Making friends can be challenging for any child, but for children with ADHD, forming and maintaining friendships can present unique obstacles. ADHD affects a child’s attention, impulse control, and emotional regulation—all of which play crucial roles in social interactions. However, with the right support and strategies, children with ADHD can learn to build meaningful, lasting friendships. In this post, I'll be exploring common challenges and effective ways to help children with ADHD develop their social skills.

Understanding the Challenges

Similarly to children with Autism, children with ADHD may experience difficulty making friends due to various aspects of their condition, including:

• Impulsivity: Many children with ADHD act before thinking, which can lead to interrupting others, blurting out comments, or behaving in ways that seem socially inappropriate.
• Inattention: A tendency to daydream or be easily distracted might cause children to miss social cues or seem disinterested in conversations.
• Emotional Regulation: Children with ADHD may experience intense emotions, which can lead to overreacting or having difficulty managing frustration, potentially putting a strain on social interactions.

These traits can make it harder for children with ADHD to connect with peers. However, parents can play a key role in helping them develop the skills needed to make friends.

Strategies to Support Friendship Skills

Parents and caregivers of children with ADHD can help! Here are six tips to assist and support your child with building their social skills, and making connections and friendships with others.

1. Encourage Empathy and Perspective-Taking Teach your child to understand and appreciate others' perspectives. Role-playing can be a helpful tool: create scenarios where they practice how to respond in different social situations, helping them recognize how their actions might affect others.
2. Build Social Skills in Small Steps Social skills don’t develop overnight, especially for children with ADHD. Start with foundational skills, like making eye contact, taking turns in conversations, and listening actively. Teach them the basics of 'reflective listening' that simply entails re-stating with an emphasis on the person's feelings (this is a great approach for parents and spouses as well). Praise them for small successes to build confidence and reinforce positive behaviors.
3. Practice Self-Control Techniques Impulse control is a common challenge, but techniques such as deep breathing or counting to five before speaking can help your child develop more thoughtful responses. Practicing these techniques during calm moments can make them easier to use when emotions run high.
4. Help with Conflict Resolution Teach your child to handle disagreements with peers calmly. Role-playing can be useful here as well; guide them on how to express their feelings without lashing out, and show them how to apologize or compromise when needed.
5. Foster Opportunities for One-on-One Friendships Large group settings may feel overwhelming for children with ADHD, making one-on-one play dates a more manageable way to build friendships. Organize activities that suit your child’s interests and are structured to help them stay engaged, such as board games, art projects, or sports.
6. Focus on Shared Interests Encourage your child to pursue hobbies or activities where they can meet like-minded peers. Sports teams, art clubs, or hobby-based classes can offer natural settings to meet friends, especially when the activity provides some structure to help with focus and engagement.

Tips for Parents

• Model Social Behavior: Children often mimic their caregivers, so demonstrate positive social interactions whenever possible. Show how to make polite conversation, handle disagreements, and offer support to friends.
• Set Up Structured Social Activities: Situations with clear rules and expectations, like sports or group activities, provide a framework that can help children with ADHD navigate social interactions more easily.
• Encourage Positive Self-Talk: Negative self-talk can hinder social confidence. Encourage your child to think of themselves as capable and kind, using affirmations and gentle reminders to help build a positive self-image.
• Work with Teachers and Counselors: Educators and school counselors can provide valuable support and insight. Ask them about programs or resources, such as social skills groups, which are often available in schools.

When Should You Seek Additional Support For Your Child With ADHD?

If your child is still struggling to make friends despite your efforts, it may be worth exploring social skills groups or therapy. You can feel free to email me at DrCarosso@aol.com, or call us at Community Psychiatric Centers at (724) 850-7200 to make an appointment for therapy. We offer social skills training specifically designed for children with ADHD. In addition, ADHD social groups can be especially effective, as they allow children to practice in a safe, supportive setting with guidance from professionals.

Bonus Post:

Tips for Supporting Social Skills During Recess

Recess is often less structured than classroom time, which can be both exciting and overwhelming for children with ADHD. Here are some strategies to help children develop their social skills during these free periods:

1. Suggest Recess-Friendly Games and Activities: Some children with ADHD benefit from knowing specific games or activities they can initiate or join, which can give them a sense of direction. Activities like playing catch, tether ball, or hide-and-seek offer structure within the unstructured environment of recess.
2. Teach and Practice Taking Turns: For children with ADHD, taking turns and waiting can be challenging. Role-play games where they practice waiting their turn, and explain how taking turns helps everyone enjoy the game more. Practicing at home makes it easier to apply these skills on the playground.
3. Set Small, Achievable Social Goals: Help your child set simple goals for each recess, like introducing themselves to one new classmate or asking to join a group. Small goals help build social confidence without overwhelming them. Over time, these goals can expand as they grow more comfortable.
4. Encourage Observation Before Jumping In: Teach your child to spend a moment observing other kids before joining a game. This brief pause can help them understand the flow of the game, the rules, and how they might fit in, which reduces the chance of interrupting or being disruptive.
5. Focus on Inclusive Games: Encourage your child to participate in cooperative games that have clear, shared objectives and rules. Team-based games, such as soccer or kickball, often foster cooperation and give children a role or “job” to focus on, making it easier for them to interact successfully.
6. Practice Social Cues at Home: Many social cues, like understanding personal space or recognizing when someone wants to change the subject, can be practiced at home. Play pretend games where you take on different roles and scenarios, helping your child learn cues such as eye contact, listening, and friendly body language.
7. Reinforce Positive Interactions: When your child tells you about their recess, praise specific positive actions, such as asking someone to play or sharing a toy. Reinforcing these behaviors encourages them to keep up these actions, building confidence in their social abilities.
8. Prepare for Common Challenges: Children with ADHD may feel discouraged if they have a negative experience at recess, such as an argument with a peer. Before recess, remind them of strategies for handling conflicts, like taking deep breaths or walking away from heated situations. Afterward, discuss what happened and reinforce positive coping techniques.
9. Coordinate with School Staff: Teachers and recess monitors can be valuable allies. Speak with them about any particular goals or challenges your child has, and see if they’re able to give gentle reminders or offer support. Sometimes, a teacher can suggest inclusive games or keep an eye on social interactions to help your child feel included.
10. Encourage Self-Reflection: After school, have a casual, open-ended conversation with your child about their recess experience. Ask questions like, “What game did you play today?” or “How did it feel to play with [friend’s name]?” This can encourage self-awareness and give insight into any additional guidance they may need.

