Written by Dr. John Carosso
As a Christmas tradition, here is one of my favorite posts, and hopefully yours as well, highlighting the true gift of Christmas!!
As a psychologist, I’m expected to talk about traditional and clinically-relevant approaches to help kids, and parents, work through difficulties. This of course would include helping people to think in more reasonable ways (cognitive therapy), behave in ways that are productive and healthy (behavioral approaches), be emphatic (Rogerian techniques), stay in-the-moment (Gestalt), incorporate the family (systems approach), and use praise in systematic ways (Applied Behavioral Analysis).
Well, yes there is. I’m usually not expected to discuss spiritual options but, in some cases, it’s like watching somebody drown and tossing a small life preserver when I have ready access to a large life-boat. Don’t get me wrong, the life-preserver is effective but, well, wouldn’t you rather be in a boat?
During this Christmas season, it seems fitting to offer a reminder that God gave His Son not only to rescue us from sin, but also to rescue us from ourselves and, in the process, heal us, soothe us, and relieve us during our times of stress, burden, and strife. Think about it, in Scripture, He’s referred to as our Advocate, the Almighty, All in All, Breath of Life, Comforter, Counselor, Cornerstone, Creator, God Who Sees Me, Goodness, Guide, Hiding Place, Hope, Intercessor, Keeper, Leader, Life, Light of the World, Living Water, Loving Kindness, Maker, Mediator, Our Peace, Physician, Portion, Potter, Teacher, Refuge, Rewarder, Rock, Servant, Shade, Shield, Song, Stone, Stronghold, Strength, Strong Tower, Truth, Wisdom, and Wonderful to cite just a few of His names. Hmmm, I wonder if maybe God is trying to tell us something about turning to Him for help?
Those strategies I cited above (cognitive-behavioral…) are undoubtedly worthwhile and helpful. God gives people like me lots of ways to help and give relief (not to mention that most of those strategies have a basis in Scripture). However, there is something quite powerful and life-changing about tapping directly into the Source (another one of His names, by the way). Give it a try, what have you got to lose?
The holiday season can be stressful, and we have lots of memories of lost loved ones that tend to surface more poignantly during this time of the year. Clearly, our mood can subsequently take a hit. However, in addition, how many of you can relate to the dismay of darkness settling-in as early as 5:00 pm? I know it gets me down in the dumps. For some, however, it’s more than just feeling somewhat ‘blue’ in mood; some struggle with severe bouts of depression during this time of year, known as ‘Seasonal Affective Disorder’ (SAD). This type of depressed mood differs from classic depression in that the onset is rather predictable, usually around September or October, and corresponds with the shortening of daylight.
As would be expected, depends on where you live. If you’re lucky enough to live in the cold Northern regions, rates go as high as 20%, but as low as 2% in brighter climates. Oh well, guess that’s bad news for all of us here in Pennsylvania.
This is not an adult-only malady. SAD usually begins in the teen years and strikes girls four times more than boys. Interestingly, teens born in the Spring or Summer are more likely to suffer from SAD than those born in the colder months. Not sure why, but might be because of how a child is light-programmed from early on in their life.
Well, short of moving to Florida where it’s still dark but at least it’s warm and not so cloudy, treatment involves the systematic use of light. Guess this makes sense given the problem is based in lack of light. The ‘phototherapy’ involves sitting briefly in front of box that emits intense light, or the use of a Dawn Simulator; both are quite effective as well as traditional cognitive-behavioral talk therapy, and medication.
I wish you and yours the cheeriest and happiest of a Holiday Season. However, if you’re feeling down, lacking in motivation, and blah in mood, or you notice your kids being exceptionally moody or agitated during the Fall and Winter months, then please do not hesitate to get help. You can reach me at jcarosso@cpcwecare.com or call 724-850-7200. You can find out more about SAD in an article on the e-Edition of the Exponent Telegram where I was interviewed about this form of depression. Check it out at www.exponent-telegram.com
God bless.
