It seems that most parents are being provided the option of their child returning part-time in-the-classroom or full-time online. However, it seems that most of the elementary schools are more prone to offer full-time in-the-classroom while most high schools are offering part-time in-the-classroom and part-time online. It appears that a difficulty establishing what is deemed to be safe ‘social distancing’ at the high school level is the rationale for not offering full-time in-school programming.
Not that my position is the end-all, but as a Clinical Child and School Psychologist with over 30-years of experience, I have clearly found, in the absence of an underlying medical condition, our kids need to be back, full-time, in the classroom. I can’t seem to find any medical “science” that suggests otherwise and behavioral health ‘science’ as well as my experience as a psychologist, with my own kids, and in talking to all of you who are parents of kids, unequivocally sites the damage to kids from not being educated in the classroom. It is quite frustrating for me, as a child advocate, and parent, to see how this is playing out. I have any number of opinions as to why this is happening but, rather, I will focus today’s post on how to make this situation somewhat workable, especially when your teen resists.
If your child is in elementary school and going to school full time, then you’re all set. We trust that the powers-that-be will not change course, and your focus will be on your child returning to school and preparing for the change in routine from the summer. I’ve written a lot on that subject, so simply see my prior posts on preparing your child for the routine of school http://helpforyourchild.com/?s=school
However, you’ll also need to prepare your child for wearing a mask (often only until they are in their assigned seat with social distancing but it seemed the rules and mandates and changing almost daily). If your child has sensory issues, you can experiment with different materials used to make the mask, and increase the time allotted, at home, for mask-wearing to practice and increase tolerance. This could include beginning wearing the mask only 30 seconds, then one minute, then two…. Of course, the mask can feature a favorite super-hero and even be part of a full costume, if necessary, to promote cooperation.
The back-and-forth between in-the-classroom and on-line is a notable challenge. As a parent, you’ll need to establish the ground rules for online days.
In that respect, you’ll need to determine, most importantly:
A big challenge is enforcing these rules on your high school student. In that respect, your teen may have ideas about how online and asynchronous learning should be carried out, while you have very different ideas. The goal, as with all matters when dealing with a teen, is to have an open conversation with your teen and attempt to reason with him or her. When dealing with a teen, we try, above all else, to avoid relying on punishments and, rather, rely on talking things out and coming to a compromise. In that absence of finding common-ground, your left with other options including trying to get his friends to offer a positive influence. In that respect, maybe your teen’s friends and their parents have already come to an agreement that online schooling should be in a family area with monitoring and not in their room. In that respect, peer’s plans are vital to potentially coming to an agreement.
If you can’t come to an agreement with your teen, then you’re left playing some hardball. In dealing with teens, it’s always best to work together, compromise, and attempt to come to a common ground. However, if that does not occur, then at some point you simply dig-in and 'do what you have to do. In most instances, these days, that involves shutting down access to the phone or video games on days of in-home schooling unless they acquiesce. Your kiddo won’t be happy, but you have limited options unless you're okay with indulging your teen's wishes.
If your teen is on board with the program, then you’re all set. Schooling is scheduled to begin at a particular time, in a specific location in the home, and carried out for a certain number of hours with planned breaks. If your child has some special needs, you’ll plan the breaks and level of oversight accordingly. You’ll likely need to check-in with the teacher on a regular basis; granted, we want our teens to be independent and for us to intervene as little as possible. However, it does not always work out that way and, in all fairness, it’s far easier to lose track of assignments and tests via an online format, than when a student is face-to-face with the teacher.
I certainly hope this challenging time goes smoothly; in fact, some kids thrive in an online format. However, many do not, so we have to prepare accordingly. Think about how your child is likely to respond, and plan this out; don't wait till the last minute.
In my next post, I’ll show you how to get control of your child's or teen's video game and phone without getting into a wrestling match.
In the meantime, if you have questions, don’t hesitate to reach out at DrCarosso@aol.com. These are challenging times. God-speed in venturing through this situation, it being resolved quickly and favorably, and all our kids, if we so choose, getting back to school in-the-classroom on a full-time basis.
As Mark Twain popularized, “there are three kinds of lies: lies, damn lies, and statistics.” I suppose there is some truth to that saying; statistics can be confounding, confusing, and twisted. However, by the same token, statistics can also add clarity and help to guide our decisions. So, with that in mind, today we’ll focus on a way to help determine whether a given treatment is effective.
