Greatest Hits - Wise Counsel: Supporting Mental Health in Adults with Down Syndrome

This summer, we're revisiting some of Hina and Marla's greatest hits from the first 10 seasons of The LowDOWN. On Season 9, Episode 2 of The LowDOWN: A Down Syndrome Podcast, Abby Rowley and Michele Mattox give us the lowdown on counseling adults with Down syndrome.

Transcript

Today on The Lowdown a podcast, Abby Rowley and Michelle Maddox gives us a lowdown on counseling adults with down syndrome. Over to you. Hina and Marla. Thanks, Danielle. Hello, everyone, and welcome to The Lowdown podcast. My name is Hina Mahmood and I am joined by my wonderful co-host, Marla Folden. Hi, Marla. Hello, Hina. How are you? I'm doing super well. How are you doing? Good, good. On today's episode, we will be tackling a very important topic that is also very complex, which is mental health. We have two guests who can speak to the complicated nature of mental health, especially in adults with down syndrome, and how supporting mental health is a lifelong process. Our first guest today is going to be Michelle Maddox, who is a licensed clinical social worker in North and South Carolina. She founded No Limits Counseling and Consulting, which is a private practice that has developed specifically for teens and adults with intellectual and developmental disabilities. She provides virtual mental health counseling to individuals with down syndrome and offers relationship coaching to individuals, couples, and groups. She believes that healthy relationships and mental health are closely tied together to promote a happy and healthy lifestyle. In our second guest is Abby Rowley, who's also a licensed clinical social worker and completed her bachelor's degree in rehabilitation and disability studies and her master's of social work from the University of Illinois at Urbana-Champaign. She's a licensed clinical social worker who previously worked as a case manager in a residential community for children and adults with intellectual and developmental disabilities, as well as in the school system. As a social worker, she currently works at the Adult Down Syndrome Center in Park Ridge, Illinois as a clinical therapist. Hello to both of you, and welcome to The Lowdown. Thanks. Thank you. It's great to have you both with us today. In the grand tradition of the lowdown, we'd like to start off with a couple of secret questions. So let's start with you, Michele. How would you describe your job to a three year old? Oh my gosh. I get to talk to really fun people all day and learn about things that they like to do and things that might be hard for them. I think that's awesome for a three year old. Yeah, totally. What would you say, Abby? Similarly, as I've explained to my own children, I help people with their feelings or if they're having a hard time. And sometimes we play games or do projects and it's really fun to help people. Yeah, I like how we all emphasize that it is a really good time because it is. We have a grand time doing it. Second question is, what's your go to office lunch for a busy day? Let's start with you again, Michele. Let's see chick fil A. Is everyone familiar with chick fil A? We're from all different places, I wasn't sure. Chicken sandwich. Either way, it's great. I love that. And you? Abby. Oh, I have the same boring lunch every day. Because I don't have the brain power in the morning to pack anything different, so I usually just have yogurt and fruit and some pretzels. Very boring. Yeah, it works when you don't have the bandwidth for more things. It gets it done, for sure. And the last question here is a bit of a fun one. Would you rather speak ten languages or play ten instruments? So let's start with you, Abby. This time. Ooh, I would rather speak ten languages. I think that'd be amazing. That'd be cool. Yes. And what about you, Michelle? Same answer. I was an undergrad minor in Spanish, and I haven't really practiced, so I've lost a lot of it, and I regret that. So I would love to be able to speak more language. It would also be awesome for all of our jobs to be able to talk to everybody more easily. Right? Very nice. Let's dive into the topic of mental health and counseling here. Just as a bit of background, I think Hannah and I are both curious as to how you ended up in this particular area of the field. So let's start with you, Abby. How did you end up here? So previously, I the majority of my career I worked in the school system, both in public schools and special education schools. So I had a lot of experience working with people of all different ability levels and challenges. I also have an aunt who has down syndrome and is a patient at the clinic. So that's how I became aware of the adult Down Syndrome Center. And so when I saw that there was the opportunity to take the skills that I had developed over my career and apply it in a different way, I was super excited to have that opportunity. And they the team here really expressed that. It's such a great need that they're like, oh, you'll be busy. We have lots of people we want you to talk to and help out. So that's how I came to to this point in my career. Okay. Yeah. That family connection, you just never know. I think it reaches pretty far for many of the people that we talk to on this podcast. And, Michelle, how did you end up here doing this? So I was undergrad psychology and I did an internship working in the disability field. And ever since then, just various direct care roles. During grad school, I was a teacher's assistant in the life skills classroom with adults, and it was probably my