Wednesday, May 24, 2017

How Western ideas about success fail disabled youth

By Louise Kinross

Much has been written about how using normal development as a rehab benchmark sets disabled kids up to fail and devalues different ways of being in the world.

Now a new study looks at how Western ideas that equate adulthood with independence, work and education marginalize young adults with developmental disabilities—and their parents.

“When transition policies and practices for disabled youth are shaped on achieving this ‘normal’ adulthood, how does that disadvantage youth who aren’t able to participate in valued ways?” asks Yani Hamdani, an occupational therapist who won first prize in the 2017 Bloorview Research Institute Pursuit Awards for her PhD research.

Yani analyzed three Ontario policies aimed at moving youth with disabilities into adulthood, and interviewed the parents of 13 young adults with disabilities like autism, cerebral palsy and Down syndrome. All of the young adults had an intellectual disability and some also had physical disabilities.

One of the most interesting findings of her research is that parents neglect their own lives and health to coordinate meaningful things for their adult children to do.

“We put this expectation on parents to raise this ‘ideal’ adult, but we don’t have anything in the policies to address what happens if the young person doesn’t get there,” Yani says. “These parents are so busy trying to create community life for their children that they don’t spend time with their friends, they don’t do things for fun, and they can’t retire when they want to, because they have to pay for programs and supports. Services are so incomplete that when children leave school the family has to run a five-day program to replace it.”

Yani says she became interested in her research because she used to develop transition programs for youth at Holland Bloorview. “We were starting to do a really good job of transferring clients to adult health care, but many parents I’d collaborated with later talked about the significant challenges they faced in creating a life for their child when they left high school” and services dried up.

Yani’s study used a critical policy analysis approach to “identify and unpack taken-for-granted ideas about disability and what constitutes a ‘proper’ adulthood, and how these shape policies and practices.”

What she found in Ontario policies and interviews with parents were implicit assumptions about a normal adulthood that position disabled teens as problems in need of intervention, Yani says.  

The transition policies—one from the world of rehab, one from education and one from developmental services—“place emphasis on normal ways of being, becoming and acting like an adult,” Yani says. For example, the education one “focused on the idea that almost all students will transition to work, further education or community living.”

These policies are well-intended and help some disabled youth set and reach goals for moving out on their own, going to university or working, Yani says.

But they exclude and marginalize those who can’t. “What is the experience of hearing that you need to be fixed for your whole life?” Yani asks. “How do you internalize that, in terms of who you are in society and what people think about you? While these policies aim to help, they perpetuate ideas about who is valued and who is not.”

One policy attempts to convey diverse ways of living as an adult, but refers to the goal of active citizenship. “What does active citizenship actually look like if a person is not physically or intellectually able to participate?” Yani says. “Is being inactive or passive less valued, and to be prevented?”

For young people who don’t develop typically, we need to think beyond the transition to adult services to health and wellbeing over a lifetime, Yani says. “We need policies and interventions that promote health and diverse ways of living a good life, and that recognize that the Western ideal of adulthood isn't possible or desired by everyone.”   

In thinking back to her time working with families on transition Yani says, “I needed more education and training on what a good life could look like if a person wasn’t going to go to work or college. And I needed to be able to talk about these possibilities in a way that didn’t imply they were less valuable than traditional paths.”

Yani says clinicians need to start talking with families about unconventional futures for their children. “We need to talk to families about a variety of ways of living well, and what they might look like.”

Yani says her findings need to be shared with policy makers and to be part of the dialogue at the beginning of research on transition.

Instead of looking at disability as a problem that needs to be fixed, Yani says we need to embrace diverse ways of living, and view disability as a kind of difference, like we do race, gender or sexual orientation. “We need to free people from social ways of thinking that, left unquestioned, marginalize or disadvantage them.”