In research, determining whether there is a statistically significant difference between the two groups is vital (is there a genuine difference between the treated group and untreated group, due to the treatment, or is the difference simply by chance). Once it’s shown that there is a significant difference, knowing what’s called the ‘treatment effect’ helps us understand the magnitude or importance of that difference. In that respect, the ‘treatment effect’ measures the strength of the relationship between two variables, i.e. between the treatment group and the untreated group. Put another way, the treatment effect measures the magnitude of the impact of the treatment compared to those who were not treated. The treatment effect is measured in what’s called an ‘Effect Size’.
Exercise can be an effective treatment for ADHD, but is temporary and lasts for only a few hours depending on how long and how intense. Regular exercise (and perhaps strategically timed exercise such as before one needs to focus for a class) is a good use of this strategy, and its effect size varies across symptoms measured:
(kids and teens meta-analysis) 0.56 – 0.84
Attention – 0.84
Hyperactivity – 0.56
Impulsivity – 0.56
Anxiety – 0.66
Executive functioning – 0.58
Social disorders – 0.59
Sources: Dr. William Dodson, ADDitude Magazine Spring, 2013: ADHD Report Oct. 2012; Sept. 2015 & Dec. 2016 Russell Barkley, Ph.D.
Antidepressant medication is clearly beneficial for severe depression, but also in moderate depression. There is less of an impact over placebo in mild depression. Relative antidepressant versus placebo benefit increased from 5% in mild depression to 12% in moderate depression to 16% in severe depression.
Buproprion: 0.18
Citalopram: 0.23
Duloxetine: 0.30
Escitalopram: 0.31
Fluoxetine: 0.28
Mirtazapine: 0.33
Nefazodone: 0.28
Paroxetine CR: 0.44
Sertraline: 0.23
Venlafaxine: 0.42
By way of comparison, psychotherapy effect size ranges between 0.22 – 0.80, depending on the experience of the therapist and the relationship between the therapist and client.
Gastric Acid mediation (Nexium…): 1.39
Oxycodone: 1.04
Metformin (diabetes): 0.87
Sumatriptan for Migraines: 0.83
Benzodiazepine for anxiety: 0.65
Antihypertensives: 0.65
Corticosteroids for asthma: 0.56
Anti-psychotic medication: 0.51
Statins for cholesterol: 0.15
Aspirin for vascular disease: 0.12
It should be noted that there is more to the story than treatment effect. In that respect, statistics deal with groups, not individuals. Consequently, one individual might get a huge benefit from a treatment approach or medication, while a bunch of other people may only experience a small improvement. If you’re that one individual who responds wonderfully, then an Effect Size of 0.2 does not mean a whole lot. Moreover, for some treatment options, it’s not applicable to compare the effect size to an entire group of ‘depressed’ persons when the medication is shown to work better for depressed females who are also quite anxious and worried about weight gain. In that instance, the Effect Size may be 0.5, but more globally may only be 0.2. This is why doctors make clinically appropriate decisions to treat individuals, not groups. Finally, keep in mind that if only 5% of people experience a notable improvement with a medication or treatment approach, that 5% can add-up to a lot of people benefiting if the condition is wide-spread and the treatment approach is widely used.
Making informed decisions is vital, and I hope this post helps in that respect. Please feel free to respond or provide any comments on my Facebook page, I would love to hear your thoughts. God bless.
Yes, about 4x as many males than females are diagnosed on the spectrum.
We know that children with autism struggle with language and social difficulties. In fact, along with:
it is clear that social and language challenges are primary in the diagnosis.
Males and females aren’t the same. Anyone who knows a female, or a male, and is married to one or the other, knows the truth to that. We simply do not think the same, nor do we have the same inclinations, affinities, or strengths. In that respect, clearly, females are better at socializing and communicating. They are far more verbal, communicative, and social.
Girls are better at using their inherent strengths to camouflage their weaknesses, blend-in, follow the lead of their peers, and avoid standing-out. This would be true for females mildly as opposed to those more severely on the spectrum.