Conclusion

Friendships are essential for a child’s growth and happiness, but children with ADHD often need extra support in building and maintaining relationships. By providing the right tools and encouragement, parents can help children with ADHD overcome social challenges and enjoy the benefits of friendship. With time, patience, and support, these children can develop the skills needed to create meaningful connections that enrich their lives. God bless you and your kiddo's as they work toward this very important goal of developing meaningful friendships. Don't hesitate to reach out for help along the way, at DrCarosso@aol.com or on Facebook. 

Making friends can be challenging for many kids, and for children with autism, social connections may feel especially difficult. Children with autism often face unique challenges in socializing due to difficulty with communication, social cues, and sensory sensitivities. However, with understanding, patience, and support, they can build meaningful relationships that enhance their quality of life. Here are 8 practical strategies for helping children with autism develop friendships and navigate social interactions.

Strategy #1: Understanding the Social Challenges of Autism

To effectively support a child with autism in making friends, it's important to understand the common social challenges these kiddos may face:

• Difficulty with Nonverbal Cues: Children with autism may struggle to interpret body language, facial expressions, and tone of voice.
• Sensory Sensitivities: Loud noises or crowded environments can be overwhelming, making social settings more stressful.
• Rigid Interests or Preferences: Children with autism may have strong, specific interests, which can make it harder for them to relate to peers with different interests.
• Difficulty with Open-Ended Conversations: Social interaction can be hard for children with autism if they’re unsure of what to expect or how to respond.

Recognizing these challenges helps parents and educators create supportive environments where children feel more at ease.

Strategy #2: Start with Familiar, Structured Activities

For children with autism, structured activities provide a predictable environment, making it easier to interact with others. Try starting with a small, familiar group setting where activities are well-defined, such as:

• Art or Building Projects: Activities that allow kids to express themselves without extensive conversation can be excellent starting points.
• Board Games or Puzzles: Games offer built-in rules and structure, so children know what to expect and have guidance on how to participate.
• Outdoor Activities: Simple, enjoyable outdoor play like swinging, walking, or playing catch can create relaxed opportunities for socialization.

Structured activities reduce the stress of open-ended social settings, allowing children to focus on enjoying the interaction.

Strategy #3: Encourage Shared Interests

Finding common interests is one of the best ways to foster friendships. When children with autism connect with peers over shared interests, it often makes socializing more natural and enjoyable. Here’s how to encourage shared interests:

• Explore Clubs or Classes: Look for local clubs, classes, or activities that align with the child’s interests, like robotics, art, or sports.
• Social Stories and Books: Social stories can help a child understand how to interact around shared interests by providing examples in a story format. For instance, a book on animals might serve as a bridge to connect with a peer who loves pets.

Shared interests can open doors to meaningful interactions, making socialization feel less intimidating. Encouraging your child to join groups where they share an interest helps to make social interactions easier because a child with autism has a predetermined subject the children can bond over.

Strategy #4: Use Visual Supports and Social Scripts

Visual supports and social scripts can be incredibly effective for teaching social skills to children with autism. They offer clear guidance on how to engage with others, making interactions more manageable. These serve as a sort of 'dry-run' or rehearsal of what things they can expect, and how to navigate these situations in a less stressful manner.

• Visual Supports: Use visual aids such as pictures or diagrams to illustrate appropriate social behavior. These could be visual schedules showing steps of a social activity (e.g., greeting someone, asking to play).
• Social Scripts: Social scripts are pre-written dialogues or prompts that help children practice what to say in certain social scenarios. For example, a social script for joining a game could include, "Hi, can I play with you?"

Practicing these scripts regularly helps children feel more comfortable using them in real life. Rehearsing the social scripts and referencing those visual supports will build confidence and comfort.

Strategy #5: Teach Turn-Taking and Listening Skills

Learning to take turns and listen is essential for building friendships. Role-playing activities can be an effective way to teach these skills:

• Role-Playing Scenarios: Similarly to the idea of developing a script, roleplaying allows a child to gain confidence in how a conversation flows. Practice scenarios with a family member or therapist where the child takes turns or practices listening. For example, pretend to play a game where each person has to wait for their turn and react to the other’s response
• Play Dates with Guided Interaction: Arrange a play date where you can help guide turn-taking and listening skills in real time, gently prompting the child to respond to cues or wait their turn.

