Monthly Archives: April 2014

Multiple Complex Developmental Disorder (McDD)

Multiple Comlex Developmental Disorder (McDD) is recognized as a subtype of PDD-NOS in the Netherlands. It is an autism spectrum disorder in which people also suffer from emotion regulation problems and thought disorders. Its proposed criteria according to the Yale Child Study Center are as follows:


  1. Impaired social behavior/sensitivity, similar to that seen in autism, such as:

    • Social disinterest

    • Detachment, avoidance of others, or withdrawal

    • Impaired peer relations

    • Highly ambivalent attachments

    • Limited capacity for empathy or understanding what others are thinking or feeling


  2. Affective symptoms, including:

    • Impaired regulation of feelings

    • Intense, inappropriate anxiety

    • Recurrent panic

    • Emotional lability, without obvious cause


  3. Thought disorder symptoms, such as:

    • Sudden, irrational intrusions on normal thoughts

    • Magical thinking

    • Confusion between reality and fantasy

    • Delusions such as paranoid thoughts or fantasies of special power



In The Netherlands, slightly different criteria are used. For example, social disinhibition is proposed as a possible symptom in the social impairments category.

In the Dutch Wikipedia, McDD is referred to alternatively as juvenile schizophrenia and juvenile BPD. However, most parent-directed sources highlight the intense anxiety which is at the core of McDD. Psrenting, therefore, needs to be aimed at providing structure and boundaries and helping the child reduce their anxiety and emotional lability. Parents need to refrain from showing too much emotion to prevent the child from absorbing the parent’s emotions.

Children with McDD often experience psychotic symptons or full-blown psychosis in adolescence. The emotion regulation problems become less pronounced as individuals with McDD grow into adults, but social problems an thought diosorders often remain significant. Antipsychotic medications can be used to help reduce psychotic symptoms. Even so, most McDD individuals will need lifelong support.

I do not have a diagnosis of McDD, although I think I may meet its criteria. I remember my parents were asked about thought disorder symptoms and unprovoked emotional outbursts at my first autism assessment, but they said I didn’t have them. In reality, I had a lot of bizarre thoughts as a child and still do have them sometimes, and my parents were confused about the questions on unprovoked outbursts. I have, interestingly, foudn that antipsychotics help more with the emotion regulation problems than with the thought disorder symptoms. This does mean that I suffer in silence soometimes, because I do have strange fears and bizarre thoughts, but am too drugged up to act on them.

Greek (or Turkish) Kofta

When I lived in an independence training home, I learned to cook. There were a few dishes I could cook independently at the end. I will attempt to share these on my blog. Some I cooked from fresh ingredients, while with others, I used packaged foods. I have started to make an attempt at (blogging about!) healthy eating. I’m not likely to ever go all the way on an eating lifestyle, but I do try to at least educate myself about what I’m eating.

Kofta is a Greek or Turkish lamb mince recipe, although I’ve always used beef mince. When googling for recipes in English to find the English names of spices and such, I found that kofta can be served on pitas. I usually use a store-bought package of rice and spice and gravy mixtures and add tomatoes, zucchinis and bell peppers, and of course the minced meat. However, when making kofta with my husband, we discovered that there is peanut in one of the mixes, to which my husband is allergic. We decided to mix the spices ourselves. I can’t remember exactly which spices we used, so I looked up the ingredients of the Knorr mix, which I usually use, and removed what seemed to be unnecessary additives (or things that didn’t appeal to me and for which I was too lazy to look up the English words, LOL). This recipe contains the fresh spices, but you can of course buy a store-bought mixture too.

Prep time: 30 minutes.
Cook time: 30 minutes
Servings: 2 to 3

Ingredients


  • 300 gram minced meat

  • Kofta spice mix:


    • Breadcrumbs

    • 1 shallot, very finely chopped

    • 1 garlic clove, crushed

    • 1 teasppon cumin

    • 1 teaspoon sea salt


  • Glaze mix:


    • Small can of tomato puree

    • 1 teaspoon cumin

    • 1 teaspoon thime

    • 1/2 teaspoon cinnamon

    • 1 teaspoon black pepper


  • 300 gram rice

  • 1 zucchini

  • 2 bell peppers

  • 400 gram (canned) tomatoes

Method


  • Slice the zucchini, bell peppers and tomatoes. If you bought canned tomatoes, here at least you can buy them diced.

