With the end of the year comes the end of my blogging for PsychCentral. When I was asked to participate in this endeavor, I committed to blogging for only a few months as a trial period. That time has come to an end.

Although the door has been left open for me to return at a later date should circumstances change, I want to say thank you to John Grohol and the PsychCentral staff and to the readers for their interest and comments.

In this last blog, I want to comment on an area that gets too little attention because it is so misunderstood. It’s misunderstood by nearly everyone, not just those in the ASD community. I want to talk about clinical hypnosis.

When I say the word “hypnosis,” what comes to mind? My guess is that it’s mostly the misconceptions of hypnosis: dangling pendulums, controlling people’s minds, Svengali-like staring and stage shows. In the clinical world, hypnosis is nothing like that.

I have had the very unique opportunity to learn how to integrate clinical hypnosis into my work with children from one of the world’s experts in the field -my husband, psychologist, Michael D. Yapko, Ph.D.

Michael has written the classic text used worldwide called, Trancework: An Introduction to the Practice of Clinical Hypnosis (he is currently working on a 4th edition expected out in 2012). He has been a pioneer in writing about hypnosis and depression (see his publications at www.yapko.com). Michael’s reach goes beyond his publications, as he has spoken to international audiences in 30 countries wanting to learn about hypnosis and strategic psychotherapy. His 100-hour clinical trainings, open only to health professionals, is a powerful training not to be missed.

What is hypnosis? Clinical hypnosis can be defined as a way to focus attention and communicate ideas in an experiential way that benefits a client. Now, who wouldn’t want to learn how to do that?

Hypnosis is not a therapy and it is not a cure for anything. Rather, hypnosis is a tool that, when used clinically, is designed to facilitate positive changes that a person wishes to make. There are different schools of thought regarding how direct or indirect one should be in using hypnotic techniques and communications. Some people advocate for specific philosophies, therapeutic models or approaches, but I personally don’t subscribe to anything other than what works for an individual. My husband recently called me an intellectual anarchist and I’ve come to identify with the label.

The pioneering work of the late psychiatrist Milton H. Erickson is most consistent with how I have intuitively worked with children in therapy. He saw the strengths and resources people had and utilized these in his treatment. It didn’t matter what diagnosis people had, their age, their gender, their intelligence or any other such factors. He respected their individual strengths and found ways to gently introduce new ways to use those strengths in what has come to be called conversational hypnosis. More and more literature is coming out in the domains of mindfulness, relaxation, calming exercises, visualization, and others as well, but the common denominator they all share is an experience that effects positive change in the person through an experiential mechanism not easily defined.

Hypnosis is more often than not a skill that is developed over time. Yes, there are people who experience hypnosis once and make a dramatic change, but it’s not usually the case in working with children.

A person can learn to do this for themselves (self-hypnosis) or have the experience guided by someone else. There are new CDs and DVDs coming out all the time that claim to relax children, help them focus, reduce their anxiety, manage their depression, etc. The key is in knowing what works for YOU, or your child. If a CD doesn’t work or a therapist doesn’t effect change, don’t blame it on the hypnosis. It means THAT CD didn’t work FOR YOU or that therapist didn’t connect with YOU.

That doesn’t mean there’s anything wrong with you. It means you haven’t found the right connection. Hypnosis isn’t just about talking TO a person; it is about talking WITH a person. That can be done in story form, during a game, playing with toys, using a computer, sitting quietly in a chair or many other ways. There are all kinds of ways to engage a person in perspectives giving rise to meaningful change.

With children, it is likely that the hypnotic communication will be more ‘awake hypnosis’ or ‘active hypnosis’ because most kids don’t sit still with their eyes closed. That’s okay and it is to be utilized. There is so much to learn and do with children hypnotically that is just now being explored, especially with the ASD population.

I have addressed this subject in workshops and have written on the topic as well, but much research is needed in this area to document the efficacy of how best to utilize hypnosis with children on the spectrum. A chapter I wrote entitled, “Working Hypnotically with Children on the Autism Spectrum” was translated and published in an Italian book L’ipnosi con I bambini e gli adolescenti (Ed. Maria Laura Fasciana, 2009 FrancoAngeli publisher). You can download the English version here. (Scroll down the page to get to this particular chapter)

I also wrote a chapter entitled, “The Utilization Approach to Treating Depression in Individuals with Autistic Spectrum Disorders.” In Hypnosis and Treating Depression: Applications in Clinical Practice (Michael Yapko, editor, 2006). You can also find it on amazon

There are so many intriguing aspects of working with children on the autism spectrum. It has been my privilege to know so many families and help effect positive change in their lives.

