Thursday, April 29, 2010

Manners, Etiquette and Social Convention

When collegeman was very little we nicknamed him Little Lord Fauntleroy. He had the most innate impeccable manners that anyone had ever seen. He sat nicely at the table. Put his napkin on his lap. Kept his free hand in his lap as well, and chewed with his mouth closed. While he didn’t really talk and couldn’t say please and thank you, he could say “more” when he wanted another helping. The truth is we thought that because he was genetically predisposed to manners that there would not be a problem when he got older. Guess again. Somewhere along the line, he forgot every table manner he had ever known and added in a few really bad habits. On the other hand, with HSB we didn’t even have to think along the lines of regressed table manners, he just never had any to begin with.

The truth is that I think manners for a person with autism do not come easily. Remember as with every aspect of social convention and norms, our children need to be taught the whys and wherefores. They will not pick up manners as other children do, just by watching. They will not understand why they need to use a utensil as opposed to their fingers. They will not understand that they can’t walk around with a mouth full of spaghetti sauce. They will not understand that to chew with their mouths open is decidedly unpleasant to those around them. They will not understand that their face does not belong in their food. They will not understand that it is the norm to converse during meals. As with every aspect of their lives, social stories are a handy tool

Actually I think though that we have hit on some additional issues when it comes to manners. As far as using utensils: many of our children cannot hold a fork or spoon. They have fine motor issues which prevents them from using a typical grasp. However, you can find specially designed spoons and forks for children with fine motor problems. This will help them to understand that you cannot eat with your fingers. Interestingly, that cheerio-grip that everyone‘s child starts to do in infancy, when they start to learn to self-eat, does not come so easily to our children either. Again it is all connected to the same issue. Pediatricians tell you that with practice it will all come, but truthfully if you see your child struggling with learning something that should just be a regular developmental milestone, it should set off alarm bells. Of course we know that now. I wish someone had told me about that a long time ago. It may have saved years of not knowing what the problem was and what to do.

The open chewing problem could also be attached to an occupational therapy and sensory processing issue. As with HSB who still to this day, chipmunks his food, your child may not realize that their mouth is open. In fact, it might be terribly uncomfortable for them to chew with their mouth closed. Additionally those sensory issues that prevent your child from understanding they need to close their mouths, may also prevent them from actually being able to identify when their mouth is full, or to feel how chewed food is different than whole food.

But as with any reputable OT, the person that is working with your child should be able to help identify these problems and teach your child how to cope. They should also teach you how to help your child as they are not there on a constant basis. You should be given exercises and self-help techniques that you can teach your child. Also, whether we like to discuss this or not there are many types of foods that can provide your child with the nutrition that they need and you can try what works so that it is easier to chew and swallow. Everyone talks about food preferences for a child with autism, or special wellness diets for children with autism but no one talks about it in the context of sensory issues. It’s a child on an all white diet, gluten free or lactose free diet that everyone discusses, but some of our children need a sensory free diet. Granted there are many of you out there who already know this as well. Look at Temple Grandin who for years ate only yogurt and jello. Sensory eating issues are nothing new.

So once you have mastered the sensory and OT issues surrounding the mouth, what do you do about the rest of the table manner conundrum? Some children just do not have the wherewithal to sit for a long time at the table. Whether it’s because they have upper trunk issues and it is physically difficult for them to maintain that upright position in a chair, or they do not have the capacity to focus on the events at the dinner table, or they become overwhelmed by the sights and smells of dinner itself. We need to go slow and methodical when we teach them.

Start with sitting in a chair for as long as they can. Reminding them that for no matter how long they are at the table, the napkin goes on the lap, that they need to use a utensil not their fingers. (I know, they finally master the cheerio-grip and they can’t use it and have to use that special fork you bought. Just another confusing day in the world of autism). At first it is important for them to understand that these issues are important and that this is the accepted way to interact. Oh well, back again to that social convention issue that our children just never seem to get. Mine still ask about it all the time. Why is it important? What is the purpose? How is this going to affect my life? Why do I need to make conversation when I eat? What is the big deal about not using a napkin when my shirt works just as well? Why can’t I blow my nose at the table? Why can’t I lean on my free hand? Why are you bothering me about all this crap? (OK when they are little they don’t use the word crap. But as they grow they are able to pick up on some social norms that you would otherwise they didn’t.)

