So Now What? : Education During a Pandemic

Parents, Educators and School Administrators are beginning to realize that this isn’t a break or a blizzard. Many of them are hitting the ground running, some are laying as low as possible this week and hoping things will settle, a few are immobilized. And every teacher I know or talk to is trying to figure out a strategies. Teachers, you know it is true: You LOVE strategies. And I love you for it. But these are strange times, and if your strategies or lack of them are making you feel stuck, maybe some of this will help. I have my two cents and then a list of resources for you.

First, my two cents, based on working in special education, public education, higher education and clinically over the past 25 years. The most important thing right now for kids right now is to stay calm, connected and establish new flexible routines at home. No homework packets, no busy work to keep them “occupied.” As tempting as this may be to administrators, educators and parents, that does not really lend to good learning, in fact it is this adherence to the status quo that partly got us into this problem to begin with.

  1. Play is OK. There is a wealth of research out there on the benefits of physical and digital play on cognition, visuospatiomotor skills, social emotional learning, and more. Allowing kids to engage in stress-relieving fun will make them better learners, keep them in contact with their peers, & feel mastery at a time when all of us are feeling little.
  2. Look for the embedded learning in the activity. This is different than trying to structure learning too much. When you are able to focus on your child between other things you are doing as a parent or online educator, try to identify what learning is happening with the play activity and maybe share it when the child is done. I say maybe because first and foremost this is for you to reassure you and calm your anxiety that your child or student is falling behind and will end up living in a cardboard box on the highway because they are playing Portal 2 rather than doing math sheets. Instead, watch the game a bit, and ask yourselves, are there things about physics embedded in the game? Does Plants Vs. Zombies have an opportunity to discuss task planning, sequencing, or math skills (hint, it does: all of the above.) Try to see the things that kids are always learning in play. Now don’t interrupt and ruin it.

Ok, I know that’s not enough for many of you. So here’s a list of some things educational innovators are offering for parents, kids and schools as resources for online learning:

From Continuity with Care to Zoom Memes for Self Quaranteens–My Internet Responds to COVID-19

Parenting (in RL) during a pandemic

Resources For Teaching and Learning During This Period of Social Distancing

THE COLLECTION :Explore thousands of artworks in the museum’s wide-ranging collection—from our world-renowned icons to lesser-known gems from every corner of the globe—as well as our books, writings, reference materials, and other resources.

Educators can also join one of my free Zoom groups (download free software at (http://zoom.us )

Thursdays 3-4 EST

COVID19 Educator Support: Not tech support. This meeting is to provide psychoeducation and collegial support for educators adjusting their teaching to COVID19

Meeting ID: 906-040-691

Password: 02554

Coping With COVID19: Advice for Parents & Educators

As anticipated, I’ve begun to receive a few communications from therapists, parents and educators about the social distancing impact on them and their children. The first question I get usually is something like “I’m worried about my kid playing too much video games, should I be setting limits on this with them?” I’m going to give you an answer that you may not want to here, but may actually improve mental health.

First, as I mentioned earlier this week, we are all going through an adjustment reaction to a rapidly emerging situation that is impacting everyone you know at the same time. This alone is rare in that usually some of us are not dealing with psychological upheaval when some others are. But this time, whether you are denying, minimizing, remaining guardedly calm, scared, or overreacting, you too are on the same continuum that we all are. So welcome. 😊

Local governments and schools, comprised of similarly recalibrating individuals are doing what they can to get ready for the wave of shut-downs, and this includes for many teachers and kids a break for 2 or more weeks and then perhaps online learning. Many workplaces are closing and reducing hours, which means that families are about to spend more time together in closer quarters with less emotional and financial resources than usual.

So, what can you do?

Here are my suggestions which are based on my work, research and thinking about psychology and technology over the past 25 years:

 

