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Diagnosing 2e: ADHD vs Asperger's?

3/27/2018

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By Emily Kircher-Morris, LPC

Because I work with many high-ability, gifted, and twice-exceptional individuals in my practice, I've noticed an interesting pattern with some of my clients. The story follows a specific path: A bright child was diagnosed with ADHD at a young age. Medication after medication had minimal benefit; often the parents abandoned medication altogether. As the child gets older, their lagging social skills cause more and more problems with friends and at school. We finally determine the appropriate diagnosis of Asperger's Disorder has been missed.

Many children compensate well for social struggles and concerns may go unnoticed by parents and educators. If the child is gifted, asynchronous development explains many of the quirks the child may show. However, one would expect that as the bright, quirky, asynchronous child grows older, some skills (such as the ability to meet typical social expectations) would balance out. However, the DSM-V says that for a diagnosis of Autism Spectrum Disorder, symptoms may not fully manifest until social demands exceed the abilities of the individual. When a child's struggles increase with age instead of balancing out, a diagnosis of Autism Spectrum Disorder (ASD)/Asperger's should be considered.

So, why are these kids given an ADHD diagnosis instead of ASD? A close look at the symptoms of ADHD through the lens of Asperger's can help understand how this misdiagnosis can be made:
  • Inattentiveness - A classic symptom of ADHD is the inability to focus and pay attention. A child with ASD may indeed look like he or she can't pay attention. However, is this inattentiveness better explained by a lack of understanding of the social expectations to focus in certain situations? Is the child only motivated to engage when the topic is within his or her area of interest?
  • Impulsiveness - Another symptom that leads to a diagnosis of ADHD is impulsive behavior. Again, when examined through the lens of ASD, impulsive behavior could be explained by a inability to understand the norms of typical reciprocal conversation and manifest as verbally interrupting conversations. There are social norms and hidden rules in game play and other interactions that a child with Asperger's doesn't interpret; his or her behavior can look impulsive. Intense emotions and "meltdowns" associated with ASD may also be written off as the impulsive behavior of ADHD.
  • Hyperactivity - Constant movement, bouncing, or pacing could easily be more directly related to a sensory need or stimming behavior instead of true hyperactivity. Hyperactivity can also present as a need to talk constantly; a child or teen with ASD may talk about his or her areas of interest without pausing for feedback due to difficulty understanding the social rules of reciprocal conversation.

Parents, educators, and medical/mental health professionals need to be aware of the overlap of behaviors between these two diagnoses. If medications don't seem to make a difference for ADHD, it may be beneficial to consider the presence of ASD. If social skills seem to be regressing as a child enters late elementary, middle, or high school instead of balancing out, taking a look for Asperger's could help. And finally, considering each of the behaviors that was originally explained by ADHD, and whether the motivation for the behavior is better explained by traits of ASD, can help find an accurate diagnosis. 

While any mental health diagnosis for a child can be overwhelming, accurately identifying the cause of problematic behaviors allows for proactive interventions to be implemented earlier and with better efficacy.

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The Perfect Gift for Teachers!

11/30/2017

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By Emily Kircher-Morris, LPC

'Tis the season to rack your brain for gift ideas for some of those hard-to-buy-for family and friends. One of the hardest among these is your child's teacher. As parents, we don't really always know the teachers personally enough to get them something they really want. So goes the annual search for a gift that is unique (yet general enough that any teacher would like it) and in the right price range (somewhere between $5 Starbucks gift card and a full spa day).

I used to be a teacher and a school counselor. Gift cards are always easy and appreciated but sometimes feel impersonal. Snacks are hard because some teachers don't eat gluten or sugar or coffee or chocolate (What????). Knick knacks and ornaments are tough because, eventually, there just isn't enough space to keep them.

So - don't spill the beans to my kids' teachers yet - but here is what they are getting for Christmas this year: I'm giving each of them a gift basket filled with fidgets for their classrooms.

