Mind Dive

Teaching Independence to Neurodiverse Children

• The Menninger Clinic

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What happens when neurodiverse children transition to adulthood without crucial life skills? Kristen Lombardi and Dr. Christine Drew tackle this pressing question in their groundbreaking book "Spectrum of Independence." Drawing from decades of professional experience, they reveal how many children with autism and intellectual disabilities "graduate to the couch" after school ends, lacking the fundamental skills needed for meaningful independence.

The conversation unpacks their innovative approach to teaching daily living skills, starting with task analysis—breaking seemingly simple routines like toothbrushing into manageable components. This method transforms overwhelming challenges into achievable goals, allowing parents to pinpoint exactly where their child struggles instead of giving up entirely. "It's not that they can't brush their teeth," Lombardi explains, "it's that they can't complete specific steps within that process."

Perhaps most remarkable is their emphasis on starting early. While many parents focus on academics, waiting until adolescence to address independence creates missed opportunities. Teaching a seven-year-old to shower independently provides years of practice before the pressures of adulthood arrive. As Dr. Drew powerfully notes, "People with disabilities' worlds get really small, really fast if we're not careful"—highlighting how limited independence restricts future options for housing, employment, and community involvement.

The authors balance practical advice with compassionate realism, acknowledging that independence exists on a spectrum. Their message resonates with profound hope: regardless of where a child falls on that spectrum, progress is possible with the right teaching approach. "We can always teach one more skill," Dr. Drew reminds listeners, offering a lifeline to parents navigating the challenging journey of raising neurodiverse children.

Ready to transform your approach to teaching independence? Check out "Spectrum of Independence" and discover practical strategies to expand your child's capabilities and future possibilities.

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Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.

Dr. Kerry Horrell: 0:32

Welcome back to the Mind Dive podcast. Today, we are very excited to have two guests here to talk with us. So we'll go through both our bios real quick. First, we have Kristen Lombardi. Kristen is a New York State certified special education teacher, a board certified behavior analyst, and New York State licensed behavior analyst who's worked in the field of special education and applied behavior analysis since 2002, just a little bit of time. She earned a master's degree in psychology from Queens College, CUNY, and completed her BCBA coursework through Penn State University. We also have Dr. Christine Drew with us. Christine is a assistant professor of special education at Auburn University, where she teaches graduate and undergraduate courses and works with Auburn's inclusive higher education program for students with intellectual disability. She became a BCBA in 2015 and earned her PhD in special education from University of Oregon in 2019. Together, they recently wrote a book called Spectrum of Independence, How to Teach Your Neurodiverse Child Daily Life Skills. It recently debuted on March 26th, and we are very excited to talk with them both today about their book and about their work. Welcome.

Dr. Bob Boland:1:50

Welcome.

Dr. Kerry Horrell: 1:51

Thank you for having us. Awesome. Well, thank you both for being here. We're going to start with kind of our typical first question, which is how did you both get interested in studying and working with neurodiverse folks? Christine, you want to kick us off?

Dr. Christine Drew: 2:05

Sure. So, my first job teaching was in a behavior program in a middle school. So, I like to say I have really strong feelings about deodorant. And I come by that honestly. And so, my students had lots of different types of support needs. So, basically, anyone with an IEP who also had behavior support needs, whether that was social skills or challenging behavior, they were in my classroom. And so, again, sixth, seventh, and eighth grade. And I watched as they progressed and it always seemed like supports were being peeled away. And while I understand that, you know, the idea is that, you know, as students don't need support, then we remove them. But, you know, social skills needs in fifth grade are very different than social skills needs in eighth grade. And so this, yeah, so this phenomenon of like, “oh, they're done with speech. You know, we can just kind of move on” really bothered me. because I could see that there was still a need. And so while watching that happen, I really started seeing my passion was for adolescents, students with disabilities who were going through this transformative time. And so I got my BCBA and my master's while I was teaching. And then I realized that there was still a lot that we did not know about how to support students with disabilities, and particularly adolescents. And so I went to get my PhD. Common story, I think. And my PhD, we focused on challenging behavior. Then I came to Auburn right before the pandemic. And so I was going to go straight into challenging behavior research, sort of on the same track as a lot of people do. And then COVID hit and I started looking at things on campus that I could do. So I was already working with people with disabilities. But then in my personal life, I have a really big, I really want to support people with disabilities and living a full life. So for me, that looks like sex ed. And so I started working with the inclusive higher ed program here in Auburn on sex ed, and I teach the sex ed course for them. So it was kind of a winding path. And then we'll talk about how Kristin and I met. But yeah, I was already working with the inclusive higher ed program and seeing, again, the students who came to college campus where there are really not that many structured supports, like the university doesn't provide support, and what the program was having to provide. And so again, we'll talk more about that, but it's sort of where our interests overlapped.