The social abilities you are helping your child with Autism develop are helpful for anyone, and any age. Becoming more adept in social interactions is a lifelong skill that will benefit your child throughout their life, helping them in their future careers and friendships.

Strategy #6: Model Social Interactions

Children with autism often benefit from observing and mimicking social interactions. Watching a model interact can provide valuable insights and examples to follow. A few tips to follow when modeling social interactions:

• Demonstrate Greetings and Small Talk: Show examples of how to greet others, maintain eye contact, and listen. Use simple language and be consistent. Make sure to not only model what the child should be saying but also how other people typically respond to these interactions that many of us take for granted.
• Use Positive Reinforcement: Whenever the child makes an effort to interact, offer positive feedback to encourage similar behavior in the future.

Strategy #7: Build Social Skills Through Games

Games can be powerful tools for teaching social skills in a fun and engaging way. Many games involve cooperation, turn-taking, and teamwork, which can help children learn valuable social skills in a low-stress environment. Here are some tips for using games to build social skills

• Interactive Games: Choose games that require players to work together, like building blocks or cooperative board games.
• Online Games with Controls: Some online games, designed specifically for children with autism, allow social practice with minimal sensory overload.

Strategy #8: Foster Empathy and Understanding in Peers

Sometimes, the challenge in social interactions does not fall on the child with autism. Children often are not accepting of things they do not understand. Equipping peers with an understanding of autism can foster more inclusive interactions. Talk to classmates or friends about autism in simple, positive terms to encourage empathy and patience. Here are some ways to include educating the child's peers into the process:

• Classroom Talks and Storybooks: Many teachers and caregivers use children’s books that explain autism, helping kids understand and accept differences.
• Peer Buddies Programs: Some schools have buddy programs where peers are matched to encourage friendships with children who may need extra social support.

Final Thoughts on these Tips and Strategies

Building friendships may be more challenging for children with autism, but it’s certainly possible with the right tools and support. By starting with structured activities, encouraging shared interests, and using supportive techniques like visual aids and social scripts, you can help create an environment where they feel comfortable and confident connecting with others. Most importantly, remember that friendships don’t have to follow any “typical” path to be meaningful and rewarding for children with autism.
With understanding, patience, and guidance, we can help children with autism enjoy the unique and fulfilling connections that friendships bring.

This approach provides parents, teachers, and caregivers with actionable steps to support children in forming friendships in a way that respects their needs and individual personalities.

So what is the difference? Many people often confuse shyness with social anxiety, as both involve discomfort in social situations. However, there are significant differences between the two. While shyness is a common personality trait, social anxiety is a more severe condition that can impact your child’s daily functioning. Understanding these differences can help you to recognize when what seems like "just being shy" may actually be a sign that your child has something more.

What is Shyness?

Shyness is a personality trait that many people experience at some point in their lives. It typically involves feeling awkward or hesitant in social situations, especially around unfamiliar people. Those who are shy may prefer to avoid the spotlight or large groups, but they don’t experience overwhelming fear or panic.

Key Characteristics of Shyness:

• Mild discomfort or nervousness in new social settings
• Self-consciousness or awkwardness, but still manageable
• Often improves with time and exposure to social situations
• Doesn’t generally interfere with daily life

Shyness is relatively common, and many children who are shy can still form meaningful connections and engage in social activities with a bit of effort.

What is Social Anxiety?

Social anxiety, or social anxiety disorder (SAD), is a mental health condition characterized by an intense fear of being judged, embarrassed, or humiliated in social settings. Unlike shyness, which may be mild and temporary, social anxiety often causes overwhelming stress that can interfere with daily activities like attending school or social gatherings.

Key Characteristics of Social Anxiety:

• Intense fear or anxiety about being in social situations
• Worrying excessively about being judged or rejected
• Avoidance of social situations or extreme distress when unable to avoid them, i.e. school refusal
• Physical symptoms such as sweating, trembling, or a racing heart
• Significant impact on daily functioning and relationships

Key Differences Between Social Anxiety and Shyness

Although shyness and social anxiety share some similarities, the differences lie in their intensity and impact on daily life.

1. Severity: Shyness tends to be mild, whereas social anxiety is more severe and can lead to debilitating fear in social situations.
2. Triggers: Shy individuals may feel uncomfortable in certain situations, but those with social anxiety are often triggered by any type of social interaction, even routine ones like talking in class, speaking on the phone, or ordering food.
3. Impact on Daily Life: Shyness rarely interferes with daily tasks, while social anxiety can make it difficult to attend work, school, or even engage in casual conversations.
4. Physical Symptoms: Social anxiety is often accompanied by intense physical reactions, such as sweating, shaking, or feeling faint, which are not typically seen in shyness.

How to Recognize Social Anxiety vs. Shyness

Recognizing whether your child is shy or dealing with social anxiety can be crucial for knowing when to seek help. Here are some ways to discern when your child is experiencing social anxiety or shyness.

• Shyness: If feelings of discomfort are mild and don’t stop your child from participating in social activities, it’s likely just shyness. With time and exposure to social settings, shyness tends to diminish.
• Social Anxiety: If the fear is overwhelming, lasts for months or longer, and leads to avoidance or distress in social situations, it may be social anxiety. Sometimes even children are able to sense that their fear is irrational but can’t control it.