favorite job until this one. And then after I got my master's, I did different clinical social work jobs, but working with people with disabilities was always my happy place. After I had my kids, I volunteered. For a while. I was doing Special Olympics coaching or volunteering at Gigi's Playhouse. Leading skills groups and this kind of all came together during Covid. Setting up this private practice, I started doing a therapeutic skills group for the Down Syndrome Association here, and parents started connecting with them, saying, we can't really find a therapist that knows how to work with people with down syndrome. Who is this person leading this group? And the light bulb just went off. Oh, that's what I'm supposed to be supposed to be doing. Like, why haven't I combined my education and my passion for working with people with down syndrome? And so that's how this whole private practice got set up. Mhm. Okay. Thank you both for sharing that piece because I think that's relevant and important when we talk to professionals is how they got their start. It's clear that you both really enjoy working with people with down syndrome. So what about the job are you enjoying the most these days? We can start with you, Michelle. I just really love getting to know all the different personalities and even though they are in counseling, they still bring me joy when I meet with them. And it's just nice to be able to connect with them, talk with them. I see clients out in the community, even though I'm not supposed to say hi, to run up to me. I just really enjoy being in this population. There are a lot of fun to work with. Totally. Yeah, the anonymity thing only works if both people buy into it, right? You can't pretend. I trust totally. And what about you, Abby? What are you enjoying the most about working at the adult center? I would say that it's different every day. And I have learned a lot working with the clients that I get to work with. It's fascinating to hear their perspective. Where in the session of counseling, I'm like, okay, I think we're on the same page. I get where this is going, and then they'll say something like, oh my gosh, I never thought about it that way. That's a totally different perspective. And I'm like, I'm so grateful that I get to hear all these perspectives and the honesty, and it really has helped me learn a lot and expand my skills and my viewpoint. My perspective. It is. It's a lot of fun. We get to hear some interesting stories. There's often relationship drama, so it's never the same. It's never boring. I like that in a chuckle because yes, we are familiar with both of those things. And I think at the end of the day, it's the and we'll talk about this in a little bit. But the challenges that they have are like challenges for anybody else with mental health concerns, right? So it's not any different. It's just their perspective, the way they communicated all of those things. But yeah, I feel like everything you talked about Marla and I see in our clinic as well, there's drama of all kinds, issues of all kinds, but it's just good to know that there's people like you guys out there that can help provide support properly for our for our people. So yeah, let's step into a little educational moment. So for people listening, a lot of the people, our families, a lot of some are professionals. What do you think it's important for families to know about adults with down syndrome? We can start with you, Michelle. This time, I would just say that adults with down syndrome are lifelong learners, so it's never too early or too late to start learning these mental health skills or coping skills, or increasing emotional literacy, and just really to pay attention that not all behaviors are down syndrome related. So if you think that they're acting differently, get that checked out, whether it's medical or mental health, both, and that people with down syndrome can benefit from counseling. And that was a misconception that a lot of people brought up to me when I first started this practice. Why do you think that was? What do you think was the misconception? What was it based on, do you think? Part of it, I think, is the myth that people with down syndrome are always happy. So nobody ever really thinks, oh, this is something that they might need. And then also maybe that they couldn't provide the insight or that they're not as intuitive. But there's ways to work through these issues and ways to present it, and that can help them grasp these concepts. I think it's interesting, and maybe a potential reason, too, is that counseling is still relatively stigmatized among all adults. And so this idea that a person with down syndrome would be braver and more able to be vulnerable and to accept the role of lifelong learner, then a typically developing adult might irk some people, and so they project their own sort of insecurity on the process on their adults with down syndrome. I think it's possible. I don't know if you have thoughts on that. Yeah. Abby, did you want to add to that at all? About things that you think adults should know about their person with down syndrome? That comes up a lot in my sessions with patients is with adults the concept of independence. We know a lot of our folks are. A lot of our patients are really seeking independence, and that can be really hard if they're still living with their family members. So this is a topic that I work through with families a lot about. A lot of times our patients get in their mind that if they're not doing things the same way that their parents or their family members do, then