Friday, March 25, 2011

Kinda makes my head wanna explode....

I don't know if I have come out and said this outright or not but my strongest belief as a mom raising two boys with High Functioning Autism is:


This may not be a popular opinion and may ruffle a few feathers but in my opinion it is absolutely true. When we look at opportunities for our boys there just isn't a fit anywhere.  Because of their smarty pants brains they aren't a good fit for a Challenges type program (this is a Spec Ed Program in Fred. Co. MD) and because of the behaviors that come with being Autistic they cannot always be fully included in a typical classroom. Are there any other options? YES and NO.

And ideal situation for a HF Autistic kid would be one that has an appropriate and challenging curriculum, allows for social interaction with typical peers in a facilitated way and has behavioral supports in place when needed. Now, I know, it is not the role of the public education system to give us the ideal scenario, just "least restrictive" and "appropriate".

The solution we have been working within has been something called the Pyramid Program (in Fred. Co. MD). This program is academically appropriate with behavioral supports and inclusive opportunities which sounds like a pretty close fit, right? Here is the problem. This program was not set up to meet the needs of HF Autistic kids, it was set up for kids with Emotional Disturbance. These beautiful children cannot function within in a normal classroom, they've been through a trauma, they have bi-polar disorder, they have a depression diagnosis, they have chronic pain.  These kids are having very true and very elemental responses to the outside world and honestly, who can blame them?

So here we have 2 groups of kids both with behavioral needs and both on grade level, both need services within Special Education so logically...... we put them in the same class.  I've asked many people, this isn't just in Fred. Co., this is a common result across counties and across states. From an outside perspective, I can see how and why it is set up this way but being in the trenches, this makes my brain hurt. Here we have wonderful and smart kids who NEED DIFFERENT THINGS! The main resource this program provides that inclusion doesn't is Behavioral Support but the basis for the behaviors are different. A kid with chronic pain lashing out at a teacher is a very different kids than one with Autism who is having a meltdown because the light above him is humming.

Give credit where credit is due... it is by the sheer force of will and great ability of the teachers within this program that it even works at all. If it weren't for such excellent teachers, staff and administration at this school, I think we would be in a much worse situation but I also feel like their needs aren't being met either!

I do not think that one group deserves a special program more than another. I think both the ED kids and the ASD kids need something equally. Within the school system, it is BOTH these groups that are being UNDERSERVED and it is BOTH these groups where there is so much potential.

I would love your take on this. I go around and around with myself and I get no where.  So please.... discuss......

Monday, March 21, 2011

Did you know....

That there are only two treatments approved by the medical mainstream? They are Applied Behavior Analysis (ABA) and Risperdal (Risperdoine). 

ABA is.....
Applied behavior analysis is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior (Baer, Wolf & Risley, 1968; Sulzer-Azaroff & Mayer, 1991). 
“Socially significant behaviors” include reading, academics, social skills, communication, and adaptive living skills. Adaptive living skills include gross and fine motor skills, eating and food preparation, toileting, dressing, personal self-care, domestic skills, time and punctuality, money and value, home and community orientation, and work skills.
ABA methods are used to support persons with autism in at least six ways:
  • to increase behaviors (eg reinforcement procedures increase on-task behavior, or social interactions);
  • to teach new skills (eg, systematic instruction and reinforcement procedures teach functional life skills, communication skills, or social skills);
  • to maintain behaviors (eg, teaching self control and self-monitoring procedures to maintain and generalize job-related social skills);
  • to generalize or to transfer behavior from one situation or response to another (eg, from completing assignments in the resource room to performing as well in the mainstream classroom);
  • to restrict or narrow conditions under which interfering behaviors occur (eg, modifying the learning environment); and
  • to reduce interfering behaviors (eg, self injury or stereotypy). (

ABA is not....

