Month: September 2022

Editor’s note: Second in a two-part series on friendship and neurodiversity. Click here for part 1 .

We all are different. We all are unique. This is cause to celebrate.

Yet for many children and families, the current landscape of friendships and social spaces can feel unwelcoming. Flexibility and inclusivity are often lacking, leaving little room for children who are neurodiverse, such as those who are on the autism spectrum or who have attention deficit hyperactivity disorder or intellectual disability.

There are many tools and organizations to help children with neurodevelopmental differences practice friendship-building skills and connect through social opportunities. But a larger community effort is needed, as well.

Below are some ways to welcome those who are neurodiverse into your social circle and activities. Friendship is a two-way street, of course, and all of us stand to gain in creating wider, more inclusive circles of friends. Everyone can be a friend; everyone deserves to have friends.

Start here: Understanding neurodiversity

Understanding neurodiversity — the different ways that people think, communicate, learn, and interact with their environment — is a crucial first step.

Becoming aware and accepting of these differences creates room for people who are neurodiverse to participate in social spaces just as they are. By making room for differing abilities, we demonstrate that we value authenticity and diversity.

It may help to know that:

• Many children who are neurodiverse engage in self-stimulatory behaviors like rocking back and forth, hand movements, or pacing. This may be a helpful way for them to self-soothe, or might satisfy sensory needs such as feeling too much stimulation or not enough stimulation.
• As with all children, behavior is communication and expresses desires, wants, needs, and dislikes.
• And as is true with many children, some behaviors, like silly noises or loud remarks, can also be ways of obtaining attention or communicating what is wanted, or not wanted, in a given situation.

What does it mean to be inclusive?

There is more to inclusion than being together.

Inclusion is the practice of making someone part of a group. It ensures that those who might otherwise be excluded, such as people with disabilities or members of marginalized groups, have the same rights, choices, and access to opportunities as others in the community.

Being in the presence of others opens the door to new friendships and social opportunities. But this alone is not true inclusion and does not promote belonging. Children with diverse abilities are often still stuck on the sidelines.

Sitting next to someone new at lunch or inviting someone to join a game or activity on the playground helps others feel invited and included. Parents, teachers, and other adults can help by modeling or encouraging warm, inclusive actions like these — and not just on the playground or at school.

Expanding from inclusion to belonging

Belonging goes one step further by ensuring that people feel valued and fully a part of their community. For children, cultivating belonging could mean

• going the extra mile after inviting a new friend to join a game of soccer at the park by making sure to pass them the ball.
• at the lunch table or at a birthday party, including a child with neurodiverse abilities into the conversation and creating the space for them to participate.

Actions like these help us recognize the value we each have to share. And, of course, it’s not only children who can hold out a hand. Together, by prioritizing genuine connections with people who are neurodiverse, learning and understanding one another’s needs, we can create a social landscape where everyone can belong.

How to be a good friend

Openness and kindness can foster a meaningful connection. Whether you’re a child or an adult, you can help through:

• Clear communication
  • Use clear and concise language and repeat information as needed.
  • Be open to different ways of connecting, such as through text messaging, online gaming, social media, or structured activities based on shared interests.
  • Outline plans in advance and be open to when a particular event, activity, or social interaction might need to be cut short.
• Awareness and openness
  • Be aware of sensory sensitivities and needs. Adjustments to lighting, noise, and seating can help create a more sensory-friendly environment.
  • Sometimes a consistent social space is most comfortable for people who are neurodiverse. Learn the types of socializing and social gestures your friend appreciates best.
  • Be welcoming to different ways of communicating, whether through signs, gestures, pictures, devices, or other equipment.
  • Focus on connection and shared interests rather than social convention.
• Listen and learn
  • Listen and learn how to support people who are neurodiverse — don’t assume!
  • Ask questions to understand social preferences and needs. Figure out together what fosters connection and comfort in your friendship.
  • Make space for people with diverse abilities to be themselves and be comfortable.
  • Be patient. Be flexible.

Make a commitment to wholeness

An inclusive community is one that values all people, and becomes whole by embracing its diversity and making all people feel like they belong. Schools, recreational programs, and community organizations all have a role in fostering inclusive social spaces and opportunities for people who are neurodiverse. And so do each of us.

