Month: July 2021

Behaviour that may appear maladaptive may well carry important messages and so an attempt to understand them should be made first before trying to change them.

Almost all adult account of what it is like to be an autistic child mention an overwhelming sense of confusion and a difficulty in making sense of one’s own experience. For them objects have no deeper or symbolic meaning they are just what they are. A smile is simply a widening of the mouth opening. A puppet or a teddy bear is nothing more than a structure of wood and cloth. When a person change unpredictably any relationship between others and self is not immediately obvious. It is impossible to get beyond tiny visual details to form an image of the whole. A tree appears accumulation of individual leaves which can never be merged into a single whole. It is difficult to switch off a distraction or to turn up a quite sound and listen to it. Things that are moving, things that are distant and things we are not looking at are much more attractive than anything in central vision. Pleasure comes with stability, and though stability may come slowly but it is disturbed easily. One way of maintaining stability is to do the same thing over and over again or to develop a peculiar interest or activity that is able to exclude all distractions.

Some theories are developed by cognitive psychologists that help us to understand the difficulties of autistic people. They state that the first core deficit identified is intersubjectivity. These people have deficits in differentiating between self and others. They are not motivated to respond to other people rather they are more interested in physical objects and thus preference for human interaction is poor compared to physical sensory inputs. The second one is theory of mind, that is, they are unable to form a mental image of what goes on in other people’s heads, or what it may be like to be somebody else. They cannot understand other people’s belief, desires or emotions. The third core deficit is executive function. Hence these persons have difficulty learning from mistakes and developing strategies to overcome difficulties, have difficulty in change behaviour in relation to feedback, and therefore persist in actions that are punished in some way. And then these behaviours may be labelled wilful disobedience, failure to attend, or provocative. The fourth one is central coherence. This means that they find it difficult to get the meaning of the entire story, rather remember certain words or sentences or thus focus on finer details. Thus there is a preference of parts over wholes. There is also an inability to use context in understanding objects or experiences which leads to difficulty in coping in unknown situations.

The cognitive processing found in autistic people should be regarded as a style rather than a deficit. A mind for details is not always a disadvantage and if combined with normal cognitive power can also become an asset.

Payal is a 50 year old Bengali lady who stays with her husband and a daughter. She has disturbing thoughts about any random person dying; she sees someone or remembers a name of a person and thinks that he/she might die. Her thoughts have been reinforced by coincidence. She feels anxious and guilty of the situations and remains fearful. She becomes terrified whenever a hearse car passes by her house. Her muscles contract and head aches when these thoughts come. She washes her hand repeatedly and bathes for a long time to get rid of the terrifying thoughts but they are only for a short time. The thoughts come back soon. Compulsive praying gestures are also present. She repeatedly calls or sends messages to her daughter and nephew to check on them. She becomes restless whenever her husband goes out of town for office tours. She gets irritated easily and shouts and throws household things. She has suicidal thoughts. She lacks self confidence. Self muttering is present. Sleep is disturbed.

These are the symptoms of Obsessive Compulsive Disorder (OCD).
We all have habits. Some habits come from being worried or unsure. You might have to double-check the front door is locked when you leave the house. You might always cross your fingers for good luck. For people, like Payal, who suffer from OCD, these habits take over. They can badly upset a person’s day-to-day life.

OCD can be broken into two parts, Obsessions and Compulsions. Obsessions are thoughts or images that are out of our control. They come into the mind when we don’t want them to. They can be upsetting and hard to stop. Lots of things can set them off. By and large, obsessions come from feeling unsure or scared. They can cause a lot of worry. People can feel trapped by the thoughts running through their mind. Some of the common obsessions are with germs, dirt, doubt, order, symmetry, repugnant sexual thoughts, repugnant religious thoughts, repugnant and violent images, fear of forgetting and fear that a mistake will harm a loved one. Compulsions are the things that people do to ‘correct’ or ‘put right’ obsessions. Often, compulsions don’t make much sense. People will do the same thing over and over again. This way of coping can make you feel in control. It can make you feel better, but only for a short time. Compulsions don’t have to be actions. They can also be mental acts like counting. Or, people might try to swap a bad mental picture with a good one. Some of the common compulsions are washing, cleaning, checking, avoiding things, asking for comfort from others and thinking “good” thoughts.

From time to time, obsessions come from fears we all have. There could be a very small chance that the worry will happen. You might worry that your house will catch fire. You might worry about someone you love dying. These are common worries. They become a problem when you find you worry about them too much. You can’t stop even when you try hard to. Worrying too much can be a sign of other problems. With OCD, people try to control their worry. They think they can do this by carrying out compulsions – really it just feeds the problem.