Research is showing that more and more students learn better when their psychomotor needs are met. Especially for children with ADHD and other sensory needs, a small, unobtrusive fidget actually can help them focus better than without because it stimulates the small portion of the brain that needs a distraction so the other 95% of the brain can focus on the lesson. Adults need this, too; when I provide professional development, I bring baskets of fidgets, Play-Doh, markers, and candy to fill that sensorimotor need.

Now, don't worry. I'm not going to stockpile my child's classroom with a full set of fidget spinners. (I know teachers who've had nightmares about out-of-control fidget spinner mutinies in their classrooms!) When I *teach* kids how to use fidgets appropriately (yes, kids need to be taught how to use fidgets to improve their focus), we have a few rules. The fidget cannot distract others, either visually or by making noise, and the person using the fidget needs to be able to maintain eye contact with the person who is speaking or teaching the lesson.

Here are some of my favorite fidgets that I'll be giving my kids' teachers this holiday season. I've bought and tried all of these items and have them at my home and office. 

These little tangles are a classic fidget that kids love. They twist and coil and wrap. The one downside is that some kids like to pull them apart and put them back together, which can be distracting in the classroom.

This is perfect for those kids who are always tipping their chairs. Simply wrap this exercise style band around the bottom two legs of a classroom chair for kids to use for counter pressure for their legs. Bonus: It won't result in falling over backwards!

Fun little fidget rings roll up and down a thumb or finger with minimal distraction or noise. They provide some pressure - kind of like a little massage for your finger!​

File this under "Why Didn't I Think of That?" This little mesh tube that kind of looks like a little Chinese finger trap has a marble trapped inside. Squeeze the marble back and forth to engage kids without distracting others.

Another style of fidget ring, instead of rolling vertically on the finger, it rolls around the finger. The smooth roll this fidget provides is surprisingly calming and satisfying. Again, it is small and won't be distracting to other kids!

Another great option for the child who has a hard time staying still in his or her seat. These wobble seats take just enough effort for kids to stay stabilized so their wiggling isn't a distraction to themselves or others.
(BTW - These are Amazon Affiliate links. If you opt to purchase through this link, a small portion of your purchase price will be donated to the Gifted Support Network 501(c)(3) nonprofit in St. Charles, MO.)​
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The Trouble with Disciplining Bright Kids

11/19/2017

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By Emily Kircher-Morris, LPC

Yelling? Check.
Taking their phone? Check.
Grounding for a month? Check.

​But what is a parent to do when none of these seem to work anymore? Maybe you get a shrug as your child shuffles to his or her room or a grumble as they turn over their phone. Your child seems immune to any consequence you try to implement.

What now?

The most effective punishments are those that are natural and logical. But, sending a bright kid to their room isn't too much of a punishment if he can spend an hour folding a scrap of paper into an origami Yoda or be happy staring at the ceiling, imagining the next Minecraft world he's going to build.

Ultimately, these punishments are based on the removal of a preferred activity or item. The goal of any punishment is to teach a child healthy and productive ways to behave.

What if we focus on the learning part of the mistake? What if we make the goal of any consequence an opportunity for coaching to create real-world connections to help a child understand why it is important not to make the same mistake again? Make the consequence a chance to engage higher-level thinking skills like analyzing the situation and creating new solution.
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Natural consequences:
Consequences that occur naturally without parent intervention. A child who refuses to wear a coat to school will be cold.
Logical consequences:
Consequences imposed by a parent which are logically connected to the infraction committed. A child doesn't put his bike away, so the privilege of riding his bike is removed for a set amount of time.
Restorative consequences:
Opportunities for the child to "right the wrong" through service work, researching, and collaborative problem solving.
For example, my son refused to wear a bike helmet more than once. Instead of taking his bike away, he had to research and find information about the risks associated with bike helmet safety and regulations. It was time consuming. I had to help him through the process. It also kept him from his preferred activities, but, it was engaging. It allowed him to create new connections in his awareness of the topic. It was much more effective than me lecturing him, too. And when he was able to share his learning, he felt  proud of his work instead of ashamed of his mistake.

