Mary Tanner, Author MSW, LISW-S, M.Ed.

Talk of back to school can trigger parents as much as children. Going back to homework, lunch money, after school programs, car pool etc. etc. can evoke a stress response in even the most seasoned parent. So, what can we do? First of all, Moms, Dads, Guardians, Caregivers, relax.  Everything will be OK.  Have fun in the remaining days of summer!
 
When parents ask me what they can do to help their child get ready for back -to- school, I start with the basics.  I call them the “Big Four” This is a recommendation I give year- round. 

• Good Nutrition
• Hydration
• Exercise
• Enough quality sleep

 
If you do those 4 things with and for your child, you are giving them the best chance to feel good about themselves and to perform well at whatever activity in which they partake. Sometimes, the Big Four gets put on the back burner during the summer. It is truly beneficial to be consistent and do these things year -round.   You are helping yourself too, Adults. You will have less irritable, more cooperative kiddos with which to contend.  The Big Four applies to all kids big and small and to their adults, as well.
 
I recommend limiting screen time. Children, young and old are spending way too much time on their screens. This is one of the biggest obstacles that interfere with sleep and exercise. I have had young clients who take their I-phones, I-pads, laptops to bed with them. This is a very bad idea! One little guy I was seeing was staying up all night playing games, watching shows and falling asleep at school. I got to the bottom of it and told his Guardian, who didn’t know.  She put a stop to it by simply taking all electronics away at bedtime.  It was a fight, but one that was necessary.
 
On the subject of screen time, it’s good to shut off all screens an hour before bed time. The blue light emitted from all screens interferes with our sleep cycle and makes it more difficult to fall asleep and stay asleep. If your child is experiencing difficulty with sleep, talk to your pediatrician.
 
If your child is shy or seems to have trouble making friends, summer is a good time to practice social skills. Talk to your child about communicating with others. Demonstrating skills and role playing can help them learn and develop better interpersonal skills.
 
Playdates are also helpful. Spending time with friends during the summer can help with back-to-school worries. Knowing they have friends at school eases transitions.
 
If your child is starting at a new school, ask the school for recommendations, if there are summer activities that will allow your child to meet classmates. There may be a local recreation center or swimming pool where children from their school go. I love libraries. They offer fun programs that encourage reading and may be a good place to meet other children.
 
It's important to always talk about school in positive terms. If the previous school year was difficult for your child, offer them hope and encouragement that the next school year will be better and you are there to support them.
 
If your child has experienced something upsetting, or seems anxious or depressed, talk to your school. Most schools have mental health therapists and counselors on site. It’s good to jump on potential issues early. Don’t let concern that your child will be labeled stand in your way. School resources are there to help.
 
Covid has caused issues for everyone. Educators are concerned students aren’t as far along in their learning because of lock downs and conducting classes via computers. Children are resilient and they will catch up. We, as the adults in their lives, can be their support and can help them see the fun side of learning.  Learning doesn’t just occur in the classroom, give your children experiences, nature walks, trips to the playground, regular trips to the library, time at the pool, a picnic in the park. All of these and more are opportunities for learning.
 
Have fun with your child!  Again, enjoy the remaining days of summer!

Alayna Mastrippolito, Author, Certified Peer Supporter

Transitions can feel intimidating, especially when experiencing a major change like transferring to a new school or moving from elementary to middle or middle to high school. Your child may be worried about several factors including making friends, bullies, school work, getting lost, or even whether or not they’ll be able to open their locker. Let’s talk about how to make this transition as smooth and comfortable as possible!
 
One suggestion for handling school nerves is to have them discuss or write out what they’re specifically afraid of, and then note which fears are out of their control. The idea is to shift the focus off of the things they can’t control and direct their energy towards the things they can control. When they’re done, take time to discuss or write the positive aspects of the transition so they can potentially get a little excited about it!
 
To prepare for the transition itself, it’s a good idea to get into the school routine the week before it starts. This may include getting supplies together, keeping a realistic bedtime, and encouraging more social time with school friends. If they’re going to a new school, see if they can visit the building before school is in session so they can know their way around.
 
Finally, ensure that your child is practicing self-care! This means taking care of physical health (enough water, nutrition, exercise, and sleep) and also mental health (activities that make them feel relaxed and rejuvenated). These actions will put them in the right headspace to feel their best no matter what happens at school.
 
Understand that it’s normal to feel nervous, and the nerves are what keep your child motivated to do their best! Remind your child that they’ve handled transitions before and can do it again… and they just might enjoy themselves!
 

