Inessa Manevich,Ph.D., Clinical Psychologist
310.804.6339
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What About the Siblings?

8/28/2012

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As most brothers and sisters of an individual with autism (or any disability for that matter) may tell you, it is not easy being a sibling of a child with special needs. In fact, being the unaffected sibling may pose very difficult and unique challenges to the siblings of individuals with disabilities of any kind. 

For example, as a sibling of an autistic child, you can't help but have to work with, and around the special needs of your autistic brother and sister, both at home and in public. This can be quite time-consuming, inconvenient, and embarrassing for the sibling, no matter how much he or she may love his/her sibling. Likewise, the pressure of always being "the one who should know better", "the bigger person", and "mommy's helper" may often feel like a lot of responsibility and at times, quite unfair, because, after all, "I am a kid too!"

Both research and practice demonstrate that there seems to be a fair genetic component to ASD's (Autism Spectrum Disorders) meaning that they tend to run in families. In fact, the conclusion of a study of more than 1,200 families in the Interactive Autism Network, a national online research registry found that children with autism tend to have brothers and sisters with language delays and other, less obvious characteristics of the disorder. 
http://www.npr.org/blogs/health/2010/10/04/130324617/siblings-of-a-child-with-autism-often-have-subtler-problems?f=1001&ft=1&sc=tw

Nevertheless, the families of a child with autism and other developmental disabilities are often so focused on caring for the diagnosed child, that the relatively mild issues of the siblings can be overlooked and even ignored. While it may not be feasible for the emotional and physical resources of the family to be divided equally among the children, it is important to give each child the space to be kid, no matter how well they may be functioning. 

Helping families adjust to the diagnosis of an ASD, no matter who the diagnosed individual happens to be, is just one of the specialties of my practice.

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Anxiety as a Choice

8/13/2012

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After having recently watched the latest Woody Allen movie, I wondered to myself why exactly do some of us truly relish the incessant, self-deprecating and neurotic clamor that has now become a caricature of all that is Woody Allen, while others turn their heads in sheer annoyance at such neurotic and seemingly senseless banter. Is it that those of us who tend to be more anxious ourselves feel a sense of familiarity in watching the endless worries of another depicted on the screen, thereby normalizing our own internal battles? Or is it the comfort of watching the vicious cycle of anxiety take hold of another human to the point of absurdity that allows us to work through our own catastrophic fantasies, thereby allowing us to quell our own existential dread? While a certain amount of projection and identification is certainly necessary for a true understanding of a fictional character, do some of us really see ourselves as twitchy, vigilant self-loathers who seem to be constitutionally  incapable of enjoying that which is right before our eyes?

A recent NYT article speaks very profoundly on the subject of living with Anxiety. http://opinionator.blogs.nytimes.com/2012/08/11/the-anxious-idiot/?src=recg 
The central message in this article is the idea that just because one has been diagnosed with an anxiety disorder (or struggles with anxiety), does not necessarily mean that one has to be defined by it. Essentially, the author argues that acting in accord with one's anxieties and neurosis is a choice that one makes everyday. While it is, in some ways, easier to do what is habitual and conditioned, purportedly in order to keep oneself feeling safe, those very behaviors and thoughts are reinforcing the anxiety n the first place. Engaging in the behaviors and thoughts that are defined by one's fears often inhibit the individual from having novel, corrective emotional experiences, thereby deepening the maladaptive neurological and self-fulfilling loop.

Thankfully, there are many methods that help break this often-devastating loop of anxiety and ensuing depression, i.e., various forms of therapy, mindfulness, deep breathing and yoga. The first step is usually  the realization that while it may not feel like it, one often has a choice in how one thinks, behaves and  even feels. The next important step is to remember to chose to engage in those behaviors that will ameliorate the anxiety and not perpetuate it. While some of us may be constitutionally, culturally or by conditioning more anxious and neurotic than others, we certainly have a choice in becoming the neurotic self-loathing caricatures we laugh at (or with) on the screen. 
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Deciphering Emotions

