Looking at the Lifeway/Focus on the Family mental illness study as a peer reviewer would…

AACAP ProceedingsIf I could pick the one experience in my medical career that contributed the most to my development as a physician, it would be the three terms I served on the Program Committee and New Research subcommittees of the American Academy of Child and Adolescent Psychiatry.

The Academy hosts the largest (and most prestigious) scientific meeting in the world every October in the field of children’s mental health, attracting 5,000+ professionals from fifty or more countries. The Academy members who serve on the Committee are responsible for peer reviewing all of the research proposals submitted for the scientific program at the meeting, based upon the quality and importance of the work.

In a typical year, we’d literally receive hundreds upon hundreds of submissions, and the committee would break up into teams to review each study/project submitted. Five members would review each study individually, with one member assigned as the “principal reviewer.” The “fun” began when the full committee assembled for a two-day meeting each Spring, where the principal reviewer would present their analysis of the studies they reviewed in front of everyone, and anyone on the committee could comment on each study reviewed.

BmKJR3EIEAAcytc.jpg-mediumI wasn’t a “typical” committee member in that my role was to represent the perspective of the mental health professionals practicing in the community. Most committee members were in the upper echelon of the elite in our field. Several worked full-time for the National Institute of Mental Health. A couple were future presidents of the Academy. Nearly all were tenured professors at elite institutions who were instrumental in the pivotal studies that drive the treatment in our field. It was fascinating to observe them critically analyze data and question the methods used in conducting a study. The first year was like drinking out of a firehose! I recognized how little I learned in med school, residency and fellowship in terms of evaluating research. I took great pride by the end of my tenure on the committee in the ability to hold my own with some very prestigious colleagues in the room. Our Committee leaders spoke often about setting a standard for excellence in research in our field that might be a model for the rest of the mental health profession.

The thing that is gnawing at me about the Focus/Lifeway mental illness study is this…As Christians, part of our witness is to reflect excellence wherever we’ve been placed by God. I see that as a part of our worship, because excellence is a true reflection of the Savior we as Christians claim to represent. Because of my past experiences, I think I can recognize excellence in research when I see it, and my gut is telling me this study doesn’t reflect excellence.

In examining and interpreting the study for our readers, I thought it would be most helpful going forward to put on my “old hat” as a reviewer and offer insight into how the folks who sit where I sat might think about the Focus/Lifeway study…

First question…What were the hypotheses/objectives about mental illness, the church and faith that the study designers sought to examine?

In this case, the project objectives were 1) to equip family members and churches to care for loved ones suffering from acute mental illness, by expanding the understanding of what these persons experience, applying what Scripture says about the essentials of faith, and sharing positive contributions that can be made in these individuals’ spiritual lives; 2) to help family members and churches discern the spiritual state of loved ones suffering from mental illness.

The first take on the objectives is they’re extremely broad. Understanding of what aspect of their experience with mental illness? How will they discern the spiritual state of persons with mental illness? What do we know about this topic? How will this study build upon what we know?

shutterstock_167550659_2Next question…Is the study population appropriate for the study objectives?

I would have MAJOR concerns here, given the information available to us by the study authors. The study authors chose adults with what was labeled as moderate to severe depression, bipolar disorder and schizophrenia. Why those three conditions? Would the experience of an adult with schizophrenia be in any way comparable to the experience of a person in the midst of a major depressive episode? Some people with bipolar disorder who have been stabilized on medication may be relatively symptom-free for extended periods of time…how might their experience be different?

Quoting from the report:

The focus of the theological research was on those in a state of psychosis, people with a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality.

How does this work with a sample in which 79% of subjects describe themselves as “very stable” or “somewhat stable?”

One of the imperatives that led to the creation of our current diagnostic classification is the need for common definitions and common terminology in order to conduct meaningful research. Looking at the study objectives, one would need a sample that reflects the breadth of conditions characterized as mental illness that result in significant functional impairment. Collectively, anxiety disorders are our most common mental illnesses in adults, followed by depression. Next comes ADHD, followed by PTSD. Where do they fall in the sample? The authors lumped together three conditions to represent “mental illness”…two of which are closely related, while one isn’t.

BIG PROBLEM: The authors are exceptionally vague as to how the individuals surveyed for the study were selected. The lack of transparency as to precisely how the sample was obtained would be utterly unacceptable if this work were submitted as a paper. How do we know that the subjects selected for this study actually had the conditions described in the study? How were they prescreened? Who diagnosed them with depression? Who was the “large, national panel” doing the prescreening? 200 of 355 sample participants attended Christian churches once a month or more as adults? Isn’t that percentage significantly higher than the rates of church attendance reported in the general population?

I can’t tell from the information disclosed by the authors that their sample is valid. How do we know their data is valid? Would someone seeking to test or replicate FOTF/Lifeway’s findings have enough information to do it?

Next question…Who are we comparing them to? If we’re going to look at measures of spiritual practices…Do they (or their family members) attend church? How frequently do they pray? Attend small groups? Serve? How do they stack up compared against others selected from the same population who don’t have mental illness? There is no comparison population here. That’s not necessarily a fatal flaw…but data that is significantly divergent from norms for the general population is a big red flag without a comparison (control) group selected from the same pool. Lifeway may have data on spiritual practices from the same sample pool. If so, it’s not presented here.

shutterstock_113814862-2_2Are there confounding variables that might impact the data that are unaccounted  for by the study methodology? Here’s one…we know from research out of the Barna group that the vast majority of Christians make their initial profession of faith by their early teen years. I’d speculate that mental illnesses that impact children and teens would have a more profound impact on faith or spiritual maturity than the postpartum depression that lands a 30 year old mother in the hospital who has been active with church or campus ministry for the last fifteen years. The age of onset of the conditions selected here typically occurs after the time most Christians have professed their faith. How do the results look different if you selected Asperger’s Disorder, ADHD and adults treated for depression prior to the age of 18? I can think of others…lots of adults with schizophrenia are homeless or in assisted living situations. Their family’s church experiences might be very different than those families caring for a son or daughter or parent with schizophrenia who is still living at home. We don’t know that from looking at the information presented.