The downside of restorative consequences it takes effort, time, and creativity on the part of the parent. However, the long-term benefit in learning and the relationship it fosters between you and your child will be worth the effort.
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How Are You Taking Care of Yourself Today?

10/20/2017

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By Heather Kuehnl, PLPC

Self-care is one of the most important things you can do for yourself.  It can help decrease symptoms of anxiety, depression, and daily life stresses, as well as improve mood and overall health and well-being.  When you take care of yourself, you are better equipped to care for those around you, as well.

Self-care is also vitally important to children and adolescents as well.  They can experience a myriad of moods, feelings, and mental health concerns.  It is imperative that they are aware of, and supported with, ways to implement self-care strategies to help them manage every day stressors, symptoms of a mental health disorder, or simply get some of their wiggles out.  Below you will find some great self-care activities, for children/adolescents and adults, to support you and/or your child with self-care.  
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Heather Kuehnl, PLPC is under the supervision of Emily Kircher-Morris, LPC (MO #2012026754).
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Back-to-School: Preparing Mentally and Emotionally

8/10/2017

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By Caitlin Winkler, PLPC

Backpack, check. School supply list, check. New clothes, check. Haircut, check.  It’s that time of year.  Saying good-bye to summer and hello to school is getting closer, if not already here, and you’ve checked (or almost checked) all the boxes on your to-do list.  Each year we do our best to prepare our child for a new school year.  Something we often fail to discuss is the need to be mentally and emotionally ready as well. 


School brings a whole new set of trials each year.  From academic challenges, teacher meetings, to tears over friendships, missing the bus, and the excitement of starting something new, this school year is bound to have its ups and downs.  How can you help get ready for those tough times?

Five Tips to Prepare Mentally and Emotionally for the New School Year:

1. Meet physical needs first.  If you can remember Maslow’s hierarchy of needs from Psychology class, basic physical needs are the foundation upon which everything else is built. It is hard to get up for the bus, be prepared for a test, and meet obligations at school if you’re not sleeping well, not getting adequate nutrition, and do not have a secure and safe place to live.

2. Talk to your child about their thoughts and feelings.  You could ask: What are you looking forward to?  What are you nervous about? What are you excited to learn?  Who are you looking forward to meeting?  What are some concerns you have? How will this year be different than last year? Your child may surprise you with his or her answers.  Validate their feelings and listen to their concerns without passing judgment or minimizing their thoughts.  It is important for them to feel heard and understood.

3. Be aware of your child's struggles.  Does your child have test anxiety?  Is making new friends scary or really hard? Does your child struggle with having positive behaviors at school? Think about your child's strengths and weaknesses.  As parents, it can be easy to only want to see the great things about our child, but the reality is, our children are not perfect.  Everyone struggles with something.  Helping your child prepare, work through, and persevere through a challenge or limitation is so important.  Connecting your child to resources, such as tutoring, social skills groups, and counseling can make a huge difference.  Be proactive in reaching out for help.

4. Give them the power.  Many people pass blame and fault to others.  Even as adults, we do this.  But, something so vital for our children to learn is the fact, "I can control myself- my behaviors, my thoughts, my attitude, my words."  They have the power to control themselves and are ultimately responsible and accountable for their actions.  Once they recognize and learn this, they can tackle any challenge thrown their way.  They can handle a tough teacher, an argument with a friend, a low grade on an assignment, or not making the team.  As children and as adults, we choose our thoughts, whether they are positive or negative, and our actions are born from those thoughts.  Positive thinking leads to positive feelings and positive behaviors.

5. Prioritize your schedule.  We often expect ourselves and our children to keep up a crazy, fast-paced schedule.  Many children are exhausted not just physically, but mentally and emotionally as well from the demands on our calendars.  Cutting back on sports practices, extracurricular activities, and outside commitments may be necessary.  Our children need time to just be kids- time without structure, time-lines, and expectations placed on them.  Make time to play outside, laugh as a family, and have a night at home. This can make a huge difference in the mental and emotional well-being of your child.