I’ve written extensively about how to effectively treat and manage dyslexia in my new book, Managing the 5 Most Challenging Childhood Behavioral Health Conditions of Our Day. For this post, I worked together with Mrs. Cynthia Postell, our wonderful Reading Specialist/Online Tutor at DyslexiaTreaters.com, to develop six important points about this common academic difficulty:
It’s rare for a school district to conduct a full educational evaluation prior to the second grade. In that respect, a student will rarely qualify prior to that benchmark, and school districts also often wait and see if your child is academically challenged solely due to immaturity. However, if you find your child is more than one grade level behind, it’s likely best to request an evaluation and ensure involvement in any available school programs, such as Title I. A full scope of intervention is vital: some interventions can promote a student’s progress of a half-years growth over an entire school year. However, at that rate, a student in the fifth grade might possibly be reading at a second-grade level. Don’t wait, be the best cheerleader and advocate for your child.
Your child’s ‘reading level’ is their instructional level, i.e. at what level they can read with minimal support and feel good about themselves. The reading level for your child may be in the form of a Lexile Number or an alphabet letter associated with a Guided Reading Level, developed by Fontas and Pinnell. Once you’ve been provided the reading level, find resources for your child. These reading resources are available free from public, online or school libraries. There are also free online resources available from openlibrary.org, Oxford Owl, Storyline Online, and other resources.
A productive strategy is to read a selected book to your child, then ask your child to read to you. ALWAYS use your index or pointer finger to track each word from left to right as you read. Pause for punctuation so your child will learn prosody, and to allow your child to catch their breath before beginning the next sentence. As reading skills improve, ask your child to read aloud to you, reminding your kiddo to use their index finger and pause for punctuation.
Is your child intellectual and has good reasoning skills, or are they more artsy and creative? Do they have a talent for predicting what will happen, or can they visualize and create a vivid mental picture? Does your child actively use their imagination and have the ability to be the change for innovation and ideas? Do they love horses, sharks or construction equipment? Do they want to be an astronomer, a musician or a marine biologist? Leverage those interests and strengths by finding books and material of special interest to them, which will inspire a love for reading.
You can help your child develop phonemic awareness, or the awareness of individual sounds in words. The first step is the development of the awareness of rhyme, which can be a game rather than a chore. Begin by thinking of a three-letter word, such as “big”, and engage the whole family by coming up with words that rhyme, dig, gig, jig, pig or wig. The fun aspect about this rhyming game is that the words can be nonsense words too. When your child starts to make up rhyming nonsense words and realizes they don’t make sense, that's a sign they are building knowledge of language, so encourage them and use nonsense words too. You can also help sensitize your child to rhyme by reading aloud stories and poems; some favorites are Dr. Suess, Sandra Boynton, Karma Wilson, Shel Silverstein and many more.
The next step towards phonemic awareness is blending and segmenting. A fun activity is by clapping or tapping syllables with your child. Initially, put your flattened hand under your chin to feel the syllable segmentation. If you over-emphasize the movement of your jaw as you say the words, you will feel the movement; this movement can be counted as individual syllables. Once your child is comfortable segmenting words and counting syllables in this way, your child can learn to clap their hands or tap their knee to count syllables. Combining syllables is the next skill to practice; ask your child, “Can you tell me what word “kit…. ten” makes? Continue to practice pulling apart and putting together syllables until your child is fluently reading.
These strategies are only the beginning, but a solid place to start. Another bonus suggestion: find a list of Dolch sight words, high frequency words, and the Fry First 300 words. Create flashcards or use technology to create Quizlet games and practice them daily. Most high frequency and sight words do not follow common spelling rules yet have to be recognizable on sight and texts are full of them. This practice will be advantageous to your emerging reader.
Happy Reading!!
The Christmas and New Years Holiday is magical and fun; a wonderful time of year that spreads warm feelings and cheer in families and communities throughout the world. The celebration is well deserved, and we all tend to look forward to this very special time of year.
Yeah, there is a ‘but’ for many parents with kiddo’s struggling with any number of behavioral health or developmental issues such as ADHD and autism. In those homes, the hectic and often-times over-stimulating nature of this holiday season can bring about all sorts of behaviors, meltdowns, over-activity, and fixations.
First, remember that you know your child best. Given the frequent changes in routine during the holiday season, you know whether your child fixates on the routine and if it’s best to not convey the daily schedule till the last minute, or if your child thrives on knowing the routine in advance and finds the information to be comforting. You also know whether it’s best to do all the decorations quickly, all at once, to get it over with; or if your child responds better to a slow and steady approach.