If there is anything I hope that readers will take away from this blog, it is my continued belief that we focus on the positive, we accept and utilize what our children offer us, that we not subscribe solely to any one theory or model, and that we remain open minded, and attuned to the individual person, not the labels. I wish you all a very happy New Year. Thanks for reading my blogs.

These and other ‘less appropriate’ reactions are not uncommon when kids on the spectrum receive gifts.

Pre-teaching and practice is the best intervention here. BEFORE your family and friends arrive with gifts for your child, it’s important to practice how to receive gifts.

What do you want to teach a child about opening presents? For some parents it may be that you’re wanting a child to say “thank you” and acknowledge the gift (rather than walking away or just beginning to get absorbed in it), for others, it’s to teach them how to show enthusiasm, to give them words of appreciation, or to teach them to not hurt people’s feelings.

We don’t want to teach kids to ‘lie’ per se, but sometimes, those white lies we tell are intended not to hurt other people’s feelings. “No, I don’t have one” (when in fact you do).

To do this you need some practice gifts to open. You don’t need to buy actual presents to wrap, you can take a child’s existing toys and wrap them in paper towel (good practice for learning to not to say “Oh, I already have that”), or you can hide a spoon in a pot and have your child open the lid of the pot. Or, put a rock in a bag and have your child open the bag. The idea is that the actual gift doesn’t matter. So, the more mundane the practice items, the better to teach this skill: The gift is in the giving, not the content.

To practice, you need to show/demonstrate how to open the package. Show a smile on your face, look at the person who gave it and say “Thank you.” Then show how to play with the toy or do something appropriate with it instead of just putting it back down or walking away. Have your child imitate you.

Then depending upon how sophisticated your child is, you may be able to add more content “I really wanted that” or “I was hoping to get one” “This is so cool.”

Play around with what to do and what NOT to do if your child can handle this. Show him/her how to open a gift inappropriately and see if your child can recognize the correct and incorrect ways of receiving a gift. Have him/her do the same things. Make it fun and a game.

Connect this practice to the real world by talking about the people who are likely to bring gifts to the house (aunt, uncle, grandparent, friend, etc). Talk about how your child can use his new practiced skills when opening the presents.

You may want to make a list while practicing:

Some things to “NEVER SAY” when you get a gift:
“I hate _____”
“I don’t want that”
“I have that”

Some things you can “ALWAYS SAY” when you get a gift:
“Thank you”
“That’s really nice”
“Cool!”
“Awsome!”
“My favorite!”

Happy Holidays!

I just read about another resource that will soon be available – the first Global Autism Center in Israel. The purpose is to have a site in which research can be conducted with global collaboration and reach.

The New York based charity; International Center for Autism Research and Education (ICare4autism) will acquire the campus of Bezalel Academy of Art. They will convert it in 2013 to include a state-of-the-art research facility, a university-level school of autism studies, a model school to apply the latest research to students with ASD and a foundation to support education and treatment worldwide.

The Autism Society just announced collaboration with The Arc (an organization that has been serving individuals with intellectual and developmental disabilities in the U.S. since the 1950s in The Autism NOW Center. Read more about this new resource.

For years, families have fought for financial support and in 2010, several states enacted autism insurance reform bills as part of the federal health care reform law in the United States.

The number of organizations and conferences that are now available throughout the world on research, education, and treatment continues to grow. It is no longer a Westernized issue.

Countries around the world are joining the international community in helping to bring autism awareness and services around the world. In 2007, the United Nations adopted a resolution declaring April 2nd Autism Awareness Day. Visit Autism Support and Autism-India as just a couple of examples of where to get resources in your country. For those more academically inclined, visit The International Society for Autism Research

The online resources are beyond what most people could have dreamed of even 5 years ago. I know, there are a lot of shams and claims online that do not help promote and in fact, detract from real growth and information, but the resources that are available far out way the ‘junk.’

Perspectives from individuals on the autism spectrum abound in blogs, books, conference presentations and You Tube clips.