  • Mix the minced meat and the spice mix. Mix until well combined, using your hands.

  • Divide the mince meat mixture into small portions and roll these into ball or sausage shapes.

  • Cook the rice for ten minutes.

  • Fry the meatballs or sausages until they’re ready. This in my experienece takes about 10-15 minutes, but may take longer if your meatballs/sausages are larger.

  • Add the zucchini and bell peppers. Cook for 5 minutes.

  • Add the tomatoes, glazing and 200 ml water. Cook until thick enough.


The Knorr package says you need to serve the kofta and the rice separately, but I actually love them combined.

Making Your Own Fruit Animals

When I was a child, I had a sbuscription to a Dutch audio magazine for blind children ages five to nine. The magazine was fun and educational at once, and usually had interviews in it, informative articles, as well as activities and recipes. It was here that I first learned about making a fruit hedgehog. A fruit hedgehog is made entirely of fruit, and is therefore healthy as well as being easy to make and delicious. You will need:


  • 1/2 cantaloupe or water melon

  • Lots of other fruit, whatever is available at the moment

  • 1 pear

  • Raisins or blueberries

  • Wooden skewers

Cut your chosen fruit into bite-sized portions. Put the 1/2 cantaloupe or water melon, flat side down, on a plate. This will be the hedgehog’s body. Stick fruit bites onto the skewers and stick the skewers into the melon. Cut the lower side off the pear and use the upper side to make the hedgehog’s head. Stick it into the melon using a skewer. Lastly, stick two raisins or blueberries into the pear to make eyes and one raisin or blueberry to make the nose. Use parts of your skewers to do this.

There are many variations to the fruit hedgehog. For example, instead of just fruit, you can combine fruit with cheese cubes. You can also make other animals from fruit. For example, here is how to make a fruit giraffe. For this, you will need:


  • 1 kiwifruit

  • Seedless grapes

  • 1 strawberry

  • 4 toothpicks and 1 longer skewer


The kiwifruit in this case is the body. Stick four toothpicks through one side of the kiwifruit and put two grapes on each toothpick. These are the legs. Use the longer skewer for the giraaffe’s neck, again sticking grapes onto it. Use the strawberry for the head.

Again, there are many variations to the fruit giraffe. For exaample, you can use blueberries instead of grapes for the legs and neck. You can also make the body out of a cantaloupe cut to shape. Kastly, try adding the giraffe’s typical spots. Use strawberry slices, raisins or blueberries for this.

I’m linking up with Mostly Homemade Monday. I hope my post qualifies. I apologize for no pictures. As you may’ve guessed, I’m blind, so I can’t really use pics.

Murder of Autistics: Understanding, Advocacy, Excusing

As H.L. Doherty writes, a mother killed her severely autistic child and herself. This is not the first murder/suicide where autism is involved, and it sadly will not be the last case I’m afraid. Doherty goes on in his post to shame autistic advocates who doubt that severe autism was the reason for this murder/suicide. I have to agree with the autistic advocates, in part: while circumstances can drive a person to murder or suicide, it is not like autism parents somehow need extra sympathy if they’ve killed their children. All parents of disabled children, and disabled people of any age themselves need understanding and support.

Let me tell you my experience. In 2007, I was quite severely disabled by my autism. I was aggresssive and self-injurious, including smashing my head into the brick walls of my apartment and trying to jump out of a moving car. I wasn’t being taken seriously by the crisis team, who said that admission to a hospital would not be good either. On November 2, I threatend suicide in my parents’ city, and the crisis team there took me seriously and admitted me to hospital. I got slightly bettter there, but still struggled. After years of having many meltdowns, I finally found medication that helped reduce my irritability. I have a post in the works about my changing attitude towards medication, recognizing that many autistic advocates are against the type of medication I take.

By 2015, I may or may not fall under the Long-Term Care Act. If I do, I’m entitled to residential care for as long as I need it. If I don’t, I need to get support at home, which I got a lot of already when I was in this severe state in 2007. Please note that I was quite aggressive and self-injurious all my life, and that it just escalated in 2007.

Please also note that I’m not the most severely autistic person imaginable. For one thing, I don’t have an intellectual disability and am mostly verbal. I do not claim to know what it is like to have an intellectual disability or be completely non-verbal. What I do claim to know about is the despair of having to deal with complex needs in a system that is facing massive budget cuts.