Caitlin Winkler is a Provisionally Licensed Professional Counselor at Unlimited Potential Counseling & Education Center in O'Fallon. Caitlin is under the clinical supervision of Emily Kircher-Morris, LPC (MO #2012026754).

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​Are Your Emotions Influencing How You Communicate?

8/3/2017

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By Andrea Schramm, LPC

Our emotions are a natural, powerful information gathering system allowing us to quickly gather information about our own experiences and those of the people around us. Emotions are part of our communication system and influence our social connections with others. Emotions are also physical. We all know the word “feeling” associated with our emotional experiences.

So how do our emotions and our ability to understand and manage them connect us with others in both intimate and social relationships? How can we communicate successfully incorporating our emotions?

Emotions inform communication. “I feel good…I don’t like her…Yes, I’d love to have dinner tonight…Yuk, I hate sushi.” These are all examples of how emotions inform. Emotional experiences are often connected to our past experiences, our learning history. We experience emotions associated with events we have at some point had before which form our emotional response: “The first time I ate sushi, it was disgusting. It makes me ‘feel’ sick.” We can become programmed to respond emotionally to experiences we’ve had previously.

Here are some tips for communicating using emotionally informed behaviors:
  1. When communicating through emotions, use the phrase “I feel...” Using this statement helps inform you and the other person regarding your emotion and avoids an accusatory approach such as, “You make me feel...” Avoid using the word “you” unless paying a compliment such as “You make me happy,” or “I feel happy.”
  2. Practice awareness of your own emotions. Using “I feel” can support your own ability to label and manage emotions you experience. Learning to identify and be responsible for managing our own emotions supports healthy communication with others.
  3. Engage in some deep breathes to reduce and redirect negative emotions. Learning to reduce and redirect negative emotions can reduce stress.
  4. Make statements that communicate to the other person how your emotions inform you. “I feel if we spend too much on dinner this month, we won’t be able to pay the mortgage, when this happens, I feel angry.” This approach moves feelings and emotions forward and engages the problem-solving portion of our brain.
  5. Emotions inform and can create connections, problem-solving creates long-term intimacy through shared experiences. Figuring out together how to enjoy dinners out and pay the mortgage provides a shared experience that fosters intimacy and positive emotional experiences. Emotions alone won’t sustain a long-term relationship. Moving through emotions, using the information they provide to problem-solve builds intimacy.

​Remember, emotions inform. Take some time to acknowledge and think about your own emotions. Why do you think you feel as you do? What past experiences formed the emotional responses you have? Learning to understand emotional responses can build a stronger sense of self and teach us to use emotions to build positive relationships with each other. 

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The Power of Self-Compassion

6/21/2017

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By Melissa Albers, Intern

This last semester I took a course called “Positive Psychology” as an elective in my Psychology degree. While this is a difficult subject to explain, the basic idea is that instead of focusing on what can go wrong with people psychologically, we can instead focus on what people can do right. Some common examples of positive psychology are mindfulness, savoring, growth mindset, and cognitive re-framing. But in this post I would like to discuss the topic that struck a chord with me: self-compassion.

Self-compassion is based on three important ideas: kindness, mindfulness, and common humanity. It is used when we mess up or are disappointed in ourselves. The first aspect, kindness, is shown when we don’t beat ourselves up for a mistake. For instance, think of your best friend or a family member. If they made a mistake, would you tear them down for it? Would you tell them they were an idiot and worthless? Of course not. So why do we often tell ourselves that? Treating yourself with kindness means being forgiving when you make a mistake and taking care of yourself through that mistake.

Mindfulness is the idea that we can’t simply ignore our negative feelings. When we mess up or something doesn’t go our way, it is okay to feel disappointed and upset. You shouldn’t ignore the feeling, but you also shouldn’t dwell on it. Acknowledge and experience the emotion and then let it go. When you have a negative thought or feeling, let it approach you and land on you, like a butterfly. Be still and let it rest before it takes off again.