About the Authors

Sydney Reynders, ScB, Contributor

Sydney Reynders, ScB, is a clinical research coordinator in the Boston Children’s Hospital Down Syndrome Program. She assists in research investigating educational, behavioral, and medical interventions in Down syndrome and other neurodevelopmental disorders. She received her … See Full Bio View all posts by Sydney Reynders, ScB

Nicole Baumer, MD, MEd, Contributor

Nicole Baumer, MD, MEd is a child neurologist/neurodevelopmental disabilities specialist at Boston Children's Hospital, and an instructor in neurology at Harvard Medical School. Dr. Baumer is director of the Boston Children's Hospital Down Syndrome Program. She … See Full Bio View all posts by Nicole Baumer, MD, MEd

In the US, we are fortunate to have a dizzying array of fruits that fill our grocery stores year-round. They come in all sizes, shapes, and colors, and we have all heard about the recommended five servings of fruits and vegetables a day. So, what are we eating them for? And how does the nutritional value vary between fruits? Is there any difference between whole fruits versus juice, fresh versus dried? Let’s take a look.

Differences between fruits

Just like other foods, different fruits have different nutrient values. Generally, whole fruits are good sources of fiber while fruit juices are not. And one cup of fruit juice, even 100% fruit juice, has a lot more sugar than one piece or one serving of whole fruit. In addition, whole fruits are more satiating than juices. When meeting the recommended fruit and vegetable intake, it is better to eat them (whole) than drink them (juice). However, one should not completely avoid drinking juice — if it is 100% juice — but you should limit consumption to no more than 4 to 8 ounces a day.

The freezer section of the grocery store is often stocked with quite a variety of frozen fruits. These are often peeled and cut already (like mango), which is convenient and often less expensive than fresh fruits. Frozen fruits are usually picked and quick-frozen near the point of harvest, therefore the nutrients are well preserved. Moreover, some seasonal fruits such as blueberries are readily available in frozen form. The key to selection is to choose plain frozen fruits without added sugar.

There are a number of fruits that are available in dried form, such as raisins, apricots, and pineapple — just to name a few. They also have good nutrient values, keep for a long time, are convenient to carry around, and are high in calories, making them a favorite for hikers and campers. However, some often have sugar added in the drying process, particularly mango and pineapple. Dried cranberries almost always have sugar added, as they are naturally very tart. Even for those without added sugar, the compact volume and sweetness make it quite easy to eat a lot in one sitting, and the calories can add up quickly.

Some dried fruits like raisins and apricots are also treated with sulfur dioxide to preserve freshness and color. For most people that is not a concern; however, some individuals are sensitive, especially those with asthma. Sulfur dioxide treatment is labeled on the package, so it is not difficult to avoid if necessary.

What about buying organic?

We have much choice when it comes to organic and conventionally grown fruits, be they fresh, frozen, or dried. Nutritionally, there is not enough difference to choose one over the other, though consumers might choose one over another based on farming practices and environmental impact. The US has regulations on pesticide use, but some fruits tend to have more residual pesticides than others, and it is always recommended that you wash fruits thoroughly before eating.

Differences in nutritional value

Different fruits are good sources of different nutrients. Citrus fruits are high in vitamin C, and other fruits are good sources of nutrients too. A few examples below:

Nutrient	Major functions	Good fruit sources
potassium	fluid and electrolyte balance, maintaining healthy blood pressure	oranges, raspberries, bananas, cherries, pomegranates, honeydew melons, avocados
iron	formation of red blood cells, brain growth in children	dried apricots, raisins
vitamin C	maintaining healthy immune system, wound healing, antioxidant	citrus fruits, strawberries, kiwi
folate	DNA synthesis, formation of red blood cells, early neural tube development in the fetus	oranges, mangos, avocados
vitamin A	night vision, cell growth, immune function	cantaloupe

Besides the above nutrients, certain fruits are also high in flavonoids. This is a diverse group of compounds, some of which are potent antioxidants that protect against oxidative damage, and may reduce the risk of certain diseases such as cardiovascular disease and diabetes. In particular, citrus fruits are high in the flavanones class of flavonoids, and blackberries, blueberries, cranberries, and cherries are high in the anthocyanidins class of flavonoids.

So, what fruits should we eat?

As you can see, there isn’t one fruit that has all the nutrients, so eating a variety is the key to good health. Try something new! Most adults should eat a variety of colors for about 2 cups a day. Prioritize whole fruits over juice. Eat what is in season, as it will be cheaper. And enjoy your fruits: eat mindfully to fully appreciate the smell, texture, and flavor. Bon appetit!

About the Author

Teresa Fung, MS, RD, ScD, Contributor

Teresa Fung is an adjunct professor at the Harvard T.H. Chan School of Public Health. She received her BS and MS in nutrition from Cornell University, and her ScD in both nutrition and epidemiology from HSPH. She … See Full Bio View all posts by Teresa Fung, MS, RD, ScD

Trauma can register within our bodies on a cellular level. What that means to an individual — and how best to heal from serious traumas encountered in life — is the focus of a newer form of mental health counseling known as somatic therapy.