I know there are still many people who are can’t seem to find the information they are looking for or the resources and services they need. But, hopefully, with all the new research looking at everything from genetics to environment, biology to neurology, medical to social, and the list goes on… everyone will find what they are looking for and each person will come to accept or change according to their own values and needs.

Photo by “kaibara87,” available under a Creative Commons attribution, non-commercial license.

A metaphor often used to describe sensory processing issues is the foundation of a house. I don’t know where I first heard this metaphor, so my apologies for not giving credit where it might be due.

As in building a house, one must first have a firm foundation on which to build a house before proceeding with the framing. The framing must be secure before adding the walls and roof. All these foundational components must be in place, before you can paint the walls and decorate the house. If the foundation is not solid, the house eventually begins to have cracks and problems emerge.

The same holds true for our sensory system. We interact with the world through our senses. This forms the neurological foundation upon which we interpret the world around us. Listening, Language, Understanding, Speech, Movement, Social Skills, Cognitive Skills, Academic Skills are all based first upon our systems ability to take in, to notice, to correctly perceive and respond to the information we get from our senses.

Most of us know about the sense of sight, hearing, touch, taste and smell. But, two additional senses that are extremely important and less well known are the vestibular sense and the proprioceptive sense.

The vestibular sense is the one primarily associated with balance and the proprioceptive sense is associated with our muscles and joints and the information about our body’s position and movement. Typically, these senses are evaluated and treated by occupational therapists.

But, all of us, can notice symptoms and begin to recognize when a referral to an OT may be helpful. Just like building a house, it takes many different professionals to build the structure, so even if you’re not an OT, you can make a difference.

The lists are too extensive to include here, but just for a quick overview, take a look at each of our senses and three common symptoms of each that might suggest a potential problem.

AUDITORY Symptoms:
• Over or under-sensitivity to sounds (covering ears for loud noises, not responding when spoken to)
• Difficulty repeating or rhyming
• Difficulty following directions

VISUAL Symptoms:
• Over or under excited with visual input (too much to look, too much on a page, too many toys out, not seeing obstacles, bumping into things)
• Avoiding bright lights (squinting, wearing a visor or glasses)
• Missing facial expressions

TASTE Symptoms:
• Objects or seeks out certain foods (may be due to flavor, texture, temperature)
• Gags when eating
• Unable to distinguish foods having gone bad or eats nonedible objects

SMELL Symptoms:
• Over or under-responsive to smells (may over react to certain smells with gagging or needing to be removed from stimulus, or doesn’t smell what others perceive as putrid)
• Sniffs people, objects and foods
• Doesn’t distinguish between smells

TOUCH/ TACTILE Symptoms:
• Over or under reacts to being touched (light touches are often especially offensive or even hurtful which is why certain clothing can be a problem or a tag on a shirt, seems unaware of touch unless it is intense)
• Difficulty with activities that involve touch (brushing hair, teeth, bathing)
• Not aware of whether clothes are on correctly or food is on face

VESTIBULAR Symptoms:
• Over or under reaction to movement (seeking out movement like spinning, rocking, swinging, jumping as well as getting sick from and avoiding such movements)
• Thrill seeker (enjoys heights, being upside down,)
• Falls often, needs physical support, avoids changing head position

PROPRIOCEPTIVE Symptoms:
• Over or under reactivity to touch, gravity and movement (craves touch or avoids it)
• Poor body awareness (clumsy, bumping into others and objects)
• Resists novelty and challenges, depends upon the familiar to be able to negotiate his or her world.

Sensory issues can exist on their own or as part of other developmental disorders such as ASD, ADHD, Learning Disabilities and other developmental conditions.

Whether you are a parent, a teacher, a professional or a person with these symptoms, it is important to recognize that our foundations need to be in place to maintain the higher level skills required of us. If we just ‘treat’ symptoms and don’t understand the underlying problem, we are missing the opportunity for real change.

I couldn’t talk about Sensory Processing Disorders without mentioning one of the best books on the subject. The Out of Sync Child by Carol Kranowitz. Carol is the editor of the International Magazine called S.I. Focus. As of January, 2011, it will be an entirely digital magazine and subscriptions are on sale in December & January for only $10.00.

photo credit: haglundc

Years ago I was giving a presentation and talked about how I used toy trains in therapy to address a number of therapeutic goals with children on the autism spectrum. I talked about how valuable the trains were in developing social skills, vocabulary, spatial concepts, number concepts, flexibility, and a number of other core skills.