That being said, of course we need more supports for people with complex needs, including those with more severe autism than mine. Of course we need to understand how hard it can be to care for a person who has these complex needs. What I ask Doherty, however, is to also understand those people who live with significant disabilities.

Please understand, Mr. Doherty and supporters, that we don’t choose to be self-injurious, aggressive or have complex care needs for other reasons. We agree with you that more support is needed. I, for one, am realistic enough to admit that some people need drugs to curb severe aggression. (I take a high dose of an antipsychotic to prevent milder irritability, but I am not going to advocate that children or adults who can’t consent are forced to take this.) I, for one, have myself been suicidal, so I know what it’s like to want to end your life because of lack of care.

Where I disagree with Doherty and his supporters, is where he connotes that auitsm is the cause of murder/suicides like this one, in a tone as if to say that, as long as severely disabled autistics exist, we’re asking to be killed, or at least that killing us is understandable. And it is not. Writing about murder as if it’s somehow provoked by the victim’s disability, is denying the disabled victim the basic human right to life. It is not the call for support we, the autistic community, are fighting against, or even the fact that people with severe autism and an intellectual disability exist. However, I ask that Doherty et al. please stop excusing murder just because it offers an opportunity to advocate. No-one should be murdered. Stop excusing it.

Long-Term (S)care Planning

Next year, my institution is going to undergo restructuring and all people with the lower levels of care will be kicked out. Lower levels of care in terms of institutional care, that is, so my level five (out of seven) care package does count. Exceptions are being made for those who’ve been completely institutionalized, so that they can’t live in the community, but that doesn’t include me having spent “only” seven years in an institution.

Honestly, I’m worried, but also determined. I was actually going to be referred to the Leo Kanner House workhome. The Leo Kanner House is an agency for autistic children and adults, specifically those without an intellectual disability. The workhome is their institutional, long-term placement for the more severely disabled adults, but firstly they have a waiting list a mile long (or two miles, or three), and secndly, my care package will likely by the time they have a place for me, not qualify me for care there anymore. Five out of seven sounded heavy duty when I first was assigned this care package in 2009, because I got there from three and that was already called something about “intensive support”. Currently, those with any care package below five are expected to live independently with outpatient and home supports. Fine with me, and I would’ve loved to attain this level of independence, but it’s not like the people in these care packages get the additional care that living on yur own requires versus living in a group home or institution.

As far as I’m aware, the people in care package five are allowed 24-hour care until the Long-Trm Care Act passes, which is only God knows when. 24-hour care, for clarity’s sake, means having someone available on call or at best in the group home or on the ward 24/7. There’s absolutely no-one who is allowed 24-hour supervision under the Dutch care system. Anyway, assuming that I’m entitled to group home care until whenever, but will be kicked out of the institution next year, I decided to E-mail my therapist to discuss referring me to supported housing.

There are two supported housing agencies in the area that cater to psychiatric patients – and autistics without an intellectual disability fall under the mental health system here. One of the agencies is a larger one which has existed for several decades. On their page about autism care, they only advertise a training home where autistics are trained to live independentlly and have to move out within a year. Not suitable for me, as 1. I already got enough training home experience to know I’m not going to learn much there, and 2. there’s no way I’m going to learn to live with only home supports in a year’s time, if ever. My husband and I are going to E-mail them anyway as, being a larger organization, they might be able to provide some kind of accommodation where we can live together with enough support for me.

The other organization is smaller, having only about six or seven group homes throughout the province, though mostly in my area. They have an autism-specialized group home in the nearest big city, in which they work together with the Leo Kanner House, but there are two drawbacks. Firstly, this group home is located down town, which means I won’t be able to travel safely even for just a walk around the block. The second drawback is that it is part training home too. Then there are two group homes in the countryside near a neighboring town from here. It is one of these group homes I’m asking ot go on the list for if I pass the intake interview. I will be calling this organization tomorrow after I speak to my therapist. Not sure how or when I’ll be contacting the larger supported housing agency.