Dr. Bob Boland:4:44

Great. And Kristin, tell us about your career.

Kristin Lombardi:4:47

So I started in early intervention and the bulk of my career in the beginning was early intervention and preschool services. And then as time went on, I started working with elementary school students and then eventually high school students. And now I have even some kids who are in college, but I run the whole... gamut. My initial interest was child development. One thing led to another and ended up in the field of autism. And I think what really interested me was that I saw so often that as soon as a child had a diagnosis, they were sort of written off and there was this belief that they're just not going to be capable. They're not going to accomplish. The focus was on everything they weren't going to do. And what I realized was that in many cases, it wasn't that they were not capable. They just needed to be taught differently. And that if you taught them the way that they learned, they very much could make progress. And so that's really been my sort of my big focus on my practice is how do I need to teach this to a particular student so that they're able to learn this info and live as independently as possible.

Dr. Kerry Horrell: 5:58

And how did you two meet and begin your collaboration together?

Kristin Lombardi:6:00

We, so we met at, they have these conferences, inclusive higher education conferences, and Christine was there. The first one was actually at Auburn where she works and I had gone and there was very, very few people from K to 12 at these conferences. And we, at a second conference, we met actually in Syracuse, we were having lunch and it was me and a whole table full of people who work in inclusive higher ed and and they were all talking about how the parents need to fade themselves more than they are before they drop their kids off to college. That the parents are very involved in doing more for their kids than they realize. And that when the kids get dropped off for college, they struggle. So I said, You have no idea how much these parents have to do to prepare their kids to get to you because it's not being done in the schools many times, especially with the activities of daily living. The school's not teaching your kid how to shower themselves.

Dr. Kerry Horrell: 7:04

Right.

Kristin Lombardi:7:05

And so I said to her, there's got to be a way to bridge this gap. Like, how do we get from the K to 12 gap? So that they're ready to actually make it to you. So I work with the younger kids, but she's the one that had the information about what they actually needed to be ready for that level of a program.

Dr. Christine Drew: 7:25

Well, when we started looking at writing a book, we were like, okay, great, we'll write a college prep book. And then we started outlining that. And about a week in, I was like, this is five books. This is not a single, you know, because it's, it's for our students with disabilities starting at 18. It's not that it's too late. We never want to discourage. We want to encourage, but if you're starting at 18, you're really limiting the number of practice opportunities that someone has for say, brushing their teeth independently, as opposed to if you start at six or seven. And so we realized we cannot start with the parents, you know, Oh, your kid is 18. Here's where you start. We really needed to backtrack all the way to, you know, eight to 11 years old and then scaffold up. And again, it's, you know, we had parents who would come in and say, you know, I really thought my kid was being independent at taking their vitamins and their medicine in the morning. But what I was doing was opening the pills, you know, making sure they have the right amount, putting it next to their orange juice, reminding them to take the medicine. And that kind of where parents, again, they've been doing this for 18 years, 22 years sometimes, you know, because these programs go up to 26, and they just don't know. They don't know all the prompts they're providing. They don't realize that them standing in the doorway of their kid's bedroom is the prompt to get dressed.

Dr. Christine Drew: 8:49

And that no one's going to do that when they are living in their own apartment or living on a college campus.

Dr. Bob Boland:8:55

Sure.

Dr. Kerry Horrell: 8:56

I was going to say, I work primarily with young adults and adolescents and especially my young adults. I work pretty frequently with folks with usually like level one autism. But I've seen this where they're coming into treatment because they became pretty depressed or experienced significant shame, anxiety because they went to college and they didn't do well for a myriad of reasons. But really, a lot of times these folks with autism, it's like I couldn't function properly. in the ways I knew how to function and I crashed out. And then again, a lot of feeling poorly about themselves. So I think this is huge. Like this is such, yeah, this just feels so clearly like a need.

Dr. Bob Boland:9:33

Yeah, but can you say more about that? I mean, your book obviously is about fostering independence for neurodiverse folks. And I mean, can you say a little bit about the need that you saw and a little bit more about how families are struggling with this?