Yani was surprised that despite the extraordinary efforts of parents in her study to support their adult children, they didn’t describe this unpaid work as onerous. “There’s a social pressure for these parents to create these lives for their children and to take on the stress, almost without complaint. Our policies are silent on the mental health and social consequences of that for parents.”

Yani notes that some parents did use the word “burden” when describing their fears about care for their disabled child falling to a sibling. “It’s not proper for a parent to say that they feel burdened with this situation, but they do talk about not wanting to burden another child. I found that really, really interesting.”

For youth with developmental disabilities, Yani says we need funding and services that focus on family wellbeing over the lifespan. “Not all parents and youth want the same things, so there isn’t one answer. That’s why we need very flexible policies and supports.”

Yani Hamdani (below left with scientist Amy McPherson) completed her PhD in Social and Behavioural Health Sciences in 2016 at the Dalla Lana School of Public Health at the University of Toronto. 



Tuesday, May 23, 2017

'When I'm swimming, I feel normal'

By Louise Kinross

Swim Team is a gorgeous documentary about a competitive New Jersey swim team made up largely of Latino and Asian youth with autism. It focuses on three of the team's stars as they prepare for competition. "I'm not like other teenagers," says one of these boys. "I'm autistic. When I'm swimming, I feel normal."

We also get to know the boys' parents, who talk about their experiences raising them and their frustration with a lack of school preparation and support as they enter adulthood.

The film was shown at Holland Bloorview a week ago as part of the ReelAbilities Film Festival.

I'm setting up an interview with director Laura Stolman. Stay tuned!

Friday, May 19, 2017

For this scientist, a healthy weight isn't a number

By Louise Kinross

Amy McPherson is a scientist at Holland Bloorview who is co-lead of our Centre for Leadership in Participation and Inclusion. Amy’s research looks at health promotion and obesity in children with disabilities. Eight years ago she packed up her life in Britain and moved to Toronto to become a scientist in our Bloorview Research Institute. “I’d been teaching psychology and sociology to medical and nursing students, and I wanted a new adventure that would focus on my research,” she says.

BLOOM: What led you into the field of children’s rehab?


Amy McPherson:
In the U.K. I did my PhD in self-management in childhood asthma. My research has always looked at empowering kids to look after their health by giving them the knowledge and skills—but also the feeling of control over their health—so that they can manage a chronic condition.

When I saw a job opportunity in Participation and Inclusion here it encapsulated my philosophy of working with children with long-term conditions to help them participate and be as active as they want and can be. I did an interview on Skype and I came here for a meet-and-greet. Then I moved 3,000 miles.

BLOOM: Was that a hard decision?

Amy McPherson:
It was a no-brainer. I was really drawn to the fact that no one here talked in terms of deficits in kids with disabilities. I met people who were committed to giving kids with disabilities a future that was as meaningful as any other kid’s future.

BLOOM: Can you describe your research?

Amy McPherson: When I first came I was interested in our Busy Bodies program, which promoted healthy eating, physical activity and feeling good. My office was embedded with clinicians in Therapeutic Recreation and Life Skills. That was a phenomenal opportunity to understand what went on in the hospital from a clinical perspective. I worked with therapeutic recreation specialists to understand what the kids in the program thought about health: ‘So you have a disability, what does that make health look like to you?’

It was a great introduction to rethinking my notions of what had been quite a medical approach to self-management, and looking at why participation matters. That was a springboard into looking at different aspects of health, wellness and happiness and working with kids with an existing condition to see what they want their health to look like.

BLOOM: Where does weight fit into that?


Amy McPherson: There’s a two to three times higher prevalence of obesity in kids with disabilities. That puts them at risk of the same secondary conditions that any child with obesity faces. But in addition, it can be harder for a child with a disability who is heavier to move around, do self-care and be independent. Different diagnoses also come with specific challenges that make it hard to manage weight.

BLOOM: How can we help clinicians and families address weight issues?