  • Generally covered under insurance.
  • Quick, cheap or easy. It usually is a 10-40+ hour per week therapy whereby multiple ABA specialists will work with your child in your home (although that is not always the case). The rates for ABA are based on number of specialists, these specialists are paid by the hour. Ten hours per week usually runs around $500. 
  • Available in public schools, even though the model and method lends itself easily to the class room setting. (see a list of schools who say they have ABA as primary intervention:

Risperdal is....
"Risperidone is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used to treat episodes of mania (frenzied, abnormally excited, or irritated mood) or mixed episodes (symptoms of mania and depression that happen together) in adults and in teenagers and children 10 years of age and older with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Risperidone is also used to treat behavior problems such as aggression, self-injury, and sudden mood changes in teenagers and children 5-16 years of age who have autism (a condition that causes repetitive behavior, difficulty interacting with others, and problems with communication). Risperidone is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain." (

Risperdal is not..... 

  • a SSRI or an Amphetamine, it is a combination of both.
  • Zoloft, Lexapro, Wellbutrin, Celexa, Prozac, Ritalin, etc. These drugs are commonly prescribed off label to treat some of the symptoms of Autism. 
  • forthcoming with its level of effectiveness. I've only found one site which comments on the 2- eight week placebo trials of 156 children ( They put the effectiveness at around 68% (69 out of 101 kids). 
  • Free of side effects. The medication website lists the rate of side effects occuring at a rate of at least 10%. 

Autism effects 1 in 110 children & 1 in 70 boys, there are 2 medically approved treatment options.  Of those 2 medically approved treatment options, one requires significant personal cost in both time and money and other requires constant care and consideration of a medical professional to decrease the likelihood of possible long term and potentially deadly side effects. And people wonder why the Autism community are constantly looking "outside the box" for treatment of our kids? Given those two options, wouldn't you?

Sunday, March 20, 2011

PDD-NOS & Autism & Aspergers & Retts & High Functioning Autism and and and.... a look at DSM codes.

This week I spoke to a person who treats kids with Autism regarding Social Skills classes. I need one, she didn't have one. What she did have was a bike riding program, and wanted to know my sons' diagnosis. I said, two boys, one with PDD-NOS & one with High Functioning Autism. She said, "High Functioning Autism, like Aspergers?" and I said, "No, High Functioning Autism." We obviously had a communication issue and I rang off wondering why a person licensed to treat ASD kids didn't know the difference between HFAutism and Aspergers? I've since realized that this is a commonality between medical professionals, parents, kids, authors and everyone in between.  So I decided to write here the differences between diagnosis for all and sundry to read and explore. In my head, I know the differences between the diagnosis because I deal with 2 (possibly 3 of them) and I've had to research it so much in the last 7 years. I decided to go online and do a few simple Google searches to back up my knowledge and quickly realized that the internet doesn't know either! There are a hundred articles that back up my understanding of the Dx and then there are about a hundred more that disagree. So here's what I'm going to do.... I'll give you the information as I have it, I'll give you the DSM-IV codes to look it up for yourself and then I'll tell you that it doesn't mean a hill of beans since they are going to change in all in the next DSM release next year (according to all the doctors I've spoken to in the last 6 months). Nothing in this post should be considered medical advice as I am a Lunatic Autism Mom, not a doctor.

This is the very top of the Autism umbrella, everything below falls into this category. On a family tree this would be dearly beloved Grandma and Grandpa at the base but in this case the marriage happened hundreds of years ago and the tree took a long time to take root. Now it is large and fast growing and branching off in every direction. 

This is probably the diagnosis I am the most familiar with because it is our diagnosis for Cameron (now 9). There are words that go with this diagnosis like "regressive" Autism and "high functioning" Autism. Autism is usually diagnosed between 18mos and 4 with symptoms like hand flapping, head banging, spinning, repetitive movements, lack of eye contact, lack of pointing, inability to "connect" with people and **drum roll here** loss of speech. Usually kids with Autism will have 5-10 words that they like to say like mama, duck, cat, dada, more, etc and then one day *poof* they're gone (hence the precursor of regressive Autism). Kids with Autism can have intelligence ranging from low to high, just because they have Autism doesn't mean they are stupid and conversely it doesn't mean that they are genius'. This is, I think, the biggest misconception of Autism. As the diagnosis progresses and the kids do learn to speak and prove themselves to be of average to high intelligence they usually get the precursor of High Functioning before Autism. But because of the speech delay and possible regressive speech Autistic kids cannot be re-diagnosed as Aspergers. DSM-IV code 299.0