Baylor Religion Study 3What instruments are used to measure the variables the authors seek to study? When we’re involved with a study in our practice, our outcome measures are typically normed and validated rating instruments. For example, we used the ADHD Rating Scale as an outcome measure in comparing long-acting ADHD medications, or the Brief Psychiatric Rating Scale in a study of kids with early onset schizophrenia. If I were reviewing a drug-company sponsored study of XYZ medication and their primary outcome measure is something I’ve never seen used in a paper before, my index of suspicion goes way up. What instrument or interview was used here? It’s not clear. Investigators at Baylor have developed standardized questionnaires to examine spiritual practices. Were they used? How did the authors decide on the questions they asked and why?

Looking at the study objectives, I’d expect to see questions about how often one attends church, prays, reads the Bible, participates in a small group or Bible study or serves in a ministry associated with a church. Did the authors intentionally oversample for church attenders? How many of the non-attenders became non-attenders because of their mental illness or a family member’s mental illness? When was the onset of their illness, and is there an association between the onset of illness and a decrease/discontinuation in church attendance? Are there specific church activities that are more difficult for the person with mental illness or their family members? Then again, nearly 80% of their sample was self characterized as “very stable” or “somewhat stable.” Why would one expect to see much of a difference at all in studying a group that may not be all that different from the other people attending church?

Next…we look at the data and data analysis. Is the analysis clear? Are the statistical measures appropriate? Is there any data that appears grossly inconsistent with our understanding of the topic? If some very unusual results exist, it doesn’t mean they’re not valid, but they’ll draw closer scrutiny.

In the FOTF/Lifeway study, here are some of the findings that made me look carefully…

  • 37% of evangelical pastors and 55% of mainline pastors have taken seminary courses on care for the mentally ill. They may have taken a course in pastoral counseling, but the conversations I’ve had (and members of our Key Ministry team) had with pastors and seminary staff suggests this type of training is very uncommon. The percentages of pastors who claim to have taken continuing education classes on counseling or psychology seem very high also.
  • 94% of individuals with acute mental illness say they have been prescribed medication to treat their mental illness. It’s very difficult to know what to make of this claim without a knowledge of how the sample was obtained. Most persons who received a formal diagnosis of bipolar disorder or schizophrenia have likely been treated with medication. This figure seems far above what one would expect for the general population of adults with depression, given the availability of non-medical treatments (cognitive-behavioral therapy) for depression.
  • 85% of participants reported medication was very effective or somewhat effective. Given that the majority (94%) of the sample was identified as moderately to severely depressed at one time (depression is also common among persons with schizophrenia and bipolar disorder), this number appears wildly optimistic given the research on the effectiveness of antidepressants.

Another observation about the data…the authors point out item by item where findings are deemed “significant” statistically, but never indicate whether some findings were more robust (statistically significant) than others.

Conclusions…When I’m looking at a paper, I’m interested in how the authors interpret the data in light of their findings and what we previously knew about their area of research. In this case, the authors didn’t include any such summary in the download of the study results. We’re given lots of information without context. If I’m a pastor or a church board member, what should I do with this information? To me, the survey felt like a big data dump without any attempt to make sense of the data for the reader.

So…If I were given this study as the lead reviewer, it would have been turned down. It’s possible that portions of the study could be salvaged. The pastor survey had very large numbers with lots of statistical strength, even though I suspect a survey bias in which pastors tended to give the “right” answers when questioned. My sense from the remainder of the study is that the authors didn’t fully understand their subject material, and that’s too bad. There are critically important questions we as the church need to answer if we’re going to more effectively minister with a large segment of the population.

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KM Logo UpdatedKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

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Fitting in at church…by Anonymous

shutterstock_170018114Editor’s Note:  “Sydney” sent me this e-mail last week and gave me permission to share with our readers. Her e-mail is a wonderful, first-person description of attending church as a person with Asperger’s Disorder.

Church is one place where there ought to be a place for everyone. We’ve had two very similar conversations in the last few weeks…one with a man who, like “Sydney” has autism, the other with a woman with bipolar disorder and PTSD. We share in the hope that the church will listen and learn from “Sydney’s” perspective…

I have aspergers, ADD, depression, and anxiety. I am a student who recently moved to do more studies. I am very nervous about joining a new church because of the experiences I have had in church before. I so find the loud rock concert type services completely overwhelming. However, the social aspects at the quieter services are just as overwhelming as some very perky person pounces in on me. Although I typically like structure and routine, I do enjoy contemporary (less high services) for connecting with god. In addition, there is all that small talk around swarms of people wearing all sorts of perfume who do not understand when I talk loudly, change topics, or suddenly get distracted.

Coordinating getting myself to church and then balancing a cup while talking to people is a challenge. When I finally do get the courage to introduce myself to someone, it turns out that I met the person the week before but did not remember his or her face. I am never on time for church and it is a good day when I remembered both my money and kindle bible. (Real bibles are too distracting as the smooth pages are too much fun to feel!) I feel left out as others display their feelings and get emotional during worship. I never know where to sit and always leave belongings behind after church.

I have managed to alienate everyone at my old church–apparently through breaking countless social rules (though I am not sure which ones). It is hard to know what I do wrong since no one communicates with me and I cannot read body language. Even when I try to send update emails, I get no response. It is so is hard for me to initiate conversations. Therefore, I even sent an email with pictures from Corinth and Ephesus to initiate a conversation. However, no one from church ever emailed me back. Many people when dealing with me say, “There’s Samantha. And I hadn’t even asked god for patience when I met her.” I have taken all of these “find your spiritual gifts” and “find your ministry” quizzes. All of them say that since I care about social issues and kids that I must want to do all these social activities. I like people as an abstract concept and I like helping them indirectly. I would rather hang out with the kids since I feel as immature as they are. In addition, my attention span matches theirs.

I do not want to join a small group in a new church because I am so afraid of belong alienated again. My old pastor told me I just needed to get more antidepressants and more friends–if only it was that easy. In my old church, I tried doing alpha at the church but I never felt like I was part of the fellowship. I enjoyed watching the alpha videos online more. I am currently learning from Christian courses.com and biblicaltraining.com in the meantime. When I have autistic meltdowns, worries, or compulsions, I am just admonished for not giving things to god and that I have not asked for enough healing. If I speak about issues such as modesty, they admonish me for being too shy introverted or antisocial. In discussions in admonished for always being too off topic. Do not even get me started sitting still for quiet time with god. Clear sermons with pictures and outlines are such a blessing (though church with so much socializing can be tiring!)

