Shirah Vollmer MD

The Musings of Dr. Vollmer

Re-Posting: Since I Did Another School Visit

Posted by Dr. Vollmer on April 12, 2012

Samantha, an 18-year-old junior, diagnosed with autism, attending a regular school, has really matured over the years. She used to need a shadow, a professional, to watch her at school to make sure that her behavior did not escalate out of control. With maturation, she now inhibits her impulses better, and for the most part, she gets angry, but not aggressive. Her family is unbelievably supportive. In ways that I admire deeply, both parents, married to each other, have devoted their lives to her. Samantha has an older sister, Stacy, a girl who every parent dreams of. Stacy attends a prestigious university, she has always done well in school, she has lots and lots of friends, and she is confident without being arrogant. The parents, Tom and Alex, treat both their daughters in ways which are fair, even-handed, and loving. I think about how hard this must be, to raise two totally different kids, but my practice has taught me that some parents do an admirable job. I see these parents as unsung heroes in the autism world. I see how hard they work to balance their autistic child’s needs with that of their other children. I see how much time, energy and patience it takes to help these autistic kids mature. I see that they must advocate for their children, while at the same time, they must be realistic about the limitations.

Samantha had a setback. She threw a book at her teacher. This was not good. The teacher was kind, but firm. Samantha had to write a note of apology. That’s fair. She did. I thought, naïvely, that this would all blow over. Unfortunately, the school administrators did not like her note. They interpreted her few words of apology to mean that she did not feel bad. In point of fact, she felt very bad, but she could not express herself. She froze. The parents understood this, but they could not advocate for her, because it would seem that they are not realistic about Samantha’s limitations. I suggested a school visit where I, with the parents, with his tutors, could talk about Samantha and what she struggles with. For an hour, we discussed how to help Sam. I felt this undulating course where the school administrators were understanding Sam’s autism, alternating with periods, where they could not get their heads around her difficulties.

Autism is really hard to grasp. Sam is a pretty girl. She has no physical malformations. She speaks clearly and when she wants to, she can be articulate. She is good at math, but she has trouble with reading comprehension. She has never had a friend, although she is friendly. When faced with frustration, Sam sometimes goes into a rage. In the past, she became physically aggressive, but in the last two years, she just looks angry, and walks away. When Sam gets angry, the look on her face is one of utter despair. She appears so frustrated that she seems scary and sympathetic at the same time. I do not know why this time she threw a book, because earlier moments of frustration, she could walk away. The teacher asked her to finish her math homework during lunch, a reasonable request, a request that previously caused no anger.

I think of Sam’s anger outburst like a seizure. Sam can explode, but when she is feeling good, she can contain herself, and when she is not feeling well, or she did not sleep well, or she is hungry, then she rages. Epilepsy is not that different. Those who are prone to seizures, usually have seizures when their system is out of balance, for one reason or another. So, if her rage is like a seizure, does this mean she is not responsible for her actions? No, it does not mean that, but then again, it does. By that I mean that she needs to learn responsibility and she needs to learn to control her temper. At the same time, the teachers need to understand that it is harder for her than for other children. Like a seizure, she needs to cool off, before consequences are discussed. An apology, even one that is  not as thoughtful as one would hope, is better than no apology at all. She needs to be praised for attempting to write a note of remorse. It is a good first step.

Education is about setting the bar for each child. Every student needs to be challenged, so they can work hard, and achieve a sense of mastery and accomplishment. It is the job of educators to know how to set that bar. Mental health providers, such as myself, need to help students get rid of the psychological barriers to learning, so a child can get the most out of his educational environment. With that in mind, I suggested the school visit. I need to work with the school to help Sam get the most out of her last few years of high school.

After an hour and a half, the meeting was over, and we all returned to our usual day. Like so many things in my professional life, I do not know how to assess the experience. Was I helpful? Did I say important and thoughtful ideas? Did I give them good tools to work with Sam? Did I justify the effort at putting this meeting together, given everyone’s busy schedule? I do not know. I do know that, to me, the meeting was mandatory. We needed to discuss ways to interpret Sam’s behavior. We needed to sit together and remind ourselves of all the progress Sam has made over the years. We needed to support the parents, to let them know  that we are all on the same team. In the short-term, it is fair to say, we achieved those goals.  In the long-term, about how the meeting changed Sam’s school life, only time will tell.

10 Responses to “Re-Posting: Since I Did Another School Visit”

  1. Shelly said

    Very well-written and insightful blog.

    What did you tell the school? Did you give them tools to deal with her behaviors? Is Samantha in a regular classroom or special ed? Why did the school administration want a greater show of remorse than the teacher did? What kind of expectations does the school have for an autistic child?

  2. I told the school to lower their expectations of her apology. In terms of tools, I told them to wait for Samantha to cool down before giving her a consequence. The school administrator set a higher bar. I think he misunderstood Samantha’s mindset. The school needs to expect her to do her academics and they need to help with socialization. Of course, the older the kids get, the harder it is to do the latter.

  3. Madeleine said

    I think it’s very generous of you to suggest and attend the school meeting. I’m sure that it helped a great deal for the administrators to better understand the situation, with your input and recommendations.

  4. I hope so. It is always a bit dicey. Thanks.

  5. jo said

    It’s comforting to know that there are generous, caring people like you who do all they can to help children who struggle. Thanks.

  6. Hi Jo,
    Thanks for your comment. I wanted to re-post this since many folks do not think that psychiatrists still do school visits. I find that seeing a child/adolescent in their school environment and talking with teachers and administrators is an enormously valuable means of understanding and helping children and adolescents.

  7. Jon said

    So, what was the difference between the visits of two years? Can you characterize anything that changes or anything that stays the same?

    • Hi Jon,
      Pardon me for not being clear. I did another school visit for another child. This served as an important reminder to myself how important that piece of an evaluation/intervention can be. So, I wanted to re-post my old one, while I think about how I want to formulate my more recent school visit. Thanks.

  8. Shelly said

    Lucky the child attends a regular public school so that it can’t simply chuck the difficult child out of the school. We encounter that alot over here…..the attitude of, “You don’t know how lucky you are that we keep your child in our school. So don’t make any waves because if you do, we’ll give him the boot.” They make no special accomodations for his disability and it certainly wouldn’t make any difference if he was disabled or not: conform or leave. We’ve offered several times to have the specialists come in and discuss with the personnel there what autism means, to explain to the other students what the rages are about, etc… and they simply don’t want to hear it. You make me miss good old American/Western medicine: the voice of reason.

    • Shirah said

      Thanks, Shelly, for sharing your experience. It is unfortunate that some schools are not amenable to listening to professional advice. I would like to think that will change over time, especially if we can continue to use the internet to make a case for school consultations.

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