This presents the same as Autism but does not have speech delays or regressive speech. Typically young kids will get a PDD-NOS first then will do further testing around the age of 6 to get a full Aspergers diagnosis. This is why most people aren't diagnosed with Aspergers until much much later, sometimes not even until they are adults. People with Aspergers function well within the world but have big problems with social interaction. Historically they were usually considered quirky or eccentric teens & adults. Not all people with Aspergers are geniuses and not all geniuses have Aspergers. DSM-IV code 299.80

PDD-NOS (Pervasive Developmental Disorder- Not Otherwise Specified)
Sounds like a catch-all doesn't it? Well, when Adam got this diagnosis it certainly felt that way! It means that there are too many Autism like issues to ignore, but the child doesn't exactly fit the criteria. Often this diagnosis comes with a "wait and see" quantifier. Usually there isn't a significant speech delay and usually there are only a few qualities of Autism present. The doctors want to keep an eye on their development and give them access to early intervention but the kids aren't fully categorized as having Autism. Later on, further testing can lead to a diagnosis of Aspergers. DSM-IV code 299.80

I know very little of Retts. It is primarily diagnosed in girls and presents very similar to Autism. DSM-IV code 299.80

Again, I don't know much about this disorder because I usually deal with Autism, PDD-NOS & Aspergers. From what I understand it involves typical development until age 2 and then a significant regression before the age of 10. Kind of worrisome for those parents to think "Whew! Missed Autism" when their kids turn 2, huh?  Seriously, I don't even remember this diagnosis 7 years ago when Cam was first tested. DSM-IV code 299.10

Clear as mud, right? This is probably why there is such a push to re-define the Autism Spectrum Disorders and that change is slated for next year. I guess we'll wait and see.  

Wednesday, March 16, 2011

A Different Normal

The issue of the Tooth Fairy in my home VS the home of a "typical" child is so different I figured it was worthy of a blog post. Anyone read that super annoying poem that they pass out to newly diagnosed families about wanting to go to Italy but ending up in Holland? You know the one, it's supposed to make you feel better-- you wanted to go to Italy but Holland's not so bad, right? Its just different. Just in case, I'll find it and post it. I'm sure it brings comfort to some, me? Notsomuch.  

I grew up in a "typical" house, you lose a tooth, you put it under the pillow and WOW! Someone (the Tooth Fairy) leaves you money! For us it was 2-4 quarters, the tooth forever MIA. I started to notice that my normal was going to be different when Cameron lost his first tooth. The idea of money held absolutely no sway with him at all. He didn't understand the concept of giving a clerk paper and coins in exchange for a toy or book. Therefore we took out the middle man and the "tooth fairy" hit a clearance sale and stocked up on Leapster games for $7-10. Now that we are starting round 2 of the tooth game with Cam (molars-YIKES!) the "tooth fairy" is going to have to get clever fast! Especially since his tastes now fall to expensive DS games & musical instruments. I'm thinking the "tooth fairy" will become a big time book pusher soon.

For Adam, same issue with a twist. When he lost his first tooth he was terrified! Not because he lost his tooth but because he was terrified of a fairy entering his room at night. This took hours to determine and resulted in a new method of tooth/toy transfer. I emailed the "tooth fairy" to notify her that Adam would prefer to leave his tooth at his seat at the table, Adam wrote the "tooth fairy" a note explaining his fear and thanking her for leaving his reward at the table (a cherished mommy momento). That is where we are today. Last night's lost tooth resulted in a fabulous Chewbacca figurine from the Kenner classic Star Wars line and Adam couldn't be happier. Well, he probably could be happer if he wasn't a sickie pants with a strange fever/headache/sore throat/general ickiness. I know you want a pic of my toothless wonder (with the sickie eyes and everything), so here you go....