I do not even know how to approach joining a church now since it is so evident that no one at my old church in my old city wants anything to do with me. For all the talk on forgiveness, I am apparently too eccentric and egocentric to be forgiven and to be accepted. Moreover, if not even loving Christians can put up with me, the rest of the world seems scary. I once volunteered at a Christian youth centre, but I was told I had to leave after a few days for being too clumsy. I applied to several Christian schools, but I have found them to be the least accepting of my disabilities. I have this vision that if I ever get married, it will be an empty church (not that I want to be the centre of attention making small talk and hugging others). I was told once during a healing session that I was to remember that I was a princess in God’s kingdom; however, what I also remember is the person who described me as the “pre-princess” from The Princess Diaries.

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Square Peg Round HoleKey Ministry has assembled a helpful resource on the topic of Asperger’s Disorder and Spiritual Development. This page includes the blog series Dr. Grcevich and Mike Woods developed for Key Ministry, links to lots of helpful resources from other like-minded organizations, and Dr. Grcevich’s presentation on the topic from the 2012 Children’s Ministry Web Summit. Click here to access the page!

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My Weekly Reader…September 27, 2014

Tennessee High School CheerleadersThe big story this week in our world was the survey released by Focus on the Family and Lifeway Research related to the perspectives of pastors and the experience of adults with mental illness and the church. I’d encourage anyone with an interest in disability ministry to download and read the survey…in our blog posts next week, we’ll be digging into the survey in great depth while sharing a little teaching on the topic of interpreting research studies.

Science/Medicine:

Here’s an interesting study that helps explain why kids with ADHD struggle to make good decisions…altered functioning in the medial prefrontal cortex, a part of the brain involved with choosing between multiple alternatives and learning from one’s mistakes.

Disability Ministry:

Jeff Davidson keeps sharing high quality content. Here, he answers the question Don’t you feel cheated about the life you imagined you and your son would have?

Brad Hambrick is a leader in the Biblical Counseling field. Earlier this week, he shared a very solid list of six steps to wise decision-making about psychotropic medication.

Christianity:

MelissaEdge-nowcircleMelissa Edge shares an incredible story of how God was unmistakably at work through her suffering in the aftermath of losing her husband. What do we do with our lives In the Meantime as we’re experiencing grief.

Culture:

In my line of work, I tend to see lots of kids who struggle in the face of negative influences in the culture. Here’s a look at some very impressive kids in Tennessee who aren’t ashamed to live out their faith in public…especially when the American Civil Liberties Union sent their school a threatening letter because of their school’s tradition of a pre game prayer before home football games.

Coffee Break ChurchThis coming week, we’re continuing our preparation for Inclusion Fusion, and launching “Coffee Break Church” a weekday worship experience at The Front Door for parents of kids with disabilities who are unable to attend church on the weekend. Join us this coming Monday at 10:00 AM for church, chat and online community.

Tomorrow, we’re sharing an incredibly powerful guest post from a blogger who has requested to remain anonymous. She’ll share a first-person account, Fitting in at Church, about her experiences in trying to attend church as a person with Asperger’s Disorder. Help her share her story!

Finally, while I had some issues with the FOTF/Lifeway study, the crew at Focus on the Family put together an excellent, free book for pastors, Serving Those With Mental Illness. Here’s a link to the page from FOTF where the book can be downloaded.

Have a great week!

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KM Logo UpdatedKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

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Focus on the Family, Lifeway avoid the tough questions about mental illness…

FOTF InterviewWith much fanfare, the folks from Lifeway Research and Focus on the Family released a report yesterday containing data collected from three separate surveys of Protestant pastors, Protestant adults identified with mental illness, and family members of Protestants with mental illness in what’s been titled the Study of Acute Mental Illness and Christian Faith.

I spent the last two evenings pouring through their report. Given the emphasis that our ministry places upon supporting churches as they minister to families impacted by mental illness and the prominence the studies are likely to receive throughout the evangelical church as a result of the people and organizations behind them, the release of the report is something we need to speak into. Nevertheless, I found the design of two of the surveys to be profoundly disappointing and the results of the survey not nearly as useful as they could’ve been.

We’re going to examine the results of each of the three surveys

The most useful of the three surveys was a telephone survey of 1,000 U.S. senior pastors in Protestant churches conducted last May. Responses were weighted to reflect size and geographic distribution of the churches surveyed. Here are some key findings…

  • 74% of pastors personally know one or more people diagnosed with depression.
  • 76% know one or more people diagnosed with bipolar disorder.
  • 50% don’t know anyone who has been diagnosed with schizophrenia.
  • 59% have counseled one or more people eventually diagnosed with an “acute” mental illness…defined here as schizophrenia, “clinical depression” or bipolar disorder, but only 13% had counseled more than ten. 31% answered “none.” Pastors were more likely to answer “none” as the size of the church they serve became smaller. Pastors in the South were significantly more likely to answer “none.” Note: Schizophrenia is not an “acute mental illness,” nor is depression in many instances.
  • 38% of pastors reported feeling equipped to identify a person dealing with acute mental illness that may require referral to a medical professional.
  • 23% indicate they have personally struggled with mental illness of some kind, but only 12% of pastors surveyed were ever formally diagnosed. Pastors in the Midwest were significantly more likely to report undiagnosed mental illness.
  • Only 35% strongly agreed with the statement that a Christian with an acute mental illness can thrive spiritually, regardless of whether or not the illness has been stabilized, although 41% answered they “somewhat agree” with that statement.
  • 40% agreed with the statement that medications should be used anytime they can ease symptoms of an acute mental illness.
  • 51% agreed with the statement that psychological therapy should be used before sharing spiritual principles, while 20% agreed that psychological therapy should be used before sharing spiritual principles.
  • 56% strongly agree that local churches have a responsibility to provide resources and support to individuals with mental illness and their families.
  • 68% of pastors indicate their church provides care for the mentally ill or their families by maintaining lists of experts to refer people to…but only 28% of family members of persons with mental illness reported such lists were available.
  • 49% of pastors rarely or never speak to their church in sermons or large group messages about acute mental illness.

Talking about mental illness

So…what to make of all this?