You’ve also shopped enough with your child to know the best approach. The challenge during the Season is that these shopping trips are usually a bit longer, so it’s even more important to take breaks, have fun items to keep your kiddo’s busy, and work your way into each store maybe a bit slower than usual. Some kiddo’s respond well to headphones and darker tinted glasses. However, an added challenge is the necessity of masks, which some kids find intolerable. In that case, you’d likely have to avoid taking your child to the respective store unless you can convince your kiddo to wear a visor. Also, for younger children, some stores may forego the mask mandate.
During the holidays, the daily routine that you’ve worked so hard to maintain usually becomes more unpredictable, but do your best to keep some semblance of routine and order. Social stories, written schedules, and visual schedules, and reminders can be very helpful.
It can be helpful to wait until the last minute to arrange the gifts, given the temptation your child may face to open ahead of time. However, again, you know your child best and some find it very enticing and pleasant to see the presents, and would not dare open any until the designated time. Also, with that in mind, turn-taking to open presents can be coordinated by passing an ornament to whose turn it may be to open a present. Also, offering a quiet, out-of-the-way place for your kiddo to play with his new toys may also be helpful to avoid grabbing at other’s toys, becoming overly upset if somebody touches his toys, and causing disruption.
If your child has food sensitivities or is very finicky, you may want to bring some food along to Aunt Jennie’s house for the celebration. Also, before arriving, it may also help to show your kiddo pictures of who will be there, and what to expect every step of the way. Sometimes children respond better if they gradually mix-in with the crowd as opposed to all at once; and provide a ‘safe-haven’ if it becomes too overwhelming. You’re the best judge of how much your child can tolerate, so you’ll be keeping a watchful-eye, and intervening when necessary. Also, regarding the family, prepare them for what to expect from your kiddo and how they can help the situation rather than make it worse.
These were just a few tips to consider during this Christmas season. Most importantly; enjoy this time with your children, family, and friends. Relish these opportunities, no matter how chaotic or stressful they may become at times. In years ahead, you’ll look back and miss these days. Don’t miss them now. God bless you and your family during this blessed Christmas Season.
You know the drill, you want to remove electronics as a punishment but, when you make the attempt, an emotional reaction ensues and your child or teen refuses to give-up his phone or video-game controller. If you push the matter, you end-up literally in a wrestling match, which you know is inappropriate and ill-advised, so you get worn-out over the course of time and may even give-up.
I often suggest that parents avoid direct confrontations and heated arguments – nobody wins. I’ve written prior on the importance of relying on, for example, behavior charts as opposed to cajoling your child. In that respect, the behavior chart, not you, determines the privilege level. In any case, the same applies in this scenario; the goal is to remove the electronics, when necessary, with no direct confrontation. So, how do you do that?
Some parents have had a degree of success sneaking into their kid’s room and taking their phone or video-game controller. However, that is not always effective and, really, do we want to be sneaking around our own home?
There are ways to simply shut-down your child’s video-games and phone. For example, Family Circle is easy to install and, through your router, allows you to turn off the wifi to any given device in the home, set a bedtime to automatically turn off the electronics, set time-limits, and use a ‘pause’ button.
Family Circle can also shut-off the wifi for your child’s phone, but then they can simply use their data to be online even without the wifi. In that case, you have another app-related option; there are quite a number on the market, but one is Famisafe, which downloads into your phone and your child’s phone, then you can take control of the phone, regardless of wifi (you’ll also be able to control data usage), when you see fit to do so. The app is installed in one of two ways: you send a link to your child to download the app, or you’ll have to get physical access of the phone and download yourself.
If you contact your carrier, you can report the phone lost or stolen, and they will turn it off. Nothing changes on the phone (all the apps and connections will remain intact), and you simply call the carrier when you want the phone turned back on. According to Sprint, for example, you can make such a request as often as you want.
The goal is to have a happy a harmonious home, which potentially can be enhanced if your child understands you can take control of his or her electronics at a moment’s notice, and without any direct confrontation. I hope this post helps in that process. May God bless you and your family.
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.