you're doing it wrong. Or there there's a right or a wrong way to do it. And I have to remind them, really, that there's no right or wrong way to be an adult, right? If you find something that works for you, that's great. And sometimes it can be hard for families to let go of that they are with their loved ones best interest in mind. They're trying to support them, help them be independent adults. But also there should be some flexibility and allowing the individual to make decisions for him or herself. And going along with that. The idea of allowing the individual to make some mistakes, get some experiences, experience natural consequences in a safe way based on their choices. These are things that all adults want and need in order to continue learning and growing. Is that sometimes families want to protect and support their loved one as best they can, and that prevents them from really getting some of the experiences that make life interesting and that we as all, all adults, want those kinds of experiences. Glad you mentioned the flexibility component too, because it goes both ways, right? So if we're expecting our adults to be flexible and to change something in their routine, like it needs to go both ways. So the families also need to be willing to be flexible and change how things are done just because it the buy in is a little bit stronger. When you're like, okay, let me change it this way because this is the way you want to do it. So I'm really glad that you brought up that piece as well. I think it can be hard as parents to lean into the the risk factor when you're aware that your person is exceptionally vulnerable in many cases, or might not have a strong sense of what is risky and the degree of risk of things that they want to do. So it's maybe natural or not surprising to try and overcompensate and keep it extra safe, but that can cause issues on its own, right? Let's think about other clinicians. So this could be SLPs and OTS or other social clinical social workers who are maybe fresh or new. I think there's a misconception out there, like we've talked about, that people with down syndrome or other intellectual and developmental disabilities are not good candidates for counseling, so I'm curious to hear your thoughts on that. Let's start again with you, Michel. Here, I would just say to other clinicians, just try to familiarize yourself with common characteristics of down syndrome. Of course, every individual down syndrome is just that an individual. But as we all know, working with this population, there's often some similar characteristics, whether it's self-talk that could be misdiagnosed in a mental health setting, a psychosis they could be misdiagnosed or improperly or overly medicated. Just knowing about things like the groove, and that it's not necessarily OCD, that this is actually a way that they cope with life and how they process things, and they need this routine to get through their day independently. It actually increases independence for them. So just knowing about down syndrome, before you get into working with these clients, there's a book that comes to mind which is the Mental Wellness for adults with down syndrome. We'll put a link on this episode page. I believe it's back in print, which is very exciting. It was out of print for a really long time, so we'll make sure to put that in there. For clinicians who are like, what is the sort of phenotype that we're looking at, or what are some of the commonalities? We'll attach that link. Abby, what would you say? What's important for other clinicians to know? Yeah, I would echo exactly what Michelle said, knowing those common characteristics to prevent misdiagnosis, but also that really you don't have to reinvent the wheel. If you're a clinician providing counseling to the general population, a lot of the skills, strategies, it's it can be the same for the population. The diagnosis of someone having down syndrome shouldn't eliminate somebody's willingness to work with an individual. You might have to make some adjustments. You might need to use some pictures or visuals, writing things down to help them catch in their mind and remember it a little bit better. But it's they have. People with down syndrome have anxiety, depression, just like people in the general population. And so they benefit from a lot of the same strategies that therapists would use with anybody else. I had a patient who told me that it just takes her a really long time to express her thoughts and feelings. And so she's my family often doesn't have time to sit and listen as I'm working through things. And but that's our job as mental health providers is we do have the time to listen and be a sounding board, because sometimes that's all people need as well, that they're they're able to work things through on their own. They just need to have someone who's willing to listen in a non-judgmental way. Beautifully supportive. I know that some clinicians I've heard from families that they're like, oh, they don't work with people with intellectual disabilities, or they don't work with people who have down syndrome. And that's always shocking to me, because it really isn't so radically different than working with any other person. You touched a little bit on some of the accommodations that we might make for somebody's understanding of language, or that visual supports might be helpful and to I think you said catch in their mind, which I really liked. Michelle, did you have anything else that you would say that just helps it to go a bit more smoothly, which you might not do for somebody