According to National Health Portal, in India lifetime prevalence of OCD in the general population is 2-3%, which means 2-3 persons in every hundred persons have OCD in their lifetime. It affects men and women equally.

Most people that suffer from OCD know what they are doing is not helpful. This can make them feel stuck. They might feel guilty or angry. It is also common for people with OCD to feel down. We can understand what keeps OCD going if we think about a vicious circle

Someone with OCD will have obsessive or unpleasant thoughts. These thoughts upset them. They make them feel anxious and tense. To feel better they carry out ‘habits’ or compulsions that will make them feel more in control. But, they don’t feel good for long. Gloomy thoughts like “I must be a terrible person for thinking like this” or “Nothing works, I’ll never be able to control this” go through their head. This means the obsessions are more likely to come back.

When you suffer from OCD you are trapped in a circle of thoughts. You can feel hopeless. The thoughts are linked to an emotion. This means they are very hard to control. If something worries or upsets you, it will pop into your head more often. It isn’t easy to stop the thoughts. If you try, they are often more likely to stick in your head.

People with OCD avoid things that upset them. This can seem like common sense. But, when you avoid a worrying situation it only makes your fears and doubts stronger. Face the fear. This is the only way to learn that it is not as bad as you think. Another common way of coping is to look for reassurance from friends or family. You might ask them to tell you that everything is OK. It is easy to rely on others to make you feel better or to keep you straight. This comfort doesn’t make the worry go away in the long term. It really makes your worry stronger. Facing something for yourself is the only way to learn. It will never be as bad as you imagine. Facing it will help you to feel like you can cope. It will help fight the obsession.

The symptoms in your body are the most obvious sign that you feel anxious because of your OCD. If you can learn to control your body, it will be much easier to tackle the vicious circle. Lots of things happen in your body when you feel afraid. You might feel restless and worked up. You might have a tight feeling in your chest or a racing heart. You might feel sick or faint. You will likely feel sweaty and have ‘jelly legs’. There are lots of other unpleasant symptoms. All of these feelings make you more afraid. This makes it harder to cope. You can use relaxation to fight this reaction in your body.

There are currently two effective treatments available for OCD that may be used separately or together. One is drug treatment, with medication that increases the availability of serotonin in the brain; the other involves the use of cognitive behavior therapy. They are both effective, however, some sufferers who find behavior therapy too difficult initially may benefit from a course of medication so that effective behavior therapy can be undertaken.

The medications that have been found to be particularly helpful in the treatment of OCD have specific effects on serotonin levels in the brain. Serotonin is the biochemical substance that some researchers believe is involved in OCD. In general, these medications have been shown to be effective for some OCD sufferers and assist them in bringing their symptoms under control.

Cognitive Behavior Therapy (CBT) makes use of two evidence-based behavior techniques, Cognitive Therapy (C) that looks at how we think, and Behavior Therapy (B) which looks at how this affects what we do. In treatment we consider other ways of thinking (C), and how this would affect the way we behave (B). Exposure and Response Prevention therapy (ERP) is used as part of the behavioral approach to help explore alternative ways to respond to the obsessional thoughts or doubts.

The aim of CBT is not about learning not to have these thoughts in the first place, because intrusive thoughts cannot be avoided. Instead it is about helping a person with OCD to identify and modify their patterns of thought that cause the anxiety, distress and compulsive behaviors. In CBT the person with OCD will explore alternative meanings or beliefs about the intrusive thoughts and rituals in all their guises (for example washing, checking, writing lists, tapping, touching, repeating, cleaning, trying to get a ‘just right’ feeling, praying) and will learn what it is that ultimately keeps alive the meanings they attach to such thoughts and rituals.

During a course of CBT, the sufferer might be asked to try ‘behavioral experiments’ to find out what happens when they don’t check. ERP involves being exposed to whatever it is that makes a person feel anxious, without checking or carrying out other rituals. Facing up to a situation helps you to challenge the fears and doubts you have about it. Each time you do this, you will become more sure of yourself. You will learn better ways to cope with the way you feel.

Learning to control your breathing and relaxing will help you to cope better. Concentrate only on breathing and on “relax” in the mind’s eye. Use slow normal breathing (10-12 breaths a minute). Breathe in through your nose. Purse your lips and breathe out slowly through your mouth. Practice this breathing technique and use it to help you relax when you feel anxious.

Who Are “Special Children”?

They’re children who have a disability or a combination of disabilities that makes learning or other activities difficult. Special-needs children include those who have: Mental Retardation, which causes them to develop more slowly than other children. Speech and Language Impairment, such as a problem expressing themselves or understanding others. Physical Disability, such as vision problem, cerebral palsy, or other conditions. Learning Disabilities, which distort messages from their senses. Emotional Disabilities, such as antisocial or other behavioural problems. It further include Brain injury and cognitive Impairment.