About a month later, a colleague of mine was attending an IEP meeting at a school and the school speech therapist indicated she had attended my presentation. She went on to tell my colleague (also a speech therapist) that she had bought a train set and yet, the child she was working with had not significantly changed. I don’t know how she could have misunderstood what I was saying in the workshop: it’s not the train that makes the difference, it’s how you use the train in therapy!

If you’re not a good therapist, and you can’t connect with your client, there is no train or any other tool that is going to make your therapy work.

It is so very frustrating to me that there are people who will read about “Lego Therapy” and think that it’s the Lego’s that are making the difference. You may recall a previous blog in which I discussed ‘process’ versus ‘content.’ If you don’t know how to deal with the process then the content becomes irrelevant.

It doesn’t matter if it’s a train set or Legos, as the content, or the toy, is not the salient feature of the interaction. Using a particular toy to achieve a goal is based upon having strategies and techniques for developing a skill.

Most kids on the spectrum are fairly rigid in their way of dealing with the world and the people in it. They have their ways, their routines, and their style, which often does not allow for change or dealing with the unexpected. So, let’s use the goal of increasing flexibility as an example.

Depending upon the age of the child (or person), I want to find ways that they can personally experience the value of flexibility. So with a train set, or toy cars, you can have a child drive the trains/cars on different tracks or get off on different roads and be rewarded for going a different way.

With older children, adolescents and even adults, I have used a rubber band to teach the concept of flexibility. First, I explain the concept of flexibility and rigidity in concrete ways with real world objects.

I find items that are rigid (e.g., a pen, a key, a phone, anything that’s in the immediate environment) and I show how they do not bend. They do not change. Then, I take a rubber band and I demonstrate how it is flexible, changeable.

I show how the rubber changes shapes and how it can change according to the context. For example, if I put the rubber band around a square box of tissue the rubber band becomes square, but if I put it around the leg of a chair, the rubber band becomes round.

After the concept is well understood, we use examples from the person’s life to talk about how they are being rigid or flexible. The rubber band can then be a useful reminder for how to work at being more flexible in certain situations. Currently there is a trend for wearing the colored rubber band bracelets making it even more ‘cool’ to have a rubber band.

There is much to say about working on flexibility. I just hope no one finishes this blog and comes to the conclusion that there is anything called “Rubber band therapy.”

photo credit: Leonard John Matthews

The newest test is called the Lange-Lainhart test after the lead researchers Nicholas Lange and Janet Lainhart. Nicholas Lange is an associate professor at Harvard and director of the Neurostatistics Laboratory at McLean, while Janet Lainhart is a researcher at the University of Utah.

The test is used to measure deviation in brain circuitry using a technique called Diffusion Tensor Imaging (DTI) with an MRI. Using this technique, the researchers were able to detect autism with 94% accuracy when they measured six aspects of the brain’s circuitry that correlated with clinical symptoms of autism.

Further research is necessary and it will be several years before such a test will be available for everyday use.

In another study, researchers Martha Kaiser, Kevin Pelphrey and others at the Yale School of Medicine found a pattern of brain activity that may characterize the genetic vulnerability for autism.

In this study, functional magnetic resonance imaging (fMRI) was used to identify “neural signatures” while children with ASD, their unaffected siblings and a control group of children watched animations of biological movement.

These studies are certainly promising and interesting, but the reality is that so many different areas of science are now studying how to best be able to diagnose autism. Some of those studies include:
• A chemical fingerprint in a child’s urine
• A pupil response test
• Abnormal proteins in the saliva of patients
• Eye tracking was used to identify autism at the young ages of 9 and 12 months old.

It will be interesting to see where the future takes us in terms of what will be the future gold standard in diagnosis. For me, it will always be about recognizing what a person can do, what a person can’t do, working to change what can be changed, and accepting what can’t be. The label will never be the person no matter how sophisticated our science gets at identifying the label.

Photo by Blatant News, available under a Creative Commons attribution, non-commercial license.

So what does this have to do with autism spectrum disorders? The show wasn’t about any special needs individual, but the end of the show had me thinking…

The episode was about a crime that occurred on an airplane. A man dies in the first class cabin and the investigators try and re-create the scene from the forensic evidence and the interviews from the other passengers, which don’t seem to be adding up. Each person seems to be telling a different story and complaining about the man who died as having been ‘a jerk’ of one sort or another.