And now for a funny story from my Lunatic Autism Mom vault! Some years ago I attended a Defeat Autism Now! conference in New Jersey. This took me away from the boys for 2 days and 2 nights, in that time Cameron lost a tooth! I got a call from Rob saying, "uh, Cameron lost a tooth but we have a problem." I explained the procedure, where the stash was hidden and wondered why this was an issue since he was there the last time we had a lost tooth. He continued, "thats the problem, I don't have the tooth and Cam is freaking out that the tooth fairy won't visit." I'm like, what happened to the tooth? Did you lose it? Find it! Nah....that would be too easy for our family, you see, Cameron ate his tooth. Yep, you read that right. Apparently, the tooth came out, Rob sat it on a tissue to dry and Cameron decided that was wrong. Teeth belong in your mouth, right? So back into his mouth it went and down his throat. Then Rob, not knowing where it went said, "we better find it so the tooth fairy can visit". Insert freak out here.  There is some debate as to who's idea it was to find an old tooth to show Cam and say, "here! I found it!" I like to think my cleverness came up with that, Rob likes to think it was his but either way a replacement tooth was located. For a little while at least. You see, Cameron saw this new tooth and thought (you guessed it!) teeth belong in your mouth, not on the table! And ate the second tooth. Complete gross out factor aside, yet ANOTHER tooth was brought out to a completely freaked Cameron with strict instructions to NOT EAT THIS TOOTH, it was wrapped in tissue and bagged in a ziplok and kept within Rob's sight for the rest of the day. He made it through the exchange and knew forever that even something as simple as a "tooth fairy" visit would never be as simple as we had planned. I guess in Holland things are done differently. And now a poem....(I promised, didn't I?)



Emily Perl Kingsley.

c1987 by Emily Perl Kingsley. All rights reserved

I am often asked to describe the experience of raising a child with a disability - to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It's like this......
When you're going to have a baby, it's like planning a fabulous vacation trip - to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It's all very exciting.
After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The stewardess comes in and says, "Welcome to Holland."
"Holland?!?" you say. "What do you mean Holland?? I signed up for Italy! I'm supposed to be in Italy. All my life I've dreamed of going to Italy."
But there's been a change in the flight plan. They've landed in Holland and there you must stay.
The important thing is that they haven't taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It's just a different place.
So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met.
It's just a different place. It's slower-paced than Italy, less flashy than Italy. But after you've been there for a while and you catch your breath, you look around.... and you begin to notice that Holland has windmills....and Holland has tulips. Holland even has Rembrandts.
But everyone you know is busy coming and going from Italy... and they're all bragging about what a wonderful time they had there. And for the rest of your life, you will say "Yes, that's where I was supposed to go. That's what I had planned."
And the pain of that will never, ever, ever, ever go away... because the loss of that dream is a very very significant loss.
But... if you spend your life mourning the fact that you didn't get to Italy, you may never be free to enjoy the very special, the very lovely things ... about Holland.

Thursday, March 3, 2011

The Care and Feeding of my Autistic Children

Cameron, you cannot have any more mixed veggies until you eat at least one slice of pizza!
 Adam, I KNOW ham, broccoli and baked potato is your favorite dinner but can we just make due with a hot dog and fries tonight? It's all we have until I go to the grocery store.
Yes, pancakes and sausage is normally served on Saturday morning with Daddy but can we just try it for Wednesday night?
Yes, you can get carrots instead of fries. I'm sure the waitress won't mind the substitution. 
She will bring the mustard with your dinner, I promise. I know it's not on the table right now but I promise she will bring it or we will ask again-- NICELY.
I only see carbonated beverages on the menu, do you have any juices? No. Okay, water for the boys, please.

 Yep, these are all things I've said out loud and recently, if I were a better person I would totally be smug about all of this but NOPE! It does me absolutely no good at all to be smug about their picky eating habits, even if those habits tend to lean towards some freakishly healthy options. To counteract all of that healthiness the boys also have a deep and abiding love of all things ice cream and will do many many math problems to get their hands on junior mints. Since picky eating is a topic that comes up again and again when I talk with other Autism moms, I will attempt to share with you all the lessons I learned, what worked, what blew up in my face and in the end how it all fell in to place. Maybe you will find something that will help your own plight, or maybe I can make you laugh, either way it's a WIN!