Amy McPherson: I’m very interested in how we talk about weight and weight management. Often kids get weighed and measured when they come in for regular checkups, yet we hear from clinicians that they have concerns about talking about the topic. This is true with kids in general and their families, as well as kids with disabilities. Doctors don’t feel confident and are worried they’ll ruin a relationship. It’s a hugely stigmatized issue and by doctors saying ‘I don’t want to offend anyone,’ they’re acknowledging the implicit stigma in society that higher weights are bad. We want to find ways to address weight and wellness that are not stigmatizing and judgmental, but supportive and positive.

BLOOM: How do you do that?

Amy McPherson: We’re doing something super cool. Working with Christine Provvidenza, we got Centre for Leadership funding to develop a knowledge translation casebook that is a practical handbook for health professionals about how you talk about weight. It will have things like sentence starters and scripts and simulations of positive and less-positive experiences. It will also have case studies and learning guides and will talk about what the evidence says.

One of the fun parts is that we’re working with families, youth, clinicians, researchers and students to co-develop the content for this handbook. It will be online and interactive. It’s for all children and parents, but will also have chapters addressing common challenges related to different disabilities.

BLOOM: What’s an example of neutral language?

Amy McPherson: The doctor could say: ‘Would it be okay if we talked about how you can feel healthy and energized?’ Or ‘Would you be interested in knowing more ways to stay healthy? How can I help?’

We want to encourage clinicians to have a conversation about wellness that suits the child. You may live in larger body, it doesn’t bother you and you have no medical complications. So we talk about what makes you feel well. Or, you might have a higher weight and a lot of medical complications and are distressed about it. So it may be appropriate to focus more on the weight and work together to reduce those health risks. But we need to always address it in a positive way. There isn’t a one-size-fits-all, and not everyone who weights over ‘x’ has to be subjected to a medical intervention. It’s not realistic and the evidence doesn’t support that.

Research shows that the vast majority of people who lose weight regain it. Physiologically our bodies will always try to put that weight back on, and it’s got nothing to do with will power. So what is sustainable for this person, and what does health and wellness mean to them? That’s hard for people to get their minds around, because we’re so used to saying ‘let’s fix this, let’s get the number down.’ But we’re setting up people to fail when we do that. There are physical ramifications to putting on and losing weight and it can also be incredibly damaging psychologically.

BLOOM: I’m assuming that one of the reasons doctors don’t like to talk about weight with children is that no one really knows what to recommend?

Amy McPherson: There’s very little evidence about how talking about the topic in different ways affects outcomes. In the future, we’d like to evaluate our knowledge translation casebook in different health settings to start to understand this area more.

BLOOM: What do you love about your work?

Amy McPherson:
I love designing ways to figure out what’s really important to individuals and how we can support that person to work towards that. I’m a huge fan of strengths-based approaches. What are you really good at? What are your resources and strengths? How can we support you to thrive, whatever that means to you? I’ve worked on topics like incontinence, sexuality, weight management and wellness. We just received CIHR funding for a study on solution-focused coaching for kids on health promotion goals that they set for themselves. That’s for kids with spina bifida and cerebral palsy.

BLOOM: What’s the greatest challenge of your work?


Amy McPherson: The hardest thing is to break away from the idea that health is a number and it’s just a case of eating less and moving more.

BLOOM: What emotions come with this work?

Amy McPherson: A whole mix of emotions. It’s exciting to be part of a movement that’s enhancing the field. I’m very comfortable with an approach on wellness that is individualized and means something different to each person. It compliments with my own personal philosophy that rather than ‘How can we get you to live in a smaller body?’ the question should be ‘What do you find motivating?’ A person’s best weight has been described as whatever weight a person achieves while living the healthiest lifestyle they enjoy, which I think is a lot more feasible and positive for most people.

The work is also inherently frustrating because it’s complex, and you’re trying to figure out the best way to move forward without doing damage to anybody.

The stigma around kids with disabilities and people who live in bigger bodies makes me feel very sad. And when you have the two together, it’s an intersection of multiple stigma.