  1. Focus on social distancing (skip ahead if you already have embraced this idea.) This is the most important way we have to #FlattentheCurve and mitigate against higher more rapid infectivity. As has been written at https://staythefuckhome.com/sfw/ the concept of self-quarantine works to mitigate the spread of infectious diseases. We have known this since the 1400s. This is hard on social creatures, and can start to evoke guilt in caregivers. Compassionate ideas like visiting elderly shut-ins in person; babysitting groups and play-dates; local support gatherings are all bad ideas when it comes to a pandemic.
  2. Anticipate but don’t panic. It is very likely that more disturbing information and misinformation will happen in the next several days. If you note the way COVID19 is trending things are going to worse and scarier pretty quickly. Remember this is happening at a pace that is quicker than you may be used to and be prepared to change your mind and recalibrate family rules and limits much more rapidly and often. Be prepared to say, “I know I said X but now that I have more information it is Y, and I’m sorry that we keep changing the rules on you. Building that understanding with your child that things are moving quickly is part of the overarching message “I love you, I’m listening and I’m going to keep you safe.”
  3. Let kids play their games. I have mentioned elsewhere and will include below several posts debunking the common misconceptions that demonize video games. But here let me put it a different way: 2 or more weeks is a long time to be in your home nonstop with your children in a state of embattlement. Video games are a great way to practice social distancing: Kids can talk with their friends online, escape the heightened stress at home or in our communities, and feel a sense of being in control of something. It also provides you with the respite you know you are going to need after a couple of days. Lift restrictions if your authoritative parenting style can handle it. One exception here is helping kids build in 5 minute movement breaks every 45 minutes or so.
  4. Try to see it from their point of view. No matter how much your child or teen loves you, they are used to having several hours a day away from you too. Like you, they find being distracted from family life by work and friends reinvigorating, so please don’t frame this as an opportunity for more quality time. It’s disingenuous and sets everyone up to feel like a failure when the reality of quarantine sets in. Of course if they are open to spend time with you, accept the invitation as they deliver it: Now may be the perfect time for you to finally learn how to play Fortnite with them.
  5. No, YOU go outside and play. Often parents find themselves exhorting kids to go outside when they are secretly yearning for escape themselves. If your child can be left alone safely for a bit, go outside and take a walk, get some fresh air and calm down. You already believe that exercise will do you good, so focus on the one you can control, you! Of course, if your family walks/hikes/runs together and you are not looking for alone time, definitely invite them along with you.
  6. Get in the habit of zooming, calling, texting with others regularly. Your kids may be experts at this, but older family members may need help with the habit or technology. Or you might. Learn how to use Zoom, which is being offered for free for most kids. Call and help other folks learn how to set it up and test drive it. This week is the week to get practice before things get more hectic.
  7. Practice mindfulness games and meditation when possible. My colleague Chris Willard has some excellent suggestions on this here. Don’t force kids to do this though, as it will turn them off. If anything, trust that if they are intently playing a video game they may be engaging in a form of concentration meditation which isn’t bad either.
  8. Confront and redirect the inadvertent demonization of touch. This one is huge. This past week many have become acutely aware of how often they touch their face, or others without asking permission. To control the spread of infection this is crucial, and yet we need to also resist the urge to begin to perceive touch as unnecessary or lethal. Touch and reaching is a part of healthy infant development (Beebee, 2016.) It plays a significant role in focusing attention and attachment security in adolescence (Ito-Jager, 2017.) Children need to touch themselves as part of learning motor imagery (Conson, 2011) body ownership (Hara, 2015) and the assembly of “self” (Salomon, 2017.) Research has shown that adolescents in America already touch each other less and are more aggressive to peers than in another country sampled (Field, 1999); and for all of us touch quite probably helps us with emotional self-regulation (Grunwald, 2014.) Self-touch is a cornerstone of mindfulness and compassion meditation practices. Practice everyday precautions while at the same time but remember that touch is necessary for basic neurological and psychological well-being. Find adaptive ways to continue giving yourselves touch so we do not become a planetwide Harlow monkey experiment.
  9. Special note to educators: Relax your curriculum and pedagogy. Please push back on your administrators on this one. You are all home because there is a global pandemic with all its increased stress and uncertainty; this is not a snow day or break. Kids should be focused on social connection, play and reduced stress. You aren’t going to hit your benchmarks this semester. There, someone finally said it. You can encourage your parents to read to kids, spend more time together, offer fun reading lists or math sites, but please let go of your own overarching expectations and resist any arbitrary ones placed on you as much as possible. If someone starts talking about lesson plans, say “this is a pandemic.” If someone starts talking about kids’ grades, say, “this is a pandemic.” Part of your job as an educator is to educate kids and their families about adjusting in reaction to events, I’m sorry you got stuck with this event, but there you have it.
  10. Pick one or two trusted sources to keep yourself and your kids informed. Two much information overloads kids and adults alike. Most of us don’t need to know what JCPenney or Walmart have to say about COVID19. On the other hand, I have found the info from Harvard very helpful. The Joan Ganz Cooney Center has some great thinking and writing for education and child development. Your Teen Magazine is very accessible to parents. Dr. Kristin Moffitt from Boston Children’s has a short but useful interview on how to talk to your kids about COVID19

 

If after all that you are STILL focused on screen time, please check out these items for your consideration:

 

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Treating Psychotherapy Patients in the Era of Coronavirus

As I write this, human beings are in the midst of mobilizing public health and psychological defenses against what will most likely be declared a pandemic by the World Health Organization this week. WHO and the CDC as well as state and local governments have issued guidelines, countries have begun self-quarantine, and as I write this Harvard just made the decision to move to virtual classes until further notice.

On a interpersonal and sociological level, we have begun to see the signs of adjustment reaction in conversations with others and on social media. The Nieman Foundation for Journalism has a page on Covering Pandemics which is very salient to us all in explaining adjustment reaction. It refers to the ways people attempt to recalibrate themselves psychologically during such traumatic and disruptive events, vacillating between overreaction and underreaction, minimizing and denial vs panic in their attempts to master confusion and anxiety in ways both adaptive and maladaptive. Perhaps you have noticed that (to paraphrase a comic I saw this week) all of your friends on Facebook who were constitutional scholars last month are now epidemiologists.