It’s vital to observe females suspected to be on the autism spectrum in a more nuanced and fine-tuned fashion. In talking with a female in that respect, it’s important to inquire about the challenges fitting-in with peers and how they have learned to adapt. In that respect, many females will speak openly that they rely heavily on following the lead of their friends because, in reality, they’re not sure what to do, or what to say, so they follow-along, remain friendly and affable, ‘do what others are doing’ and consequently try to fit-in and be accepted by peers despite their deficits. Many females on the spectrum are relatively successful in this respect, but the task can be stressful and exhausting.
This ability, of trying to fit-in, speaks to the resilience and aptitude of these female kiddo’s who find ways to compensate and move beyond their challenges. Boys do the same, but more-so in gross-motor pursuits with their male peers. God bless these young ones and may we be increasingly sensitive to their needs, ascertaining their challenges, and recognize how they adapt to fit-in with the world around them.
The Coronavirus has had a major impact in lots of ways, not the least of which is trying to explain to our children with autism what’s going on, and helping them to adjust to the changes in the schedule, i.e. not going to school, being watched by grandma one day, and a sitter the next.
In terms of explaining the ‘virus’; it would appear reasonable to explain that a strain of the “flu” is ‘going around’ and we’re taking precautions. In terms of providing reassurance, please see my prior post on the subject, and recognize that youths typically either don’t get the virus or experience a very mild reaction; so, that’s encouraging and worth noting to your kiddo.
You've been through this many times when there is a snow day or unexpected change in your schedule. This time, however, the change will continue a bit longer. This extra time gives you the opportunity to establish a new routine. The key is to prepare, to the extent possible, clear and specific schedules presented on a white-board or using a visual schedule for younger children. These schedules can be daily, or weekly; whatever you think is best.
It would be understandable if you give extra hugs and reassurance, as well as some extra use of the iPad to help calm the emotions. You may feel like you’re over-indulging, but sometimes that’s necessary. Try to keep the routine consistent in terms of the same order as would occur on weekends and other days off. However, you may want to increase structure a bit compared to the weekend schedule (given the length of time of this hiatus) but, no worries, establish the routine in written or visual form, and have each caretaker carry-out the routine in a predictable fashion.
To prepare for the next day, you’ll have the schedule already prepared, and use face-time with grandma (or teacher, or babysitter…) telling your child how much fun they’re going to have, and the activities in which they will be involved. Use the written or visual schedule to prepare for transitions, and allow for extra time knowing that these transitions may be accompanied by some emotion and resistance. A sticker chart with extra rewards may be helpful in that respect.
These are trying times, for you and your kids alike. As always, don’t hesitate to reach-out with any questions, and please share your success stories on my Facebook page. God bless.
Potentially, not much. If you live in Oklahoma and its tornado season, then you’ve got some things to be thinking about. Likewise, if you live in South Carolina and it’s August, a hurricane could arise at any time. Moreover, if you think like Greta Thunberg, well, the world is a very scary place.
Children who struggle with anxiety will worry, that’s what they do; they will find things to worry about and will assume the worst is going to happen. So, in all these situations, no matter if it’s over some virus or the weather, or someone is ill, or it’s an extra warm day, the answer is the same:
God bless you and your family through this trying time. Feel free to comment on my Facebook page and don’t hesitate to reach out if your child is having an especially difficult time.
Written by Dr. John Carosso
I wrote earlier that the chatter in our heads can be as distracting as any external annoyance, and more anxiety-provoking than the actual fear. Our ability to self-sooth, through calm and reassuring self-talk, and re-direct our internal dialogue is vital and can make a big difference in completing tasks. In my earlier post on the subject, I mentioned a few ways to calm that chatter, but here I’ll describe three even more powerful tools. Okay, here we go:
Prayer is calming and channels our thoughts to a higher power, which is reassuring to know that the King of the Universe has you and your family’s back, and powerful in terms of God directly intervening and calming our thoughts, spirit, and situation. Memorizing scripture, such as cast all your anxiety on Him because he cares for you, 1 Peter 5:7, and I can do all things through Christ who strengthens me, Philippians, 4:13, slows the chatter and fights those negative thoughts that counter our kid’s progress. God also seems to think that such contemplation it’s worthwhile and the-more-the-better, i.e. pray without ceasing, 1 Thessalonians 5:16.