The resounding success of The Body Keeps the Score — a fixture on the New York Times bestseller list for more than four years running — testifies to mounting public awareness that trauma affects people deeply. Thus far, though, somatic therapy hasn’t caught up to cognitive behavioral therapy (CBT) and related techniques in understanding, use, or research proving its worth, a Harvard expert says.

What is somatic therapy?

Most people likely haven’t heard of somatic therapy, says Amanda Baker, director of the Center for Anxiety and Traumatic Stress Disorders and a clinical psychologist in the department of psychiatry at Massachusetts General Hospital. Unlike other mind-body approaches such as mindfulness meditation, mind-body stress reduction (MBSR), and mindfulness and self-compassion (MSC) — which are steadily growing in use — somatic therapy hasn’t hit the mainstream.

What’s the fundamental concept? “It’s a treatment focusing on the body and how emotions appear within the body,” Baker explains. “Somatic therapies posit that our body holds and expresses experiences and emotions, and traumatic events or unresolved emotional issues can become ‘trapped’ inside.”

Who might benefit from somatic therapy?

Since disturbing feelings often show up in the body in debilitating ways, somatic therapy aims to drain those emotions of their power, relieving pain and other manifestations of stress, such as disrupted sleep or an inability to concentrate.

These types of emotions can stem from a variety of conditions and circumstances that somatic therapy may potentially help alleviate. They include

• post-traumatic stress disorder (PTSD)
• complicated grief
• depression
• anxiety
• trust and intimacy issues
• self-esteem problems.

“Anxiety can lead to muscle tension, particularly in the neck, shoulders, jaw, and back,” Baker says. “It can cause a lot of discomfort, pain, stiffness, and trouble with daily activities. If we’re experiencing chronic anxiety or distress, it’s almost like we have our foot on a gas pedal. It’s not a panic attack, but we’re never feeling a reprieve and there’s a constant wear and tear on the body.”

How does somatic therapy differ from talk therapies?

Typical talk therapies such as CBT engage only the mind, not the body, encouraging people to become aware of disturbing thoughts and behavior patterns and work to change them.

But in somatic therapy, the body is the starting point to achieve healing. This form of therapy cultivates an awareness of bodily sensations, and teaches people to feel safe in their bodies while exploring thoughts, emotions, and memories.

“Cognitive behavioral therapies focus on conscious thought and work on challenging thoughts in relation to anxiety and behaviors, helping desensitize people to uncomfortable sensations,” Baker says. “But somatic therapy is more about relieving the tension, as opposed to desensitizing people to it.”

Even mindfulness meditation, which some experts consider somatic in nature, differs in one key way from somatic therapy, Baker says. “Mindfulness meditation lets any feeling or emotion come into our minds without judgment, as opposed to homing in specifically on bodily sensations that are happening,” she says.

How is somatic therapy carried out?

A somatic therapist helps people release damaging, pent-up emotions in their body by using various mind-body techniques. These can vary widely, ranging from acupressure and hypnosis to breathwork and dance.

Other techniques are just as integral but aren’t household terms. Some on this list include:

• body awareness, which helps people recognize tension spots in the body as well as conjure calming thoughts
• pendulation, which guides people from a relaxed state to emotions similar to their traumatic experiences and then back to a relaxed state
• titration, which guides people through a traumatic memory while noting any accompanying physical sensations and addressing them in real time
• resourcing, which helps people recall resources in their lives that promote feelings of calm and safety, such as special people and places.

What to know if you’re considering somatic therapy

Scant scientific research has focused on somatic therapy and its benefits, Baker notes. That’s one reason why she always recommends cognitive behavioral therapy, which has proven benefits, as at least a starting point.

“Anecdotally, I’ve heard people do find tremendous benefit from somatic therapy, but it doesn’t have the same research backing yet as CBT and some other forms of therapy,” she says.

Health insurance may be more likely to cover somatic therapy, she says, when a person is dealing with extreme symptoms of mental trauma, such as seizures. Otherwise, insurers are more apt to cover established therapies such as CBT.

Additionally, finding an experienced somatic therapist can be challenging. “I think fewer folks are going to be trained in somatic therapies than CBT, so finding an experienced practitioner is definitely a tricky process,” Baker says. One useful resource is the US Association for Body Psychotherapy, which offers a Find a Therapist search tool online.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD