child is intelligent or has a great vocabulary that he will pick up social skills on his (or her) own. Social competency doesn’t have anything to do with IQ. You can be perfectly intelligent and still struggle socially. That’s because social skills have to be learned.

The analogy I always give is math. Some people just get it, while others struggle with it.

I flip numbers, so I’m someone who struggles with it. That doesn’t mean I can’t learn it. It doesn’t mean I’m stupid. It just means that there is a specific way I have to learn it. I can learn just about anything else by any method I choose. I can see it, hear it or do it, doesn’t matter unless it is math related. If it is math related I have to see it, hear it and do it frequently in order for it to stick.

It’s similar for children who have trouble socially except social interactions are far more complex than math. Whereas math has clear and logical rules, social interactions are heavily influenced by emotions and context. If you don’t have some understanding of emotion and context it makes it very difficult to act in a socially acceptable manner.

The Road To Good Social Skills
A child cannot learn emotion and context by being taught social skills in isolation. While it is important in some cases to either start with or focus on the behavior, social skills need to be taught in a broader context that either is or feels like a natural environment.

Think about it. What good does it do to teach your child to look you in the eyes if he doesn’t understand why? It’s like handing him the formula for division without explaining how and why to use it. In fact a frequent complaint of children who have been taught skills in isolation is that they did not understand why they should use the skill. Once they understood why they should use a skill improved how they used it.

Appropriate social skills instruction seeks to create social understanding. Unfortunately very few programs have this objective. That is one of the main things that hold them and the children they work with back.

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Any time something is misunderstood, it is feared. Autism is no different. People fear it. While great strides have been made in the public’s awareness of Autism much confusion remains.

The nature of Autism doesn’t help. It is not a clear cut disorder. Autism is actually a spectrum of disorders. Autism Spectrum Disorders can range from severe to relatively mild.

In fact, it is not uncommon for there to be disagreement about whether or not a child is actually on the Autistic spectrum. Obviously that happens in the milder cases, but it does happen.

The Label of Autism Changes Everything
Some people hear the word Autism and freak out. Parents who had been hanging out and letting their children play together all of a sudden start acting weird when they find out the other child has Autism. Never mind that everything was fine until they heard the label.

While it is unfair, in some respects it is understandable. If you read my recent article about “Us and Them” you have some concept of why this happens. Humans naturally segregate the people they meet into groups of “like us” and “like them”. And being like them means you can’t be one of us.

Parents want nothing more than to protect their children. They want them to fit in. Part of fitting in is not having behaviors that are deemed quirky by the group.

Of course, children pick up quirky behaviors no matter who they are around. Let’s face it, when you get down to it, we’re all a little quirky to someone. A child with Autism just makes an easy scapegoat. Sure in some cases they have a lot of quirky behaviors. However, the fact remains, Autism is not contagious.

While the causes of Autism remain shrouded in mystery, one thing we do know is that you can’t catch it like a cold. You’re not going to end up on the spectrum just because you spend time with someone who is.

The Wrong Assumption About Autism
Children do learn a lot through modeling. However, it’s wrong to assume that just because a child has Autism your child will pick up a negative behavior. It’s also wrong to assume that a child with Autism can’t pick up an unwanted behavior from a child who isn’t on the spectrum. They can. I know my daughter has a few catch-phrases and behaviors that some parents would undoubtedly frown upon. All kids do. No one is perfect.

Part of the bias against Autism comes from a preconceived notion about what Autism actually is. Generally we hear about the most severe characteristics that can be present with Autism. And while I’m not saying that justifies a bias against those with severe Autism, I am saying that is not a fair characterization of the entire spectrum.

Some adults with Autism argue that they are disabled more by the view society holds of them than by Autism itself. To me, that is a very powerful statement. It says a lot about how we as a society are treating those with Autism. It also says a lot about the shortcomings of labels.

The Problem With Labels
Labels can bring a sense of order and understanding; however, they can also bring preconceived limits and stigmas.

While there is something to be said for being able to identify something and categorize it, there is also something to be said for not being hamstrung by what you or others think you are suppose to be.

I hope you’ll keep that in mind the next time you hear any label and especially that of Autism. While it is not very well understood, Autism is not contagious. We need to be careful not to treat those who have it as if it is. We need to keep an open mind and get past the label.

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