How many times have you been doing something with your children or spouse, or maybe walking the dog during a quiet and peaceful evening, and you should be enjoying the moment but, instead, your mind is a million miles away contemplating all sorts of negative and fretful things about tomorrow, last year, and what you should be doing instead of what you are doing? There are few things that so thoroughly steals our joy, robs us from being present with loved ones, and inhibits our ability to enjoy any given experience. So, don’t do that!!! Instead, take captive every thought, 2 Corinthians 10:5 (bonus Scripture), that is to say, take control of your thoughts and focus ‘in the moment’ on who you’re with, what they are doing, the smells, sounds, how you’re feeling, the sentiment of the moment – wrap yourself in the experience and truly live in that time and place. It’s really not hard, and it’s so worth the effort.
So, I’m not entirely familiar with the eastern philosophies and their spiritual underpinning and techniques, but if the goal is to clear your head then this technique is apparently something worth considering. I understand that even kids can learn this mantra, so to speak, which slows things down and is quite calming. I’m far more familiar with progressive relaxation, which is essentially self-hypnosis. In that respect, most don’t know that hypnosis is essentially a deep state of relaxation. In any case, if you try progressive relaxation, which involves, paradoxically, actively and purposefully relaxing your body and thoughts, you’ll notice how much more relaxed you become compared to only, for example, laying down and taking a nap. In fact, ironically, we can actually be quite uptight and tense even when we think we’re “relaxing.” Kids can easily learn to take control of their body and mind, and quickly progressively relax, at any point during the day. It’s quite powerful and calming.
Try these techniques and see what works for you and your kids. Please provide feedback in that respect on my Facebook page. Okay, now go and calm that internal chatter.
A young man named Ryan Langdon, from his post at InsideMyMind https://insidemymind.me/2020/02/05/how-my-internal-monologue-affects-my-attention-deficit-disorder/ wrote of his internal dialogue, as a person with ADHD, that he referred to as being hyper-neuro-vocal in that he tends to have hyper self-talk that interferes with his concentration. In his own investigation, he found that others with ADHD tend to get carried away in their hyper self-talk, while those without ADHD sometimes report not even being aware of any self-talk or internal dialogue (what he refers to as being hypo-neuro-vocal). In fact, Ryan speaks of the primary challenge, for him and his experience of ADHD, as being his internal dialogue that interferes with his concentration.
Do you think in words, in an internal dialogue, in pictures, or are you not aware of any internal thoughts (must be rather quiet)? I’ve had the opportunity to interview literally tens of thousands of individuals ADHD, anxiety problems, depression, and autism. The bulk have described active self-talk that seems to interfere with daily functioning. I don’t know anyone with no internal dialogue. Maybe there are some who are not aware of their own self-talk, which does not mean it’s not present. In fact, such thoughts are often referred to as automatic thoughts, which are simply thoughts that are so automatic that we don’t even realize we’re having them. However, everyone is different and we’ve all heard of individuals (maybe this is your experience) who tend to think and process information predominately in pictures (visual learners…). I would imagine that most of us think in both words and pictures (we talk to ourselves, and visualize people and experiences). The primary issue, in terms of a ‘disorder’, is the extent to which our thoughts interfere with our daily functioning.
I’ve never talked with a person struggling with anxiety who did not have anxiety-provoking self-talk or a depressed person without depressing self-talk. Individuals struggling with ADHD tend to have thoughts they can’t shut-off that manifest in non-stop talking (that is rather distracting for them and those around them), and individuals with autism tend to have a strong internal focus and/or obsessive thoughts about any random item or interest. Frankly, there is barely anyone on this planet who doesn’t have trouble, at one time or another, getting a handle on their thoughts. One of the primary aspects of therapy is helping to control what’s going on in our heads.
We learn to control our thoughts, that’s what we do. We use internal forces to think about something else, which is the basis for the best-research therapeutic approach used today; cognitive-behavioral therapy. We also use external cues to remind us to stay focused; either way, we learn to redirect our thoughts to more healthy topics and perspectives, and back-to-task. Medication can be very helpful and tends to quiet the background chatter and sharpen our focus. Auditory and visual cues can also be a plus in terms of, for example, wearing ear-buds that play a recording, every minute, of a friendly voice reminding us to stay on-task, or a visual cue on our desk to remind us to focus, or highlighting every noun or verb in a paragraph so we must stay active and focused in our reading, and on-and-on it goes. There are countless strategies.