Recently I was seeing a longterm patient of mine, I’ll call her Randi*. Randi is 65, and began seeing me 10 years ago for help with dual diagnosis addiction and major depression. She also has a chronic pulmonary condition. I’ve been seeing her online for the past several years, most recently from her home in Costa Rica. This session was full of uncertainty and questions: She was scheduled to return to the US to renew her visa, should she come? Should she be holding hands at AA meetings? Should she be attending them? She has begun to follow the CDC recommendation of social distancing, and was worried about the impact of this on her mental health.

The guidelines we are being issued by public agencies are as clear as they can be during a time where data is still changing and community responses are fluctuating. At this time several suggestions are consistent from the CDC and can be found here.

As clinicians it is not our responsibility to learn epidemiology or get a degree in public health. However, we have a very important part to play in addressing the mental health issues that will accompany and/or be exacerbated by COVID19. I am listing the ones I have seen emerging in the hopes that we can help provide ancillary support for the mental health and behavioral health of our patients. If you are a therapist, please consider these. If you are a lay person, these are for you too.

  1. Reality-testing requires research. One of the main goals a therapist provides to the patient is supporting accurate reality testing. As mentioned above, reaction adjustment impacts our reality testing. Patients may present minimizing or panicking. To intervene, we need to know what the research as it is current says. Currently the mortality rate is 3.4% so yes, it is more lethal than the flu. We also do not know how this figure will change when more people are tested. But that is what we know. So the therapist needs to model both an not-knowing stance and assert what is currently known. This includes implicit communications (hand sanitizer in waiting room, offering teleheath sessions) as well as explicit ones (confronting extreme statements on either end, sharing what you know and verifying the source of your information.) Keeping abreast of the research allows you to help patients who are in higher risk populations shift their thinking and behavior to the new situation, while reassuring patients in lower risk populations understand their risk. Pointing out overreacting and under-reacting requires us to know what it is possible to know at this time, as well as manage our own countertransference response as we go through our own period of adjustment reaction. As this is all in flux be prepared to have discussions that are in flux.
  2. Address the needs that public health agencies aren’t in regards to social distancing. While it is becoming clear that more people are being advised to practice social distancing, the impacts of that on mental health are not being adequately discussed. This is absolutely understandable as the primary goal of public health in is to reduce infections to increase population survival. But helping the individual person-in-the-environment is where we come in as therapists. We know the importance of decreasing isolation for good mental health. We need to anticipate an increase in depressive symptoms, anxiety, and substance relapse may occur if the psychological impact of isolation is not addressed. We will need to help patients explore how to renegotiate boundaries as they rethink whether to hold hands at an AA meeting or a second date. We will need to help people shift to online therapy and self-help groups rather than avoid them. Social connection will need to be more planned and intentional, more technologically dependent for many. We may need to assert that immunocompromised individuals stay out of our physical offices for their safety, and explore the feelings this evokes for them.
  3. Support patients in preparation for managing their psychopharmacological needs. Help them anticipate pharmacy delays and encourage them to follow the recommendation that they get 2 months worth of prescriptions whenever possible. Be prepared to offer more case management with them as they negotiate resistance with health insurance companies.
  4. Confront and redirect the inadvertent demonization of touch. This one is huge. This past week many have become acutely aware of how often they touch their face, or others without asking permission. To control the spread of infection this is crucial, and yet we need to also resist the urge to begin to perceive touch as unnecessary or lethal. Touch and reaching is a part of healthy infant development (Beebee, 2016.) It plays a significant role in focusing attention and attachment security in adolescence (Ito-Jager, 2017.) Children need to touch themselves as part of learning motor imagery (Conson, 2011) body ownership (Hara, 2015) and the assembly of “self” (Salomon, 2017.) Research has shown that adolescents in America already touch each other less and are more aggressive to peers than in another country sampled (Field, 1999); and for all of us touch quite probably helps us with emotional self-regulation (Grunwald, 2014.) Self-touch is a cornerstone of mindfulness and compassion meditation practices. Therapists need to help patients and their families practice everyday precautions while at the same time reminding them of the necessity of touch for basic neurological and psychological well-being. We need to anticipate that we may be asking people to do something which conflicts with adaptive self-soothing responses to distress. We may be unintentionally causing a reenactment of a trauma survivor’s bodily domination by the abuser when we start telling her what she can and cannot do with her body. We may be taking away a kid with ADHD’s main way of focusing. So the goal of therapy becomes the reduction of shame and irrational demonization of touch, and the development of adaptive ways to continue giving ourselves touch so we do not become a planetwide Harlow monkey experiment.
  5. Last but not least, hold the therapeutic frame. The majority of our patients were working on things in therapy before the events of the past two weeks. I have asked each in the last portion of the session “what do you imagine you would have been talking about in therapy if you hadn’t been discussing the coronavirus.” In the case of Randi, that question prompted her to remember that someone had attempted to break into the apartment where she lived alone, itself a pretty distressing event! Another patient, a 30 year-old male with Dysthymia, had made two major and difficult behavioral changes that week, a success that would have been crowded out by COVID-19 if we hadn’t paused to discuss earlier events. We need to keep an eye on the ongoing work, how the patient’s neurotic styles vis a vis pandemics are often in keeping with their style overall,and what other events have occurred in their week.

