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Monday, May 31, 2010

The Magic of Tootsie Rolls


My daughter, Beckie, has AD/HD. Now that she's a teenager, her primary challenges are with the executive functions (EF) like planning, organization, and working memory. She also continues to need more prompts and external rewards than her peers without EF challenges.

Beckie and her sister have been sharing a hair dryer for years. It is important to Beth, the older sister, to have the hair dryer put away after use. Beckie couldn't care less if the hair dryer gets put away, so there is little internal motivation on her part to do so. Remember, anything that requires extra steps is not popular with our kids or adults with AD/HD. Additionally, they need more frequent rewards than their "neurotypical" peers. This need often extends into adulthood.

The hair dryer wars went on for a while, with hard feelings on both sides. Since the girls were not able to work out their differences and the hostility was escalating, we met as a family to problem solve together. If something didn't change, the hair dryer wouldn't be the only thing to blow at our house. At one point in the discussion, Beth told Beckie she just needed to remember to put the hair dryer away. "After all, you are a teenager. It's not like I'm going to give you a Skittle every time you remember to put it away. You just have to make yourself do it."

When I heard Beth say that, it was a light bulb moment for me. Having recently attended a conference on Executive Functions, it was fresh in my mind how the presenters shared that many with EF struggles will continue to be externally motivated throughout their lives. Since the EF challenges continue throughout the lifespan, affected individuals also continue to need more encouragement, praise, recognition, and rewards than those without EF struggles. This explains why my husband, who regularly makes the coffee, asks me how it is sometimes before I've even taken a sip. My first thought is, "Um, it's fine. It's always fine?"

I've come to realize that my husband needs that frequent positive reinforcement because making coffee and doing other chores is not intrinsically satisfying to him. He needs to know that his efforts are appreciated. Once I understood that, and realized that my son with AD/HD is the same way, I trained myself to make a point to express thanks for even mundane, everyday things. They need that. I can easily give them that. So when Beth made the comment about Skittles, I realized that Beckie was getting no reward when she remembered to put the hair dryer away. She honestly tried to remember, but since having the hair dryer put away was meaningless to her and she is highly distractible she often forgot. Since it wasn't important to her in the first place, she experienced no internal satisfaction when she completed the task.

I devised a simple plan to help Beckie be more successful, and hopefully end the hairdryer war or at least reach a truce. Knowing that she loves Tootsie Rolls, I bought a bag of miniature Tootsie Rolls and put them in a small bowl in the bathroom. I told Beckie that every time she remembered to put the hair dryer away, she could have one Tootsie Roll. Beckie thought it was a great idea.

Now some of you are thinking, "Why should a teenager need a treat to do what she is supposed to do? Won't that just keep her dependent on external rewards?" Good questions. Here's what I think. By showing Beckie a simple way to motivate and reward herself, she is learning a strategy that she can eventually use on her own. Because her EF difficulties are likely to continue into adulthood, she absolutely needs to figure out ways to reward herself. Would it bother you as much if she were buying the Tootsie Rolls herself and using them as rewards for completing tasks? Probably not, because most of us do this in one form or another. I'm just showing Beckie an example of what she can do to keep herself motivated and on task. In the future, she will know how to do this for herself.

Asking Beckie to try to remember to do a task that was not important to her just didn't work. She meant to, intended to, sometimes did remember to, but not with adequate consistency. Now, every time she goes into the bathroom, she sees the little bowl of Tootsie Rolls. It is a visual reminder and incentive several times a day, even though she only dries her hair once a day. She is aware that one of those treats will be hers if she remembers to put the hair dryer away. Guess how many times she has forgotten to put it away since the Tootsie Roll plan has been in place? Zero! She has not forgotten to put that hair dryer away a single time, and it has been several weeks since we implemented the plan. Did this teenager benefit by an external reward system? The results would indicate an absolute YES!

The hair dryer war seems to have ended peacefully, and Beckie has had great success while learning a strategy that will serve her throughout her life. She reports that she feels she has met the challenge, although she adds with a grin that once in a while she has forgotten to take a Tootsie Roll reward.

Thursday, May 27, 2010

Facial Recognition and Social Implications

Most of us have times when it's hard to recall someone's name, although we recognize the face. We readily admit, "I'm terrible with names" as a disclaimer when we first meet someone so he won't be offended in the future if his name slips out of our grasp. This difficulty with name recall is both common and understandable. Unless an individual's name makes it from our working memory into our long term memory, and pretty quickly, we are not likely to remember it in the future. For most of us, it is easier to recall the visual information and appearance of another person's face than the auditory information of a name. Sometimes we recognize someone but can't remember the context in which we met them. Church? Community activity? Friend of a friend? Because this is such a common experience, most people are pretty forgiving if we've forgotten the name but at least show recognition that we have met before. Often, there is mutual forgetfulness and the other person does not remember our names, either. No harm done.
My son, Josh, has significant working memory challenges. I realized over time that my son not only was unable to recall names, neither could he readily recall faces. He had no difficulty recognizing those of us he interacted with on a regular basis, but for those he saw infrequently he honestly had no memory or context for knowing them. It would be unsettling for him when virtual strangers (to his mind) would call him by name and initiate a conversation. Josh has never been good at faking anything, so he would genuinely ask, "Do I know you?" or "I'm sorry, but have we met?" Unfortunately, this attempt to be polite and seek clarification had negative social implications. People naturally feel hurt when others don't remember them, especially people whom they remember quite clearly and have shared past experiences. I remember a mother of one of my daughter's friends coming up to me and telling me that Josh asked who she was and she told him "I've only known you for YEARS." It was true, but months would go by in between each brief contact and Josh never transferred the information to his long-term memory so each contact was starting fresh - for him. If I told Josh who people were and when he had seen them before, it sometimes jogged a vague memory for him.
There is a name for this "face blindness", and the term is "prosopagnosia". In severe cases, individuals have difficulty recognizing their own family members, friends, and even themselves. Many people with autism, PDD, and Asperger Syndrome experience prosopagnosia. I guess Josh had a fairly mild version, and I wondered if what registered in his mind's eye was like a snapshot of faces, rather than the more dynamic version of faces changing to reflect a variety of emotions. Since Josh used to have difficulty recognizing different emotions expressed on faces, I thought maybe he only had one still picture in his mind and if it didn't match what he saw there was no recall. I don't know for sure, and Josh has improved over the years. It's too bad that there's not facial recognition software we could install in our brains to help us make the connections. I have worked with many children with autism who focus on part of something rather than seeing the whole. If this happens when a child looks at a face, he may see just the nose, or only the mouth, and not how those parts comprise a face. I have had children stare at an object I've held in front of my face, without recognizing that there was a person holding the object. If a face is viewed as individual component parts without seeing the whole, that face is not likely to be recognized in the future.
For our verbal children with the language skills to express themselves, we can teach them strategies to ease the social tension. Having someone admit "I know lots of people have trouble remembering names, but I even have trouble remembering faces sometimes" may prepare others in advance so they won't be offended or surprised when they have to reintroduce themselves. For our nonverbal or less verbal children, we can advocate for them by explaining the challenges of prosopagnosia and reassure others that it is not a personal slight when our children don't acknowledge them with recognition. My hope is that when we explain that there is a neurological glitch, others will be more flexible and accepting and won't misinterpret our struggling learner's behaviors in a negative way.