They truly don’t get the social convention idea. Luckily for us collegeman does have an eye to his future and we try to explain to him about interpersonal relationships and their direct relationship to success in the working world. He does sort of get it now, especially since everyone else seems to be telling him the same thing, not just us. You know he is at that age when whatever the parents say means they do the opposite, well just what I tell him, hubby is still considered the wise sage for now. But I give hubby that, a relationship with his sons is something he has longed for, for a really long time. The fact that collegeman in his own way worships his father is nice for the husband.

HSB on the other hand, while he isn’t so hard to direct about social conventions nonetheless doesn’t really care about them. He goes about his life, happy in his world and if you want to join in you are always welcome. We call it “HSB Land.” He will gladly invite anyone in who wants to come and sees no reason to really leave. He does however; get the social conventions of proper interaction and its need, especially since being still in highschool it is enforced on a daily basis. He is constantly reminded by those that work with him. Hopefully it will sink in and things in the future will be easier for HSB than they have been for collegeman.

Meanwhile, collegeman was making fun of HSB the other day, that people have to keep on top of him all the time. He likes to tell HSB that no one had to do that for him in highschool. I interjected and told collegeman that they didn’t teach him properly and it’s why he still needs help today in college with the classroom coaches. We are trying to make it so that HSB may not need the same level of support. “Oh,” collegeman said and he promptly stopped making fun of his brother. I could see the introspective look on his face. He was thinking that those in highschool didn’t help him like they should have. It is not something that he is outwardly talking about, but I bet if he meets any of the teachers from the highschool again it’s going to be a question in the conversation, and so it should be. But as hubby said about the mistakes made with collegeman by the highschool, what is important for the school is for them to take their errors and make sure that they do not do the same with any other child. Truthfully we also have to stay on top of everything too. We do not take anything for granted as we did with collegeman and demand real updates and discussions and meetings about the progress that HSB is making or not making in the realm of social convention.

I can’t explain enough how important these lessons are. We do call them social skills in some way. When your child is taught to take turns and play nice with others. When they are taught to raise their hand to ask a question and how to advocate for themselves throughout life. But the real world requires an added level of social convention that many of us forget. We make allowances at home for our children and we sometimes forget that manners and etiquette are truly important in the everyday work-a-day world.

Now does this mean that the boys are ready to go out the door on their way after all these years of social skills and one-to-one help and even etiquette lessons? Yes, we gave them etiquette lessons. We thought at one point that if a total stranger taught them some table manners and interpersonal skills it might stick a little better than if we were the only ones working on this issue. They loved the lessons. She was a really nice and elegant woman who taught them, and I think in some respects it actually helped. We stopped after the summer because it was time for school and there are just so many days in a week and hours in a day. But since they took those lessons they do not give us too much of a fuss about sitting at the table, hand on the lap and conversation during dinner. But, yes, collegeman still forgets to wipe the spaghetti sauce off his face without a reminder. I can always tell what he ate for lunch at school by what is left on his face or the front of his shirt.

I have to say that eventually I think everything will come together just fine. This past Passover the boys participated not only in our little Seder but in a Seder at their aunt’s house. While they were not always perfect, it could actually be chalked up to them being teens instead of having an autism episode. They read their parts, ate heartily and participated in conversation. It also was a much smaller gathering than at Thanksgiving so I think that may have made a huge difference too. The sensory input was not so overwhelming for them. But at the same time I would like to think that they are finally getting the hang of that social convention called table manners, and etiquette.

Next on the list is holding the door for the little old lady walking into the store behind you instead of letting the door hit her in the face. Of course in today’s world, people figure that they have no social awareness because they are teens. We do get a smile when I chastise the boys for their bad manners, and usually I get the same response, “Don’t worry, dear,” the old women say,” everyone eventually learns.” Little do they know, that for that I say a little extra prayer as I make a huge nuisance out of myself and remind the boys once again about social convention, manners and etiquette.

Until next time,