These are some of the most important “new” responsibilities I see us having as therapists when dealing with the emerging coronavirus crisis. I imagine more will be revealed, and I imagine that at some indeterminate time in the future it will become more clear what the psychological impacts of adjustment reaction, social distancing and touch aversion had on human development. In the meantime, please consider sharing this with your colleagues and patients so that they do not lose sight of important impacts on their mental health caused by necessary public health precautions.

Such interventions and frame maintenance model an adaptive stance in that they are hopeful: That there is a lot of work to be done is always an expression of hope, never despair.

*patient identification changed to protect privacy

References

Beebe, B., Messinger, D., Bahrick, L. E., Margolis, A., Buck, K. A., & Chen, H. (2016). A Systems View of Mother–Infant Face-to-Face Communication. Developmental Psychology, 52(4), 556–571. https://doi.org/10.1037/a0040085

Conson, M., Mazzarella, E., & Trojano, L. (2011). Self-touch affects motor imagery: a study on posture interference effect. Experimental Brain Research, 215(2), 115–122. https://doi.org/10.1007/s00221-011-2877-7
Field, T. (1999). American adolescents touch each other less and are more aggressive toward their peers as compared with French adolescents. Adolescence, 34(136), 753–758.

Grunwald, M., Weiss, T., Mueller, S., & Rall, L. (2014). EEG changes caused by spontaneous facial self-touch may represent emotion regulating processes and working memory maintenance. Brain Research, 1557, 111–126. https://doi.org/10.1016/j.brainres.2014.02.002

Hara, M., Pozeg, P., Rognini, G., Higuchi, T., Fukuhara, K., Yamamoto, A., Higuchi, T., Blanke, O., & Salomon, R. (2015). Voluntary self-touch increases body ownership.(Brief article)(Author abstract). Frontiers in Psychology, 6. https://doi.org/10.3389/fpsyg.2015.01509

Ito-Jäger, S., Howard, A. R., Purvis, K. B., & Cross, D. R. (2017). Attention focus and self-touch in toddlers: The moderating effect of attachment security. Infant Behavior and Development, 48(Pt B), 114–123. https://doi.org/10.1016/j.infbeh.2017.05.001

Salomon, R. (2017). The Assembly of the Self from Sensory and Motor Foundations. Social Cognition, 35(2), 87–106. https://doi.org/10.1521/soco.2017.35.2.87

Triscoli, C., Olausson, H., Sailer, U., Ignell, H., & Croy, I. (2013). CT-optimized skin stroking delivered by hand or robot is comparable. Frontiers in Behavioral Neuroscience. https://doi.org/10.3389/fnbeh.2013.00208

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Video Games & Meditation

Let me start by saying I’m a huge fan of meditation. I’ve done certificate trainings in mindfulness and clinical practice, classes on guided imagery and visualization, and meditation to enhance neurological development. I’ve seen the research on how meditation positively impacts the brain in general and specifically white matter connectivity as we age. More personally I have been a lifelong student and practitioner of meditation in various forms: I’ve chanted in ashrams, done walking meditation, participated in Dzogchen talks and practice, engaged in mindfulness practice, Benson’s relaxation response, yoga, the Eight Gates of Spontaneous presence, and many more. That’s a lot of meditation! I don’t do it as consistently as I wish, but I have a healthy respect for the various forms of meditation, and refer patients to it regularly.

This is one reason why I find it troubling how so many fans of meditation hate on video games and gaming. The same folks who are speaking about compassion and mindfulness and calm sound like raging fundamentalists when they start speaking about “screens” and the spurious research that video games are adversely affecting our lives and neurology. They seem to think that meditation has to occur on a bamboo mat in a candlelit rock garden to be meditation. Cultural misappropriation aside, this really limits the potential audience who could benefit from meditation.

Part of this is due to the recent popularity of mindfulness meditation, which made DBT sexy and available to the mainstream, much as psychoanalysis expanded from treating hysterics to the general population with our neurotic styles. This is wonderful, mindfulness meditation is very useful and effective. And it is only one form of meditation. Less talked about nowadays are the focusing or concentration meditations, and guided visualization meditation. But when we do remember those, the impulse for many is to imagine that the object of focus has to be something low tech. We think candles and mandalas, but what if video games could also be objects of focus? In fact, what if playing video games is a form of concentration meditation?

Recently, I decided that I wanted to do my part to make meditation more available and gamer affirmative. In particular, I have developed a guided visualization meditation called “Your Powerful Video Game Avatar.” Through the support of Insight Timer, I am now happy to share it with you. I hope you will find it of benefit. If you are a gamer new to meditation, I hope this may be the Welcome mat that invites you to try meditating. If you are not a fan of video games, I hope this deepens your insight and compassion into that art form. Mostly, I hope it brings maximum playfulness and status bar boosts to all sentient beings. 😊

Your Powerful Video Game Avatar

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Streaming, Path of Exile & The Repetition Compulsion

As many of you know I have begun streaming. My goal in doing this is to both have some fun, and reach a wider audience when talking about psychodynamic concepts. This is my latest attempt, in which I talk about the Repetition Compulsion in terms of farming for a unique sword in the game Path of Exile. Keep in mind that the conversation about the repetition compulsion during the stream if for a general audience, and should not be substituted for seeking out medical advice or a mental health professional. My hope is that you’ll share it with the gamers in your life, therapy practice, class, etc. And of course if you sign up to follow my Twitch channel I’d be delighted!

