The Center for Connection

logo--mainI have the honor to be a part of The Center for Connection (CFC), a newly formed practice started in September 2015 to serve children, families, and adults. We are a multi-disciplinary practice in Pasadena, California. Our team is comprised of psychotherapists, neuropsychologists, occupational therapists, and educational therapists. We meet weekly to discuss cases through the dual lenses of our different disciplines and our common framework of interpersonal neurobiology which focuses on how relationships shape and develop our brains, our mind-body connection, and our behaviors.

Please visit our website at www.TheCenterforConnection.org

 

Rule Out Sleep Issues First

iStockSleeping child

I often ask parents to tell me about how their child sleeps.  Why?  Lack of sleep can look very much like attention problems, and can contribute to difficulties with learning and behavior.  Think about how well we as adults perform (without benefit of caffeine) when we haven’t gotten a good night’s sleep.  Imagine what it might be like for our children when poor sleep happens over days or weeks.  I ask whether the child snores, or breathes heavily through his mouth while he sleeps.  I ask about the quality of the child’s sleep:  Does your child sleep through the night?  Does your child have trouble getting to sleep?  Does your child seem sleepy during the day, or does he wake up irritable?

Years ago, during my child’s annual physical, our pediatrician asked about my son’s sleep: “How many hours of sleep per night does Griffin get?”  She saw nothing wrong with my answer that Griffin slept nine to ten hours per night.  Later, I began to suspect a sleep problem when, in spite of a full night’s sleep, he seemed pretty groggy in the mornings or woke up extremely irritable.  I remember asking our pediatrician about sleep apnea when Griffin was seven because he was a mouth breather and he had always snored heavily.  Our pediatrician told me to stand beside the bed after he fell asleep and see if he stopped breathing.  I did this, and, relieved, I found that his breathing did not stop.

At age ten, my son had difficulty focusing in school.  He was having frequent meltdowns and was miserable.  His uncontrollable behavior led us to a difficult decision to try medication.   Over time, we saw that the medication helped him to stabilize and returned some tranquility to our family life.  Fast forward to age fifteen.  My son was still snoring and we finally went to a neurologist who ordered a sleep study.  We went to a special office that had bedroom suites where my son spent the night hooked up to monitoring equipment.  The results showed that he aroused twenty to thirty times during the night due to involuntary muscle movements and breathing that stopped due to an obstruction in the throat (sleep apnea).  The neurologist prescribed medication for the muscle movement and my son had to have his enlarged tonsils and adenoids removed.

We repeated the sleep study post surgery, and discovered that he was still waking up due to a physical closure in his airway.  Part of this second sleep study was a trial on a CPAP (Continuous Positive Airway Pressure) machine.  The principal behind the CPAP is simple:  If air continues through a mask during the night, the airway cannot shut down. With a CPAP, my son slept through all the cycles needed to feel rested and refreshed.  In short, my son was waking up several times per night because he was not breathing.  As a result, he never got into deep sleep, or Delta cycle, so the quality of his sleep was terrible, even though he “slept” for nine or ten hours every night.

After a few nights on the CPAP,  my son was much more rested he when he got up in the morning.  It was magical how quickly his mood and outlook improved. Later that year, when Griffin had his wisdom teeth extracted, the oral surgeon showed us on the x-rays how physically narrow his airway is, so that when Griffin is lying down, it all but closes off. Ever since this discovery, I began to ask about sleep.

Some physicians are beginning to consider the possibility that sleep issues may be closely related to ADHD.  The New York Times printed an article titled Diagnosing the Wrong Deficit. A second article in the New York Times titled In Blur of A.D.H.D., Sleep Troubles May Be a Culprit suggests that sleep issues be ruled out first before diagnosing ADHD or prescribing medication for attention deficit.  I think this is wise.

Update: 7/17/17

Here is a link to a recent article in the Washington Post that outlines the reasons it is important to pay attention to sleep patterns and the amount of sleep older children and teens get. There are more distractions (i.e. screens, peers) and more school demands placed upon teens, it can be easier to lose precious time to sleep.