After my first read through the survey, my initial reaction was to question the extent to which the folks who designed this project understand the concept of mental illness. Were they hoping to study the impact of severe mental illness and stumbled onto the concept of “acute” mental illness? How or why did the survey authors decide to ask specifically about schizophrenia, depression and bipolar disorder? 90% of patients with bipolar disorder experience recurrent mood episodes resulting in most instances in a need for lifelong treatment. Schizophrenia is certainly not an acute illness. Here’s the first sentence in the National Institute of Mental Health’s (NIMH) information page describing schizophrenia…

Schizophrenia is a chronic, severe, and disabling brain disorder that has affected people throughout history.

The diagnosis doesn’t matter as much as the severity of functional impairment the person experiences from symptoms related to the diagnosis. Want to know what mental health condition results in severe impairment to the greatest number of adults according to NIMH? It’s anxiety! The authors never asked about it in the survey.

Here’s my most significant criticism of this survey…they didn’t ask the right questions!

If I had access to 1,000 pastors, here are some of the questions I’d ask…

To what extent do you believe mental illness is indicative of an individual lacking sufficient faith in Christ?

What percentage of the time do you believe that mental illness is a direct result of habitual sin in the life of the affected person?

How often is prayer likely to lead to remission/cure of the following conditions?

  • Depression?
  • Anxiety?
  • Autism?
  • Schizophrenia?
  • PTSD?
  • ADHD?

In the last year, have you referred a person attending your church who appears to be experiencing symptoms of mental illness to…

  • A fellow pastor (inside or outside your church) for counseling
  • A Nouthetic, Biblical or Christian counselor
  • Their primary care physician
  • A secular psychologist or counselor
  • A psychiatrist (MD/DO)

What challenges would you anticipate a person with mental illness or a family member with mental illness might experience if they sought to regularly attend worship services at your church and participate in other activities your leadership views as essential for spiritual growth (small groups, Christian education, missions/service, etc.)

Here are a few thoughts on this survey of pastors…

Why weren’t questions like those I suggested included in the survey, especially after Ed Stetzer from Lifeway noted in an earlier blog post that a high percentage of Americans views prayer and Bible Study alone as sufficient for overcoming serious mental illness. Where do those attitudes originate? I wonder if the folks at Focus on the Family didn’t want to ask tough questions that might embarrass some of their longtime friends and supporters?  Are they even aware of the experiences of shame or blame reported by faithful Christians when seeking comfort and support during episodes of mental illness? Are they so isolated from Christians with outstanding reputations for doing quality academic research on disability-related topics that they didn’t know where to go for help in tackling a project like this one?

It’s interesting that while nearly a quarter of pastors identify themselves as having personally experienced mental illness, roughly half never sought help. Why not? Is the stigma against seeking help that great among senior pastors? Do they have difficulty finding high quality mental health care that’s affordable under their health care benefit packages? Is it a lack of trust of mental health professionals? Somebody should’ve asked.

Lifeway 3Last…and this is one area where this data is consistent with surveys looking at other areas of disability…there’s an enormous disconnect between what pastors believe their church is offering in the way of supports and what families in the church experience in describing the availability of supports when it comes to mental illness. The graphic on the right illustrates this point nicely…the church may have resources to help support persons with mental illness and their families, but if we never talk about mental illness at church, how would those who might benefit know that the resources even exist?

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KM Logo UpdatedKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

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How my daughter taught me about friendship…Jonathan Holmes

HolmesJonathanEditor’s note: We’re grateful to Jonathan Holmes for serving as our guest blogger today.

Jonathan serves at Parkside Church in Cleveland, Ohio as the Pastor of Counseling. He graduated with degrees in Biblical Counseling and History from The Master’s College and a master’s degree from Trinity Evangelical Divinity School. Jonathan and his wife, Jennifer, are parents of three beautiful daughters, Ava, Riley, and Ruby. Jonathan also serves on the Council Board of the Biblical Counseling Coalition. I’m grateful to Jonathan for his willingness to explain the world of Biblical Counseling to a child and adolescent psychiatrist with one foot in academia. Here’s his post…

I learned something valuable about friendship from my daughter.

A few weeks ago my two oldest daughters and I were at our local library. As any parent knows, going to the library with kids can be a bit stressful. As you juggle piles of Bernstein Bear and Fancy Nancy books, clean up dishelved copies of other books avoid judging stares from the librarians all while all while telling them to “shhhh…”

On this particular day near the activity area, there was a sweet little girl in full leg braces and a walker in the corner. As the she carefully placed animal puzzle pieces into their respective places, I hurriedly tried to strategize in my mind how to keep my two girls away from her as not to bother her or embarrass her. Truth be told, I realize in hindsight I was more afraid and embarrassed than I would venture she ever was.

Before words could come out of my mouth, my sweet and friendly daughter Ava had gone over to introduce herself. In the space of seconds, she had asked her what her name was (Hannah), what grade she was in (pre-K), and why she was in leg braces (unknown). As Hannah’s mother kindly looked on, I nervously re-ordered the pile of books I had accumulated.

As time went on and the girls happily became enveloped in their world of princesses, puzzles and giggles, I relaxed and took a deep breath. There was no awkwardness now, just the fun whispers of girl-to-girl chatter.

As we walked out of the library, Ava looked up excitedly saying, “I can’t believe I made a new friend!” In the coming weeks, she would tell me she had seen Hannah at her school (they’re a year apart) and had waved at her. Every once in a while, sweet Hannah will come into our conversation, and Ava will remind me of the friend she met at the library that summer day.

Reflecting back, I’m so thankful for my daughter’s kind heart and gracious outreach. Hannah’s mom told me that day not many kids reach out to her because she has disabilities. In that moment, I realized how simple, yet profound friendship can be in the life of a child. It can brighten one’s day, put a smile on one’s face and in the best of ways it can soften shame, alleviate stigma and lift spirits.

That day my daughter taught me to enter into other people’s worlds with love and care. You don’t need to have fancy words or a planned out monologue…sometimes the simplicity of “Hello, I’m Ava” is all you need to begin a friendship.

You see that is exactly what Christ does to us when he calls us into friendship with himself. In some of the most life-changing words ever spoken, Jesus says to the disciples in John 15:15, “No longer do I call you servants…but I have called you friends…” Think on that for a moment. The Son of God, Immanuel, comes to us and calls us friends. Could there be any sweeter message? Any kinder outreach?