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Why Kids With Autism Should Stream

Like many therapists who work with adolescents with autism, I frequently get asked for guidance on improving peer relationships as they get older. Contrary to the stereotype, autistic kids do often crave peer relationships, dating, and popularity. It can make adolescence especially poignant as kids with ASD want to establish more independence from parents and gain the esteem of other teens but don’t know how to connect with their peers yet. They can experience heightened social anxiety, and retreat into coping mechanisms which help self-soothe but make them stick out when they very much want to blend in. There can be an uptick in depression, which increases hopelessness and decreases self-care. Decreased self-care leads to poorer hygiene, which makes teens even less popular. Parents, sound familiar?

So how do we interrupt this vicious cycle?

One way is to get your kids streaming online. Streaming, or live-streaming, is the broadcast of content over the internet on platforms such as Twitch or YouTube. The content can include commentary while playing or watching a video game, discussing a television series, plays, presentations on topics of interest, music, etc. You’re probably thinking “Riiiight, what does streaming have to do with helping kids on the spectrum become popular?”

Ok, stay with me here and I’ll give you some reasons:

1. Streaming promotes theory of mind

Anyone who has ever watched a streamer has had the experience of being in the audience. By empowering a teen to stream, we also create an opportunity for them to imagine the other out there watching. Even if they have few viewers to start with, we encourage them to act “as if” they were in a social setting where others have minds and feelings like they do and could respond to them. This reinforces the concepts of theory of mind and empathy, both in the streaming act and later in reviewing recordings.

2. Streaming is a very normative adolescent medium

Whether it be gaming, unboxing, critiquing videos or talking fashion, a majority of teens are now consumers of streaming culture, watching thousands of streams every day. It can be very empowering to let adolescents with autism know that they can be creators of streaming culture as well. Also, it takes the edge off of poor hygiene: In cyberspace everyone smells just fine.

3. Streaming can allow for 21st century social scripting and role play

Children and teens with autism are often being trained in social pragmatics, which has three general components: The ability to use language for different purposes (requesting things, greeting people, passing on information;) the ability to adapt language to changes in listener or environment (speak louder in noisy settings, speak differently to child or adult, give more or less information as needed;) and following unspoken norms or rules of conversation (taking turns speaking, gauging for interest, emphasizing points or emotions.) One way youth with autism can build mastery in social pragmatics is through the use of social scripts, practicing the rules and formula in low-stress environments where the social stakes aren’t as high or immediate. Streaming can provide such a place to do so, where teens can practice greeting viewers, looking directly at camera, pausing to view chat or take Discord questions, enthusiastically thanking viewers for watching, and ask what they might want to see next time, etc.)

4. Streaming allows for review

Streaming can usually be recorded, both the stream and the video recording of the streamer. This can provide the adolescent the opportunity to review and refine their social pragmatics with or without adult feedback. I ask my patients if they want me to watch at any point, and tell them I won’t be offended if they don’t want me to watch. After a stream, ask your teen how they felt when they were doing it. Were they able to forget they were being watched? Did knowing they were streaming live effect their speech or behavior in any way? How did they deal with questions or comments? What did they notice about their viewers? Do they feel energized or depleted afterwards? It can also be important to normalize their reluctance to view the recordings–many of us dislike seeing ourselves on camera, no matter how useful it could be.

5. Streaming allows the teen to behaviorally say “Hey, I want to put myself out there.”

No one starts streaming by accident, but starting a streaming channel can help teens overcome their social reluctance by embedding social engagement in content that they find enjoyable and invigorating. Have you noticed that it can be more invigorating to talk with people about topics that are interesting to you? Autistic kids think so too! The challenge is that a lot of times they are afraid to put themselves out there because they have had years of well-meaning adults talking about their “perseverating” on topics. As I have mentioned elsewhere, this concept is pathologizing and highly subjective: If you talk to me about football for more than 20 seconds, I’ll start to get bored think you’re perseverating. That said, many people can feel overwhelmed and ambivalent in the face of an enthusiastic person going on for a length of time. You know they are trying to engage and want to support that, and yet it feels too much! Streaming lowers the pressure on that for the listener, who can pause or take time off from watching if it gets too much for them, while still being engaged overall. Yes, part of the problem is the interest deficit in the neurotypical person–the problem doesn’t reside solely in the neuro-atypical one!

6. Streaming makes affinity groups larger and more accessible

Many teens on the spectrum have interests and intensity of interests that place them in the minority. This can lead to isolation and lower self-esteem, because they have fewer opportunities for mirroring from peers and their community. There are probably a whole bunch more people in Boston and Atlanta who spent February 3rd, 2019 watching football than My Little Pony, which can make the Bronies out there feel less-than. However, at any given time in the world, there is probably a larger group of MLP fans, and streaming helps flatten the world. Streaming, like technology in general, amplifies things and breaks down barriers. Don’t have anyone to talk My Little Pony or anime with? Start streaming narrations and discussions of episodes, and before you know it, you may have 1,800 people to connect with! There’s something for everyone, even those craving an online marathon of Mr. Rogers episodes..