8/7/2012

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I recently watched a wonderful Op-Doc (a short opinionated documentary) titled "Anosmia". In this piece, the filmmaker profiled a number of individuals who have lost, or never had the sense of smell. The film did such a fantastic job visually depicting certain pungent objects and situation that the smells associated with these objects appeared to literally ooze from the screen. I found the experience particularly powerful as I watched myself instinctively scrunch up my nose and physically tighten up when watching a fish being gutted or watching the removal of a dirty diaper, and noticed the pleasant relaxation in my muscles when viewing the center of a flower and watching rain fall. Not only did I have a physical reaction to these pictures, but I noticed that my feelings followed suit--I felt light and happy when watching rain fall and tense and relatively disgusted when looking at a dirty diaper.
http://www.nytimes.com/2012/08/07/opinion/anosmia.html?ref=science

Now granted, one typically has a more positive association with summer rain than they do with a soiled diaper, but what I found so powerful was how the images triggered a sequence of internal events. The visual representation of the image triggered the memory of the object's smell, which triggered the physical reaction to the smell, which likely triggered some memories associated with the smells, which, in turn or in tandem triggered the emotion. At the conclusion of the film, I was left feeling the overall emotional state induced by the internal process described above, without a conscious awareness of the process itself.

In most cases, we all go through a similar, likely unconscious sequence of events when taking in a novel stimuli. What often remains of this process in our memories, however, is our emotional experience and not the object, memories or fears that may have triggered the emotions. Since this process often happens outside of our awareness, we often notice the resulting feeling state and mistakenly attribute the emotion to whatever happens to be in our conscious awareness at the time. 

For example, let's say you find yourself tense, anxious and jittery one day at work and assume that you are really nervous about your upcoming presentation, causing you to perhaps doubt your presentation giving skills and perhaps even your job competence (a cognitive leap, for sure). Later in the day, however, your colleague points out that the two of you had recently discussed a particularly traumatic and threatening news article, that made her feel vigilant all day. Now perhaps because you were busy preparing for your presentation or because the article was too distressing to think about,  you "forgot" about the distressing news but were left feeling quite anxious. In an effort to understand this feeling you searched your readily available surroundings and found the presentation that you were working on and assumed that you must be nervous and anxious about this, and went so far as to assume that your nervousness not only has to do with giving presentations but with your general inability to do your job well.  In this instance, you went from feeling anxious about something that has little to do with you personally, to feeling insecure about your entire professional competence!

These types of misattribution errors are quite common and can cause significant distress, if the unconscious processes are not brought into conscious awareness. Whether you are able to stop yourself and examine your own process in the moment, or need an objective therapist to help you track your associations, attending to your unique physical, cognitive and emotional assumptions and reactions can be a wonderfully freeing and healing endeavor.  
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Pets and Autism

8/3/2012

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A recent French study found that introducing a pet into a household may lead to less deficits in social functioning in children with autism.  Those children that got a new pet after the age of five, showed "fewer deficits in their abilities to share food or toys with their parents and other children", and were better able to provide comfort to their parents or other children when the other was sad or hurt.

While this study is small and it would be unwise to draw too many conclusions, it appears that perhaps interaction with an animal may trigger the mechanisms responsible for the concept of "theory-of-mind" in these children, or the ability to take the other's perspective even if "the other" is an animal. It appears that a new pet may make the child want to work at negotiating a relationship with that animal, exercising the muscles responsible for noticing and attending to the cues in the behaviors of others that signify the other's needs, such as when the animal wants to be played with, fed, or petted.
http://www.foxnews.com/health/2012/08/02/new-pets-may-help-autistic-kids-socially/

Interestingly, the study did not find any differences between those kids who had a pet since birth and those who never had a pet on how social behaviors progressed over time. Perhaps it is the novelty of this new being that may trigger a wish from the child to learn more about it and hence provides more intrinsic motivation to relate to it. Or maybe in the instances when the pet precedes the child, the pet is trained to behave in a certain way with the new baby, but when the animal is introduced when the child is older, the two are forced to negotiate their own unique relationship. Or it may simply be that this new thing is soft and fuzzy, and the only way for the child to get the novel sensory good stuff from this creature (i.e., petting, warmth, cuddling--rush of oxytocin), without the bad stuff (i.e.,biting or scratching--pain) is to learn the pet's behavioral and perhaps non-behavioral cues.
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    Dr. Inessa Manevich

    *Information in this blog is for educational purposes only and should NOT be used as a substitute for professional therapy*

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