else, but you would do for an adult with down syndrome, for example. Yeah. As Abby mentioned, visual aids are huge. I use a lot of videos, social stories, any kind of mapping out steps to calming down, telling clients to keep their own calm down folder and even with adults. So a lot of times when I'm working with families, parents are like, oh yeah, we used to use visuals a lot when they were kids, but we haven't so much now. And so I'll tell them to bring that back in. And Abby said it just helps another part of their brain connect it all. A lot of parents will be like, we talk about this all the time, and they seem to get it when I talk to them and then they forget. So I'm like, okay, we'll bring in some pictures and just keep it all so they can access it when they want to. As a review. So yeah, the visuals are big role play activities. What else do we do, Abby? Just I mean, like you said, just talking to them. A lot of my clients come in, maybe not necessarily like clinically depressed or diagnosed with anxiety, but they just have some stressors. And for them, what we think, oh, well, that's not that big of a deal. Well, it is to them. So just letting them vent and get things off their chest. I've had a lot of parents tell me just after one session, and usually the first session is just like a get to know you let them talk, see what's going on type thing, and the parents will contact me and be like, oh, they just seem so much lighter. And I'm like, oh, but they just wanted to talk to somebody. And especially during like quarantine and Covid and everything, they just wanted to talk to somebody that wasn't in the house with them. Right. Like all of us? Yeah, totally. I think that is really interesting. It sounds like you both really hone in to your skills as a trained listener. And what's interesting, I think about that in part, is that you might say, oh, they have other friends who have down syndrome, and so shouldn't they just talk to their friends? But Hannah and I's experience, I think, points to the idea that doesn't necessarily work out very well, because communication often breaks down among peers, or they just relate in a different way that doesn't rely so much on this, these long sentences and big pauses and that kind of thing. They're having a blast together, but they're not necessarily having a heart to heart together. But the there's a huge value in finding somebody who is willing to wait and ask the right questions and do those kinds of things. Yeah. And I've also seen that they'll often internalized feelings of others. So if they were talking to a friend or a family member who's had something stressful happen to one of their friends, then they'll immediately take on those emotions. I'm just as sad as you are, or I'm feeling just as to stress, so it might be hard for them to have a back and forth. Heart to heart. Because all of the emotions. So much empathy. I think, Abby, you wanted to add something there too. Yeah, I think that. So individual counseling is amazing for that reason. Sarah Michelle said that when they're it's peer to peer, they get too wrapped up into it. And it can not be as helpful as we would hope it would be. Other hand, Michelle and I, we both do groups where it's more like educational, and I think then it's a really great benefit to have that peer support, where if you get one person who's really buying into whatever the concept is we're teaching, whether it's like healthy lifestyles or healthy relationships, and then they can tell their peers being like, yeah, no, you should do this, you should do that. It can sometimes then resound better coming from somebody who's had the lived experience and like, oh yeah, I can see myself doing that as well, even if they're saying the same things we've been saying it. The peer support can be really helpful in certain contexts, although yes, in certain for other situations, that it would be more appropriate to just do the individual with a trained pest. Abby, could you actually expand? I was interested when when we were reading your bios that you guys both run groups as well. What would a typical group session look like? I was just curious. We do groups, we pick a topic that we hear a lot of concerns about from numerous patients. We've done coping skills or managing conflict, workplace social skills, dating and relationships, things like that. And all of our groups are virtual. So we're reaching people across the country, and even some people from Canada have joined our group. So that's really nice. But yeah, so it's often we try to keep it as conversational as possible. We present topics and there is that guidance, that education piece being like for example, like in our healthy relationships, like these behaviors in a relationship are not okay or it's never appropriate to date your coach or your teacher, right. So they need that information. But then we do leave it open where we ask questions and get their feedback and they're able to talk to each other and give each other feedback. That's how we do our groups. And there is something to be said about having a peer with with a similar or same lived experience, right? Because I know that for people with down syndrome, their one of their many strengths is that there's they're so good with social connectedness. So I think once they have a similar experience or they understand that somebody else is going through something similar, it will help them process it, but makes them feel less alone, too, right? So they understand that they're not the only ones in those feelings. So this is a great benefit of a group