7. Streaming can help kids develop other life skills

Been struggling with your child to get a job? Take a month or two off from the struggle. Help them set up a streaming channel. Then subscribe to Patreon, a platform that allows creators to accept income from people who want to foster their art. Maybe you can prime the pump a bit, to reinforce the work/income connection. I can’t tell you how many parents send mixed messages about money and work to their kids. Kids think a $50 bill they got in a birthday card from Aunt Mable is “my money” that they earned, when in reality it is a gift. Allowances may or may not be connected to chores, which are often a source of added conflict. Instead, why not have Aunt Mabel become a patron and donate $4 a month for the year to the teen’s streaming channel? That way, there really is a connection between work and income, and Aunt Mabel supports the arts? (Parents may want to self-check here to see if they are biased about their children and the arts. If you think art is not real work or valuable, that only a unique few can make a living from it, or that talent is entirely innate and you have it or don’t, then you are biased about your children and the arts.)

To get started, I recommend using Open Broadcaster Software, which is free and well-supported. Tom’s Hardware has a good reference for getting started here, just keep in mind you can stream much much more than video games, although doing that is cool too!

I do want to acknowledge that encouraging teens to put themselves out there has some real risks. Some of the streams and videos may be pretty quirky, and nothing vanishes completely on the internet. They may encounter hate speech or hurtful comments during the stream or afterwards, just like they may encounter it in life. They may feel very self-conscious after reviewing the stream. But I do think that for many teens with autism (or neurotypical kids for that matter) the rewards can outweigh the risk. Parents want to check for their own tech biases here: Do you support your youngster playing a sport? Risky. How about having them join martial arts, drama club, or run for student office? All risky. So why not encourage them to stream about something they like?

Curating an online presence for others, real and imagined, is actually a component of digital literacy we all need to do sooner or later, online streaming about a topic or activity of interest may give children and teens with autism some valuable practice and sheltered learning. It may also help them meet people in the wider world who share their interests, think they’re cool, and increase their popularity. That seems like a substantial reward to me.

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Tetris Beats Nazis: Video Games & Worry

This week I have two stories about video games, one that causes worry and one that effects it.

The first, worrisome, one concerns white nationalism, video games and propaganda. For as long as we have had Nazis, Aryanism, or White Nationalism, we have had its propaganda. Art is one of the most powerful medium that propaganda gets disseminated: Paintings by Erler and Feuerbach; film by Leni Riefenstahl; and music curated by Axis Sally were all examples of how the art form was used to convey Nazism. It should surprise no one that 21st century art mediums such as video games have their own share of deplorables.

One example, which I won’t link to, from the early 21st century was “Ethnic Cleansing” which came out in 2002. Since then there have been games like “Muslim Massacre” and “Zog’s Nightmare.” The games primarily target, Jews, Blacks, and Latinos, and are often on or linked to Nazi sites. Meanwhile, young people may find themselves being solicited online, where low-to-no moderation servers and bulletin boards like Discord and 4Chan provide a safe place to foster white supremacy.

Today, NPR came out with a story worth your attention, on the rise of recruitment efforts by white hate groups in online gaming environments. Now please don’t blame Fortnite. Most video games, even the violent ones, do not blatantly pedal nazi propaganda. The few that do are pretty explicit about it. What we need to worry about is how disillusioned and disenfranchised young men are vulnerable to being recruited by domestic terror groups, and of course they will be doing recruitment where youth are, including video games. My recommendation? When hate crimes or white supremacy comes up in your family discussions please ask your kids if they ever here things online that sound like hate speech or stereotypes. Assure them that you are more interested in hearing about what they may be experiencing than pulling the plug on Call of Duty, and that this is just one thing that people need to keep an eye on in online communities.

If anything shows up in their chat, consider taking screenshots and sending it to Discord or the chat platform you are using to let them know about the hate speech or recruitment. Both things are violation of TOS, and if your child doesn’t send it and someone else does they be banned themselves. Above all, keep an eye on gameplay, the content and the chat happening while it is happening. You don’t have to be Big Brother all the time, but let family members know that occasionally the games and chat need to be without headphones so you get a sense of who their “friends” are, just like you would if the friends were visiting your home in body.

Now that I have you worried about something new, go play some Tetris. That’s right, a recent study published in Emotion, a psychology journal, found that Tetris helped distract people from worrying by helping them achieve flow experiences. I have discussed before how distraction gets a bad rap and is actually evolutionarily adaptive. Here is some more research to support that theory!

So, now that I’ve made you worry, go play a little Tetris. You can do that here. Then, tomorrow, go vote.