Why You Need to Pay Attention to Older Kids’ Sleep Habits

 

A Happy Collision with Love

My six-year-old friend was playing in his backyard last weekend.  He captured some bees and he put them into a small cage.  He peered through the clear plastic and sat watching the bees peruse the small cluster of white blossoms he placed inside. He enthusiastically hoisted them up to show me when I arrived.  “See?  We caught these on the bush over there.”

Later, he wanted to release the bees.  Being the curious sort, he squirted the bees with water before he freed them and noticed that they did not fly off when he took them out of the cage.  I encouraged him to let the sun dry their wings and to watch how they would fly away when ready.  Instead, he tried to stab one bee with a stick.  I felt myself cringe.  “Oh no, don’t do that to the bee,” I said.

“Why not?  There’s a million of them,” he said.

I wanted a brief answer, but there was so much I wanted to explain: the importance of bees to our ecosystem, that they pollinate the many flowers that we love, and that bees are critical for growing the fruits and vegetables we eat.  I thought, Yes, there are many bees in this world, but now their numbers are threatened. I felt it was my duty to teach all this to my inquisitive friend.  Lacking inspiration in the moment, I said, “Bees are important to the flowers.”  He, being a six-year-old, responded by finding something else that caught his interest and he ran off to another part of his backyard.  I saw the bee, its wings dried, fly away.

A few days later, a friend happened to email me a TEDTalk about The Hidden Beauty of Pollination.  These are stunning images of our Earth’s pollinators:  bees, hummingbirds, butterflies, bats. It is worth a “full screen” view. (I sent this video to the parents of my young friend as a far better response to his question of “Why not?”)

As parents, we often feel there are so many things we are supposed to teach our children.  It is sometimes difficult to navigate “teachable moments”.  Often those serendipitous lessons can be the most powerful when we follow the happy collision of our child’s natural-born curiosity and happenstance.  I wished I had seized the chance to show the importance of one small bee.

Louie Schwartzberg, the filmmaker who captured these gorgeous images in time-lapsed photography, said in his TEDTalk, “Beauty and seduction, I believe, is nature’s tool for survival, because we will protect what we fall in love with.”  Perhaps all we have to do is to expose our children to a variety of things so that they can fall in love.

What happy collisions have you noticed with your children lately?  What have your children fallen in love with?  Comments about the Louie Schwartzberg’s TEDTalk and film?

 

What Parents Know that a Diagnosis Can’t Tell Us

“Your son has Asperger’s Syndrome,” our psychologist says.

The office feels like the air has been sucked out of it, like a tsunami pulling all the water out to sea to gather up into a gigantic cresting wave.  I feel like I am sitting on the beach just waiting for it to break.  Did he actually say Asperger’s?  An odd giddiness of relief begins bubbling up.  Now what?  My eyes fix on the grain in the oak conference table.  Paper clips are splayed on the dark wood and I am intrigued that they sparkle in the afternoon light in a way that the oak cannot, silver against wood.  My head hurts.

Ken, the psychologist, a colleague of mine, explains his reasons for his diagnosis.  I am used to being on the other side of this conversation in the work I do as an educational therapist.  This time, I am the parent.  I am full of memories:  the night we had different dinner plans and my son cried inconsolably for an hour for what he calls Kabuki shrimp, his favorite dish …the container of bright orange foam ear plugs we keep handy like other people keep breath mints…the time I changed plans when he was five and he sobbed for two hours, “You promised and didn’t do it.”… the kids in elementary school who called him “Mr. Encyclopedia” and how they stopped inviting him to their birthday parties…at barely three years old, his fascination with a lightning storm that he called “stranger light”…the way he wears his t-shirts backwards to keep the tag from itching, and only buys a particular brand of khaki shorts and slip-on shoes… when an idea gets hold of him, he becomes unstoppable (think: locomotive) as he goes into “mission mode”…his unquenchable curiosity about how things work… his intricate knowledge of computer graphics, mostly self-taught.  Don’t tell me, I know he is wired differently, and yet, this is how my son has come into this world, into my heart. There is no one else quite like him, and I’ve always loved that.

“Hmmm,” I say.  “I had a feeling it would be something like Asperger’s.”

