NYIPT Template

NYIPT faculty member Dr. Martha Herman teaches our candidates about “organic conditions,” including Asperger’s Syndrome, that afflict many children. Here she explains how she skillfully helped a young boy identify and express feelings of sadness and loss, a great accomplishment that was recognized by this child’s mother.

I was seeing a 5-year-old Asperger child I'll call John, in therapy at a therapeutic nursery school. He was a serious, shy, and anxious child, who related cautiously but did form genuine relationships with me and other school staff, and he was receptive to our input. John had 5-year-old twin cousins whose mother died of cancer that year, and his mother frequently had the twins at their home. One day one of his cousins, without thinking, called John's mother "Mommy." John chillingly responded, "She's not your mother. Your mother is dead." This was said with no malice. To John it was just a factual, literal statement. Yet it greatly upset his cousins and all the adults present, and John's mother wept as she told me the story.

John's mother and I decided to try to help him understand what his cousins felt about losing their mother and how they felt about his comment. Both in therapy and at home we worked on understanding feelings, his and others, which this sweet but confused child had in abundance, but did not understand intuitively as typical children do. This involved direct discussion about death and loss and missing people. In our sessions I kept the focus on feelings and motives. I brought up emotional incidents in class, and at home, and those that occurred in the moment between us, helping him understand what he and others felt and how they reacted, and I suggested more adaptive alternatives: for example, that the Elmo that had sent him into a panic at a birthday party, was just an adult in a costume who could safely be approached; or that the classmate, who was screaming when his mother left, did not mean to hurt John’s ears, but needed reassurance that his mother, like John’s, would return.

The play in our sessions was a mixture of his spontaneous behavior and my frequent interventions, elaborations, and additions. He preferred, especially in the beginning, activities that were concrete and objective. He liked to push the buttons on a calculator and watch the numbers change, and he liked to practice writing letters, or pushing cars and school buses repetitively on the floor. I would add more symbolic toys (for example, adding children to the school bus, with a parent and teacher at the beginning and end of their route, while I enacted a little drama with dialogue and sound effects). I often had symbolic toys on the table when he arrived, (little people, animal families, a doctor’s kit, as well as a cradle and a baby doll who looked like his little sister), and I encouraged him to use them. I initiated fantasy and pretending through role play. For example, I suggested we could pretend to be rabbits like the one in the pop-up toy, a prospect that initially frightened him (“But I am not a rabbit, I am John,” he said with a hint of panic). Gradually, he increasingly participated and initiated this play on his own, and thus was helped to imagine experiences from the perspective of others.

Then about six months later, his mother came in and told me that she and John were talking about his aunt, and he burst into tears and cried about his aunt’s death. It was his tears that especially affected her, because rote statements can be easily learned without emotion. She said, "Never has a mother been so happy to see her child cry."