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Yeah? Tell That to Squirtle: The Fallacy of “Screen Time”

Recently, the American Heart Association release an “statement” decrying the dangers of screen time. The report, according to USA Today, said screen time can lead to sedentary behavior increasing the odds that kids can grow up obese. The statement says among other things,
Although the mechanisms linking screen time to obesity are not entirely clear, there are real concerns that screens influence eating behaviors, possibly because children ‘tune out’ and don’t notice when they are full when eating in front of a screen.. (USA News & World Today, August 8, 2018)
Most people won’t dive deeper than the article and it’s quote, which is problematic in itself. “Although the mechanisms linking screen time to obesity are not entirely clear,” is really a way of saying what “this is a correlative statement, which is very different than causality.” If you are unfamiliar with the vast difference between the two, this is a great video to explain it. Come back when you’re done.

The problem with these studies, once they get amplified, is that they fuel the ongoing panic we have with emerging technologies. Once again, here’s my reminder list:

1. Doing any activity for more than several hours in a row is unhealthy, with the exceptions of sleep and meditation.

2. Not all “screens” are equal, have identical lighting and spectrums, and therefore identical impact on sleep.

3. Research shows that using your eyes at night stimulates the areas of your brain that arouse you. So reading, looking at your aquarium, crosswords, and even knitting will also hinder the onset of sleep if you use your vision.

4. Whether in a scientific journal or Trump’s “400 lb guy in a basement,” can we please stop fat-shaming people? Not every heavy body type is the same, nor is obesity a moral issue. Why not focus on teaching your children to be kind, critically thinking and funny humans than focusing on their bodies so much?

In fact, I can make a very different correlation, based on my experience with PokemonGo. This summer I increased my gameplay of this screen-based smartphone app quite a bit. To date I have walked over 150 miles catching Pokemon. I also have lost 5 lbs. My experience would predispose me to conclude that increasing this screen time has actually decreased the sedentary nature of my lifestyle, and lowered my weight. Of course, the fact that I spend half of my time in a rural community with friends who like to hike in the summer doesn’t hurt either, but that’s correlation for you.

While I’m at it, since folks are so concerned with the public health of our children here are some pro-active suggestions based on other possible correlations:

  • Stop fat-shaming kids so they seek escaping reality so much.
  • Fund schools better and test them less so things like recess are longer than 15 minutes.
  • Institute better gun control so children and their families aren’t afraid to go outside and get shot.
  • Decrease stigma of trans youth so they can safely explore gender in ways other than just an avatar of a different gender.
  • Make playgrounds and athletic teams universally accessible so that kids can play and engage regardless of physical differences.

You want to connect some dots, there, I got you started. Now stop going for the low hanging fruit and blame something other than Nintendo.

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Can’t We All Just Game Along?

I had a powerful reminder about the prosocial nature of video games this week, and it was nowhere near a console screen. I was on my way home and ran into a Dunkin’ Donuts, in a town I’d never been to before and was unfamiliar with. I ended up waiting in a rather lengthy line and was a bit grumpy. I happened to be wearing a T-Shirt which said this:

I hadn’t worn it for ages, and had forgotten in fact I was wearing it until the cashier called out to me, “I love your shirt.” Cue the endorphins.

“Thank you,” I said, and smiled (which thanks to state bound learning probably cued my body to produce even more endorphins.)  Waiting in the line seemed much more pleasant by this point. I ordered my coffee and sandwich and while waiting for them received another compliment from a customer walking by.

The third person to compliment me was a man in his 40s, scruffy and in jeans and t-shirt. “I love that game,” he said. “I haven’t played it in a while though.”

By now I was in a mood that allowed me to initiate conversations, so I asked “What are you playing nowadays.”

He proceeded to tell me that his 14 year-old daughter had gotten him into Fortnite. She had enjoyed it initially for the crafting, he said, because she really enjoyed Minecraft; but now that they were playing together she was enjoying the combat as well. His face lit up as he recounted how much fun they were having together. I told him about a study that had been done by Brigham Young that indicated increased levels of protective factors against depression. He smiled at that, and we both went on our way.

We spend so much time debating the neurological impact of playing video games that we often lose sight of another dimension; that of talking about playing video games. Talking about arts and culture is a powerful social adhesive. It identifies commonalities, allows for compliments and increased levels of engagement with others, allows us to recall exciting moments and share them. All of these activities in turn facilitate attachment, and increase a sense of well-being on the neurological level. That was the best line I’ve waited in a ages!

We need to find a way to get that message to Salty Sally the Social Worker and Morose Martin the Mental Health Counselor, whose eyes grow dull at the mention of gaming when their patients bring it up. “How much time are you playing Candy Crush?” they say, in uninviting tones, and eye such T-shirts as a clear sign of video game addiction. The next patient, who comes in with a T-Shirt of Monet’s “Water Lilies,” will get a compliment on it and no such screening for an Impressionist Art Addiction. In fact, the WHO didn’t include Art Disorder this go round at all, unless you include the art form of the video game.

In this current political climate, where we are so polarized, I wonder how many bridges (Minecraft or other) might be built if we paused to ask strangers in line if they play any games? I imagine Republicans, Democrats and Independents alike play something.

If Teams Valor, Instinct, and Mystic can all get along together raiding in Pokemon Go, perhaps we can too..