With this new friendship comes great opportunity and responsibility. With each outreach of friendship we actually tell the story of the gospel to an unbelieving world. With each encouragement to pursue others in friendship we communicate the love of Christ to people in desperate need of such community and relationship. Even recently, the need for friendships in the church has been expounded here at this blog.

It was with these thoughts in mind that I wanted to write a book on the topic of friendship. The Company We Keep: In Search of Biblical Friendship, is a short, yet accessible book designed for parents, ministry leaders, small group participants—really anyone who desires a biblical theology and practice of friendship.

This is also why I love the work of Key Ministry. I know at the core of Key Ministry is a desire to see children loved, cared for and friended in Christ.

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Adobe Photoshop PDFIs it possible friendship exists for a greater purpose than my enjoyment and comfort? Is friendship more than just having some people to hang out with on a weekend, participating in a book club, or hitting the golf course together?

These questions and more are answered in Jonathan Holmes’ new book, The Company We Keep: In Search of Biblical Friendship. Biblical friendship is first and foremost about a relationship with Jesus Christ. As you are brought into friendship and relationship with the Father, Jesus Christ calls you a friend! It is out of this friendship, that our human friendships find their beginning and their purpose.

Available through Cruciform Press.

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My Weekly Reader…September 19, 2014

BPCOverwhelmed by all the information coming at you?In this week’s Weekly Reader, I’ll share some features that caught my eye over the last week. The Weekly Reader is meant to be a two-way feature! See something that our team at Key Ministry missed? Something we should read? Post it in the “Comments” section below for all of our readers to enjoy!

Science/Medicine:

Mental disorders are responsible for nearly a quarter of all years lived with disability worldwide. Despite the presence of cost-effective, evidence-based treatments, getting treatment to people who need it fails to be a high priority. A look at The Unconscionable Gap Between What We Know and What We Do

Disability Ministry:

Jeff Davidson from Rising Above Ministries has another excellent post…Top Ten Church Myths About Special Needs Ministry.

My colleague Barb Dittrich reminds us of the challenges faced by the families ministered to by churches we serve in 5 Ordinary Things That Aren’t So Ordinary for Families With Special Needs.

Ellen-casualI had the pleasure of brainstorming ministry ideas for a couple of hours in a videoconference earlier this week with Ellen Stumbo. I think all of us will want to meet Ellen’s daughter after reading My Daughter’s Disability Is Not a Tragedy.

Christianity:

The Adrian Peterson child abuse case has resulted in criticism of the church for encouraging corporal punishment. How should the church respond?

Culture:

There continue to be arguments about what constitutes “settled science,” but the evidence that children do better when they’re raised by their biological father and mother in a married family is so compelling, an argument can be made that persisting in denial of the obvious is cruel and abusive.

Black_Cara_smallWe had a great response to this past week’s training with Dr. Cara Daily on spiritual development in kids with autism. Jolene Philo joins us at our Front Door Online Church platform this coming Thursday (September 25th) at 12:00 PM Eastern to discuss PTSD in kids with special needs. Colleen Swindoll- Thompson will be with us for our first Parent Chat on Thursday at 8:30 PM Eastern. We have online worship  this week on Sunday, Monday and Wednesday evenings. Cara’s videos remains available on Front Door daily through October 4th.

Thanks to all who prayed for our Google Grant application! We were approved this week. The $10,000/month in free online advertising that accompanies the grant will be invaluable in expanding the number of churches able to discover our training and participate in November’s Inclusion Fusion Web Summit!

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Adrian Peterson, Christians and corporal punishment…

shutterstock_55828699It was only a matter of time…from the CNN Belief blog:

There’s one detail about the Adrian Peterson child abuse charges that no one seems to be noting: his alleged crimes didn’t happen simply under the guise of “parenting” but rather “Christian parenting.”

But the NFL star’s Christianity shouldn’t be missed or undervalued in the sharp debate about his actions. Those of us who grew up in conservative Christian churches know all too well the culture that shapes the parenting beliefs of people like Peterson.

Today, the most notable proponents of spanking are American evangelicals. They not only preach the gospel of corporal punishment, they also impart messages that lay the foundations for abuses against children and the protection of such abuse by our legal system.

We have books about spanking. Popular Christian talk shows promote the benefits of spanking. Pastors preach and theologize spanking. Organizations like Focus on the Family offer parents resources about how and when to spank.

The ties between Christianity and corporal punishment are so strong that a large number of conservative Christians parents simple deny studies that suggest spanking does more harm than good.

Now, I’m not saying that evangelical churches are to blame for what Peterson did to his son. But the church isn’t innocent in the matter, either.

Peterson TweetMuch was made in certain media circles about Adrian Peterson’s first tweet (pictured at right) following his recent indictment in Texas for child endangering. Peterson has publicly identified himself as a Christian in media interviews, albeit a Christian with a messy and complicated personal life.

Those with negative views of Christianity will undoubtedly seek to use this most recent incident and the media discussion around the data suggesting that “born-again” Christians are more likely than Religious Gap on SpankingAmericans in general to view spanking as an acceptable discipline strategy with children. (see right, from FiveThirtyEight).

Allow me to share three questions for your consideration from my perch as a physician specializing in child and adolescent psychiatry who also serves in a disability ministry organization…

Is this our “hill to die on?”

I’ve been wrestling with this topic from a Biblical standpoint and from a professional standpoint. I started by going back through the Bible, digging into Strong’s dictionary looking up the definitions of the relevant words in Hebrew. Proverbs 23:13-14 was especially challenging. My ultimate take (without sharing 5,000 words of Bible commentary) is that this is a disputable issue among faithful Christians, and the question of whether Christian parents are required to use physical punishment in disciplining their kids isn’t foundational to our faith. Every verse is equally inspired and equally true…but not every verse is equally important. The big idea I see throughout Scripture is the importance placed upon parents actively engaged in the loving discipline of their children.

I don’t consider all corporal punishment as inappropriate or abusive, although I don’t recall an incident of using spanking in our home when our kids were growing up. They’re good kids who generally make pretty good decisions. I don’t believe my wife and I are in violation of Scripture because we didn’t use that technique. At the same time, I don’t have a problem with a parent who, in their best judgment with forethought, planning and good emotional control uses brief spankings resulting in temporary discomfort with a child engaging in potentially harmful behavior when evidence exists that spankings are helpful for the child in question.