Tips for Managing Shyness and Social Anxiety

There are many things you can do to help your child manage feelings of shyness or full-blown social anxiety. The key is to take things slowly and with kindness. Causing more tension about overcoming these issues will often do the opposite of improving them!

For Shyness:

• Practice gradually exposing your child to social situations to build confidence.
• Help your child to challenge negative thoughts about social interactions.
• Focus on building one-on-one connections before larger group settings.

For Social Anxiety:

• Cognitive behavioral therapy (CBT) can be very helpful to help your child manage anxiety so We teach your child relaxation techniques like deep breathing to ease physical symptoms.
• Gradually face feared situations in small steps, starting with less intimidating scenarios.
• Seek professional help at Community Psychiatric Centers if anxiety interferes with daily life.

Some Final Thoughts About Social Anxiety And Shyness

While shyness and social anxiety may seem similar at first glance, the key differences in their severity, impact, and physical symptoms highlight the importance of distinguishing between the two. Understanding these differences allows you to help your child address challenges effectively—whether through self-help strategies for shyness or seeking professional support for social anxiety. If you want help or have questions about your child’s ‘shyness’, feel free to email me at DrCarosso@aol.com. God bless!

What Really is a Panic Attack?

We often think of a panic attack, sometimes referred to as an “anxiety attack” as this abrupt and spontaneous experience of intense anxiety, possibly occurring in some sort of public setting, from which there is a need for immediate escape to someplace calming and “safe.” A panic attack is often considered a dysfunction of the autonomic nervous system that leads to a momentary hyper-reaction of our involuntary bodily functions such as breathing, blood pressure, and digestion and feelings in the gut.

This over-reaction manifests in rapid and shallow breathing, heart palpitations, dizziness, and nausea.  Of course, that’s all true. However, you know as well as I, sometimes these ‘attacks’ don’t manifest in that traditional way; the trigger can be predictable, not so spontaneous, and occur in your child in response to daily life demands such as going to school, attending a sport or activity, or some perceived anxiety-provoking event. The impact is the same; your child has an intense emotional episode and it’s really tough to soothe or console.

How to Manage a Panic Attack

We focus on finding a calm environment for our child, remaining calm, providing healthy and soothing self-talk for the kiddo, and slowing down their breathing.

One at a time

First, a focus on finding a calm and soothing environment, and remaining calm ourselves. If your child has frequent episodes of heightened emotionality, based in anxiety and fretfulness, it’s important to find a room or area in the house that has a calming environment, remove most items that can be used to throw or make a mess, maybe has some comfortable items such as beanbag chairs or some pillows, as well as some favored soothing items such as some stuffed animals to help with soothing and calming. As a parent, it’s vital that we remain calm, don’t raise your voice, watch your town, and speak in short and succinct phrases. In that respect, too much information only causes more anxiety. We want to offer reassurance and brief direction on how to calm.

Next… the Most Beneficial Breathing Exercise

One of the first things that happens during this type of anxiety or panic attack is the breathing goes haywire. At the same time, as the breathing is rapid and shallow, so is the thinking; the thoughts are racing and ‘all over the place’. So, we need to slow things down. The best way to accomplish that goal is to slow down the breathing. We often hear of a number of breathing activities and exercises including diaphragmatic breathing as well as mindful breathing. I suggest a simpler approach that’s easy to learn, practice, and carry out even in the heat of the moment. It goes like this:

Breathing Exercise for Panic Attacks

• Inhale deeply through the nose
• When you think you can’t inhale any more, take another short inhale through the nose, completely filling the lungs
• Hold your breath for three-five seconds
• Exhale very slowly through your mouth
• As you are exhaling imagine breathing out all of the anxiety and fretfulness

Try this right now, it’s quick and easy. You’ll see it has a notable if not dramatic calming effect. It helps to slow things down and then it’s easier to think more clearly. This technique can be practiced during the week and then used as situations begin to escalate. Granted, it’s even more powerful to transition this technique into a mindful breathing exercise that entails using that same breathing cycle but doing it approximately 3 to 5 times in a row. Sometimes, however, it’s difficult to get children to practice the mindful approach and they’re more on board with practicing this simpler method that nonetheless is quite effective.

What’s next? Thoughts!!

It is vital that we help our children to think in a calming and soothing manner. In that regard, what has caused the overreaction in the first place? It’s caused by over-reactive thoughts with the child telling him or herself that the situation is dire, horrible, and will end badly. Almost invariably, the thinking is irrational and unreasonable and, when we can moderate the thoughts, the feelings and the emotions moderate as well. So, we use a whiteboard and notes to instill calming and self-soothing phrases that the child needs to learn to communicate to oneself throughout the week. These phrases can be practiced and associated with prior experiences of stress. As a situation arises, as the parent, you can recite some of the phrases in a calm and gentle tone to help your child internalize and, at some point, your child will start using the phrases himself to self-soothe.

Creating a Sanctuary from Panic Attacks and Anxious Thoughts

Panic and anxiety attacks can be overcome when combining these approaches of a calm and soothing environment as well as a calm and soothing approach from you as the parent. Deep and slow breathing, and helping your child to think in a calm, reasonable, and rational manner also help. However, it takes daily practice of the breathing techniques and soothing self-talk, as well as planning and contemplation in regards to creating a calm environment in, for example, the child’s room. However, this is all time well spent and can be quite beneficial.