Ryan’s post, which got about a million views, has been appreciated by so many who can relate to his challenge of controlling his internal dialogue. In fact, like so many who can relate, Ryan perceives his challenge with ADHD as not being distracted by external stimuli (such as a tapping pencil) but, rather, his own thoughts. That is a fascinating and integral aspect of ADHD, not to mention anxiety, autism, and every other disorder with which we struggle; if we can control our thoughts, we can control the disorder rather than it controlling us. I’m looking forward to hearing more from Ryan, and from those who learn productive ways to overcome their daily challenges. God bless.
We find the rate of ADHD increasing by upwards of 10% over the past ten years, and the boy/girl ratio is upwards of 3:1.
Maybe the rates are rising because practitioners are better at assessing and diagnosing this condition. Or, maybe the condition is actually increasing due to toxins in our environment or some other cause.
I wonder if we’re becoming less tolerant to the types of behaviors typical of boys?
My goal is not to be political, and maybe I’m off-base, unenlightened, and not entirely ‘woke’, but it’s hard not to see a war going-on against boys. I understand that girls have been stereotyped, and that is wrong, but I wonder if the pendulum has swung too far the other way? In that respect, boys seem to get the short-end of the stick across the board. The things that make boys, well, boys, are increasingly seen as negative, punishable, and are prohibited if the behaviors come from boys. Those traits that are seen as masculine are labeled as “toxic” and boys are compelled to be, well, more like girls. Ironically, girls are being taught to be more like boys, which is fine (I guess), so long as boys can also be like boys. When it comes to males, we are averse to anything rough-and-tumble, so to speak, in favor of those things compassionate, sensitive, and nurturing. There are zero-tolerance policies that tend to target boy-like behavior. We tend to avoid males competing or being adventurous. No more “conquering” our world and we don’t confront or have conflict but, instead we hug, and God-forbid we play with toy guns, or even draw a gun, or pretend to be a cowboy, don’t dare draw a picture of a tank blowing something up, no more dodge-ball, and everyone has to win. Instead, we have to sit, pay attention, be quiet and mindful of our manners, and control our impulses for an increasingly longer period of time. It’s a world tailor-made for girls, but not-so-much for boys.
I fully appreciate the need for sensitivity regarding guns and weapons given the reality of school shootings. However, I can’t help but think that, at least in some cases, we take that sensitivity to the extreme. Maybe we need to have a sensitivity, as well, that boys need to be permitted to be boys, and not perceive a threat where there isn’t one.
It’s alarming to look at the graduation rates between males and females. It’s actually a national tragedy that no one seems to care too much about. In that respect, ten percent more females graduate high school than males, and there is almost a 20% disparity between males and females in earning any type of advanced degree (Associates, Bachelor’s, Master’s, and Doctorate). What’s your best guess as to why this might be the case?
There is no doubt, in my humble opinion, that ADHD is a genuine disorder and that some kids are well outside the norm in terms of their ability, or lack thereof, to maintain focus, control impulses, and remain settled. However, while that might be the case, in some cases, we may be setting-up boys for failure, not doing them any favors, unfairly targeting them with unrealistic expectations, and straight-up pathologizing typical boy-behavior. At the very least, it may serve us well to at least entertain that possibility.
What type of classroom helps boys to be boys, and achieve? First, let them be active. In that respect, activity-based programs allow for more movement throughout the day, stretch-breaks, use of clipboard with standing, sitting or lying on the floor, high-interest topics (let them choose their own topics), more change of pace in the classroom, teach outside, allow pretend ‘army’ and dodge-ball and gross topics that boys find captivating. Learn by doing, invite men in the classroom, permit choices in assignments and projects, more opportunities for hands-on projects, group-work, experimental learning, collaboration, competition, and creating avenues for boys to reach-out and accept help as opposed to shutting-down or acting-out. An environment such as this would help boys in general, and those with ADHD, to feel more comfortable in a classroom and achieve higher levels of success.
My goal is not to be political or controversial, but instead to help boys perform to their fullest potential. That’s all. Now let’s go out and advocate for these boy-friendly environments, at home, and at school. God bless you and your kids, both boys and girls alike.
So, here is the DSM-V diagnostic criteria for ADHD. We are pretty familiar with these symptoms and recognize the impact they can have on a child’s life. Look them over for a quick review, and then we’ll discuss whether there is something missing from this list?