I heard a great analogy while discussing this topic with one of our child fellows who worked for many years with traumatized kids in which she compared spanking/corporal punishment with medication…her comment was that spanking is like a medicine that may be helpful in certain situations, but isn’t something we’d typically use as our first choice when we have other medicines that are equally helpful or more helpful that lack the potential for serious adverse effects associated with spanking if kids get too large a dose.

In terms of the “big picture” of how we publicly live out our faith, do we as a Christian community want to allow the issue of whether corporal punishment is required by Scripture to define us when the potential exists for the issue to become a stumbling block to others who might be considering the claims of Christ?

Are kids with disabilities more likely to experience corporal punishment?

We need to consider that kids with our most common disabilities are much more likely to experience difficulties with self-control, emotional self-regulation and delaying gratification compared to their same-age peers. Many struggle with a lack of cognitive flexibility to consider a variety of responses when problems occur. Others have issues with applying lessons learned in one situation in a slightly different situation. I’d hypothesize that kids with less obvious disabilities are often the recipients of more corporal punishment, especially here in America.

Corporal punishment is still permitted in public schools in nineteen U.S. states. Data collected by the U.S. Department of Education suggests that kids with disabilities are significantly more likely to experience corporal punishment in school when compared with “typical” peers…

Corporal Punishment Disability

Here’s a paper published in The Lancet examining the worldwide prevalence of violence against children with disabilities. Note: While I’m not characterizing spanking as constituting “violence,” I would hypothesize that a greater risk exists for spanking to increase in frequency and intensity when kids have more difficulty with self-control. This analysis of seventeen studies across different cultures suggested that kids with moderate to severe disabilities are 3.56 times more likely to experience physical violence compared to “typical” peers.

If kids with disabilities are disproportionately impacted by corporal punishment, do those of us who serve as disability ministry leaders need to influence this conversation within the church?

Are we increasing the number of kids impacted by disabilities when corporal punishment goes too far?

Here’s a study of 25,000+ adults in Canada looking at the association between child abuse and mental health. Adjusting for socioeconomic factors and other interview-identified mental disorders, adults exposed to physical abuse as children were 2.3 times more likely to meet criteria for one or more mental illnesses compared to non-abused peers. Here’s data from the Adverse Childhood Experiences study conducted in the U.S., outlining a myriad of mental and physical health conditions experienced by those exposed to traumatic experiences in childhood.

Given the barrage of attacks Christianity faces here in the U.S. by those seeking to secularize the culture, the level of support among Christians for corporal punishment in the aftermath of the Adrian Peterson case will be used as a club against the church. How important is this issue to the foundational truths of our faith? How should pastors and other ministry leaders speak into this issue?

We better be prepared with an answer…soon.

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KM Logo UpdatedKey Ministry is pleased to make available our FREE consultation service to pastors, church leaders and ministry volunteers. Got questions about launching a ministry that you can’t answer…here we are! Have a kid you’re struggling to serve? Contact us! Want to kick around a problem with someone who’s “been there and done that?” Click here to submit a request!

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A child psychiatrist’s discomfort with the Adrian Peterson case

Adrian PetersonThe severity of the physical punishment Adrian Peterson administered to his four year old son is utterly unacceptable. If the photographs of Peterson’s son following the incident posted by TMZ Sports are accurate, he clearly crossed the line between acceptable corporal punishment and child abuse/endangerment. The seriousness of the incident is magnified because of what we’re learning about the enduring effects of trauma, and it would be my hope that the enhanced awareness of the impact of excessive physical punishment and multigenerational abuse would result in tens of thousands of children being spared the treatment experienced by the boy in this case.

With that said, there are several aspects to how the Adrian Peterson case is being handled that leave me feeling very unsettled…

TMZ abuseFrom time to time, situations occur involving kids in our practice we develop a suspicion of physical abuse that we’re required by law to report. I’ve NEVER had a parent lose their job because of physically abusing a child…presumably because it would be highly unusual for this type of information to become public. When we’re involved in cases similar to this one, the typical response is for Children’s Services to place the kids with another relative or family member, or in a short-term foster placement if no appropriate family member is available. A judge might issue a no-contact order against the offending parent if they live or work somewhere else, tied into a required plan the offending parent needs to complete to begin highly supervised visitation.

In the Peterson case, there are MANY different voices calling for his indefinite suspension or expulsion from the NFL. If we’re establishing a standard that parents implicated in situations like the Peterson case are going to be deprived of their livelihoods and due process rights, society will be creating a tremendous disincentive for those experiencing domestic violence to seek professional (or in many locations, spiritual) help, because all states have mandatory reporting requirements for professionals, and in 27 states, the legal mandate to report extends to clergy.

shutterstock_52640113The role that “mob rule” plays in situations like this one where the influence of social media on sponsors has resulted in great pressure on the NFL to overlook due process rights is very troubling. In a case like Peterson’s in which a child was clearly a victim of excessive physical force, society is appropriately angered and wants instantaneous justice. Corporations are easily influenced by angry consumers. But what happens when a group savvy to social media finds themselves offended by attitudes or beliefs associated with traditional Christian teaching? Had the Pharisees been in existence in the 21st century, I have little doubt that the #WeWantBarabbas hashtag would be trending on Twitter.

There are people in society who are going to use this incident to advance an agenda. Yesterday, a blogger for CNN associated Adrian Peterson’s actions with “Christian parenting.” The issue of corporal punishment is a topic that disproportionately impacts Christians from more conservative traditions and African-Americans. Here’s a very interesting interview conducted by Jim Rome with Charles Barkley about the Peterson case that illustrates the cultural divide on the issue…

Turning to the Peterson situation, Rome asked Barkley if it’s OK to hit a child.

“I’m from the South. I understand Boomer’s (Esiason) rage and anger … but he’s a white guy and I’m a black guy. I don’t know where he’s from , I’m from the South. Whipping — we do that all the time. Every black parent in the South is going to be in jail under those circumstances.”

Rome: “It doesn’t matter where you’re from: Right is right and wrong is wrong.”