When your child is teething, give them cold or frozen veggies to chew on. It will help them through teething and will give them the vitamins they need. (from a parenting magazine)
For us this totally worked! I carried around frozen veggies for years and years. I've even put frozen mixed veggies on McDonald wrappers right in between the cheeseburger and french fries! Now 9 years later I get a very cranky Cameron who feels that a meal isn't complete without something veggie on his plate. Adam cares less but will still eat mixed veggies, no salt and no butter, but he does still prefer them a little frozen. I can do that! 

Make your child try at least 2 bites of everything at every meal. They may find they like something new and really, 2 bites isn't too much to ask. (a pediatrician)
Uh... nope! This failed miserably! Lets not forget that our special Autie kids have tactile sensitivity and thats not just for fingers and toes everyone! Textures are a BIG DEAL! Cameron could not stand mashed potatoes no matter how decadent I fixed them or how loaded I made them, that soft kind of mealy texture was just too much for him to handle. This "just try 2 bites" started with a big fight at the table, us basically forcing him to try them and ended with vomit all over the dining room table in the middle of dinner. It wasn't my proudest mommy moment and I have never strong-armed Cameron into trying something ever again, bribery on the other hand....  Years later, Cameron now tolerates mashed potatoes. He prefers them lumpy and made with chicken stock instead of milk but he will eat them. 

Adam, on the other hand, was more subtle. As a baby (and even now) he LOVES to eat and there were very few things he wouldn't eat.  That was until we tried peaches. In some amazing feat of biology or chemistry or something the day he tried peaches, Adam also defied some kind of law of nature. Of course it was puree'd veggies and fruit for my then 6 month old, we started with a little rice cereal (yum!), ate 3 or 4 bites of peaches (baby grimaces are adorable) and then 1/2 a jar of green beans. THEN came the vomit. Somehow, some way, he was able to only puke up the peaches without even a hint of white from the cereal or green from the beans!!  This would prove to be only the first of many miracles from this child.

**SORRY for the delay, I'm back and trying to remember what else I wanted to write about!**

If you want your child to try something new, put it on his plate. If he doesn't eat it, put it on his plate the next time you make it. Eventually he'll try it once it becomes familiar. (I have no idea where I read/heard this but I think it was either from another ASD Mom or a doctor specializing in sensory issues)
Totally worked-- I think. By the time I heard this, Cam was much older and already had a pretty good list of foods he ate. We decided to try this idea with mashed potatoes since we knew it was a sensory thing more than a taste thing. We put a little on one of his divided plates (LOVE Corelle!) and he ignored it. I didn't grow up during The Depression so I'm pretty comfortable throwing food away especially if we are working towards a goal. I would guess that it took 4 or 5 times before he tried the potatoes and he did gag a little but he ate them. A few more potato dinners later he'll eat a whole serving and will gag only if we make him eat the potatoes. Here's where we fall down on this plan, now that we KNOW he'll eat them we often suggest that he eats all of them (often with gagging). I don't like that and I really shouldn't do it any more. I'm sure some days he is more sensitive and I shouldn't push.

Food is just food, you eat to fuel your body not to fill your heart. (my brain after reading long articles on stress/emotional eating)
I am a serious an emotional eater and as such should wire my mouth shut and get my keister to the gym more to work off all the effects of emotional eating. Not going to happen so instead I try my best to realize what I'm doing, decide if its worth it (because really, sometimes it is) and then deal with the outcome-- no excuses, no lies. Moving away from the old school, "food is love", "Grandma made this just for you, you're too skinny, eat up!", "lets celebrate, I'm taking you out to dinner" ideas is hard. So is trying to loose a ton of weight so really it comes down to which you would rather do.