When children and teens need therapy, it’s not unusual for caregivers to feel like they have failed. But rather than being a sign of failure, seeking help for your child is a brave act.

Sometimes children and adolescents need counseling, just like adults. They may be suffering from a mental illness, which affects a staggering 1 in 6 youths in the U.S. every year. Or they may need guidance with working through emotional issues related to family, school, trauma or other situations. That doesn’t mean there is anything wrong with them or you. It just means they need the assistance of someone who specializes in helping people overcome their life challenges.

No matter the reason why you are seeking therapy for your child, taking that first step can be scary. Here is a list of frequently asked questions to help you prepare for what comes next.

What Should I Tell My Child About Going to Therapy?
Be open and honest about why they are going to therapy and how you think it will help. At the same time, be sensitive to the worries or fears your child may have. Many children and adolescents think that therapy means there is something dramatically wrong with them. You can help ease this concern by explaining your child that they will learn new skills and tools for coping with their challenges, and that these skills and tools can help them for the rest of their life.

Will I Meet with My Child’s Therapist First?
The first session will be between you and the therapist to freely discuss your concerns and why you think your child needs therapy. If you think your child may be suffering from mental illness, be ready to talk about the signs or symptoms you or others have observed and when they started to occur. Come prepared with questions for the counselor as well. Common questions include:

• How frequently will my child need to come to therapy?
• What techniques will be used to help my child?
• What are the goals that you will work toward with my child?
• How will we measure progress?
• How can I support my child throughout the process?

Will the Therapist Keep Me Updated About My Child’s Progress?
In most cases, you will not take part in the sessions with your child. This is to provide your child with space to open up about things he or she may not be comfortable sharing in front of you. However, most counselors will schedule one-on-one parent sessions to share information and provide guidance on how you can help your child at home.

What if My Child Doesn’t Like the Therapist?
Talk to your child and try to understand why he or she does not like the therapist. Keep in mind it may take several sessions for the relationship to “click.” However, you should always trust your instincts. It may be that it’s simply not a good fit. If that’s the case, it’s OK to move on and find another therapist.

What Can I do to Support My Child?
Commit to making sure your child attends all appointments. We know this can be challenging for working parents and for parents of school-aged children. However, improvement will only be made if your child attends all sessions. In addition, talk to your child’s therapist about specific actions you can take to support your child at home. And finally, be patient. Progress takes time, and you will not see a breakthrough overnight. There may even be setbacks. But over time, you will see a change for the better.

When It’s Time to Get Help
At Compass Point, we have an experienced team of child and adolescent therapists who are ready to work with you and your child. Because we know how important it is to find the right therapist for your child, we will do our best to match you with the best fit from the start.

When you schedule an appointment using our online scheduler, you’ll answer questions about your child’s needs, your preferred location and your schedule. Within minutes, our system will generate a list of available providers who have the skills, capabilities and expertise to help you and your child. It’s that easy.

Take the first step. Call or request an appointment online today.

$25 per group paid upfront at our Anderson Office or Dayton office

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​So, first things first, why expand “the talk” to your child beyond giving them a book, showing them a video, or describing anatomy without further explanation? As a sex therapist, the majority of my clients come in feeling embarrassed to talk about sex or have a lot of misconceptions about it as adults because no one ever talked to them about it. Many people were raised with the underlying message that sex is awkward, taboo, or shameful to talk about – some were fortunate enough to have parents that were a bit more open to talking about it, but may still have only learned about anatomy, and not much else otherwise.

​By closing off our kids from talking about sex, we’re modeling the notion that there’s something inherently wrong with sex – that it needs to be hidden and can only be discussed with our partner. The problem with this is that as adults, most people have no one to turn to when they’re experiencing sexual difficulties. Forget about talking to a friend, co-worker, spiritual leader, etc. – most people just avoid the topic. And if the doctor doesn’t bring it up (which they probably won’t since they too feel awkward talking about sex), who can one turn to for guidance and advice? Porn? The industry that takes sex and scripts and edits it to look more like a movie than real life? I don’t think so. While porn might teach a technique or two, it doesn’t address issues such as pain, dysfunction, lack of desire, etc. Therefore, by setting a new trend and talking to your child about sex, you’re setting them and society up for better sex education and therefore better sexual health.