for sure. Michelle, you had mentioned a little bit about the pandemic, and I know Marla and I and our colleagues here have seen that be a big challenge for our people with down syndrome, whether they're teenagers or adults or even younger. How has your work changed during and after the pandemic? My work started during the pandemic, but just seeing in the population in general, we talked a little bit about the groove earlier and how a lot of people with down syndrome like to have certain routines. So maybe during the pandemic, they got stuck in a somewhat negative routine because there wasn't a lot to do. So now that things have opened back up again, they may be stuck in that, not wanting to go out or be as social. So they've become more isolated, even though they don't really have to be. But it's that transition to going back to doing all the things that they used to do has been difficult for a lot of clients, and I think it's been very challenging because there was a couple year period where we're like, we can't do this. It's dangerous, we can't do that, we can't do this. And a lot of my students and people that I know really internalize that, like public spaces are scary. And that idea has stuck around longer for many of the people that I know. And it's taken much, much longer to undo that. While it was necessary at the time to explain what the world was going on, it's stuck. I'm sure you've probably seen similar things, right? Abby, how about you? Similar to Michelle, or what are your thoughts on what you're seeing now? Post pandemic with some of your clients? The same as Michelle. The isolation and the developing a non-desirable groove. I can't tell you how many evaluations I've done, even like in twenty twenty three, twenty twenty four, where the families or the patient themselves say this all started during the pandemic, where all these major behavioral things came up and they have had a hard time shaking them, or they've developed over the years. They're not the same. But so many times I've heard that phrase that this all started during the pandemic when people were isolated and didn't. We were all totally thrown off and didn't know what to do. And we saw that how it affected family members. And so the mental health of the people you were living with was really impactful. So if everybody's stressed, if everybody's on edge, that just the empathy radar. It really seeped in deep for our patients. The one benefit, I guess, would be that within our healthcare care system. It allowed we were allowed to do virtual visits and that's that opportunity has stuck. So now we're really glad that we can reach more people. And since our patients typically don't transport themselves to and from the clinic, and they maybe were relying on family members or caregivers or elderly parents, this is a new opportunity. So that's the one silver lining, I guess I would say with the pandemic is now we can see more patients virtually. I was going to say the same. The virtual piece has been huge, especially for clients that have anxiety. Anyway, being able to sit in their bedroom or familiar surroundings and have a session, whereas before maybe the parent couldn't even get them out the door to the session. So now they have more access. And then as clinicians, what are some key considerations when thinking about whether mental health supports would benefit an adult with down syndrome? What are some of the things you go through as a mental checklist in your minds, where you're considering whether your services would benefit somebody with down syndrome. Abby, would you like to go first? When I'm meeting with a family or with a patient for the first time, evaluating the patient and the family's willingness to engage, I have seen some patients who I was like, oh, they would really benefit, but they were just in a place where they were not at all willing to come to the clinic or sit on a virtual appointment or talk or. And so we've tried some different approaches to try to open them up, to get them willing to engage. So that can be a sign where it's like if the person sees any benefit in this, or even just likes coming here and talking to me, I'm like, okay, yeah, let's go through with this. I think it's also really important that the individual and the family believe in the benefit of therapy. I've worked with some patients who are really gung ho and they're like, oh, I love coming to talk to Abby. And I think she's really helpful. And the families we don't this is taking a long time. Or you guys meet an awful lot and I don't know. So that can be a challenge where we want people to really feel like it's helpful and that they see that it is meaningful work, even if it's taking longer than they would have ideally liked. But yeah, we try to keep it. We try to offer our services to as many people as we can and taking different approaches. Some patients who are maybe less verbal or have a harder time communicating. We try to talk more with the family about behavioral strategies they can use at home, helping with creating visuals and just providing listening ears to the family and the patient. And then some patients. It's really they're really excited about the idea of coming to therapy on a regular basis, and they would come every day if they could. Yeah, it's really different for each person. But those are some of the things I look for. I imagine some people might be wondering what long means. So let's put a rough sort of parameter on it, because it does long mean five times, or does long mean fifty times, like let's put a time scale on it. So for listeners