Finally, self-compassion deals with the idea of a common humanity. Essentially, everyone else messes up and makes mistakes just as much as we do. This is a part of the human experience, and we should embrace it just as we embrace joy in accomplishments.  Your negative experience is shared by many other people in this world, and in that fact, you can find comfort and strength. Feelings are a part of the human experience.  You aren’t the only one who has been overlooked for a position or promotion, felt disappointed in your choices, or has had their heart broken by a friend or loved one.

Self-compassion isn’t always easy, but it’s something I’m trying to get better at every day. When you practice self-compassion, it can lower your anxiety, self-criticism, and depression. It can also increase your connectivity to others. So while you may stumble and mess up along the way, don’t beat yourself up for it-- have self-compassion instead and keep moving forward.


Melissa Albers is an intern at Unlimited Potential Counseling and Education Center. 

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Counseling Before Marriage? How Couples' Premarital Counseling Sets Up a Successful Marriage

4/27/2017

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By Caitlin Winkler, PLPC

What is premarital counseling?  You may ask, "If my future spouse and I are in love and ready to get married, why would we need counseling?"


I believe this is a common way of thinking among individuals and couples today.  Counseling is often viewed as a tool to help solve a current problem or struggle, but it is also something that can be used before an obvious issue arises.  

Think of it this way: if you are building a house, what is one of the most important steps?  Engineers and builders would argue laying the foundation is critical.  Why?  Because the foundation is what everything else is built upon.  Without a solid foundation, the house will be weak, it may fall, and it will not last long.  The same is true with marriage.  In our marriages, we often wait until we start to see the walls crumbling before we seek help.  

One preventative, proactive measure to take is premarital counseling.  Yes, you are excited about marriage and do not fear divorce.  But what happens when the storms of life start to blow and your strength is truly tested?  Premarital counseling helps to strengthen your foundation.  It involves thinking, planning, discussing, compromising, and preparing for a future life together, perhaps sharing about topics not even thought about before.  It is designed to be a tool that helps create solid, lasting marriages.

I am excited to offer premarital counseling at Unlimited Potential Counseling in the O'Fallon/Dardenne Prairie area.  Our world needs strong marriages to help build strong families.  This service is offered through a Christian perspective and integrates the importance of faith in the relationship. Please contact me and I will be happy to answer any questions you and your future spouse may have!

Caitlin Winkler is a Provisionally Licensed Professional Counselor at Unlimited Potential Counseling & Education Center in O'Fallon. Caitlin is under the clinical supervision of Emily Kircher-Morris, LPC (MO #2012026754).

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Getting Through Life's Storms - World Pompe Day

4/18/2017

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By Caitlin Winkler, PLPC

When thinking about how I wanted to approach writing this blog, I really struggled with what direction to take. There is so much I wish I could share and convey in my words.  I hope you find some encouragement, hope, and peace in these thoughts that come from a very personal place.
 

International Pompe Day is recognized each year on April 15th. The day is designed to bring awareness of this rare genetic disease and hope to those impacted by it. This strange name (pronounced POM-PAY) may sound familiar. President Trump highlighted Pompe on Rare Disease Day in February during a joint address to Congress.  Never before has Pompe been shared on the world stage in this way. To hear Pompe mentioned in this setting was overwhelming because of the personal relevance it brings to my family.
 
Our son was 8 days old when we found out he failed the newborn screening for Pompe Disease. With further testing, a lot of waiting, and many tears, doctors confirmed his diagnosis on his one month birthday.  At that time, we didn't know what the next year would hold: Would he survive? Would he be in the hospital all the time? Will he ever walk? How do we handle this? 