I’m thinking to myself, LIAR!  My professional side zooms to the rescue while my inner parent wants to belly crawl under the table for a few days.  Of all the things my son’s difficulties could be, I am completely blindsided by this diagnosis.  Honest, I didn’t know.  Too embarrassed to admit it, I feign no surprise.  After all, I work in this field.  How could I not know this?  I know my son is quirky.  I know he doesn’t pick up on social stuff.  I know he’s “scary smart”.  I know he gets overwhelmed by too much sound.  I know he gets stuck in ideas and he can’t let go of them.  I know he can’t picture the other guy’s viewpoint.  I know all that.  I know so much and I know so little in this moment. The official branding of these behaviors as Asperger’s confirms this knowing, gives it a name.

“Ken, what should we do?”  I ask.

I expect Ken to talk about an action plan, finding professional support, and the right fit for school.  These things I know.  I know Ken will set us on the right path. I’m conscious of my hair that brushes against my lower back.  It feels heavy, as if its weight has increased.  I’m not sure what our future holds and I’m uneasy.  I know there is no quick fix.  The tsunami wave is right there, curling over me, frozen.

“You already do this.” Ken says, “Love your son, no matter what.”

I take a deep breath.  Yes.  In my soul, I know.

 

My Educational Therapy Practice

 

When I tell people I am an educational therapist, they ask, “What is that?”

An educational therapist understands the academic, neurological, and emotional components of learning.  This distinguishes us from tutors who often focus on completion of school assignments or building skills in specific subject areas. An educational therapist “is a professional who combines educational and therapeutic approaches for evaluation, remediation, case management and communication/advocacy on behalf of children, adolescents, and adults with learning disabilities or learning problems.  These problems include, but are not limited to, dyslexia, attention deficit disorders, reading, writing, language or math disabilities, low motivation levels, low academic self-esteem, and poor social, organizational, and study skills.” (Association of Educational Therapists, a national professional organization)

Who are my students?

Students in my practice span a wide age range, and consequently, the academic skills that fall within elementary school through college levels.  I assess students for academic skill, and conduct diagnostic teaching sessions to determine the “breakdown” points.  My strength is in teaching reading, writing, and math at the elementary school level and most of my students are in the third through sixth grades.  My passion is teaching writing, to help students find their voices.

Connecting Thoughts, Emotional States, and Learning

I create a safe place for discovery and I remain curious about what makes it difficult for a student to learn. I gently examine, with the student, what may be blocking the way.  My role as an educational therapist is to help students to understand the connection between their thoughts, their emotional states, and their learning.  How a student thinks about and “frames” his/her experiences in school can have a strong effect on learning.  Often, re-framing the way a student perceives academic struggles, opens up a path to address the very thing that causes frustration, avoidance, anxiety, or fear in learning situations.  These techniques, although therapeutic in nature, do not constitute therapy.

Mind-Body Connection

So much of our world is filled with stimuli, and many students can be quite sensitive to this.  I believe relaxation and mindfulness techniques are skills students must have to improve their focus and clarity, and thus increase their learning potential.  I teach students about their mind-body connection so that they can recognize and reduce their anxiety.  Students learn to calm themselves and become more mindful of their body’s signals so that learning can be maximized.  My students work to develop a set of self-calming and soothing activities.

Happy Brain

My students get used to hearing me say, “What makes your brain happy?”  We often have conversations about how the brain functions, and in particular, how a student’s brain works.  Do images make more sense to you than printed words? Do you need to hear information more than see it? What happens when you get “brain freeze” during a test and how do we work around that?  We try to determine what happens inside our skulls and what current research tells us about how our brains function.  Discussions like these help students with atypical learning styles to begin to recognize what it takes for them to learn effectively.  Once students accept their  brain’s strengths and weaknesses, they begin to utilize compensatory strategies and advocate for themselves.  If students know what their brains do well and what their brains struggle with, they can work toward developing their own set of compensatory strategies.

 Let’s Play!

Most importantly, I approach learning as a form of play, and I invite students to have fun acquiring new skills and information.  We do this by learning to give ourselves permission to make mistakes, to feel that we do not need to do things perfectly, and to become keen, curious observers for the sake of exploration and discovery.

If you are a parent of a child who may benefit from educational therapy, please contact me.