I'm Here to Help

Whether your concerns are panic attacks and anxiety, or learning challenges, I am here to help! Don’t hesitate to reach out with any questions at DrCarosso@aol.com or on Facebook. Or you can make an appointment for therapy or an evaluation at 724-850-7200. You can also see more at helpforyourchild.com under parent resources. God bless you and your kiddo.

First things first... I find it quite disparaging to refer to anybody by a label or by a condition – such as “autistic”, “schizophrenic”, “bipolar” or as a “depressive” as opposed to “a person who has been diagnosed with autism”. A person’s condition is one small aspect of their identity, it does not define them. Actually, I feel the same way about identifying oneself by one’s profession - I really don’t like to think of myself as a “psychologist” but, rather, as a person who works as a psychologist. In any case, just wanted to point out that the title of this post is somewhat off–putting and that fact is not lost on me. It’s all too common that such phrases are used, and I think we should think twice about doing so. Okay, moving on…

I feel the same way about identifying oneself by one’s profession. I really don’t like to think of myself as a psychologist but, rather, as a person who works as a psychologist. In any case, just wanted to point out that the title of this post is somewhat off-putting and that fact is not lost on me. It’s all too common that such phrases are used, and I think we should think twice about doing so. Okay, moving on…

What is This “Savant” Thing All About?

"Savant" is a term used for a person who has developmental disabilities but has an exceptional and extraordinary splinter skill. Those who saw the movie Rainman, know that character had an incredible mathematics mind and could count cards at a blackjack table or immediately cipher the number of toothpicks that fell on the floor. There are estimates that about 10% of people with autism have Savant abilities and about half of people with Savant Syndrome have autism. These exceptional skills can include musical talent, calculation, artistic ability, spatial ability, memory skills, and mechanical aptitude.

Famous Examples of Savant Syndrome

There are some extraordinary examples of individuals with Savant Syndrome. Kim Peek could calculate dates for events hundreds of years in the past or future. Stephan Wiltshire could draw detailed cityscapes from memory. These individuals had abilities beyond just a special interest or passion.

The More Common Scenario

Individuals with autism are commonly rather obsessive and tend to fixate on various topics, interests, or even fears or concerns. Granted, these individuals may not have extraordinary abilities, but it is expected that kids who fixate on any given topic will know everything about it. For example, everything about trains, more details and names of dinosaurs than a paleontologist, know every capital city, the name of every president forward and backward, and every make and model of every vehicle you see on the road. It’s often truly remarkable.

These individuals may not be brilliant, but their passion has led to them memorizing this information. I suppose any of us could do the same if we put forth the effort, but they put forth the effort. As an aside, often these passions are not particularly problematic and can be quite productive and gainful. It is not entirely uncommon that these individuals go on to have a profession in the field of their passion. At times, however, they can get in the way if the child or youth is talking about presidents, or whatever, when in the presence of peers who obviously don’t share that interest. In that respect, it’s often important to keep these passions in check.

Impact on Treatment

Okay, so what’s the connection between a child’s passion and their treatment plan? We would want to incorporate the child’s passion into their treatment. It can be challenging to motivate a child with autism to carry out tasks or learn about a subject when they are not interested. However, they will be laser-focused on a favored activity. So, we find ways to incorporate their interests into the topic at hand or we use their interest as a reward for carrying out the unfavored task.

A child with autism may not be interested in learning about the Civil War, but what if their passion is locomotives? What if we were to incorporate how railroads impacted the war effort and note that all Civil War battles east of the Mississippi River took place within 20 miles of the rail line? It wouldn’t be a stretch to then talk about specific battles, Generals, and how the war played out in the context of the railroad. Another option is to simply use the topic of interest as an incentive for carrying out an unfavored task. Sometimes it requires a bit more creativity to make all this come together, but there is great potential.

I hope this post has helped to distinguish between Savant Syndrome and autistic individuals who have a strong special interest. If you have any questions regarding treatment planning or any aspect of treatment regarding your child, feel free to reach out at DrCarosso@aol.com or on Facebook. God bless you and your children and have a wonderful rest of your day.

The Bermuda Triangle??

Okay, so what does Bermuda have to do with this post besides the fact that it’s a really cool place to go on vacation? Well, not much, and admittedly I included it just to get your attention. The triangle context I’ll be using today has much better outcomes than the one from Bermuda lore.

In today's example, you actually want your child to be inside the Bermuda Triangle. The triangle shape is very pertinent and important to classroom success. As parents, we want our children to receive optimal attention and monitoring from the classroom teacher. No matter if our kiddo is neurotypical, or has ADHD, autism, or other challenges, particular seats in the classroom receive more attention, eye contact, and prompting from the classroom teacher than other seats.

Picture a Triangle

Picture a traditional classroom, with the front row being the base of the triangle and the two angled sides extending into the middle portion of the classroom. The children sitting in that triangle receive the most attention from the classroom teacher. That’s where you want your child seated. I would suggest that the more attention your child needs, the more important it is to sit near the front and in the middle. A 504 plan or IEP sometimes refers to this as “preferential seating” but that term can be rather vague. I want you to be specific when having those discussions with school staff.