BLOOM: I would like us to do more research looking at how we can help children feel comfortable in their own skin. I’ve heard of kids with amputations who wore hot, heavy prostheses for years, even though they didn’t help functionally. And then when they feel more comfortable with their bodies, they abandon them. One woman with no arms in a BBC interview described it as being her ‘independence day.’

Amy McPherson: There are huge parallels between the stigma associated with size, and the stigma associated with other body differences. Difference is not emphasized enough. For example, very often the health benefits of things like being active and eating well are overshadowed by weight loss and unrealistic body ideals. Traditionally in rehabilitation, we haven’t been so good at looking at the big stuff that matters to youth with disabilities—beyond the physical, the function, the fix. We hear that our kids in school often don’t get health and sexuality education. I’ve heard of students with disabilities being told to leave the classroom during those sessions because they don’t need it. We can do so much better.

BLOOM: If you could go back and give yourself advice when you were just starting out in this work, what would it be?


Any McPherson: You’ve got to be really tenacious. It’s a bit of a roller coaster, but you need to stick with it and stick with high standards at all times. And collaborate. That’s where the fun is—in working with other scientists, clinicians and families to come up with, if not solutions, then approaches to the things that are really important to children and families.

Monday, May 15, 2017

Kudos to Johnson's Baby for its new ad

By Louise Kinross

Johnson's Baby released a new ad that features a child with Down syndrome for Mother's Day. 

It begins with a close-up of a baby's beautiful blue eye, with the line: JOHNSON'S BABY CELEBRATE LOVE AND DIVERSITY.

Then it moves to other baby parts, the toes, chubby fingers stroke a leg, then touch the tummy, hands clasp, and we see the soft skin of the baby's back. Finally, the child's face is revealed, and he smiles. He's a baby with Down syndrome.

WITH A BABY WITH DOWN SYNDROME flashes on the screen. 

According to the Buzzfeed piece linked to above, Johnson's Baby posted the clip on Facebook with this message: "For us and for all mothers, all babies are Johnson's babies."

I love this ad. I love that it conveys the value of every child. I love that Johnson's is including babies that have been marginalized. This is a BIG deal.

I just wish they didn't have to include the child's diagnosis: WITH A BABY WITH DOWN SYNDROME.

The ad speaks for itself. The baby conveys the message of diversity. 

Would a similar ad with an African American baby say: WITH A BABY WITH BROWN SKIN?

Of course not. 

I can't wait to see what kinds of diversity Johnson's Baby brings us next. I hope this is an ongoing series designed to show us the beauty of all children.

The ad was created by Brazilian ad agency DM9.

Friday, May 12, 2017

Students run concussion rehab program for youth

By Louise Kinross

There’s little science to show how to best help youth with concussions who continue to be bothered by headaches, fatigue and dizziness.

A new research study at Holland Bloorview is testing the impact of a six-week program of education, low-intensity exercise and relaxation on 200 youth aged 10 to 18 who have concussions, most of them sport-related.

“We want to know if this active rehab approach works for kids with concussions, and, if it does, at what time points after the injury,” says co-investigator Anne Hunt.

The study design is innovative because it’s carried out by students who are clinicians in training. This includes students in their final year of occupational and physical therapy and kinesiology.

The youth with concussions first come in for a series of brain and body fitness tests. “Based on this, we prescribe an individual exercise program that has an aerobic component, like walking or riding a stationary bike, as well as up to 10 minutes of sports-specific coordination drills, and five minutes of relaxation through deep breathing or visualization,” Anne says. “We go through our Concussion and You handbook, which covers things like how to conserve energy, good sleep hygiene and tips for returning to school.”

Over the next six weeks, the youth carry out the exercise program at home and call or visit the students running the program for support. At three and six weeks they come in to have their fitness levels and health reassessed.