who are really unfamiliar, they have a sense of what that means. Yeah, I think I've had to talk with some families about because it really depends on the individual. Right. So there are people who your friends, family members who may have been in therapy for decades. Right? Some people really just need that support going once or twice a week for many years. Other people, it can be a short term, couple months, year or with a lot of our patients that we see if they're in the school system during the summer, they're great, no problem. Then come the winter months and we need to pick it up a little bit. So it really does depend. I have seen some patients weekly for two years and it's what is the end goal right. Are they making incremental progress? It may take a really long time, but again these are adults that we're working with. And so they may have had some of these habits or these behaviors or thought patterns for decades. So it takes a long time to challenge those thoughts or behaviors that are no longer working and sort of dive deep. So again, that's a hard question because it really does depend on the individual. Michelle, did you want to add anything to that as well? Yeah, just like Abby was saying. So I might see clients for a year or more. Sometimes I start out seeing them weekly, and then if the parents are reporting that they've seen behavior change or a certain level of calm and the client reports that they're feeling better, we might go to every other week or once monthly check ins, we taper off. But then I've had a lot of clients that will circle back even after they've finished, because there might be a life event that triggers, if they were seeing me before for grief, for whatever reason, something else could happen a year from now that triggers those same feelings and reminds them of that past event, so they might need to come back. It is a lifelong process for sure. Michelle, let's start with you first. For the next question. What advice do you have for parents? I know there's been really great little pieces that you guys have both mentioned, but what should parents be on the lookout for that might indicate mental health concerns, or may indicate that they need to seek out some support from professionals like yourselves? Sure. Most parents Contact me because they've seen a behavior change in behavior. They are crying more, or they're not wanting to do fun activities that they used to like or enjoy. Sometimes self-talk has changed. We said that is a common trait, but sometimes it might get or sound more angry or negative, or they're doing it more often, or they seem to get stuck in that self-talk. So those are a couple behaviors that I'll see. And if there's been any like transition or stressful life event, when we talk about grief, it's not just if someone died, it could be a sibling left the house and went to college, which is a happy event, but traumatic for the person with down syndrome that's used to living with them their whole life, or a parent separation, or just moving to a new house. Any kind of change. Finishing high school and now they have this whole new world. Now what am I going to do with all my time? Great. A lot of my clients when I first started were coming in with stress or anxiety or depression related to relationship issues, whether they didn't have as many friends as they wanted or they didn't know how to make friends, or they wanted a boyfriend or girlfriend, or didn't know how to make one, or they had gotten fired from a job because of inappropriate boundaries at work. So that's why I started incorporating a lot of my groups or relationship focused, and I'll incorporate that into counseling. So really, any change in behavior or life change, or just if they're telling you their if it's just a friend isn't talking to them, that's a huge deal to them. Whereas us, we might not put ourselves in counseling for that, but to them it could be the end of the world. My best friend or whoever isn't talking to me anymore. And it might help them just to go talk to somebody so you don't really have to wait and try to diagnose them as depressed or anxious if they're feeling like stress or acting differently in any way. I think I would seek out counseling and it's so great to help at that point before things could possibly get worse, right? So it's a really important note for listeners and for all clinicians to take away, is that sometimes those little things that seem like, oh, you're mad at this particular person, that they're not talking to you or you're not. But it can, it can, you can it can just build into something bigger. So it's a great opportunity to talk to professionals like yourselves early so that we can help with coping with those things and things like that in the future as well. Yeah, I think it is really similar to what Abby was talking about, that the more ingrained something is, or the bigger issue, or the more of your mental brain space it takes up, the longer you need to work on that thing and to redevelop a healthy way of managing those things in your life. Abby, did you have anything to add in terms of advice for families or for parents about what to be on the lookout for? Yeah, really, just what Michelle said. Just changes in behavior, change in mood. I do hear from families. There's nothing really wrong. Like he's still going to work. He's still got his friends, but he just seems sad. And I think that's really great to recognize those maybe more subtle changes because like you said, we do also get a lot of families where they come in a crisis point where it's really come to