After further testing (again) and meetings with doctors and genetic counselors, our son is said to have a mutation which indicates a later onset of this disease, meaning he is developing and functioning as he should at this time (He just turned 3 this weekend!).  However, at some point in his life, he may begin to have symptoms. This disease involves a build up of complex sugars in the body, causing muscles to breakdown and begin to lose functioning.  This can lead to troubles with the heart, eating, walking, and breathing.  As the disease progresses, depending on the severity and extent of symptoms, it can lead to death. We are grateful for a healthy boy, but if I let myself, I can easily worry about what tomorrow holds and if/when this disease will begin affecting my son.

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As parents and adults (and kids!), it can be easy to worry about tomorrow.  Whether it is a rare disease diagnosis, a financial crisis, death of a loved one, or traumatic event, life is going to throw some curve balls our way!  Walking through these trials is painful, miserable, and just plain hard.  So what can we do when life gets bad?  Here are some things that helped me survive and tread through some of my personal storms:
 
1. My faith 
2. Strong support system- family, friends
3. Allowing myself to grieve and cry
4. Not taking a single moment for granted - life is short
5. Finding the positive and counting my blessings
6. Taking it one moment at a time - baby steps
7. Allowing people to help and asking for help
8. Kept going - I learned I am stronger than I thought I was!
9. Sharing my story when I am able to encourage and help others

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"You are braver than you believe, and stronger than you seem, and smarter than you think."
~A. A. Milne
I don't know what your world looks like right now.  The future may be unknown and terrifying.  As Christopher Robin said to his great friend Winnie the Pooh, "You are braver than you believe, and stronger than you seem, and smarter than you think."  

You've got this.

​
Learn more about Pompe Disease:
 https://rarediseases.org/rare-diseases/pompe-disease/


Caitlin is under the clinical supervision of Emily Kircher-Morris, LPC.
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5 Tips to Build Your Relationship through Fitness

3/21/2017

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By Andrea Schramm, LPC, CRC

We’re all familiar with the physical and psychological benefits of exercise for ourselves. Exercise can support weight loss, improve your heart health, improve your sleep and reduce your risk of depression. The Mayo clinic recommends just 150 minutes per week of moderate-intensity exercise, or 75 minutes per week of vigorous exercise. That’s a little over 20 minutes a day to reap the positive benefits of daily exercise! But, we all know just how difficult it can be to add just 20 minutes of something new to our busy lives.

But what if you took the time needed for physical activity and did it together with someone you love? What if sharing this time with another person gave you the boost and motivation you are looking for and fun while you exercise together? Here are some tips to getting started with exercising together as a couple.


  1. Choose an activity you both enjoy. Choose a basic activity you both feel competent doing to maximize the effect and your success in maintain the habit. Working out together and sharing physical activity can increase the efficiency of the activity for both partners. It’s the simple presence of someone we feel close to that boosts our energy output. It is a “win-win” for both partners.
  2. Maximize your progress by setting mutual goals. Caring about your partner’s fitness goals in addition to your own can improve your level of physical engagement in shared activities. Build success by agreeing to each maintain a basic level of your own internal motivation to benefit the most from sharing your fitness goals and experiences with each other.
  3. Set time aside for your activities. Replace date night dinner and a movie with dinner and a walk in the park. Walking together in the park creates a coordinated action which promotes emotional bonding. Matching each other’s rhythm and pace can help you feel more in tune with each other.
  4. Benefit from both low and high-intensity workouts. Keep it relaxed with a leisurely walk or get sweaty together enjoy the benefits of increased heart rate, sweaty palms, and shortness of breath associated with both physical arousal and romantic attraction! Grab those bikes and hit the trail to fall in love with exercise and each other!
  5. Start small and reward yourself. If shared exercise is not already a part of your daily life together, add a short walk a couple times a week to begin. Use the time to support each other emotionally through positive conversation. You’re looking to build the benefits of joint participation in physical activity. Set small rewards for yourselves when you meet reasonable goals such as maintaining your shared exercise for one week, two weeks, a month. And have fun giving yourself and each other the gift of togetherness through exercise!

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