He irritated the other passengers with his attitude, his complaining, kicking the back of another passenger’s seat, running up to the cockpit door, and eventually trying to open the airplane door.

The investigators were able to figure out that the other first class passengers eventually ‘took down’ this man, fearing he was going to kill them all when he attempted to open the airplane door. Their “group” attack on him ultimately resulted in his death. The coroner found evidence that the man was suffering from encephalitis (an inflammation of the brain, usually due to an infection).

So again, you might be asking, and this has to do with ASD, how?
I’m getting there…

At the end of the story, there is a discussion amongst the investigators about whether the passengers should be charged with murder. Some say “yes,” of course, the man died and he wouldn’t have, had these people not ganged up on him. Others say “no,” they were simply defending themselves and given the context, that’s human nature.

The conversation ensues over whether the context is important and what the situation would have to be like in order to know whether you would be willing to kill someone.

Would you have to be personally threatened? Would you kill to protect a loved one? Would you have to be at 30,000 feet? And the questions continued.

The investigators are asking each other these questions when Grissom, the professional father figure in their lives and outstanding forensic entomologist, is asked the question about what he would do.

And here it comes – wait for it – the connection to ASD.

He responds that they are all looking at it from the wrong perspective. Instead of looking at the individual passengers and how they responded to the man, he asked why doesn’t anyone look at it from the dead man’s perspective?

Grissom goes on to say, (I paraphrase here); it took all these people to take the man down and yet it would have only taken one to ask the man if he was alright? What was going on? Could someone do something to help him?

The encephalitis is what caused the bizarre behaviors on the plane and had someone taken the moment to help figure out what was wrong with this man, to look at it from his perspective, maybe the outcome would have been different.

Photo by contraption, available under a Creative Commons attribution non-commercial license.

Anyone who has worked with, lived with or is personally diagnosed with an autism spectrum (and can critically analyze themselves) has known this for years. Test scores are usually NOT an adequate means of assessing a child with ASD”s abilities, let alone predicting them!

I would add, that it is not just IQ scores that don’t predict academic performance, but I have advocated for years that language test scores don’t predict language abilities either, especially in high functioning individuals.

I know from a purely bureaucratic perspective in order to provide services and funding as well as to conduct research we need to have inclusion and exclusion criteria with standardized measures. But, there is probably no more agitating a situation for me then trying to convince members of an IEP team that a child needs special services despite their test scores.

Just because a child scores at the 90th percentile on a vocabulary test, doesn’t mean he has an adequate vocabulary to engage in age appropriate conversations or academic assignments. Just because a child can tell you the emotions on a pictured face in a standardized test, doesn’t mean he is able to recognize emotions when they occur dynamically and quickly on the face of a real person in a real interaction. Just because a child can memorize a list of numbers or words, doesn’t mean he has a good memory and can remember to put his homework in his backpack or remember the instructions for his homework.

The list of what a child can do on a standardized test versus what they can do in real life can go on and on. The concept of ‘discrepancy’ is often associated with children diagnosed with Learning Disabilities (LD) because it is the discrepancy between their IQ and academic abilities that actually defines the label LD. But, the fact is that children on the spectrum have significant discrepancies in many different areas.

There is the familiar discrepancy between having a phenomenal attention for some things and almost no attention for other things. The discrepancy between having adequate language skills and yet poor conversational skills is classic. The discrepancy between having a significant knowledge about certain subjects, almost to the point of savant in some instances, and yet knowing nothing about social rules is often amazing.

The current research study indicated that in 90% of the children with ASD, their IQ scores did not predict their academic achievement with some children doing better than their IQ predicted and some doing worse. Maybe, despite my initial cynicism, this will be the lasting value of the research. Tests don’t predict one way or the other for children on the spectrum even though in the general population of neurotypical individuals, IQ is usually a good predictor of academic achievement. The authors go on to suggest, “Improved social abilities may contribute to academic achievement.”

In the late 1990’s Daniel Goleman, in his groundbreaking bestseller, Emotional Intelligence: Why It Can Matter more Than IQ addressed the importance of our social-emotional development and its impact on our ability to function in the world.