The Triangle is Only One Tool

There are many other suggestions and accommodations that can help your child experience increased levels of success in the classroom. These could include:

• having your child sit at a carrell that blocks out external stimuli and reduces distractions, using headphones to block out external noises or a quiet area to work,
• extra time to complete assignments,
• material being provided in audio form with an option for them to dictate their work instead of handwriting
• a token economy system to incentivize completing any given project or assignment,
• breaks that include running in the gym for a few minutes,
• being the class helper that gets your kiddo out of their seat and moving around periodically throughout the day,
• a visual prompt on the child’s desk to remind them to pay attention or turn in homework,
• a vibrating alarm on the child’s wrist that vibrates every eight minutes to remind to pay attention, and so on.

Having one of these, or multiple options to try is a good way to discover what might be the best fit for your kiddo.

Wrap Up:

If you have any questions regarding improving your child's classroom success, feel free to reach out to Facebook or at DrCarosso@aol.com. I hope you have found this post be helpful in recognizing the importance of what’s referred to as preferential seating in the specifics of what that might look like. Hope you have a wonderful day, and God bless you and your kiddos.

Let’s look at the numbers.

The more current CDC autism prevalence estimates are for 8-year-old children across 11 monitoring sites in the Autism and Developmental Disabilities Monitoring (ADDM) Network.

• CDC Estimated rates of children aged 8 diagnosed with Autism:
• 2023 - 1 out of 36 children
• 2020 - 1 out of 54 children
• 2018 - 1 out of 59 children
• 2016 - 1 out of 68 children
• 2014 - 1 out of 68 children
• 2012 - 1 out of 88 children
• 2009 - 1 out of 110 children
• 2007- 1 out of 150 children

Why the Increase?

The general explanation for the increase in autism rates over the past few decades is typically related to a number of factors. It's the same story told over and over. These factors include that practitioners are becoming more capable of diagnosing mild autism that would have been missed years ago. Moreover, children who were misdiagnosed years ago, such as with ADHD or intellectual deficiency, are now being accurately diagnosed with autism. 

Mild vs. Severe Autism

Another line of thinking is that rates of mild autism are increasing because mild autism would have been missed years ago (similar to what I mentioned above), but the rates of severe autism are about the same. However, that’s not accurate. Rates of autism are skyrocketing, and the rate of ‘profound’ autism is also increasing. In that respect, data shows that about one-quarter of children with autism have profound autism. I’m not so great with math, but one can cipher that if the rate of autism is increasing, so too is the rate of profound autism. Given that ¼ of the autistic population has profound autism and each year the targeted population size increases.

What About Increases in Other Childhood Conditions?

Is there any possible connection between the reason for increases in autism and similar increases in rates of ADHD, childhood allergies, general developmental disorders, and learning disorders among a slew of other childhood conditions? It’s even more disconcerting that the general health of our kids is progressively worsening.

What Can We Make of This?

I conduct autism evaluations numerous times daily. These children are delightful and endearing, and it’s expected that they will make substantial progress in their course of treatment. However, not uncommonly these precious kiddo’s are quite compromised and the parents are justifiably very worried and stressed. The road ahead for them is quite challenging, especially in the case of moderate to profound autism. 

What is The Current Reaction?

I recall how everyone was astounded 20 years ago at the 1/150 rate. At the time, it was headline news on a daily basis. I wish it could be explained how the rate is now 1/36 and this situation is not headlined daily as a national emergency and a number-one priority at the CDC. If you recall, it wasn’t so long ago that we shut down our society for over a year due to a condition that was not known to impact healthy children. Are the big guns like Autismspeaks running daily ads for us to call our government representatives to pressure the CDC to laser-focus on this issue? I don’t see this concern even being broached much these days in the national or local media.

What Potential Causes Should be Investigated?

A better question is what shouldn’t be investigated? Is there anything off-limits? There seems to be a focus on genetics, and that’s warranted, but how would genetics explain the increase? How about toxins in our environment, air, or water? Processed foods? Additives like high fructose corn syrup, aspartame, BHA and BHT, food colorings, MSG? All would seem to be worthy targets.

Sadly, there are some areas that are taboo and cannot be mentioned without being called a quack, so most practitioners and researchers don’t even go there. Of course, one taboo subject would include vaccinations. It’s difficult to get past the fact that, when I was a kid, there were like 8 vaccinations by 18 months of age (and what was the autism rate in the 1960s?), and now it’s over 60 vaccinations administered in dozens of shots by 18 months.

Whether or not those vaccinations are necessary or effective is irrelevant – I’m not suggesting you don't get your child vaccinated! But you have a right to know whether there is a potential negative impact. Isn't there a potential negative impact of every medication? However, we’re told unequivocally and emphatically that there are no ill effects from vaccinations.

Does that sound reasonable? You have a right to know if there is a way to reduce any conceivable potential negative impact. Possible things could include further spacing-out the administration schedule, or are there some vaccinations for illnesses that are so rare that the vaccination can be discarded? In this current climate, these are questions that can’t even be asked let alone explored. I wonder if these questions will be asked when the rate is 1 out of 20? 

If I’m off-base or ill-informed, or you have a different perspective, feel free to email and correct me at DrCarosso@aol.com or respond to me on Facebook.

This is a fascinating and frequently–asked question. We often hear that autism and ADHD are both on the neuro-divergent spectrum and therefore have an inherent connection. However, after 35 years of seeing these conditions firsthand, I will tell you that while there are similarities in how the condition impacts children’s daily functioning, ASD and ADHD are clearly different and distinct.