Kristin Lombardi:9:46

Yeah, and finish what you, the thought you were saying is that, so those are the level one things With autism, when you start then also talking about the students that have the intellectual disability, they also end up depressed and not living a full life. They don't necessarily make it to not a typical college, but they don't necessarily even make it to an inclusive higher ed college. And when the K to, I guess, 21, a lot of times they can stay in the school until 21. When that ends, there's nothing. There's a line in the book that Christine came up with about the kid graduating to the parent's couch or their basement. And so there's a need wherever you are on the spectrum, because I think if any person's goal, right, is to be able to live as independently as possible, to be able to make decisions for themselves and to live a full life by having a job, by having friends, by having activities that they're interested in. And what I was seeing on my end is that the kids were not being prepared for that, that there was a lot happening in their high schools where they were sort of being prompted through participating on things that weren't going to carry through to after graduation, that they were being prepared to work in supported job sites versus actually having a job where they were responsible for themselves and their work. And that they went from having a relatively full schedule as far as being in school all day to graduating and then maybe having a couple hours a week worth of stuff. And then, yes, the depression, the anxiety, the loss of skills, the isolation. Yeah. Christine, do you want to add?

Dr. Christine Drew: 11:33

Yeah. And I think that, you know, the students that we have in our inclusive higher ed program are, for perspective, there's something like 315 inclusive higher ed programs in the United States. 10% or so are residential, meaning they actually live on campus. And so we have 80 applicants a year for 10 spots. So it's incredibly competitive to get into these programs. So even if a student is able to get into an inclusive higher ed program, they are still struggling. And that doesn't even consider the 70 who did not get in or who don't have the financial means. These programs are incredibly expensive. I can go into that. I can do a whole separate podcast on that if you want. But yeah, there are a lot of barriers for students. And again, I think a lot of parents... hitting 21 feels like falling off a cliff. There's no more speech services. There's no more OT. There's no more PT. There's vocational rehabilitation. But like Kristen was talking about, that's a couple hours a week of support. That's sort of, they find you a job and then you're kind of on your own. And again, that is only employment, which is just one domain, if you want to think about it, of independent living.

Dr. Kerry Horrell: 12:52

I'm thinking about a previous episode we did on the podcast around autism as we were very lucky to get to interview Temple Grandin and talk about her work. And I'm just thinking about some of what she shared with us and her life's work, which is like... people with autism are, they need, they have different needs, you know, like can be incredibly capable when given appropriate tools. And so I'm hearing, I think totally. Yeah. I'm appreciating. I imagine your work is going to be so hopeful to families. Because again, I think working with families, this is one of the things where like you were just saying, Christine, it's like, we're terrified. We're terrified what's going to happen when we're gone. We want our, we want to know our kids will be okay moving into adulthood. And so I do think kind of, yeah, go ahead, Kristen.

Kristin Lombardi:13:37

I think hopeful and also eye opening because what some of our parent readers said to me was that they're so caught up in the moment. These are people who have kids that are maybe eight, you know, in that nine, in that age range. And the one mom in particular said to me, I'm so caught up in our day to day that, I didn't even think about what this was going to look like at 15 or at 20. And so there, you know, there's part of the book, I think where we're talking about, you know, it's really great if you're able to teach your kid how to shower themselves before they hit puberty, because a lot of parents, that's like a big thing that they kind of still don't want to be showering their kid at that point. So just point some of those things, pointing those things out. It, there's hope, but then there's also this motivation to move forward.

 

Dr. Christine Drew: 14:27

We tried to balance, we tried to balance and we use vignettes, which are just little stories about, you know, family and what they're dealing with. And so we, we did, we had probably six parent readers that consistently gave us feedback on what we were doing as we were going through and writing. And so I think, you know, we, we, tried to strike a balance. And we had parents say like, this is my life. This is what I'm dealing with. And we drew a lot on our experiences as practitioners. And I draw on my experience of watching students in college who are maybe either doing great at home, like you were talking about, where they do great at level one at home, but then when they're on their own, it's a lot harder. But then also maybe having parents who have a really optimistic and kind of unrealistic idea about what their child can actually do on their own because they've never tested it. They've just sort of assumed like, oh, well, they're doing it on their own. When they're in a different environment, it will transfer. Well, what do we know about autism and generalization? Yeah.