One of the positives about moving into a group home is that my therapy falls under a different insurance scheme then. Under care packages for those in institutions, you’re only entitled to 50 minutes of “treatment” a week. That’s normal, you’d say. The thing is, “treatment” includes not only psychotherapy, but also art therapy, social work, consultations with a psychiatrist, etc. Basically anything other than staff support and day activities. Based on this, I get psychotherapy only once every other week at best (even though until recently I had no other forms of treatment, but oh well). Under group home care packaging, support will still be covered, but treatment isn’t covered. You’ll have to get that paid for through health insurance. That means, if I’m correct, that you can get more treatment paid for if your diagnosis warrants it, which mine does if I have to believe my therapist, who says that people with borderline personality disorder normally get at least a session a week. (Day activities are from 2015 on covered through the local government to make things complicated, so I have no clue how m uch I can get of those.)

I also asked my therapist to contact the Leo Kanner House about doing a consultation there. In all honesty, I’d like to get therapy there (they offer psychotherapy too) rather than at my local mental health agency, but as far as I know, getting both agencies involved is also possible if you have a dual diagnosis. As I wrote a few weeks ago, however, my diagnosis of autism is being questioned, so I’m asking my therapist to call my old institution to request my old records, too. I don’t mind having to answer a zillion questions about my autism for only about the fourth time (yay, I can do sarcasm, does that make me NT?). What I do mind is having to get my parents to come over again, for the third time in their case, to do the developmental assessment. Oh wait, what if my childhood development has changed since 2007? My therapist had better get the records, and she’ll hopefully straighten up about my blindness, as the Leo Kanner House had a blind client several years ago.

June 16, 2002: Becoming Aware of My Autism

Good Friday has a special place in the mind of Brielle’s Mom, blogger at Brielle and Me, because it was the day she first became aware that something wasn’t normal about Brielle. I do not know when my parents became aware of my blindness, or whether there was a specific event that caused them to worry. I do know they, like Brielle’s parents, knew I was at risk, because they kept warning the NICU nurses not to turn up the oxygen.

With regard to my other disabilities, my parents knew about them for years before I was diagnosed. Like, when I was first diagnosed with autis, my parents told the doctor that they’d suspected it since I was two-years-old. That was eighteen years ago at the time.

I do not remeber becoming aware of my blindness at a specific moment, but with the autism, there is a specific moment which caused me to start to wonder. It was June 16, 2002, 3:50 AM. I was in my rooom, the volume of my CD player turned up, writing in my journal. On June 17, I was expected to disclose a very personal struggle of mine to my high school tutor. I had not been able to speak out of anxiety the previous Friday, and he had me come in on MOnday to write down what was going on, what caused me to fail five subjects in ninth grade because of mostly lack of effort. The reason I struggled was my becoming increasingly aware of the fact that I was never going to be seen as “normal”, and that I had to compensate for my blindness in some way. I also started becoming aware of my alters that year, but I didn’t disclose this to my tutor that Monday, or ever until several years later when he read my online journal.

Back to Sunday June 16. My father came into my room shouting. I don’t know until now, and never knew, what made his angry: the loud music, the fact that I was still awake, or what. “Are you autistic or somehting?!” he shouted. I knew better than I know now why he was saying that I was autistic, believing at the time that antisocial behavior like turning up the music in the middle of the night, is typically autistic. It wasn’t the first tiem or the last that my parents labeled me autistic or any number of other neurodiverse conditions or mental illnesses. It was the one time that the message got through. Not that I shouldn’t be up late or play loud music, but that something wasn’t normal about me. I suspect neurotypical teens sometimes play loud music at night too, so in this sense I do not know what made the comment get through to me this time. There were far more typcal signs that my parents commented on: my stimming, my meltdowns my social withdrawal and bizarre behaviors, etc. But this time, I believed my father.

I was obsessed with autism for the next nearly two years, until again it was my father who pulled me out of it. I didn’t want anything to do with autism for the next two and a half years, until my staff at the independence training home decided I needed an evaluation. I was given the diagnosis of autism on March 16, 2007.

If you have a disability, is there any specific event that made you aware of it? If you have a special needs child, when did you first realize they weren’t developing typically?

Disability and Childlessness: It’s Complicated

I am disabled. I am childless. For a long while, I identified as childless by choice. In a way, it is a choice, because I do not experience reproductive problems that I know of. In another way, it’s not a choice, because I would’ve wanted to be a parent. I’m not “childfree”. I am disabled, and this has influenced my decision to remain childless. That doesn’t make it not a decision, but it makes the decision tougher than had I truly been childfree.