Autism and ADHD Core Symptoms

When considering the core symptoms of the two conditions, the differences become clear. The core symptoms of ADHD are impulsivity, distractibility, and overactivity. The core symptoms of autism include persistent deficits in social communication social interactions, and restricted, repetitive patterns of behavior, interests, or activities.

Similarities and Differences

In regards to the core symptoms, those with autism can be quite attentive and focused on their favorite activities. Moreover, children with ADHD are not obsessive or repetitive in their behaviors.

The Extent of Social Awkwardness

Autism and ADHD are similar in how they impact a child’s functioning in life. The conditions impact particular areas of life in the same way but for different reasons. For example, children with ADHD tend to be overbearing, super enthusiastic, “over-the-top”, and rambunctious.   Their behavior may be seen as “too much” and therefore peers may shy away. Children with autism also have social difficulties but for different reasons. For example, a child with autism may struggle with social interactions because they talk incessantly about their favorite topic, or may stand too close, abruptly begin or end an interaction, or not understand how to navigate through a social encounter. The child with autism, however, often does not pick up on social cues and presents as somewhat socially peculiar and awkward. This is often not the case with children diagnosed with ADHD.

Distractibility with Autism and ADHD

A child with ADHD obviously struggles with distractibility, which is the cardinal feature of the disorder. Children with ADHD often want to pay attention, are trying to pay attention, and have every intention of doing so. It is just really hard for them to do so.

However, a child with autism typically is preoccupied with some other internal stimuli such that they don’t pay attention because they simply want to focus on something else instead. They may be thinking about dinosaurs or trains, or have their own agenda - there’s no intent to disrespect, it’s just that they have their own agenda and tend to stick to it.

Regulating Emotions

It’s quite clear that children with autism or ADHD tend to be more emotional than other kiddos - they both have a hard time controlling their reactions. However, again, the reasons tend to be different. Children with ADHD have difficulty with rejection and redirection, and simply have a hard time controlling their emotions. Keep in mind that ADHD is considered to be a disorder of executive functions, one of the executive functions is ‘emotional regulation’. We often see, with medication management, and the subsequent improvement of executive functions, that a child is more attentive, focused, and more emotionally under control.

Children with autism also tend to struggle with their emotions because of the inherent signs and symptoms of autism. In that respect, a child with autism tends to be quite rigid and has a strong need for sameness. When the routine is interrupted, the kiddo has a hard time and can become quite emotional. Children with autism often have their own agenda and have their own way of doing things - they marched to a different beat. Consequently, when redirected, there is a propensity for emotion because “they just don’t quite get it”. Consequently, as one might expect, the treatment process is quite different between these two conditions.

The Differences Between Autism and ADHD

Those are three primary areas where ADHD and autism tend to differ. Both conditions present challenges in regard to sociality, distractibility, and emotions, but they do have several different factors. I hope this post helps to clarify and it stands to reason that, as a result, the treatment process would be different between a child with ADHD and a child with autism. If you have any questions or wish to pursue an evaluation or treatment, feel free to follow up at DrCarosso@aol.com and see more posts at HelpForYourChild.com and the AutismCenterofPgh.com.

There is always a search for remedies for symptoms of ADHD. Children with ADHD struggle with distractibility, impulsivity, and being fidgety if not outright hyperactive. These difficulties can interfere greatly with daily functioning. This includes in the classroom, but also at home with getting through homework, getting off to school in the morning, or doing chores. Some parents use textured stickers, bubble Pop-it sensory toys, fidget spinners, or squishable balls in an effort to refocus the fidgeting. There are a host of behavioral interventions that can be helpful but it’s always important to determine whether any given approach is actually helpful for your child.

What Typically Works, and What Doesn’t Work?

There are all types of things you can do to improve focus when doing a task at home. Standard strategies to assist with improving attention include, for example:

• removing distractions
• making sure the child’s phone or electronics are nowhere in sight
• having a set schedule for the task
• being organized
• using buzzers or alarms as reminders
• Post-it notes to keep on track
• checklists for smaller parts of a larger task
• Alexa can even give a prompt or two at predetermined times

In the child's classroom, it can be harder to eliminate all the distractions. Other children can often be sources of distractions. But there are still ways we can still help the child focus on the tasks or instruction. We may have a child sit in the front row, use noise-canceling headphones, or use a Carrell when completing tasks to block out external stimuli.

What about Movement Activities?

It’s been established that movement activities and breaks help children with ADHD. Taking a break after a while allowing the child to run around and burn off some steam, and then return to the task has been a long-standing and effective strategy. A modified version of that would include the child being able to, for example, stand beside their desk, move around, and stretch while or before completing a task. These approaches have tended to work quite well and are commonly used to help children with ADHD in the classroom or at home.

What About More Subtle Movement Activities?

However, what about more subtle movements such as using fidget spinners or a squishy ball? Do these more nuanced movement approaches work? Well, it depends. Research and my own observations have shown that, for some children, using various devices such as fidget spinners helps to promote attention and task completion. However, for other children, it actually increases their distractibility and results in less task completion. So, it’s a mixed bag.

So, Does That Mean Fidget Spinners Work?

What this means is that, just like with most other strategies, any given game plan or treatment plan needs to be individualized and child-specific. In that respect, what works for one child may not work for another. That’s why we always take a well-thought-out, child-specific approach that is based in data collection, experimenting with different approaches, and closely assessing what works and what doesn’t work.