a head like he's lost his job, he's having bathroom accidents, a list of all these symptoms of some these stressors that have gone on and these sort of created this crisis. Whereas if we're noticing the subtle changes, you can maybe catch it a little bit earlier. So I think it's really great to always just check in. And sometimes those when people are like, oh, he just seems sad. Sometimes it what it turns into for me is, oh, just like a monthly check in. And other times we start talking, we realize, oh no, you've got a lot going on. We're going to meet regularly. There's lots to talk about. There's lots to work on. So it never hurts to just start that process because if you don't need it, great. If it was just a one time, small little blip on the radar. Great. But if it's not, then we can start working on it. I'm curious for both of you how you find it changes. Because, Michelle, you were saying that people tend to circle back when somebody has an established rapport with you already. Do you find it easier with sort of the next event or the next time that they need to come see you, they remember you? Is it easier to gain traction and get started with working on things, or does it feel pretty fresh every time that somebody circles back? It's easier. It almost feels like we never stopped. It'll be like, okay, remember what we did before? A lot of reminders and bringing back the tools that maybe they forgot they had. We practice a lot of coping skills, especially with my older adults. They weren't always taught how to calm down. It was go to this space and calm down. But they weren't taught how to calm down once they got to that quiet space. Teaching coping skills or calm down activities is It's huge. So when they come back, it's usually just a lot of reminders. And you've been through this before and we got through it. So let's see what we did. And as usually yeah before we kind of end, either of you have any resources or any any websites or books or things that you would recommend? I will put a link on our show page, especially for the group programs that Abby was talking about and the book Marlo was talking about. But yeah, but any personal resources you'd like to recommend to families that we could also add to that list? So where I work, the Adult Down Syndrome Center, we have our resource library with tons of resources for the patients or the individuals with down syndrome family caregivers and professionals. So if if you're a clinician and you have a patient who has down syndrome and you want to learn more about it, we have resources for you. If your family members saying I don't or other people going through this, what's going on with my loved one? We have those resources and lots of visuals for the individual things on a variety of topics mental health, but also just hygiene schedules or visuals. Lots of different stories, lots of different things to look at. And then that's also on our resource library. We do also have the mental wellness book is completely available online now, and it's also in Spanish, I believe. So we have a link to that on our website as well. So you can read the whole thing right on your tablet or laptop. Perfect. It's great that it's available in Spanish now too. That is wonderful. Yeah, I add anything to those resources. Yes. As Abby said, they have the best resource page. I get a lot of resources from their visual aid library, and I know down syndrome connection of the Bay area. They have a mental health tablet on their website as well that has a lot of visual aids and just YouTube. You can actually find helpful things in YouTube if you know what to look for. As far as calm down videos, if you just search like deep breathing exercises, muscle relaxation if you just know what to put in. And a lot of times I'll put up like coping skills for teens or deep breathing for teens, mindfulness for teens. That seems to be on a good, understandable level of clients. So I do use a lot of YouTube videos, and then I have a resource page on my website, No Limits Counseling. Org. It's mostly programs to get involved in in my area. But then there's also some national resources. Just as I said earlier, a lot of people were coming to me with relationship issues. So I started a list of all the organizations I know in the area that serve people with disabilities, just to keep them connected to their community, because I think that's a huge piece. Most of my clients that are busy and specifically connected with their disability community and have peers in that way seem to bounce back quicker if they have that support around them. So just finding any organization in your area that has social programs, fitness programs, job training, anything that they can do that's meaningful and that they can stay connected. I would recommend, and I'm just going to mention the the Adult Down Syndrome Center Resource library. We use it all the time. And one of the cool things about it is that you have a lot of adults that are making videos for other adults. So like, nothing is more motivating than to see somebody who is like you or is going through the same things to talk about it. And so there's some really great resources on that as well. Yeah. But thank you both so much for taking the time to chat with us today. We really appreciate it. I think it's a really great way to let our families and other clinicians know that mental health supports are needed for everybody, and that they're also available through wonderful programs like yourselves. So thank you so much. We appreciate you joining us today. Thank you. Thanks for having me.