“Families tell us that health providers or coaches encourage the kids to push through their symptoms, or to work at a higher intensity than we do,” Anne says. “This can make their symptoms worse or slow their recovery. We teach them what it means to work at a low to moderate intensity. Ours is a very careful, methodical program. Some kids may only be able to start at two minutes of aerobics when they first come in.”

Having students run the program has many benefits. “We tell the clients participating that they’re not just helping us learn about concussion, that they’re training these students,” Anne says. “The kids tell us they love working with the students, who are younger, whereas I’m sort of more of a mother figure. All of the students come in with a wealth of experience. For one client they may need to develop sport coordination drills for volleyball, whereas another client needs dance or lacrosse drills. The students work together, given their different professional roles, to divvy up the assessments and scope of practice.”

Andi McHugh, a physiotherapy placement student, says she’s gained confidence “because we’ve been given a lot of autonomy. In other placements, you’re working more closely with your supervisor. Here, it’s more self-directed learning but with peers you can bounce ideas off.”

Tesca Andrew-Wasylik, who just finished a five-week placement in the concussion program, agrees. “Being part of a student-run clinic is such a unique experience. 
I've enjoyed the challenge of being presented with a problem and finding a way to solve it independently, while still knowing I’m being supported by my supervisors. I think it’s very successful in preparing students for the real world and reinforcing autonomous learning. I’ve learned so much about collaborative practice and family-centred care, as well as learning from the families and kids that I worked with.”

Tesca graduates this year as a physiotherapist. She's shown working with Emma, 10, in the photo above.

The research is funded by Scotiabank, and is cost-efficient because it’s implemented by students rather than staff.

Study results are expected in two years and the researchers hope they will inform best-practice guidelines on rehab for youth with concussion.

Thursday, May 11, 2017

What I consider when writing about my son

By Kari Wagner-Peck

My book Not Always Happy: An Unusual Parenting Journey comes out on May 16. Yes—I’m one of those people who finds their life experience so interesting I wrote a book about it. But first I wrote for several years on my blog about my husband, about me and mostly about our son Thorin who lives with Down syndrome.

I started the blog because I didn’t relate to much of what I was reading about Down syndrome. I didn’t fit the typical profile myself. I was 49 years old when I became a first-time mother, married to a man 14 years my junior. We adopted a boy with Down syndrome who was in foster care. I quickly realized if I wanted to read about someone like me, I would have to write it. I knew it would be funny, angry and not about how I felt about Down syndrome, but how Thorin felt about everything. About 60 per cent of the time I don’t actually write about Down syndrome. I write about us and have found that even with our quirks we are not that different than any family.

My most consistent dilemma is—is it really okay to write about Thorin? You can Google Thorin and find countless links to on-line content including photos. That thought fills me with concern and sometimes outright fear. So what over-rode my concerns to write about my son? And what restrictions do I impose? I have some thoughts.

Social justice narratives and social commentary are important

Social justice narratives and social commentary sounds stuffy, not fun and lecturing. Two things happened that made me not see them that way. When I was 12 years old two books showed up in my family’s bathroom: The Grass Is Always Greener by the Septic Tank by Erma Bombeck and Dick Gregory’s *igger. I read both within days of each other. I learned from Gregory that civil rights stories could be told in a personal, funny and sharp tone. From Bombeck I learned that the isolation of parenting in the status-conscious suburbs could be viewed in a good humored way—in spite of the fact that I was 12 and raised in a working class family.

At the beginning of this journey I justified my decision to write about Thorin because my narrative challenged existing perspectives about raising a child with a disability. I couldn’t relate to the idea of grieving a Thorin without Down syndrome. I objected to the notion that Thorin is an angel from heaven. I had no time for a laundry list of things Thorin will never do. This quote has been on my blog since day one: “I exist as I am, that is enough” from Walt Whitman’s Song of Myself. That was the premise. I told myself that by writing about Thorin I was helping to change the narrow view ascribed to all people with Down syndrome. I stick by that and I hope it is true.