Dr. Christine Drew: 15:40

And intellectual disability and generalization. And it's really hard. It's tough for them. So I think it's also getting the parents to really take honest looks at what their child is capable of doing. We have checklists and, you know, we have a whole process for that. So hopefully parents can be a little more in touch with, you know, what's really going on.

Dr. Bob Boland:15:59

Yeah. I mean, one of the skills you talk about in the book is a task analysis. And can you say a bit about that and why that's so important for independence?

Kristin Lombardi:16:07

All right, Christine, you want to take this one? 

Dr. Christine Drew: 16:08

Yeah. So a task analysis is a process and a product. So the process of task analysis is taking what we think of as a simple task, right? Brushing teeth. We probably don't even put that on our to-do list. It's just something we do as part of our daily routine. We don't have to think about it. But when you break it down, toothbrushing is so many different skills and so many different pieces. So walking to the bathroom, getting toothpaste and toothbrush out, unscrewing the lid on the toothpaste, putting an appropriate amount on your brush, which is not the same as what the commercials show you on TV, right? It's supposed to be a pea size amount, not a whole swirl. And so at any point in that routine, things could go sideways, right? If you have some fine motor difficulties, it could be the lid. If you have some difficulties with memory, it could be remembering that you need the toothbrush and the toothpaste and the cup. And then you forget the cup and you wander out of the bathroom and you don't come back. A task analysis, when you break it down, can result in a checklist for the person to use themselves eventually. But it also gives the parent, instead of saying, well, my kid can't brush their teeth, it turns into my child has difficulty with this particular step of the routine. And then you can engage in targeted teaching as opposed to like, well, I'm giving up on, not giving up, but I just don't even know where to start on this whole thing. It feels too big. So breaking it down gives them that. And then that can be translated into an actual support for the person to use independently.

Dr. Kerry Horrell: 17:39

Kristen, anything more you want to share for this one?

Kristin Lombardi:17:41

No, I think it was a pretty thorough answer. I think it's helpful for parents to be able to isolate the exact parts where the child is struggling. Although some kids might be struggling with the whole sequence. I think a lot of times kids are struggling with isolated parts. which then prevent them from completing the task. And it is very easy to throw your hands up and say, my kid can't brush their teeth or my kid can't shower. When in reality, there's just these parts that they can't do. And it's a lot easier to work on those isolated parts than to be stressing about the entire sequence if that's not what needs to be looked at.

Dr. Kerry Horrell: 18:20

Especially when brushing your teeth, taking showers, a lot of times these happen when brushing your teeth, for example, would happen in the morning sometimes. I mean, again, for most of us all the time, when there might be other kids who are trying to brush teeth and we got to get in the car, we got to get to school. Like, yeah, I think I can so appreciate and empathize with families being like, just here, let me help you. And let's just get this done with. And I think knowing that there is a step-by-step way to work on this and to target it, I think probably feels, again, practical in a way that's just like, oh, well, you have to get your kid to learn how to brush their teeth when that's been so challenging to do.

Kristin Lombardi:18:58

We do discuss too in the book that obviously the morning routine can be very rushed for a lot of people. And that's so sometimes like if you're working on tooth brushing, maybe what you really want to do is work on that in the evening before bed. You're going to brush their teeth in the morning for them and have them practice it in the evening when you have a little bit more breathing room. I mean, I tell parents all the time when we're working on dressing, start with the pajamas. They're easier to get on and you have more time in the evening than you do in the morning. 

Dr. Kerry Horrell: 19:29

And I will say, and I’m going to own that this question is coming from some of my bias. Please feel free to correct me, but in my mind, independence might not be feasible for all neurodiverse kids.  And this is a big question, so feel free to take this wherever you'd like to take it. But how do families know this is a reasonable thing for us to work on and dive into? And perhaps independence isn't a skill that we think our kids are going to be able to get to.