 

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Taking Leaps: Fortnite, HIPAA & Psychotherapy

“You keep dying,” Sam* said. The annoyance in the 9 year old’s voice was palpable. I looked at my avatar lying face down on the screen. Another of the 100 players in the game, appearing as a brunette woman in sweats sporting a ponytail, was doing a victory dance with her rifle over me. Sam was nowhere to be seen on the screen, but I knew he was hiding somewhere in the game, and seething.

“You’re disappointed in me,” I said calmly. A moment of quiet.

“Yeah.”

“You were hoping I’d be better at this, as good as you or maybe better, and it’s frustrating.”

“Yeah… Can we try again?”

And so we tried again and again, and while we did I talked with Sam about the other adults who were disappointments to him, who kept leaving or letting him down. And I guessed that we were also talking about his frustration and disappointment in himself. And at the end of our appointment I promised I would practice Fortnite, the game we had been playing. We had turned on our webcams again so we could see each other to finish the session, so I could see that he brightened at this idea.

“Nice to see you again,” I said. He smiled faintly.

“You too.” His screen went dark.

As I reflect on the work I do with patients, meeting them where they are at, I am struck by the same issues, opportunities, and conversations that can happen in an online play therapy session. I only wish more of my colleagues would try it. What gets in the way? For some it is a dismissal of emerging technologies which masquerades a fear of trying something new. For others it is a worry about running afoul of HIPAA and being sued. If you are one of those people who wonders about how to integrate video games online into your therapy practice, read on.

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Quick, without Googling it; what does the “P” in HIPAA stand for?

If you are a psychotherapist or other health provider, you probably guessed “privacy.” At least that’s often the consensus when I ask this question at my talks. It would be understandable if this was your guess. You’d be wrong.

The correct answer is “portability,” the basic premise that individuals have the right to healthcare treatment that moves with them as they go through the vicissitudes of life and work. That is also where technology comes in– electronic health records, telemedicine, etc., are ways that technology increases portability by collapsing time and space so that the patient and the healthcare professional can get to work.

In therapy, that work traditional has happened in an office setting. And in the case of children and youth especially, that meant play therapy which was bounded by the space and time of a physical office. From Uno to Sandtrays to the infamous “Talking Feeling Doing Game,” we have often assumed that play therapy needs to be the games of our own childhoods. But 21st century play can, and I maintain should, include 21st century play. That’s where video games come in.

In the days of the Atari 2600, there was no worry about patient privacy, because the system was hooked up directly to a television that didn’t even need to be connected to cable. But nowadays with SmartTVs, PCs and PS4s, video games are often played online with many other people and seamlessly connected to voice chat. This can be a concern for the psychotherapist who is unfamiliar with newer technology, especially with games like Fortnite, which boast Battle Royales having as many as 100 players at a time in the same game instance.

Videoconferencing programs and online therapy using video/audio chat have been around long enough to have specifications that adapt to HIPAA’s privacy requirements, largely because there is market force behind developing products that can be sold to the healthcare industry. Video games and their platforms, on the other hand, do not have a similar demand to give them an incentive to supply. Games like World of Warcraft, Platforms like STEAM, and streaming services like Twitch were designed for gamers, not therapists, and it is unlikely they will go through the technical and legal procedures to become HIPAA compliant anytime soon.

Some therapists have begun developing their own video games, which, like most therapy games are dismally boring. They are thinly veiled therapy interventions that are disguised as play, but lack any of the true qualities of play. True, they are more likely private; but they are also boring, and easily recognizable as “not playful” by patients. Mainstream games have broader appeal, critical user mass, and better graphics and gameplay in many cases, and are more immediately relevant to the patient’s life. But they are definitely not HIPAA-compliant. So what to do?

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My solution, which I’m sharing as an example that has not been reviewed by policy experts, lawyers or the like, has two parts:

  1. Due Diligence– Research the existing privacy settings and technologies to maximize benefit and minimize risk to patient privacy. So for example, I structure the “talk” part of therapy to happen over HIPAA-compliant software like Zoom or GoToMeeting. We start on that platform with video camera on, until we begin playing. Then we, turn off the camera to save on bandwidth and talk over this software, not the game. Previously, I will have sent the patient or their parent a snapshot of the settings of the game we are using with the voicechat disabled if possible. We also want to lower or turn off the game sound so we can hear each other. So in the case of Fortnite, the settings would look like this:

 

2. Limited HIPAA Waiver- This is the part most therapists overlook as even being a possibility. You can ask patients to sign a release waiving in a limited capacity their HIPAA rights in order to use noncompliant technology. It is entirely voluntary and I’ve yet to have a patient decline. I use a informed consent form that I developed that looks like this:

 

These are examples of how to engage with online technologies in a clinical way that is thoughtful yet forward-moving.

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Whether you love Freud or hate him, most experts agree that he was one of the fathers of modern psychiatry. He was also an early adopter. He based his hydraulic model of the drives on steam technology of his era. His concept of the “mental apparatus” was likewise integrated from the advances in mechanics and his formulation of ego defenses such as projection occurred simultaneously with the Lumiere brothers’ creation and screenings of motion pictures. Regulatory concerns aside, therapists can be early adopters. Doing so would probably help our patients no end, and definitely cut down on my waitlist.

* “Sam” is based on several patients whose identifying information has been disguised to protect patient privacy.

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