Barkley: “I don’t believe that because, listen, we spank kids in the South. I think the question about whether Adrian Peterson went overboard — Listen, Jim, we all grow up in different environments. Every black parent in my neighborhood in the South would be in trouble or in jail under those circumstances.”

Continuing…

Rome: “My thing is: I don’t want to tell anybody how to raise their kids and I really don’t want anybody telling me how to raise my kids. But let’s make a distinction between ‘child rearing’ and ‘child abuse.’ That was child abuse. There’s no fine line here.”

Barkley: “And I totally agree with that. But I think we have to really be careful trying to teach other parents how to discipline their kids. That’s a very fine line.”

The legal line between corporal punishment and physical abuse is a gray area…intentionally (and appropriately) so, because kids are different in how they perceive and experience such punishment. For example, a smack on the back of the hand or the buttock that would result in minor discomfort for some children could result in serious harm for a child with hemophilia. A child who has previously been a victim of neglect or abuse may also experience corporal punishment differently than a child who hasn’t been exposed to such treatment.

I fear incidents like this one will be used as a club by those in society who take issue with the traditional role of parents and the family unit and would seek a larger role for public institutions in establishing the value systems imparted to kids.

One final observation…In the midst of all the media coverage of what should and shouldn’t be done about the Adrian Peterson situation by all of the parties involved, it’s most concerning to me that I haven’t yet seen anyone in the national media (at least, no one I’m aware of) ask the question of what’s best for Adrian Peterson’s kids? Isn’t that really what’s important here?

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Key Ministry-NewKey Ministry developed a series of blog posts to educate pastors, ministry leaders volunteers and parents on the topic of Trauma and KidsClick here to discover links to the posts in the series, along with a list of recommended resources for pastors, church staff, volunteers and parents serving kids who have been victims of neglect and/or physical or sexual abuse.

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Updated…How are kids and teens with ADHD different?

shutterstock_172150682Editor’s note: Out of the 700+ blog posts featured here since the middle of 2010, the post I’ve printed out and shared most frequently with parents coming through our office is this post on the differences in kids with ADHD. Here’s an updated version taking into account research developments since the original was written in 2010… 

ADHD is among the most commonly identified mental disorders in children and teens in the U.S. According to a 2011 study, 11% of youth between the ages of 4-17 have received a diagnosis of ADHD, and over 6% are actively being treated for the condition with prescription medication. Given the sheer number of  kids affected by the disorder, the need for the local church to serve, welcome and include them (and their families) has become too great a problem to ignore.

We need to understand the nature of the disability associated with ADHD if we’re to appreciate the challenges the condition presents for the church and for parents invested in their child’s spiritual development.

According to the DSM-5 criteria, children, teens and adults with ADHD have a developmentally inappropriate degree of inattentiveness, poor impulse control and in some (but not all) instances, hyperactivity.

barkley_homeRussell Barkley, Ph.D. is one of the world’s foremost experts in researching brain mechanisms in children and adults associated with ADHD. I had the honor of being his co-presenter at a day-long symposium on ADHD a number of years ago and was surprised to discover that he’d co-authored a paper with Dr. William Hathaway from Regent University entitled Self-Regulation, ADHD and Child Religiousness (Journal of Psychology and Christianity, 2003; 22(2):101-114). Here’s a fascinating lecture on the nature, causes and treatment of ADHD that Dr. Barkley gave on February 13, 2008 at the U.C. Davis MIND Institute.

Dr. Barkley’s theories suggest that ADHD is a disorder not only of attention, but of executive functioning as well. Executive functioning describes a set of cognitive abilities involved in controlling and regulating other abilities and behaviors. Such functions are necessary in initiating goal-directed behavior, suppressing impulses arising from lower brain centers, and planning future behavior.

There are five key executive functions: Behavioral inhibition (critical to development of the other functions), non-verbal working memory, verbal working memory, emotional self-regulation and reconstitution. We’ll describe in more detail the consequences of delays in the development of these functions.

shutterstock_144843835Behavioral inhibition involves the ability to delay one’s response to an event (allowing time to think), interrupt a chain of responses to an event and the capacity to keep competing events from interfering with the initial response. Without this ability a person would be entirely focused on the immediate consequences of any action or behavior and would be unable to develop the capacity for self-control. Kids in whom the development of this capacity is delayed will be unable to suppress the publicly observable aspects of behavior.

Non-verbal working memory involves the capacity to maintain a picture of events in one’s mind. The ability to analyze situations for recurring patterns in order to predict future events is critical in anticipating consequences of behavior, managing relationships and planning complex, goal-directed behavior. Moral conduct and social cooperation are contingent upon this capacity as well the retention of events in sequence that allows one to estimate the time required to perform a task. Kids who experience delays in developing this capacity will have more difficulty remembering multi-step directions, more difficulty completing tasks (especially tasks that take a long time to complete), and will tend to underestimate the amount of time necessary to complete assigned tasks.

Verbal working memory involves the capacity to think in words. Internalization of speech allows kids to internalize social norms and rules, facilitating moral development. As kids develop this capacity, they’re able to hold a thought in their mind without having to actually say what they’re thinking. A classic example is the inability of little kids to pray silently. Kids with delays in development of verbal working memory would tend to talk excessively compared to peers, have more difficulty organizing and communicating thoughts, struggle more with use of proper grammar and experience more challenges in following rules and directions.

shutterstock_86980295Emotional self-regulation involves the ability to keep private one’s initial emotional response to an event or situation. This allows a child to modify their response to an event as well as the emotions that accompany the response. Capacity to sustain motivation for future-directed behavior is contingent on this ability. Kids who experience delays in acquiring this capacity will likely appear to overreact in response to minor provocation, have more difficulty appreciating the impact of their actions upon others, and have more difficulty summoning the drive or emotional states to overcome obstacles or complete goal-directed behaviors. Their response to initial frustration is usually to quit the activity or task.

Reconstitution involves the ability to use private visual imagery and language to represent language and actions. This allows us to mentally rehearse possible solutions to problems when attempting to overcome obstacles in order to complete a task or achieve a goal without physically having to carry out each and every solution. Kids with delays in acquiring this capacity will experience much more difficulty generating solutions to problems when they get frustrated or stuck.