Why Learn About These Children?

The more parents understand about how a child grows, the better prepared they’ll be to recognize special needs – and seek help promptly.
Children with special needs require extra attention, teaching, care – and love!
Parenting for special child:
• To accept your child the way they are and try to understand about their problems.
• It’s important to know about your child’s problem. The more you know, the more you can help yourself and your child.
• Praise your child when he or she does well. Build your child’s abilities. Talk aboutand encourage his or her strengths and talents.
• Be clear, be consistent and be positive. Set clear rules for your child. Tell your child what he or she should do, not just what he shouldn’t do. Be clear about what willhappen if your child does not follow the rules. Have a reward program for good behaviour. Praise your child when he or she shows the behaviours you like.
• Learn about strategies for managing your child’s behaviour. These include valuable techniques such as: charting, having a reward program, ignoring behaviours, natural consequences, logical consequences, and time-out. Using these strategies will lead to more positive behaviours and cut down on problem behaviours. You can read about these techniques in many books.
• Talk with your doctor about whether medication will help your child.
• Pay attention to your child’s mental health (and your own!). Be open to counselling. It can help you deal with the challenges of raising a child with special needs. It can help your child deal with frustration, feel better about himself or herself, and learn more about social skills.
• Be mindful to interact with and teach your child in ways that are most likely to get apositive response. Learn what is likely to trigger melt-downs for your child, so you can tryto minimize them. Remember, the earliest years are the toughest, but it does get better!
• Learn from professionals and other parents how to meet your child’s special needs, but remember your son or daughter is first and foremost a child; life does not need tobecome a never ending round of therapies.
• Let your child help with household chores. These can build self-confidence and concrete skills. Keep instructions simple, break down tasks into smaller steps, andreward your child’s efforts with praise.
• Encourage independence in your child. For example, help your child learn daily care skills, such as dressing, feeding him or herself, using the bathroom, and grooming.
• Meet with the school and develop an educational plan to address your child’sneeds. Keep in touch with your child’s teachers. Offer support. Find out how you cansupport your child’s school learning at home.
Tips for Parents: Brain Injury
• Work with the medical team to understand your child’s injury and treatment plan.Don’t be shy about asking questions. Tell them what you know or think. Makesuggestions.
• Keep track of your child’s treatment. A 3-ring binder or a box can help you store thishistory. As your child recovers, you may meet with many doctors, nurses, andothers. Write down what they say. Put any paperwork they give you in the notebookor throw it in the box. You can’t remember all this! Also, if you need to share any ofthis paperwork with someone else, make a copy. Don’t give away your original!
• If your child was in school before the injury, plan for his or her return to school. Getin touch with the school. Ask the principal about special education services. Have the medical team share information with the school.
• When your child returns to school, ask the school to test your child as soon aspossible to identify his or her special education needs. Meet with the school and helpdevelop a plan for your child called an Individualized Education Program (IEP).
• Keep in touch with your child’s teacher. Tell the teacher about how your child isdoing at home. Ask how your child is doing in school.

WE, as human beings, are responsible for our own lives. We are responsible for what we think and what we choose not to think. Though it might seem like a common statement to make, let’s stop for a moment and evaluate its importance.

How many times have we thought about ourselves in terms of what other people think of us? Probably, much more than we realise! Give it a moment of consideration. Do we label ourselves lazy, when our mother calls us lazy because we have delayed taking a bath? Do we consider ourselves judgemental after our spouse has accused us of being judgemental since we criticised themduring an argument? If you answer yes, then it is likely that you are identifying with whatever you are thinking. This also means that you might be thinking ‘whatever I think, I am so.’ If I think I am lazy, then probably I am. If someone close to me thinks I am judgemental, then I must be so.

If we try to evaluate if this is true, perhaps we might find ourselves mistaken. Do we become synonymous with the ‘adjectivelazy’ if we acted lazy on one or more occasions? Then what about the times, when we got up and did our job right away because it was important to do so. Why is it necessary to call ourselves judgemental just because we might have acted judgementally during an argument with spouse? The thing to consider here, is, that we are notsolely what we call ourselves or what others call us. We might be much more than that. Despite labelling ourselves ‘negatively’ and calling ourselves lazy, judgmental, or other names, we might act quite differently under different circumstances. Labelling ourselvesmakes us focus on only one aspect of ourselves and closes our eyes to the whole range of behaviours and thoughts that we are capable of performing. It may even make us less thoughtful leading to a tendency to act in an automatic and robot-like fashion.

Isn’t it better to focus on what we are capable of, rather than what we have done or been in the past? That’s a question we need to ask ourselves!

We are not our thoughts – Ushnaa Ghatak