Kristin Lombardi:20:01

Yes, we really appreciate you asking this question. We actually spent a lot of time working on chapters two and three of the book, which are assessments. Chapter two is assessments for the child's So certain prereq skills, you know, does your child able to follow basic directions? Is your child able to complete a task, like just like a puzzle, for example? Does your child have the necessary safety skills? So for example, a child who is engaging in PICA, you're not going to leave them unsupervised in the bathroom and risk that they're drinking the shampoo or eating the toilet paper. That's dangerous. And it's not that we say to parents, if your kids don't have these prereq skills or don't have these safety skills, you should never do the book. But what we say to them are, these are skills that you want to have in place before starting the book. And here are some suggestions or resources to look at in order to do that. And then there's a chapter for the parents. Because they're the other part of this. It's not just that this is all on the kid, right? The parent is the one that's facilitating this. So things like, did you not have any major crises or major changes happen in the last couple of weeks? If you just gave birth to a child, another child, and your house is under a major renovation, this is not the time to start this right now. Are you willing to shift the... sort of the organization of your house and make things so that things are accessible to your child. You know, if your child can't reach their toothpaste and the toothbrush because you have it like in the medicine cabinet, well, then they can't really be independent with brushing their teeth unless you put those things back in a place where they're able to get them. So that's definitely discussed in detail. There are obviously, there are some cases, if you have a child who has, where there's like paralysis, they may not be able to get themselves dressed. Putting a task analysis, it is not going to help. If you have a kid that has fine motor delays, but still has access, and maybe can be accommodated by having an automatic toothpaste dispenser, then yes, then maybe that's the sort of kid that could benefit from this.

Dr. Kerry Horrell: 22:15

That makes sense to me. Christine, anything to add?

Dr. Christine Drew: 22:17

Yeah, I think that We also, you know, we spectrum of independence, right? We, the things that we do all day, you know, none of us are truly independent, whatever the no man is an island, right? And so what we want is to move from dependence closer to independence. So again, if you're thinking about it from a parent perspective, if you are doing the same thing for your 15 year old that you were doing when they were five, that is a lot different. And that is a lot to consider when you're thinking about them being an adult, you not being there, right? And so daily care skills, so showering, bathing, toileting, toothbrushing, those are things that can greatly increase your child's, you know, basically increase their ability to move into the community to be a part of the community. And so we're not saying, you know, we're saying as independent as possible. And so even if you have, you know, a child who has paralysis, or who has a fine motor delay, or has something, we are saying there are accommodations and ways that you can increase independence and just move further along that spectrum. And, you know, we've, again, I have students with intellectual disability that are on a college campus, which would have been unheard of not that long ago. And so I think it's also challenging the parents to think about this long-term goal and also tiny goals along the way and not saying, you know, like, well, the goal is college. The goal is how independent. That's huge. It's huge for an eight-year-old without a disability. to be thinking about college, right? But it's about these little, little, little steps that move you toward whatever that goal ends up being. There's a section in the book where we talk about how people with disabilities worlds get really small, really fast if we're not careful. You know, after graduation, you know, their social circle diminishes, their employment opportunities diminish, and so it's about giving people access to the greatest number of choices possible and that might be that you live in a group home it might mean that you live in a house with four other people with disabilities and you know there's one person there who is supporting you but that is not an option if you cannot shower yourself.

Dr. Bob Boland:24:48

sure

Dr. Christine Drew: 24:48

right probably right yeah so

Dr. Bob Boland:24:51

Wow. So a lot of our listeners are clinicians. And what advice do you have from them? How can they be helpful in this process?

Kristin Lombardi:24:59

This is another great question that we appreciate you guys asking. You're in a perfect world. We hope that all families have access to a great clinician. We wrote the book specifically for parents because there are so many families who do not have access to a clinician, especially ones in the more rural areas. So we wanted parents to be able to pick up this book and read it themselves and work through the activities. However, ideally, we would love if the clinicians were doing it with the parents and offering that extra level of support and guidance. And, you know, there's a lot to be said for having sort of an outside perspective on things. So the parent sees things one way. And a lot of times a clinician comes in and says, That's not exactly what's happening here. So let me show you another way to look at this and another way that we could maybe go about teaching this skill. 

Dr. Bob Boland:25:54

That makes sense. Christine?