            So, when is the best time to start talking to your child about sex? The reality is, as early as possible, so that it never becomes a taboo topic in your home. Teach your child from an early age to label their anatomy properly. Teach girls the difference between vulva and vagina and let boys know about their penis and how sometimes it might grow, and that’s normal! Also, teach your children from an early age about consent. Rather than forcing hugs, kisses, or tickles, ask them if it’s okay to give them a hug, or ask them if they’d like to give Grandma a kiss. Teaching them from an early age that it’s okay to say “no” will help give them a voice early on to advocate for their own rights when it comes to their bodies. This is important not only for lessening any potential shame around sex and our bodies, but it’s also very important in the court of law. There have been cases where a perpetrator did not receive a full conviction because the child didn’t know how to describe the assault that happened to them, since they didn’t know how to properly label their body parts. And while this is an extreme example, it highlights the importance of teaching children proper anatomy and consent.

            As children get older, continue to have the conversation about sex. Answer questions honestly and make yourself available as someone to talk to. If you catch your child self-pleasuring, rather than yelling, smacking hands, shaming, etc., provide a gentle tone and have a discussion with them in private and set the standard that you and your household value. If your values indicate that self-pleasure is not okay, calmly explain to your child why without including shame messages. If your values align more with self-pleasure being acceptable, try explaining to your child that it’s fine for them to do it, but in the privacy of their own room, etc. It’s natural for children to explore their bodies, including their genitals as they age. It’s very likely that at a young age, they will discover masturbation and experiment with it. However, by addressing it in a way that reduces shame through a gentle tone and explanation (rather than just telling them “no” or “don’t do that in public!” ), they are much more likely to be open to coming to you when sexual issues arise. In addition, shame around their body and their natural desires will be much lower.

            Into adolescent and teen years, continue having the conversation. Explain to them about puberty changes so it doesn’t come as a shock when their bodies begin to change. You can give them a “welcome to puberty” package (razor, shaving cream, deodorant, tampons, pads, etc.) and let them know they can come to you with any questions they have about these changes. Make sure you explain to your kids not only the physical repercussions of sex (some potential side effects such as pregnancy, STIs, potential physical enjoyment, etc.) but also the emotional side effects (potential feelings of joy, connectedness, sadness, shame, etc. depending on the outcome of their experience) and again, that they can come to you to process any of these feelings/outcomes. Check and see if your child has a mentor with whom they’re comfortable talking about sex in case they still feel awkward talking about it with you.

            While there is plenty of other information to be considered regarding the sex talk, the biggest highlights are these:

1. Get comfortable with it yourself. If your kids see that you’re feeling shameful/embarrassed about sex, they’re likely going to feel that way too. That might mean that you practice giving “the talk” to yourself first in the mirror, or practice saying the proper anatomical parts out loud by yourself or with your partner.
2. Be open and reduce shame-based messages as much as possible. By showing your kids that sex isn’t something they need to keep hidden and that you’re a safe person to talk to about it, they will hopefully come away with less shame around sex and be more open to discussing any difficulties they’re having in the future.
3. Explain the reasons behind any values that your family has about sex. Kids are less likely to push the boundaries if they understand why they’re in place. If you simply tell them “because I said so,” they’re probably going to try and figure out the why on their own, versus if they had a clear understanding of why something is on- or off-limits.

 
By being open with your kids about sex and their bodies, the hope is that in the future they will experience less shame and be more empowered with making their own decisions regarding their choices. No matter what phase of life they are in right now, it’s never too late to have the talk. You’ve got this!
 

​Cyber bullying is bullying, no doubt about it. In fact, it can feel even scarier because the victim is isolated at home when reading it...and they often feel they have no one to go to for support.  We believe this page does a great job defining the forms of on-line bullying and can be useful for teens, parents and educators alike! If you or someone you know is a victim of cyber bullying, please feel free to contact us for support.  With Care Connect, we can get you an appointment with a licensed therapist within 48 hrs.
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​Tips for parents on cyberbullying management and prevention
How to tell if your child or loved one is a cyberbullying victim

There’s a chance your child, friend or loved one is the victim of cyberbullying but too embarrassed to admit it. Here are some signs:

• They avoid social situations or groups of friends that they once enjoyed, preferring to spend more time alone.
• They act out, displaying angry or upsetting behavior in a manner unusual to them.
• They suddenly spend less time on social media platforms that they once frequented.
• New, unknown numbers or texts suddenly appear on their phone.

Comforting your child after an incident of cyberbullying

• Approach the situation gently, allowing them to explain the situation to you at their own speed free of interrogation.
• Let them know that online cruelty does not reflect their value as a person.
• Inform them that the cyberbullying may not be personal, and that the bully may not understand the harm they are causing since it is being done from behind a screen.
• Advise them that retaliation or responding to the bullying can only make the situation worse.
• Tell them it’s not the end of the world, what seems like a crisis now will inevitably pass.
• Counseling - If the damage done by cyberbullying is severe, and the victim feels ostracized from their peers or afraid to go to school, he or she may benefit from professional counseling. Professional counselors, at school and otherwise, are trained to deal with cyberbullying and use specific techniques to manage the situation and help victims overcome their pain and self-esteem issues.
  