For the boys, I try very hard to make food a non issue. If there is something I don't want them to have, I don't put it in the house. If I am eating, say, a cookie at 9am just because I'm an adult and I can, then if they want one they can have one too (but just one). All snacks come from the snack drawer in the fridge or the bin in the closet-- no exceptions and it is my job to make sure those snacks are things they like and things that are healthy. If Cam wants pancakes for dinner but we can't have it that night because I've already planned (or already cooked) something else, then he can write it on the calendar for whatever day he wants. Meals are not snacks and snacks are not meals. This means that when we sit down for a meal it will have some basic elements like protein, veggie/fruit, etc. it does not mean that there will be granola bars, cheese sticks or peanut butter crackers on a lunch or dinner plate. I have two personal rules about shopping, I have been rigid in them and I have never deviated from them (because for my boys it is either yes or no, sometimes to them would equal yes). (1)We don't sample anything given away at Costco-- this comes from Cam's food allergy days. I didn't want him to try something THEN realize that it contained an allergen, then once he was out of the cart I didn't want him to wander off to "try" something in a busy store. With 2 kids known for running off, even at 6 & 9, it's a chance I'm not willing to take. (2) We never buy anything at check out. When they were babies the answer was 100% no, 100% of the time, they stopped asking. Now that they are older, they occasionally ask again and the answer is still no. Typically if we are at a store with a candy isle, we're buying food anyway and there is a snack in the cart somewhere that they would like just as much. It's a simple re-direction, especially with the "that is not a snack, that is a treat" idea already firmly planted.

The outcome of this has been rather surprising. Now that they are older and choosing their own snacks and meals, they make pretty good choices. There are treats in the house, they get them occasionally. Nothing is "off limits" if it is in the house, just some things are "not at this time". They've responded pretty well. I'm looking forward to their teen years to see how it all carries over. I'm hopeful that they will understand the difference between snack and treat and will make choices accordingly.

A funny and enlightening story for me (because all things can be looked at different ways, this one is funny to me because it is enlightening)
Cameron recently started a program called Coping Cat along with a medication trial. We are targeting the stress, focus, anxiety and impulsivity that is getting worse as he is getting older. I avoided all pharmaceuticals until Cameron was 9, which I feel is a huge triumph since I've been getting pressure to medicate him since he was 2. At some point the anxiety he was feeling and his impulsivity was past the point of re-direction. When anxious, he would shut down and no once could reach him. It's a helpless feeling for both him and for me. I still didn't want to do meds because I didn't think he could communicate his feelings/hurts enough if something was going wrong. But we hit a wall, had to make a decision and we did. That doesn't mean that I like it though..... Anyway, back to the story. We tasked our beloved Behavioral Psychologist to come up with a plan for helping Cameron work through his anxiety, focus, and impulsively (Very different things, requiring different methods and different types of medications) and to recommend a doctor willing to walk us though the medication trial. So we started seeing a Pediatric Psychiatrist who specializes in Autism to start the med trials and we started a program called Coping Cat with the Behavioral Psychologist simultaneously. I'll save my medication rants for another day, my story comes from the Coping Cat program. This is a great program where the kids first identify emotions in pictures, tv, etc, then identify emotions within themselves, then identify how their body feels when faced with these emotions and finally how to help regulate the emotions. During one of the first sessions they talked about a time when Cam was feeling particularly emotional. He said, "dinner last night". The doctor thought this was odd because dinner isn't usually a particularly emotional time for kids, especially Cam since he doesn't have many eating problems and had just started eating a wide variety of foods. It took a while to figure out why chicken and rice was creating strong emotion in Cameron but in the end Cam decided that the emotion was jealousy. WHAT???  Cam went on the explain that he was jealous of all the other kids who didn't have to eat rice for dinner because it was so boring and he didn't want it. I immediately thought back to the night before where we were all eating, there were no issues and he ate his whole plate without complaint! I guess the whole time he was thinking, "ugh, I hate rice, I wish I didn't have to eat rice, it's so boring, other kids don't have to eat rice, I'm jealous of those kids who don't have to eat rice." You know, I haven't made chicken and rice since. Not because he didn't like it but as a silent and tacit reward for identifying his feelings and then expressing them. What a HUGE milestone!

I guess my bottom line on the care and feeding of my kids is:

  • are they eating some protein, some veggies, some fruit, some "other"?
  • are they taking a vitamin?
  • are they growing?
  • are they happy?
It's best to have a YES on all four but truthfully, if you have to have a NO for any of them at the dinner table it should be the last. I don't like that Cameron was jealous during our dinner of chicken and rice but if rice is what we had and rice is what he needed then I'll just have to deal with the jealousy. The occasional unhappy meal is inevitable but not insurmountable.