On Musings of an Aspie, there’s a post on honoring your choices as an autistic woman (or man). It is a postscript to the autistic motherhood series on the Autism Women’s Network. The post concludes that older autistic parents have a responsibility to share what they’ve learned with the younger generation of autistics. This, in my opinion, goes for autistic childless people too. As autistics, we often feel left out, and it’s important to have people whose experiences we can relate to who are older than us and can share with us what they’ve learned. Likewise, we need to be mentoring the even younger generations.

I find it extremely hard to connect to people with whom I have enough in common that we can share our knwoledge and experiences and support each other this way. This may be because I have multiple disabilities. The Internet has opened a world for me, but when, with this current blog, I began to spread my wings outside of the disability blogosphere, it also amplified my differences. It may be just me, but I see Mom bloggers everywhere.

Childlessness, like disability, is a minority status. And now that childlessness is no longer the only way for disabled women, it adds up to someone’s otherness. I’m not saying that childlessness should be the norm again for disabled women. What I do want to say is that it’s still a reality for a lot of disabled women (and men), and that it’s often still a painful reality that is complicated by prejudice and stimma both surrounding disability and childlessness. I do understand that the assumption that disabled people are childless by default, needs to be challenged, but this assumption should not be replaced with additional stigma for the person who finds their disability actually does make it impossible for them to become a parent.

Life with a Disability Isn’t Easy

I decided to buy a new eBook again and went with I’m Not Here to Inspire You by Rob J. Quinn, a collection of essays (most originally posted on his blog) on life with severe cerebral palsy. In the first essay, Quinn tackles the assumption among people with disabilities that life with disabilities is easy for other people.

I have seen this assumption, and held this assumption myself. Interestingly, I’ve seen it within the disability community too. When I disclosed my autism diagnosis on a blindness E-mail list, I was told that this need not keep me from living a productive life. Look at Temple Grandin! And since blindness by the philosophy of this group did not need to keep me from living a fulfilling life, there were no limits to me obtaining a Ph.D. Other than the fact that 95% of the non-disabled population don’t have a Ph.D., I might say.

We’d like to believe that all people need to do to achieve a productive life is ignore their limits. When you have a physical disability, these limits in the media are multiplied, and therefore the overcoming of them is a thousand times more inspiring. Reading these stories, sometimes actually endorsed by disability organizations, makes the ordinary disabled person look totally meek. I, for one, have never felt encouraged by Helen Keller or Temple Grandin, at least not by the inspiraporn that surrounds them. People with disabilities who live productive lives can offer valuable advice, but it’s not like their mere existence inspires me.

I remember reading a 1950s fictional book about a teen going blind and going to a special school. In it, one of his classmates, a totally blind boy, wants to run a shop when he’s older. People find him an inspiration, but he says something like: “If I want to run a shop when I’m older, I need to pour as much energy into it as my far-away uncle who sits on the government does.” This book dates from the 1950s as I said, when you could only become a telephone operator if you were blind and living in the Netherlands. However, what it signifies as that living a productive life with a disability is hard.

Like Quinn, I don’t mean this to discourage people with disabilities. However, I want to say that it’s not like a disability has no impact. It’s not like you can just ignore it and say “So what?” to eveyr hurdle and move on. Of course, keeping a positive attitude is better than to dwell on negativity, but it’s not like it will magically get you your dream job. Besides, keeping a positive attitude is not the same as never being frustrated.

Finding Answers in Disability Limbo

A few months ago, I wrote a post about my need to belong somewhere within the disability community and my possibly intruding upon communities I don’t belong to. One such community is that for brain injury patients. As far as I was concerned, “brain injury” was always followed by “sustained after birth” or preceded by “traumatic” or “acquired”. Yet brain injury can occur at birth too. Only then it’s not called brain injury, right?

Since my autism diagnosis is being questioned again, I’m feeling an increased need to figure out what exactly is wrong with me. In part, this entails putting a name to what I have. Are my motor deficits diagnosable as dyspraxia, mild cerebral palsy, or are they not diagnosable at all? Am I autistic or not? Then again, putting a name to my disabilities is but one of my quests. As I’ve experienced, most communities are open to those with an uncertain diagnosis, so it’s not that I need to have a diagnosis to fit in with a support group.