Dr. Christine Drew: 25:56

Yeah, and I think clinicians, and again, I'm thinking about the ones that have access to students in schools, right? OTs, PTs, SLPs, sometimes BCBAs, depending on the school district. There's this, again, I was a teacher. I don't speak ill. I don't want to speak ill of schools. But there is a box on all IEP paperwork that says parent training. And that box does not get checked very often, at least by the time they're in middle school. And because it's an extra thing, no one is wanting to essentially... pay for that. You know, teachers aren't necessarily trained in how to do that. BCBAs are, should be. I think SLPs should be as well, OTs and PTs. But thinking about as a professional, if you're working in schools and working with clients in a clinic, that is not their actual world. The actual world they will live in when they graduate is not a school setting, is not a clinic setting. It is community, right? It's community-based. And so thinking about and planning for that and challenging and pushing teachers and parents to think about that too. I think again, you know, toothbrushing, you have lunch at school, you have breakfast at school. Toothbrushing can happen there. Showering, not so much, but you can go over things like hygiene, right? Deodorant. You can teach hair brushing. You can teach these things. And I know there's always like, it's an educational need. If your hair is in a rat's nest and it is pressing on your scalp and it is causing you pain, that is going to impact your ability to access your education. If you are the stinky kid, if you smell bad, that will impact your ability to make friends. And so, you know, I think it's just kind of extending past what we see as an educational piece and think about the broader world that that student will exist in. after they leave school or on the weekends, in the evening, you know, they're, they're only at school for a little bit of time or they're at the clinic, not even that long and thinking about where they're going after you.

Dr. Kerry Horrell: 28:03

And I'm imagining like therapists and pediatricians, like some, sometimes their role might be referring like, Hey, there is like with working with families and being like, there is additional supports that are out there that can be helpful. And like, you know, hopefully it's, helping connect to resources. Cause that's one of the, I mean, I will say I have a huge heart for pediatricians and just feeling like they have a ton on their plate in regard to different checklists that they are screening for and thinking about. But I just feel the need to say that our pediatricians do so much in their 15 minute allotment with folks, but coming in with, with, you know, some sort of neurodiversity. Like I think that hopefully part of the role of some of us as clinicians, because again, I'm not trained in this, would be, hey, there are resources out there. There's hope. There's practical stuff. Let's get you connected. 

Dr. Christine Drew: 28:57

Practical stuff. And I worked with developmental behavioral pediatricians before when I was at University of Oregon. They are spectacular humans. They are managing medication. They are thinking about the family and the child's quality of life. They are considering puberty. They are thinking, at least the ones that I worked with, are thinking really far ahead and planning ahead. And so, yes, absolutely. They have been great in terms of connecting people with services where they exist. So

Dr. Bob Boland:29:32

that's another thing. That's the hard part is that's a very specialized. Yeah,

Dr. Christine Drew: 29:36

it is. It is. So, yes, totally. We I recognize the support. And, you know, Kristin has worked in the school districts before, too, you know, in the past. So absolutely.

Kristin Lombardi:29:46

Yeah, I don't I don't know if all of what was just said is entirely accurate for everybody, because there are a lot of pediatricians that are not using the checklist. I just brought my two year old in and I had a ton of paperwork to fill out. But I have spoken to a lot of parents who, when they're bringing their kids into the pediatrician, are not getting those checklists where they're looking for developmental delays at these early ages, you know, from birth to three. To see a developmental pediatrician here, you could wait a year. Some of them have wait lists to the point where they don't even have wait lists anymore. They're so booked that you can't just you can't get in.  Trying to get private evaluations, also, you could call 15 places and you're lucky if you can get an appointment at one in less than six months’ time. Even if a school is giving you services on your IEP, it doesn't necessarily mean there are therapists to staff it. As far as outside of school, like after school.

Dr. Kerry Horrell: 30:46

Right

Kristin Lombardi:30:47

I’ve had kids who got services at the preschool level who were approved for services. It was all on the IEP and less than 50% of it was staffed. And when I went in to do the eval, like nine months had passed. So this wasn't like we had just started. And I do not live in a rural area.

Dr. Bob Boland:31:05

No, you're in the New York area, right?

Kristin Lombardi:31:07

Yes. I'm on Long Island. So it's populated. And in theory, we have access to what we need. And yet, so this is happening here. I can't imagine what's happening in some of the more, right, isolated areas. Yeah.

Dr. Bob Boland:31:20

Yeah. Imagine outside major medical centers and stuff.

Dr. Kerry Horrell: 31:24

So there is, on a very structural level, a lot of work to do to get these support systems in place across the different ways that people get care at school, from the medical field. Yeah.