The amount of time it takes for research to sometimes catch up to what we already know is frightening. At the same time, there is a stunning amount of new research and discoveries every day. I guess it’s just another discrepancy – this time in the world of research.

To read the complete research article entitled, “Discrepancies Between Academic Achievement and Intellectual Ability in Higher-Functioning School-Aged children with Autism Spectrum Disorder” click on the November 2nd online issue of the Journal of Autism and Developmental Disorders.

[Photo by Mike Baird, available under a Creative Commons attribution non-commercial license]

For years I have been advising teachers, parents and other therapists that working in isolated contexts is only good to a point. We MUST help our kids apply the skills in real world contexts if we’re going to serve them in the long run.

I think of all the times I used the other people in my offices for “practice.” Taking my clients to their offices, learning to knock on doors, ask questions, have a conversation, request something, learn to greet or say ‘goodbye” and the list goes on. I have also had office locations that were in shopping centers that allowed me to take kids out in the real world and deal with spontaneous everyday experiences at grocery stores, drug stores, and the ever popular bakery and frozen yogurt shops for treats!

When you are isolated in an office or classroom, it is easy to forget all the natural and unplanned things that happen in real life. Therapists and teachers are used to having goals or curriculums to follow, but the real world doesn’t work like that.

Parents are dealing with their kids in the real world and they are expecting that the skills kids are learning in school and therapy will help their children in the real world. So often, that is not the case because we’re not teaching kids how to apply the skills. Real world experiences are the best teachable moments.

The number of skills that can be taught in the real world are endless: social skills, language skills, math skills, life skills, behavioral and emotional regulation, problem solving skills, and the list goes on and on and on.

Too often I would hear from teachers and therapists that they can’t take their students or clients outside of the classroom or therapy room. By having a store in a school the opportunities for many of the same teachable moments are now brought to the kids. The only unfortunate thing I see is that this is being offered at a school for special needs children instead of being part of a mainstream school. By having special needs and non-special needs individuals working together, you simulate a much more natural real world environment.

The non-special needs students get to know and understand how to listen to, help and appreciate the needs of those with special issues. It was always so disheartening to me when I would take a child into the grocery store and a worker was obviously unfamiliar with the awkward or unusual language or behavior manifested by my client. By teaching neurotypical kids how to work with individuals in the real world that may have special needs is a skill sorely missing in our educational system.

Photo by hoyasmeg, available under a Creative Commons attribution non-commercial license.

Obviously, not every child on the spectrum has the same capabilities for being independent. That is a judgment call that only those around a child can make. But even then, there are differences in how one parent versus another sees their child’s abilities or one professional versus another.

My general philosophy is to give a child the benefit of the doubt, and slowly provide more and more support as they need it rather than the reverse of providing the support and then withdrawing it.

Although this will not work for all children, I have found that it’s easier to add supports where necessary instead of making our children dependent and then removing those supports.

Too often children become dependent on our continuous prompts, directions, and supports making it near impossible to think for themselves.

A strategy I often use (and teach to parents and teachers) is to learn to ASK your child the question they need to ask themselves, rather than telling them what to do.

After all, how many parents and teachers wouldn’t be happier if they could stop telling their children all the time what they needed to do? Some independence would be a welcome break for the adults and certainly a welcome skill for the kids.

For example, when you are getting a child ready for school, instead of saying, “get your backpack” or “do you have your books?” ASK, “What do you need for school?” and then after your child starts to understand this, which may take a day or weeks, start ASKING, “what question do you need to ask yourself before we leave for school?” Then, after a few days, wait and simply look at your child before heading out the door without asking any questions to see if he initiates the question on his own and get’s his backpack.

The quicker you can withdraw prompts, the easier it is to live without them. If a child knows he can always count on you to ask the questions, he never has to do it himself.

So often parents would come to therapy and say something like, “He just has to look at you and he does it, but I have to say it 10 times at home!” I suggest looking at who is teaching whom?

That’s not meant as a criticism of parents! So, please no comments about my not understanding. I do understand and I do get it. But, we have to start looking at what we do and how our actions influence our children regardless of their best intent.

If a strategy works – great. If it doesn’t – fine. We have to keep adding tools to the tool chest of strategies that can help our children adapt and develop into the best they can be and that means as thinking individuals and independent as possible for them.

photo credit: weconomy book