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Tips on preventing cyberbullying from happening to your child

• Educate your child on how to properly conduct his or herself on social media, i.e., don’t pose revealing photos or overly personal information.
• Friend, or follow, your child on the social networking sites he or she uses. This way you can monitor their activity from afar.
• Tell your child not to friend strangers, and to allow only trusted friends and family members to view their posts.
• Don’t openly engage with your child publicly on social media, as this may encourage taunting and bullying. Don’t post potentially embarrassing photos or content, either.
• Keep your computers and devices in the common areas of the home. Discourage them from using social media in private areas.
• Report instances of cyberbullying to social networking sites where they take place (links located below).
• If cyberbullying is a repeat issue, restrict their usage, or bar them from social media, altogether.

Cyberbullying laws and in school policy
Often a child will not be able to deal with an instance of cyberbullying alone, and the situation may require intervention by the school in order to put a stop to the behavior.

You may believe that confronting the parents of the bully is a good solution, but they might react unpredictably, denying the charge, or becoming aggressive. Research finds that the bullies are often physically and verbally abused by their parents, and they may not be the best individuals to confront about a cyberbullying situation.

Approaching the school in order to deal with an incident of cyberbullying is the best choice. Even before going to the police, this is the best course of action, as the school will have the contacts of every student, as well as a law enforcement liaison on campus at all times who will best know how to proceed with the situation. If bringing in the cops is necessary, then they will likely do so.
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To prepare:

• Take screenshots of the cyberbullying activity for evidence to support your case. If the bully uses their Facebook or Instagram account to bully your child, rather than an anonymous account, the evidence will be undeniable.
• Gather any texts, emails or other messages from the bully.
• Once evidence of the incident is gathered, make a call to the principal’s office to set up an appointment to discuss the situation

​Schools are mandated by state law in every state, to have an official anti-bullying policy, with Montana being the last to do so in 2015. Many states have laws that require schools to deal with off-campus behavior as well. Even if cyberbullying incidents take place off school grounds and after the last bell, they may still be forced to take action. Schools are required to keep classrooms a safe place conducive to learning, and off-campus cyberbullying can negatively impact this environment.

Interested in learning more about Cyberbullying? You can read more on Alarm.org. ​If you or someone you know is a victim of cyber bullying, please feel free to contact us for support.  With Care Connect, we can get you an appointment with a licensed therapist within 48 hrs.

Sleep is a major issue for many adults and children who have been diagnosed with autism spectrum disorder (ASD). Recent studies suggest that up to 80% of young people with ASD also have difficulty falling and/or staying asleep at night. The incidence rate of sleep problems and disorders is also high among adults with ASD, particularly those who are classified as ‘low-functioning’. Lack of sleep can exacerbate some of the behavioral characteristics of ASD, such as hyperactivity, aggression, and lack of concentration. As a result, people with ASD who have a hard time sleeping may struggle at work or in their classroom.

We’ll look at some of the most common sleep issues among adults and children with ASD, as well as some suitable treatment options and tips for managing ASD and sleep on a regular basis. First, let’s look at how the medical and psychiatric communities currently define ASD.
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What Is Autism Spectrum Disorder?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is considered the most authoritative guide for evaluating and diagnosing mental health disorders in the United States. According to the latest definition (last revised in 2013), the diagnostic criteria for autism spectrum disorder (ASD) are as follows:

• ‘Persistent deficits’ in communication and social interactionthat occur in multiple settings. These deficits may a lack of engagement in back-and-forth conversation, ‘abnormal’ approaches to social interaction, and failure to respond to social invitations. ‘Poorly integrated verbal and nonverbal communication’ is another common deficit; this may be accompanied by irregular eye movements, nervous tics, lack of facial expression, and other physical signs. Finally, people with ASD often have deficits in ‘developing, maintaining and understanding’ different types of relationships.
• Restricted, repetitive behavioral patterns. These patterns may be manifested in motor movements, speech, or use of everyday objects. Common examples of these tendencies include constantly lining up objects in the same manner, mimicking the speech of others (known as echolalia), or repeating ‘idiosyncratic’ phrases. People with ASD may also be unreasonably rigid about breaking from these patterns, and may express dismay when asked to do so. They also demonstrate ‘highly fixated’ interest on specific subjects, as well as ‘hyper- or hyporeactivity’ to sensory factors in their environment (such as smells and/or sounds).
• Although many people are diagnosed and treated for ASD as adults, symptoms must be or have been present during the early development period.
• The symptoms must be serious enough to cause ‘clinically significant impairment in social, occupational, or other important areas of current functioning’.
• The symptoms are not ‘better explained’ by the presence of another condition, such as an intellectual disability or a global development delay. The DSM-5 notes that ASD and intellectual disabilities are often co-morbid, or simultaneously present, in children and adults. However, both classifications carry different sets of diagnostic criteria.

​The latest DSM revisions also note three distinct ‘severity levels’ that can be used to assess how much support (if any) a person with ASD requires on a regular basis.
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Previous Definitions

Prior to 2013, ASD was broken down into different autism subtypes based on severity of symptoms. These subtypes were eliminated and omitted from the DSM-5, and their diagnoses have all been absorbed into the ‘ASD’ definition. Although these subtypes are no longer officially diagnosed, they are still widely discussed within the medical and psychiatric communities. Additionally, some are still included on other authoritative lists, such as the International Statistical Classification of Diseases and Related Health Problems (ICD) database maintained by the World Health Organization (WHO). The four most common subdivisions of ASD (as previously defined by the DSM) are:  

• Asperger syndrome: Asperger was once considered the mildest incarnation of ASD. Children and adults with Asperger display symptoms like inability to pick up on social cues, hypersensitivity to sensory stimuli, and preoccupations with hyperfocused areas of interest. However, many people with Asperger are high-functioning.
• Autistic disorder: This was once considered a middle-of-the-spectrum condition. Symptoms are more intense than those in people Asperger, but less severe than the most debilitating forms of autism.
• Childhood disintegrative disorder: This was considered the rarest — and most severe — form of autism prior to the DSM-5 revision. Most often diagnosed in children between the ages of two and four, CDD was characterized by strictly limited social, speech, and cognitive abilities. Many children with CDD also developed seizure disorders.
• Pervasive development disorder, not otherwise specified: PDD-NOS was essentially a term for any autism spectrum condition that didn’t meet strict criteria for one of the three disorders mentioned above. As a result, symptoms for PDD-NOS ranged from milder than Asperger to more severe than CDD.  

In addition, some disorders once considered part of the autism spectrum were removed from the ASD diagnostic criteria prior to the DSM-5 revision in 2013. Rett syndrome, for instance, can cause symptoms in children that are similar to those associate with autism; however, Rett syndrome is caused by a genetic mutation, and also carries symptoms not found in other ASD disorders. Social communication disorder is another example; people with SCD often struggle with everyday communication, but the disorder is distinguished from ASD due to a lack of repetitive behavior patterns.

The root cause of ASD remains unknown, though most researchers today believe that both genetic and environmental factors play a major role. Recent studies have pinpointed some genes that are prevalent in people with the disorder, and brain-imaging tests indicate that the brains of people with ASD develop differently than the brains of other individuals. The general consensus is that ASD originates from defects in the brain that affect how the brain grows and communicates with other areas of the body. Studies have yet to identify any specific environmental factors that directly cause or influence the development of ASD. However, the scientific community has debunked and rejectedthe longstanding belief among parents that child vaccinations lead to a higher incidence rate of ASD in developing children.

Diagnosing ASD in Children​
Most children with ASD begin to display symptoms by age three, so early detection and evaluation is critical. The ASD diagnosis process for children is divided into two stages: developmental screening and comprehensive diagnostic evaluation.
Parents are urged to begin developmental screening at a young age to evaluate their children for ASD and other intellectual disabilities. The Centers for Disease Control (CDC) recommends ASD screenings for all children at the ages of nine, 18, and 24-30 months, adding that a reliable ASD diagnosis can usually be made by age two. Additional testing may be required for children who are considered high-risk for ASD, including those with family members who have already been diagnosed or those who have displayed ASD-related behaviors.

During the developmental screening stage, doctors watch for signs and symptoms of ASD diagnostic criteria. These include deficits in communication and social interaction, restricted interests, and repetitive behaviors. Speech and language skills are often delayed in children with ASD; they typically will not respond to their own name after 12 months. Other ‘red flags’ include refusal to acknowledge or point at moving objects after 14 months, showing little interest in playing ‘pretend’ games after 18 months, and sustained repetition of words and phrases, as well as physical signs like avoiding eye contact, constantly rocking back and forth, compulsory hand waving, and/or exhibiting ‘unusual’ reactions to sensory stimuli. Additionally, children with ASD often display at least one of the following traits or behaviors:

• Hyperactivity
• Impulsive actions
• A limited or short attention span
• Aggression and tantrums
• Self-injury or self-harm tendencies
• Abnormal eating or sleeping patterns

According to the CDC, the most commonly used developmental screening tools include the following:

• Ages and Stages: This series of 19 questionnaires focuses on the child’s communication, motor skills, and other areas of development. The questionnaires are age-specific, allowing doctors to evaluate children as specifically as possible.
• Communication and Symbolic Behavior Scales (CSBS): This ‘Infant-Toddler Checklist’ evaluates children based on the following criteria: emotion and eye gaze; communication; gestures; sounds; words; understanding; and object use.
• Modified Checklist for Autism in Toddlers (MCHAT): This questionnaire features 23 ‘yes or no’ questions related to the toddler’s interests, speech, motor skills, and behavior. The questionnaire is scored on a scale of 0 to 20, with 20 being considered extremely high risk.
• Parents’ Evaluation of Developmental Status (PEDS): This evidence-based screening evaluates children based on ‘language, motor, self-help, early academic skills, behavior and social-emotional/mental health.’
• Screening Tool for Autism in Toddlers and Young Children (STAT): Designed for children between the ages of 24 and 36 months, this evaluative test consists of 12 separate segments; most children complete the screening within 20 minutes.

If developmental screening yields results that are consistent with ASD symptoms, then a comprehensive diagnostic evaluation may be recommended. Family participation during this second phase is vital. Parents can describe symptoms and behaviors to the evaluation provider, who can then take these statements into account when conducting the diagnosis. The presence of at least one parent can ease the evaluation process for the child, as well.
In order to perform an accurate evaluation of ASD in children, doctors rely on a set of diagnostic tools. The CDC notes that a comprehensive ASD evaluation should include at least two diagnostic tools; the following four diagnostic tools are most widely used:

• Autism Diagnosis Interview-Revised (ADI-R): Used to evaluate children 18 months or older (as well as adults), the ADI-R interview includes specific questions related to social communication and interaction, restricted interests, and repetitive behaviors.
• Autism Diagnostic Observation Schedule-Generic (ADOS-G): This ‘standard measure of social and communication deficits’ consists of four 30-minute evaluation modules based on the subject’s expressive language abilities.
• Childhood Autism Rating Scale, Second Edition (CARS2): This scale designed for children two and older is designed to achieve two ends: distinguish symptoms between ASD and other disabilities; and gauge the severity level of ASD symptoms. Different tests are administered based on the subject’s functionality level, and the assessor rates the child based on frequency, duration, and intensity of each ASD diagnostic criterion.
• Gilliam Autism Rating Scale – Second Edition (GARS-2): This evaluation tool for teachers and clinicians can be used to evaluate anyone between 3 and 22 years of age. The 42 items on the scale are grouped into three categories: stereotyped behavior; communication; and social interaction.

Once the comprehensive diagnostic evaluation is complete, parents can discuss the outcome with their physician and — if the child receives an ASD diagnosis — explore possible treatment options.

Considerations for Diagnosing ASD in AdultsASD is a lifelong condition. People with ASD typically begin to show symptoms of the disorder during their early childhood. In some cases, however, these symptoms will not become apparent until the individual has reached adulthood.  
Due to the wide range of symptoms and severity levels, diagnosing ASD in adults can be a tricky process — particularly for those who have not received an ASD diagnosis as children. According to neurologist David Beversdorf of the Autism Speaks Autism Treatment Network, an adult seeking an ASD evaluation should first discuss the matter with his or her physician. During this consultation, the patient should explain why they are seeking an ASD diagnosis. These reasons may include changes in the way he or she behaves or interacts with others, as well as heightened sensitivity to sensory factors, acquired repetitive behaviors, or newly restricted interests.

Most licensed physicians are not trained to diagnose ASD themselves, but they will be able to steer the patient in the right direction — and, in some cases, refer them to a specialist with a background in ASD diagnosis. Due to a widespread scarcity of clinicians that specialize in ASD, Dr. Beversdorf suggests meeting with a medical professional that evaluates and treats young people for the disorders. These include developmental pediatricians, child psychiatrists, and pediatric neurologists.
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One major issue for diagnosing adults with ASD has been a lack of reputable screening and diagnostic evaluation tools. With the exception of the Gilliam Autism Rating Scale — which evaluates subjects up to 22 years of age — these tools are designed for child subjects, not adults, who tend to be less honest and more secretive when undergoing these tests. Deceased parents are another obstacle for diagnosing adults, since mothers and fathers provide key information to clinicians during the early screening and evaluation stages of child ASD testing.
The Adult Repetitive Behaviours Questionnaire-2 (RBQ-2A) appears to be a step in the right direction. Introduced by the Journal of Autism and Developmental Disorders in 2015, the ADBQ-2A is designed to evaluate adults based on repetitive behaviors and restricted interests. Because the questionnaire excludes social communication and interaction, it should not be seen as a definitive evaluation tool for ASD in adults. However, RBQ-2A can be used to help adults decide whether their behaviors and interests are indicative of a disorder that may necessitate formal treatment.
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How Does ASD Affect Sleep?

A 2009 study published in Sleep Medicine Reviews noted parents report sleep problems for children with ASD at a rate of 50% to 80%; by comparison, this rate fell between 9% and 50% for children that had not been diagnosed with ASD. The rate for children with ASD was also higher than the rate for children with non-ASD developmental disabilities.

In a recent study titled ‘Sleep Problems and Autism’, UK-based advocacy group Research Autism noted that the following sleep issues are common among children and adults with ASD.

• Difficulty with sleep onset, or falling asleep
• Difficulty with sleep maintenance, or staying asleep throughout the night
• Early morning waking
• Short-duration sleeping
• Sleep fragmentation, characterized by erratic sleep patterns throughout the night
• Hyperarousal, or heightened anxiety around bedtime
• Excessive daytime sleepiness

The study also pinpointed several underlying causes for these sleep problems that are directly or indirectly related to the individual’s ASD diagnosis. These include:

• Irregular circadian rhythm: The circadian rhythm is the 24-hour biological clock that regulates the sleep-wake cycle in humans based on sunlight, temperature, and other environmental factors. The circadian rhythm is processed in the brain, and many people with ASD also exhibit irregularities with their sleep-wake cycle. Additionally, some studies have noted a link between children with ASD and irregular production of melatonin, a natural hormone that helps regulate circadian rhythm.
• Mental health disorders: Conditions like anxiety and depression are often co-morbid with ASD; these conditions often lead to insomnia and other sleep disorders. Studies have also suggested that as many as half of all children with ASD also exhibit symptoms of attention-deficit hyperactive disorder (ADHD), which can cause elevated moods around bedtime.
• Medical problems: Epilepsy is often co-morbid with ASD, and seizures can greatly impact sleep — even on a regular basis, in severe cases. Other common medical issues among people with ASD include constipation, diarrhea, and acid reflux.
• Medication side effects: People with ASD who take medication may experience side effects that interfere with sleep. Selective serotonin reuptake inhibitors (SSRIs), for instance, may cause agitation and hyperactivity prior to bedtime. Antipsychotics like haloperidol and risperidone, on the other hand, may cause excessive drowsiness during the day that leads to sleep onset and sleep maintenance problems. Please scroll down to the ‘Treatment’ section for more information about ASD medications.

People with ASD often struggle with daily pressures and interactions more than individuals who do not live with the disorder. Lack of sleep can greatly exacerbate the feelings of distress and anxiety that they experience on a frequent basis. As a result, may people with ASD who have trouble sleeping may struggle greatly with employment, education, and social interaction — all of which can impact their outlook on life.
Persistent sleep problems in people with ASD may indicate a sleep disorder. Insomnia is the most commonly reported sleep disorder among adults and children with ASD. Insomnia is defined as difficulty falling and/or remaining asleep on a nightly or semi-nightly basis for a period of more than one month. A study published in Sleep found that 66% of children with ASD reported insomnia symptoms. A similar study from 2003 found that 75% to 90% of adults then-diagnosed with Asperger syndrome reported insomnia symptoms in questionnaires or sleep diaries.

In addition, parasomnias such as frequent nightmares, night terrors, and enuresis (bedwetting) have been widely reported among children with ASD, particularly those once diagnosed with Asperger syndrome. The child’s inability to express their fears and discomforts upon waking — often due to ASD — can complicate the way parasomnias are addressed and treated. Additionally, children with ASD often wake up in the middle of the night and engage in ‘time-inappropriate’ activities like playing with toys or reading aloud.
Sleep researchers are currently studying the relationships between other sleep disorders and ASD. For example, Dr. Steven Park recently noted a possible connection between ASD and obstructive sleep apnea (OSA), a condition characterized by temporary loss of breath during sleep resulting from blockage in the primary airway that restricts breathing. Dr. Park’s theory suggests that the intracranial hypertension found in many babies and infants with ASD may also cause the child’s jaw to take on an irregular shape, which can lead to sleep-disordered breathing as well. Other studies have explored the link between ASD and disorders like narcolepsy and REM Behavior Disorder. However, insomnia and parasomnias remain the most common sleep disorders among adults and children with ASD.
Next let’s look at treatment options and considerations for adults and children with ASD who are experiencing a sleep disorder.
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Sleep Therapy Options