Back when I was diagnosed with autism, I didn’t want a specific ASD diagnosis. The psychologist, who ultimately gave me an Asperger’s diagnosis anyway, said he wanted to do an assessment of my strengths and weaknesses. I don’t know whether a quick DSM-IV interview amounts to that, but to me, a lot of questions remain unanswered.

It could be my slight neuropsychology obsession, but I want to know why I have issues I do have. I want to understand, in a way, why I can’t function at the level I’m supposed to given my intelligence and verbal abilities. Is it normal to be unable to load the dishwasher but able to write a lengthy blog post? I don’t think a diagnosis, whether it’s autism or brain injury, will answer this question per se, but what will? It is most likely that I have quite bad executive dysfunction, but can this at all be validated? Should it?

It isn’t purely that I’m overanalytical and want to understand my every bit of brain function. It’s more that I’m struggling terribly with being seen as more “high-functioning” than I am in daily life. Not that I want to reinforce the stereotypes surrounding the Asperger’s diagnosis, but my mere existence won’t defeat them either, and I’m sick and tired of having to prove myself.

Why I Can’t Live Independently

I was asked the question again, on a Facebook group for parents of bliknd/autistic children (where I share my perspective as a blind/autistic adult). When people realize I’m above-average intelligent and verbal, they often ask why I can’t live independently. That is, unless they, like my therapist, assume that no blind person can. She originally had it written into my treatment plan that, if I had not been blind, I would’ve been able to live independently with outpatient support. I had this removed because it quite likely would’ve impacted my funding.

Honestly, it is quite a painful question for me. I have somewhat suppressed the memories of the time when I did live on my own, and don’t really like to think of that time. Then again, I have to if I want to clarify my support needs.

I couldn’t live on my own back in 2007, when I tried, because I had terrible meltdowns in which I’d become self-injurious and aggressive, and I wandered. I also couldn’t do daily living tasks because I needed very clear instructions and needed lots of one-on-one instruction. I lived in an independence training home prior to this and got lots of instruction there, but I got overwhelmed very easily and had meltdowns etc. then. I was more or less kicked out of the independence training home because of my meltdowns.

In addition, I have mild motor deficits. I don’t know whether this is the cause of my inability to perform simple daily living tasks like putting a topping on my bread, but I can’t do these things. My gross motor skills are better, so I can technically operate a vacuum cleaner for example, but I get overwhelmed by the noise so much that I either forget where I was vacuuming or shut down completely. Vacuuming and sweeping are not the problem, as blind people in the Netherlands generally get fudning for a housekeeper to do these tasks. Unless, that is, you have a partner who is non-disalbed, but then again my husband has to do all the cleaning now that he lives alone, too. Same for cooking, so these are not a problem.

It is really hard to put into words what went wrong when I lived on my own. Yeah, I had meltdowns and wandered, but, as an intelligent person, can’t I just control those behaviors? With medication (including a high dose of an antipsychotic), these behaviors have become less frequent, but other than that, I’ve found nothing that helped me. The meltdowns and wandering still occur regularly enough that it’d be a safety issue if I lived independently again. Besides, the fact that I have 24/7 support available should I need it now likely causes the meltdowns to be less frequent. I have learned to delay my need for assistance, but still ultimately need a good deal of assistance during the day. Besides, in cases of (perceived) emergency, I just need to be able to reach someone. And you might say my perception of emergencies is screwed, but when I’m sensorially and/or cognitively overloaded, I can’t make that judgment. Oh, did I mention I can’t get myself out of my husband’s apartment safely using the stairs, which I’ll need to in emergency cases? I could likely learn this, but I’d need a fair amount of instruction. I do know the stairs and don’t know whether I could walk them without falling if I didn’t get assistance. For those who’ve seen me walk the stairs at home fine, these are firstly different (indoor) stairs, and secondly my motor deficits have gotten slightly worse.

When I write this, I can hear the judgment of certain people, including possibly certain readers, in my mind. Some people may want to minimize my support needs because they are in denial. Others mighht want to discredit my opinions, for I am allegedly not like their child. I was going to write about all the unsafe situations I’ve been in (and not just unsafe as perceived by me) because of lack of support, but I think it’s pointless. It hurts too bad to think of these, and most likely people aren’t going to change their perception of me unless they genuinely want to, in which case the above paragraphs should suffice.