Six or more:
__ failing to pay close attention to details or making careless mistakes
__ problems sustaining attention in tasks or play activities
__ often not appearing to listen
__ having trouble following through with directives or fails to finish tasks
__ being less than well-organized and poor time management
__ reluctant to engage in tasks requiring sustained mental effort
__ losing things
__ being easily distracted by extraneous stimuli
__ forgetful
Six or more:
__ being fidgety or taps hands, squirmy
__ often leaves seat when remaining in seat is expected
__ often runs or climbs when not appropriate to do so
__ Unable to play quietly
__ moving around excessively and always being ‘on the go’
__ talking excessively
__ blurts out answers
__ having problems waiting for turns
__ having a tendency to interrupt and intrude at times
These signs need to be seen prior to 12 years of age and notably impacting a person’s life.
It is becoming increasingly apparent that emotional dysregulation is such a primary aspect to ADHD that there is a consideration of adding that specific symptom to the list of criteria. We don’t often think of emotional outbursts being related to ADHD symptoms, but they are. In fact, a secondary though related symptom is also very common; a hypersensitivity to rejection or redirection. I’ll be many of you are all too familiar with that aspect of ADHD even though it’s not part of the criteria.
Medication often helps to improve attention and concentration, but an interesting additional effect is that kids often appear calmer and more at ease, even when faced with being told ‘no’ and when frustrated. That’s a reflection of the medication’s impact on that specific executive function of emotional control.
Hope that helps
It’s important to understand the scope of symptoms and executive functions associated with ADHD. If not, then we tend to feel confused, we can’t target treatment, and may even pursue unnecessary secondary diagnoses. If we know what we’re looking for, it’s easier to grasp, and then it’s easier to treat. God bless you and your kids.
ADHD is described as a disorder of the prefrontal lobe of our cerebral cortex, which is the area of the brain that controls higher-order thinking. This ‘higher-order thinking’ is also known as a set of executive functions that help us to more effectively get through our day.
The specific executive functions include: Impulse control, flexible thinking and ability to shift between topics, emotional control, initiating a task, working memory (keeping thoughts in our memory and quickly acting on them before we forget), planning and prioritizing, organizing, self-monitoring (assess our own performance and measure it against some standard of what is needed or expected), and monitoring the passage of time.
Trying to determine how to treat “ADHD” can be daunting. In that respect, the diagnosis shows-up in a bunch of behaviors, there are lots of different symptoms, and it can be challenging to prioritize which behaviors and symptoms to target. However, if we look at select executive functions, as opposed to a bunch of symptoms and behaviors, then we can target treatment in a way that will be most effective, practical, and helpful.
There are lots of examples and, in that respect, check-out our Parent Resources, for our ADHD AND EXECUTIVE FUNCTIONING pamphlet that highlights specific strategies to improve each executive function. An example for time-management includes using a chore-card that lists the chore, the steps to complete the chore, the time allotted for each step, and the time the entire chore should take, then set a timer.
I hope that information helps.
Understanding executive functions is super helpful. Here is a checklist to help in determining where your child may be struggling, which targets the treatment process. More to come in the next post, specifically about emotional control.
God bless you and your kiddos!
Dr. C
Executive Functioning is overseen by the Pre-frontal Cortex; it’s the “command and control” center of the brain and helps to manage life tasks. It involves mental control and self-regulation. These functions allow for managing time, paying attention, switching focus, planning and organizing, remembering details, and avoiding saying or doing the wrong thing.
___ Inhibition and Impulse Control: Stop one’s behavior at the appropriate time, thinking before acting, and filtering-out distractions in the environment.
___ Shifting, and Flexible Thinking: Move freely from one situation to another both in thought and behavior.
___ Emotional Control: Control emotional reactions by bringing rational thought to bear on feelings.
___ Task Initiation: Ability to begin a task and to independently generate ideas, responses, or problem-solving strategies (getting started on a task…)
___ Working Memory: Capacity to hold information in mind for the purposes of completing a task (shortly after a direction, remembering the task-at-hand)
___ Planning and Prioritizing: Ability to plan how things are going to be accomplished and order the items in terms of importance.
___ Organization of Materials: Impose order on work, play, and storage.
___ Self-Monitoring: Ability to monitor one’s own performance and to measure it against some standard of what is needed or expected.
___ Monitoring Time: The ability to self-regulate based on time-constraints and have a sense of urgency. The capacity to plan for a task or goal, no matter short or long-term. The ability to accurately judge the passage of time.