If the preliminary assessment indicates the presence of a sleep disorder in a child with ASD, then treatment will likely be the next step. Cognitive behavioral therapy (CBT) has proven fairly effective in alleviating sleep disorder symptoms for young people with ASD. CBT is designed to improve sleep hygiene in patients by educating them about the science sleep and helping them find ways to improve their nightly habits. A study published in the Journal of Pediatric Neuroscience noted that children with ASD are often set in their routines, so establishing a consistent bedtime schedule can be quite beneficial to them. A healthy bedtime schedule might consist of the following:

• Putting on pajamas
• Brushing teeth
• Using the toilet
• Washing hands
• Getting in bed
• Reading a book (or being read to)
• Shutting off the light

Additional behavioral interventions may help children with ASD improve their difficulties with sleep. According to a ‘Sleep Tool Kit‘ published by the Autism Treatment Network, these interventions include the following:

• Create a ‘visual schedule checklist’ with pictures, objects and other visual aids that can help a child with ASD grasp the concepts more easily.
• Keep the bedtime routine concise, and limit it to roughly 30 minutes before bed. Otherwise the child might become overwhelmed with too many commitments.
• Order the routine so that stimulating activities like television and video games come first, followed by reading and other relaxing activities.
• Physically guide the child to the schedule at first, and use verbal cues to remind them to check the schedule. Teach them how to cross things off on the checklist themselves.
• Provide positive reinforcement whenever the child follows the schedule correctly.
• If the routine must be changed, let the child know in advance so that they can mentally prepare for the disruption. Alter the checklist ahead of time to reflect these changes.

In addition to CBT, light therapy (also known as phototherapy) may also help children with ASD sleep better. This form of therapy is usually conducted using a light-transmitting box kept near the child’s bed. By exposing the child to bright light early in the morning, this therapy can help boost melatonin production and make children feel more alert throughout the day.

As of April 2017, the Netflix original series 13 Reasons Why broke a new record: it saw more social media volume than any other Netflix original series.  During it’s first week alone there were over 3.5 MILLION tweets including its title (not to mention Facebook, Instagram, SnapChat, Tumblr etc)! The show was produced by Selena Gomez, who is no stranger to mental health topics.  In an interview from June 2017, Gomez responds to questions about the dark comment by saying “Whether or not you wanted to see it, that’s what’s happening. The content is complicated. It’s dark and it has moments that are honestly very hard to swallow, and I understood that we were doing something that is difficult. But these kids today are so exposed to things that I would never even comprehend when I was 8.”
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As a therapist, I can completely agree with what she is saying.  I hear a lot of parents holding tight to their “not my child” or “not at my kid’s school” mentality…and I talk to enough middle and high schoolers to tell you YES, your kid is exposed to these topics and YES, it happens at your kid’s school (as well as on-line, via texting, on television and at sleepovers).  

The thing I liked the most about 13 Reasons Why was that it exposed the sexualized cultures and chronic sexual harassment that young girls have come to expect in middle and high schools around the country.  It seems to be starting younger and younger too…I have 5th and 6th graders regularly discuss the frequency of sexualized talk, jokes, and requests. 
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The thing I liked least about the show however, was the ease with which the main character killed herself and the graphic nature in which it was shown.  No human being needs exposed to those types of graphic images in any context.  It is unnecessary violence that further perpetuates our culture’s desensitization.  I further dislike that the image is one more thing for people who are depressed and considering suicide to struggle with thinking obsessively about.  They are already fighting so hard to block their own intrusive thoughts and images, I do not believe this horrific scene was necessary in order to get the show’s message across.

 ​In response to 13 Reasons Why, our practice chose to ask our clients why they choose life.  We asked them to write anonymously on post-it notes and put their answers on display in our lobbies on our (More than) 13 Reason’s Why Not posters.  What we found was interesting.  It seems that the majority of our answers fell into five categories: 

​The beauty of this is that we can draw a conclusion that if you continue to work on these categories in your life, then you will decrease your risk of suicidal thoughts and gestures.  If you are struggling with finding reasons to live, I strongly suggest that you reach out to a therapist for guidance.  Therapy is a collaborative experience in which the therapist will work with you to explore your values and help you set goals to achieve your life worth living.  Please feel free to contact Compass Point Counseling Services if you live in the Greater Cincinnati area (www.cpcs.me), we’d love to help.