In fact, even if the research suggested that something was quite effective across the board, that doesn’t mean it’s gonna work for your child or vice versa. You never know until you try. However, again, each strategy needs to be well thought–out ahead of time, implemented strategically, and assessed quite thoroughly and intensely to determine its impact. It’s almost always the case that any given strategy needs to be fine-tuned and tweaked with time. So you won't know if fidget spinners will work for your child unless you try.

Before You Turn to Fidget Spinners...

Effectively managing ADHD, in any setting, is a challenge and takes ample thought and strategizing. I’m always here to help and that’s what we do here at Community Psychiatric Centers and the Autism Center of Pittsburg. We work with kids and teenagers and are well-versed in managing the signs and symptoms of ADHD. If you need help, don’t hesitate to reach out at Dr.Carosso@aol.com. I hope you found this post to be helpful. Have a great week, and God bless you and your kiddos and your family.

At Community Psychiatric Centers, we diagnose and help treat many different childhood issues. One of the disorders that we specialize in is Autism Spectrum Disorder or ASD. When a parent suspects their child may be on the autism spectrum, one of the most reassuring things to do is to gather information. I am often asked some excellent questions about autism, including:

• When does autism usually show up in a child’s life?
• Can autism start later in a child’s life?
• Can autism get worse over the course of time?
• Can people “grow out” of autism?

Okay, here are the answers:

When Does Autism Show Up?

Autism typically shows up as early as 18 months of age. In fact, I’ve had many parents tell me that they noticed something was ‘different’ about their child in early infancy, even after only a few months of age. They noticed that their child was not particularly cuddly, did not want to be picked up, would arch their back when touched, or seemed content being left alone. These events are often described as their child being exceptionally calm and quiet.

Sometimes odd behaviors will surface by age two. Behavior like poor eye contact, flapping of hands, spinning in circles, jumping, or related behaviors. It’s important to note that, in mild autism, signs may not show until four, five, six years of age, or later. Here’s what happens in those circumstances: when a child has mild autism it is not uncommon for the child to be friendly, engaging, and pleasant. The child may get along quite well with their age mates, at that young age, because not much is expected in regards to play skills in terms of simply getting along and running around and playing games such as chase.

Signs as Kids Grow

However, as children get older, the level of sophistication of social interactions greatly increases. Much more is expected and sometimes it’s hard for children with even mild autism to keep up. They may fixate on various topics rather than have a free-flowing back-and-forth conversation. They might fixate on the solar system or some other topic to the extent that other children may find it off-putting. The kiddo may stand too close or not pick up on social cues. As they get older, these types of behaviors become less tolerable and more noticeable.

Sometimes the child’s pleasant demeanor and sociability outweigh their oddities such that they get along pretty well and there is little in the way of complaints from parents or teachers. In some circumstances, they grow into a teen or adult and get along relatively well with only some mild “quirks”. It would be questionable if, in such a case, the condition is even diagnosable. Again, it’s when those “quirks” become problematic and notably get in the way of a person’s life that something becomes diagnosable.

Can Autism Show up Later in Life?

Can autism start later in a person’s life? No, not so much. The symptoms of autism first present in the early developmental period. However, the actual signs and symptoms may not become fully manifest, or fully noticed, until later in life. Sometimes not till later childhood that social demands exceed social capacities or ability to mask. The general understanding is that autism is an early developmental condition. If signs of autism “show up” later in life, it’s because the subtle signs were missed during early childhood. There are some medical conditions that can have some accompanying signs of autism. For example, Down Syndrome, as well as an array of other medical and chromosomal conditions, but such invariably shows up quite early in life.

Can My Child Grow Out of Autism?

I am also often asked if a child can grow out of autism. I tell parents that it’s not so much a matter of “growing out of it”, but that their child will progress and show fewer symptoms over time. That really is what treatment is all about. The idea is to target the signs and symptoms of autism, improve them, and reduce the severity, intensity, and infrequency of the signs and symptoms. Then the condition improves and the child presents as less autistic over time.

What about the next question: Can the condition get worse over time? By and large, I found that, with treatment, the condition does not get worse, it gets better. However, that also depends on the severity of the condition. In that respect, a child with very mild autism can demonstrate notable improvement and, in a few years, may barely meet the diagnostic criteria. It’s rare that the condition worsens though there typically are ‘ups and downs’ in the treatment process.

For example, when a child is going through puberty sometimes there is an increase in emotional volatility, but that can also be true for neurotypical peers. If a child with autism is going through a difficult time, if there is a family disturbance or bullying at school, or if treatment is interrupted for whatever reason, then the condition can worsen for a period of time. But it’s also expected that the child will rebound when things stabilize.

Wrap-up

So, to recap, autism is generally an early developmental condition with signs and symptoms manifesting by 18 months of age. In the event of more mild autism, sometimes symptoms do not noticeably interfere with the child’s life until late childhood but, when looking back, most parents can see that the child presented with some idiosyncrasies even during the early childhood years. The condition does tend to improve over time, especially with proper treatment, and it’s unlikely to worsen. I’ve seen children diagnosed with mild autism who after a few years of treatment and much improvement, no longer meet diagnostic criteria for autism.

The Autism Center of Pittsburgh is part of the family of CPC practices. If you would like to learn more about how we diagnose and treat Autism, visit our website. I hope you found this post to be helpful. If you have any questions, or if you’re seeking treatment for your child, feel free to reach out to me at DrCarosso@aol.com.