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friendships

11

Busting a Common Autism Myth

By | NESCA Notes 2024

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

I often hear from parents and caregivers that their child has several friends and likes going to social events, leading them to wonder how they could have autism.

First, let’s take a look at what autism is:

Autism spectrum disorder is a neurodevelopmental disorder classified by persistent deficits in social communication and social interaction skills.

To meet criteria for an autism spectrum disorder, one must exhibit the following social communication deficits across multiple contexts:

  1. Deficits in social-emotional reciprocity—this may include feeling unsure or uncomfortable when approaching others, having difficulty initiating social interactions, or having difficulty responding appropriately when approached by others. When engaged in conversation with others, it may be difficult to engage in back-and-forth conversation and share interests/emotions.
  2. Deficits in nonverbal communication skills—examples include poor eye contact, poorly integrated gestures in conversation, reduced facial expressions, difficulty reading the facial expressions and gestures of others, and not picking up on subtle body language cues.
  3. Deficits initiating, maintaining, and understanding relationships—characterized by difficulties making new friends, not wanting to engage with peers in any capacity, or difficulties maintaining long lasting friendships.

One must also demonstrate evidence of at least two of the following: repetitive behaviors, inflexibility/rigidity, restricted and intense interests, and sensory sensitivities.

Next, let’s look at what autism isn’t:

While individuals with autism experience social challenges, it is a common misconception that having autism means not having any friends or social skills at all. Contrary to this popular misconception, I evaluate many children, adolescents, and adults who are on the autism spectrum, are socially motivated, and have numerous friendships.

It is important to remember that while a diagnosis of autism requires social communication deficits, that does not mean a complete lack of skills must be evident. For example, I see many individuals on the autism spectrum who have several longstanding friendships but have difficulty making new friends. Conversely, some individuals find that they initiate friendships well, but have difficulty maintaining friendships over time. It is also possible for an autistic individual to demonstrate appropriate eye contact and facial expressions but have difficulty reading subtle nonverbal cues of others. With high social motivation, it still may be challenging to know how to participate in social conversation, how to build on the interests of others, and how to respond to emotional reactions.

Individuals with high-functioning autism often get overlooked as they have learned to “mask” or “camouflage” really well. That is to say that they work hard to “fit in” or hide areas of vulnerability. It might not feel comfortable for them to participate in group conversations or to interpret nonliteral language. They may feel as though there are written social rules that everyone else has access to except for them. When observing them, it may appear as though they are social and well-integrated into social environments; however, they may report a vastly different internal experience.

Taken together, having an autism diagnosis does NOT mean there is a complete inability to form friendships or participate in social settings. Rather, aspects of social communication can be challenging and warrant supports and services designed to enhance these skills.

If you have any questions or concerns regarding your child’s social development, speak with your pediatrician and/or schedule an evaluation with one of our neuropsychologists at NESCA.

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

9

ADHD & Social Skills

By | NESCA Notes 2022

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

When most of us hear the term “ADHD (attention deficit hyperactivity disorder),” we think of the little boy who can’t sit still at his desk or the girl gazing out the window lost in her own thoughts during class. While difficulties with hyperactivity and/or attention are core features of ADHD–embedded directly in the diagnostic label–there are often co-occurring features that are less obvious. Moreover, even the central aspects of ADHD can have far-reaching impacts beyond the classroom. One of the most frequently misunderstood and overlooked facets of ADHD is its potential impact on social functioning.

In clinical practice, parents of children with ADHD are often confused by the unexpected and indirect ways that attentional and executive functioning deficits can affect social functioning. They sometimes wonder if their children have an additional challenge, such as autism spectrum disorder. Most often, that’s not the case. Rather, it’s more likely that one or more of the following is at play:

  • Kids with ADHD can have difficulty selectively attending to relevant social cues
    • Imagine looking through a camera with a broken zoom lens. At first everything is in frame at once; it’s too much information. Then you try to zoom in, but when you do, sometimes the lens focuses on unimportant things (like the random details in the background), leaving out what’s most relevant (like the person you’re trying to capture in your photo). Children with ADHD have difficulty figuring out what details to focus on and struggle to effectively “zoom in” on those elements. In social settings, which are often unstructured, kids with ADHD are even more prone to “zoom in” on unimportant things and miss the more salient information. They can also become easily distracted and fail to register important information in the moment. To others, this can come across as lack of interest (for instance, the child who seems not to be listening or is distracted by sounds, sights, or other sensory information in the moment). It can also lead children with ADHD to overlook contextual cues about what’s expected in a given social setting, which can lead to inappropriate behavior.
  • Children with ADHD often struggle with nuance, making inferences, and reading between the lines
    • Social situations are much more complex than we often realize. Successfully navigating social interactions requires paying attention, not just to surface level information but to the often subtle, implied meaning embedded in things like figures of speech, tone of voice, and body language. For many with ADHD, it’s already a challenge to maintain focus at the surface level; the task of trying to simultaneously attend to and interpret subtext is too much. Individuals with ADHD may focus on what another person says (the content of their speech) but fail to notice the eye roll or sarcastic tone of voice that goes along with it.
  • Impulsivity can lead to social faux pas
    • Impulsivity is a central feature of ADHD in many cases. In social settings, difficulty inhibiting impulses can take many forms. For some, it may simply present as rapid-fire speech, leaving little room for others to respond in conversation. It can also look like interrupting, cutting others in line, or expressing ideas and opinions in a way that can be hurtful or seem rude. Especially in younger children, impulsive behavior can lead to difficulty sharing, physical aggression towards others, and trouble with turn taking. Children who have more difficulty slowing down and inhibiting impulses are more likely to inadvertently offend others or to engage in behavior that their peers may view as odd or inappropriate; in turn, this can lead to trouble developing and sustaining friendships and other positive relationships.
  • Hyperactivity makes participating appropriately in some social settings difficult
    • There are some social contexts in which an abundance of energy is a very good thing. For this reason, many ADHD kids can excel in activities like sports, into which they can channel their high energy. But other social situations demand a different set of skills. For kids with hyperactivity as part of their ADHD, sitting still and maintaining quiet can be a challenge. They may struggle with activities like going to the library, watching a movie in a theater, attending church or religious ceremonies, or sitting at the table in order to have family dinner.

The good news is that there are ways to manage these social challenges. If your child with ADHD has difficulty with any aspects of social functioning, it may help to seek out social skills training with a therapist or through a structured social skills training program. Interventions often include a combination of explicit instruction, modeling, role playing, and feedback. Parents can also help by implementing simple, consistent ground rules for behavior and providing gentle but clear reminders as needed. Additionally, parents can facilitate play dates with peers, during which the parents take an active role in helping children utilize social skills and engage with each other appropriately.

Finally, though ADHD can present challenges in the social domain, kids with ADHD often possess many strengths that can help actually them succeed socially. Children with ADHD can be highly engaging, curious, energetic, creative, and open-minded. When these strengths are reinforced, kids with ADHD can often utilize them to create fun, rewarding social interactions and to develop rich, dynamic relationships.

 

About the Author

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

Dr. Rodriguez lives north of Boston with her husband and three young children.  She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.

To book a consultation with Dr. Rodriguez or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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