Thorin is not emblematic of Down syndrome


I’m writing about Thorin to try to change a bigger world view about people with Down syndrome, but he is not a symbolic character. This one is trickier and thornier. I wrote about telling Thorin he had Down syndrome by explaining to him that he had a super power called Down syndrome and one of his powers was farting. I wanted him to know he was like everyone else.

Just days before our talk, Thorin, then 6, wore his Thor costume to the screening of the film Thor. If he loved My Pretty Pony as much as The Avengers I would have said he had a magic power and that’s likely how a Brony is created. Some mothers were reasonably upset because they assumed I was suggesting all people with Down syndrome have super powers. Some were also upset that I said farting was a super power. I should add that my husband thinks farting is a super power. Soon after I gave Thorin the genetic description of Down syndrome. He grew bored and utilized another super power by telling me to stop talking. Our original conversation would play out for years to come and in fact is the book’s epiphany.

The stories I choose to tell aren’t about Thorin’s Down syndrome but instead about who he is as an individual—his love of taking photographs, his obsession with The Avengers, his struggles with communication, his anger with being treated like a baby, his kleptomania and his storytelling abilities—take for example I Love You Eyeball Cheeseburger.

Thorin’s past is off limits

Thorin was placed in protective custody. That’s the most people know. One can assume that sort of thing doesn’t happen if a family has had a bad day, but when something harder and more tragic transpired. That information is at Thorin’s disposal when he is an adult. It isn’t for public consumption. Related to that is the fact that I want to be as respectful as possible of his biological family for Thorin’s sake. Thorin has made, for now, an evolved peace with his past that I cannot fathom, and with his “ex-mother,” as he refers to her. What I do share is the Byzantine process of state adoptions because it isn’t the typical story of family-making or even adoption. If you want a great story on how Dunkin Donuts Munchkins got us our adoption worker, you’ll have to read the book.

I do not write about my parenting frustration or wine consumption

I chose to be a parent at what is considered to be an advanced age. I didn’t expect it to be a picnic all the time or a shit show. I was grateful I had a chance to do what I had wanted for decades. My frustrations are mine. Same with all my relationships. My point of difference is not what an asshole my son is or how disappointed I am in my husband. Instead I write about my own perceptions and mistakes. I don’t find writing about parents who drink funny in general. That’s right I’m judgey. In fact I’m imperfect. I exist as I am. That’s enough.

Thorin has say in what I write about


In the early years of the blog I made those decisions for myself. Now I ask Thorin what I can write about. Consequently, I don’t write as much as I did. Lesson learned. He is a burgeoning tween—with feelings, experiences and ideas about what he does not want others to know. That’s his right and I respect it. He has crushes, but I’m not allowed to talk about on whom. He feels strongly, but I can’t always say about what. He has some ideas that are private. I’m doing a reading at a book launch party next week at a local bookstore. At first Thorin had said he wouldn’t go. When his best friend, Ella, said she wanted to attend, he said he would go but would leave while I read about him. Tonight leaving theatre class I asked, “Would you help me pick out what I read? Can I suggest stories and you decide?”

“Yes.”

“Do you think you will go outside with Daddy?”

“I do.”


Kari Wagner-Peck is a social worker and writer who homeschools her son Thorin in Portland, Maine. You can follow her at A Typical Son.



Wednesday, May 10, 2017

Immerse yourself in disability art

The ReelAbilities Film Festival is holding its free Family Film and Art Day at Holland Bloorview on Saturday May 13 from 10 a.m. to 4 p.m.

Five films are being screened as part of ReelAbilities, which is presented by the Miles Nadal JCC. This is a great opportunity to see films about the lives, stories and art of people with disabilities and Deaf people.

There are also inclusive art activities for the whole family at Holland Bloorview and a lunch-time youth panel on arts and accessibility.

Reserve your free tickets at toronto.reelabilities.org.