The theory described above applies only to kids with the classic, combined type ADHD in which kids have difficulty with impulse control and hyperactivity. In general, they know what they should do, but lack the self control to do what they know is right. They also are challenged to generate work product, be it schoolwork or completion of chores at home. Kids with the inattentive subtype of ADHD have problems with focus, concentration and information retrieval. They are more likely to complete their work, but make careless mistakes in doing so.

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KM Logo UpdatedKey Ministry is pleased to make available our FREE consultation service to pastors, church leaders and ministry volunteers. Got questions about launching a ministry that you can’t answer…here we are! Have a kid you’re struggling to serve? Contact us! Want to kick around a problem with someone who’s “been there and done that?” Click here to submit a request!

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Church: The Friendliest Place in Town? Mike Woods

Banquet at Levi's HouseTo this day, I can still recall the particular dreams and aspirations that I had for my boys when they were born. However, as I traveled the long and weary special needs journey, my hopes and dreams for my boys on the autism spectrum have had to undergo major revisions. One of those revisions has had to be in the area of friendships. Watching your child struggle to make friends can be difficult, but for parents of kids with autism, it can be devastating. Many of you who are reading this have been there, done that, and I’ll bet that it still breaks your heart that very few people in your child’s life have ever attempted to be their friend.

Many kids, teens, and adults on the autism spectrum are deprived of friendships. It is not unusual, especially for those on the moderate to severe end of the autism spectrum, for all of the relationships to be with people who are either family or those who are paid to be with them (i.e., therapists, para’s, respite providers, etc.).

It’s difficult for those of us who have friendships to imagine what it would do to us if we did not have any of them at all. Friendships help us to grow, develop, enjoy, laugh, relax, share, and participate meaningfully in our community. An absence of friends makes it difficult to develop self-respect and a sense of self-worth. An absence of friendships can lead to loneliness, despair, and depression.

Friendships with those who are like us are a normal part of life, but Christian friendship should reach out, in particular, to those who are different and those who are marginalized. The problem is that many churches do not do a good job at reaching out to those who are different. The problem of a lack of friendships with people with special needs is a very real one and is facilitated by two primary factors:

  1. Extractional Church

The church operates, in large part, as “extractional.” By extractional, I mean to say that churches, with all of their programs and events, have a tendency to remove believers from their non-church relationships. Alan Hirsch, author of The Shaping Of Things To Come, states that, “Within 3 to 5 years a new believer hardly has any meaningful friendships outside the church.”

The US Congregational Life Survey reveals that the longer people worship at a church, the more bonds they develop with other church members, and the less meaningful contact they have with non-church members (US Congregational Life Survey, December 6, 2011). Neil Cole, author of Church 3.0, agrees with this previous statement and adds:

Instead of connecting to the world, churches have a tendency to isolate people inside the church community. I have met countless Christians who have spent so much time in church that they no longer know any non–Christians.”

UnfriendlyChurchWhen the church cuts off the friendship ties of new followers in favor of building only safe Christian relationships, it has less impact in the community. The influence the church sacrifices by cutting off friendships outside of the church is that the community at large is robbed of God’s kingdom influence…to include the special needs community. As a result, the potential exists for the church to be considered by the special needs community as a group that is judgmental, fearful, and exclusive. As a result, it is often perceived as the un-friendliest place in town.

  1. “Same As Me” Friendships

Human beings are social creatures. We’re made in the image of a social God who is Trinity so it is only natural that creatures made in God’s image should desire friendships. For most of us, our friendships are based on the “same as me” principle. When many of us reflect on our own friendships, we find that the majority, if not all, of our friends are very much like us: socioeconomic status, common interests, age, culture, common activities, religious preferences, and so on. This process of developing friendships reflects the philosophy within our Western culture and, by implication, on the church that is embedded within that culture. The limitation of “same as me” friendships is obvious…friendships with those who are “different” are virtually nonexistent.

The type of friendship that is revealed in the Gospels in the life of Jesus differs radically from our Western cultural understandings of friendship. In the Gospels, Jesus presents us with a radically different perception of friendship. Jesus befriended those who were cast out by society— the tax collectors, the blind, lepers, the poor, the mentally ill, harlots, all those who were in many respects radically unlike himself.

Jesus modeled a form of friendship that was radical in that it transcended “same as me” relational boundaries and was extended towards those who were different. Pastor John Swinton, a former mental health nurse, stated “In the earthly life and ministry of Jesus one finds a continuing picture of a man entering into friendships not with social equals, but those whom society had downgraded and considered unworthy of friendship.

The Solution: Friendship As An Outreach Ministry Of The Church

BrokenFriendshipsIt is within the area of friendships, that the Christian community has a vital contribution that they can make to the care of people, and families, with special needs. Professionals and medical specialists often focus on the biological, psychological, medical, or neurological aspects of a disability in order to bring healing. It is a gift that God has given to some. However, the whole body of Christ can offer a distinctive contribution to the care process thru friendships. Nancy Eiesland, former professor of theology at Emory University, suggested that friendship is the distinctively Christian gift that the church has to offer marginalized people. She rightfully believed that, “Friendship is necessary for the church to be the church in any kind of meaningful sense because the authenticity of the gospel is always judged by the ability of Christians to live their lives in ways that reflect the truth of the message.”

I believe that the role of the church lies in creating a community of people that should be willing to develop and nurture friendships with people with special needs. These types of friendships, in and of themselves, would be the best way for the church to become the friendliest place in town. I can’t think of a better form of outreach ministry than friendship. Caring for people with autism in this way would not be an act of charity but an expression of the true nature of the church and the One we seek to image.

Friendship with those living on the autism spectrum or any other special need is not an option for the church; it is a primary mark of the identity and faithfulness of the church that is seeking to demonstrate Jesus every day, in every way, to every one.

The featured image is Christ in the House of Levi by Paolo Veronese, referencing Luke 5:29-32.

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Mike-Woods-Joy-Prom-@-1024x615In addition to serving as a Church Consultant with Key Ministry, Mike Woods currently works as the Director for the Special Friends Ministry at First Baptist Orlando. Prior to joining First Baptist Orlando, Mike worked for nine years as the autism and inclusion specialist for a large school district in metropolitan St. Louis. Mike regularly blogs for Key Ministry on topics related to “missional” Special Needs Ministry…how churches can “leave the building” to share the love of Christ with families impacted by disabilities in their local communities.

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