Dr. Christine Drew: 31:39

Well, and again, parents... There aren't a lot, you know, when you sell a book, this is our first time, but when you try to tell a publisher, hey, this is why this book is important, there just aren't a lot of parent action-based resources. So there's stuff about grief, there's stuff about, you know, how to, you know, self-care and, you know, self-help books like that. But when it comes down to here is what you do with your child in a way that's accessible to a non-professional, there's not a ton. And there's some that's meant to be accessible. And then when you look at it, it's not really accessible. I think it's professionals writing and not necessarily getting parent feedback on what's accessible to them. So I think there's also just this void there. unfortunately where parents don't have a lot of good, you know, they're, they're Googling, they're on Facebook groups asking for support. They are in WhatsApp groups saying, here's my problem. What do I do? And they're getting, you know, maybe trickle down therapy from other parents that have gotten help. And it, you know, there's just not a lot of primary resources where a parent can go and say, Here's what I need to do with my child. Here's scenarios, you know? So I think a lot of them are pretty adrift.

Dr. Bob Boland:33:01

Well, I think it's a nice thing. Your book gives a lot of hope. And I must say, like, I have a number of friends and families that, you know, are kind of, I think you call that the graduating to the couch stage with their kids of kind of really wondering what's next. And I don't know for people like them and really for anyone, like what, what kind of messages would you want to give them now to walk away from this with?

Kristin Lombardi:33:25

I think one of our messages is the earlier you can start, the better, if possible. And that it's not too early to start in many cases. Like Christine was saying, at like six, seven, to start working on independent tooth brushing and washing yourself in the shower. It's great. And that there may be parents who are listening to this who who have tried everything, who have had amazing therapists and they weren't able to make progress. And that happens. I have seen that. It does happen. But then I also, a lot of times we'll see families that they didn't try certain things just because they didn't know to try those things. And that for those families that you don't necessarily, I always tell a parent, I don't know what the ceiling is yet because I didn't get in and start working with your child. What I can tell is that your child has potential and that he's still learning or she's still learning. And when I feel like we maybe hit a ceiling, like I'll let you know, but we're not there yet. And I don't, there are very, very few times where I've said to a parent, like, oh, we hit the ceiling. Like usually there's more that can be done.

Dr. Christine Drew: 34:35

Yeah. And my, one of my master's professors said we can always teach one more skill. So

Dr. Bob Boland:34:41

Good way to think of it.

Dr. Christine Drew: 34:43

You can always learn one more thing. And then when you're done with that one thing, you can move on to another thing. And the thing about daily life skills and daily living skills, use it or lose it. And if you use it every day, you are really likely to retain it. So these skills are not going to disappear in the way that going to the lunch, to the cafeteria, right? That is a skill. But maybe you won't use it once you graduate. You will use toothbrushing when you graduate. You will use showering. You will use getting ready to go somewhere, dressing yourself, the nighttime routine, right? These are things that are going to stay with your child. And then, you know, we know it's a big investment on the front end. And we acknowledge that in the book. But that investment pays dividends in the long run in terms of their independence, in terms of your time. treating your 15-year-old like a five-year-old that's a lot of work that you're doing and, you know, gaining your own independence back as well.

Dr. Kerry Horrell: 35:45

Yes. Well, I can tell you as someone who has been able to see the book and I'm saying to my reader or to the listeners, this was an incredible resource. It's very practical. It's very usable. It's not filled with jargon and like,

know, tons and tons of single stage paces. It is, it's very, very usable and encouraging. And so we're so grateful for your work and, and for coming on and sharing with

Dr. Bob Boland:36:08

Yes, thanks so much. Thank you. And once again, we've been listening to... Also, let's say the book one more time. Oh, yeah. Gosh, yeah.

Dr. Kerry Horrell: 36:16

This is... I'm not going to say it. What are you going to say? No, no, no. I thought you were going to read it. I'm going to steal it then. This is Kristen Lombardi and Dr. Christine Drew. We've been listening to you. And their newest book, Spectrum of Independence, comes... We'll be out by the time this.

Dr. Bob Boland:36:30

By the time this comes out. Yeah. Absolutely.

Dr. Kerry Horrell: 36:32

You were going to say that.

Dr. Bob Boland:36:33

Well, thank you so much for joining us. 

Dr. Christine Drew: 36:35

Thank you so much for having us. We appreciate your time. Thank you so much.

Dr. Bob Boland:36:39

And once again, I'm Bob Bowen.

Dr. Kerry Horrell: 36:41

And I'm Kerry Horrell. 

And thanks for diving in.

Dr. Kerry Horrell: 36:44

The Mind Dive podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.

Dr. Bob Boland:36:54

For more episodes like this, visit www.menningerclinic.org.

Dr. Kerry Horrell: 36:59

To submit a topic for discussion, send us an email at podcast at menninger.edu