Written by Dr. John Carosso
Parents are often told about the importance of structure, that they need to increase structure, and that structure is vital to helping children who need “more structure.” However, what does that mean?
The simplest way to explain structure is that ‘more structure’ equates to more rules, direction, and close over-sight. During any given time of day, or activity, the more rules and direction you give your child, and the closer you stand in proximity, the more “structure” you’re providing.
The more rules and directives, the more the child knows what to do, the more predictable the outcomes (for you and the child), and less room for problems, arguments, and contention.
The first scenario - three children return from school and play together without rules or direction. The three children roam about, intrude in each other’s play, move from one thing to the next, make messes, and run around as the parent yells for them to behave.
In the second scenario - the children return from school and each is directed to a different part of the house, they are given directives (rules) including to play separately in a specific pre-planned activity for 10 minutes, clean up, then move onto the second activity, then they can have their after-school snack eaten in separate areas. During the entire time, the parent is closely monitoring and giving lots of praise, at close proximity, for their on-task behavior. Thereafter, the three can come together in a favorite game, with the parent present, for eight minutes or less before moving onto another activity depending on how the first game transpired.
So, what do you think of those two scenarios? Which is more likely to be successful for a child with autism or ADHD? Which scenario leaves less room for problems? Which has more predictable outcomes? The two different scenarios reflect how direction, rules, and proximity equate to ‘structure’, how ‘structure’ looks in real-life situations, and what happens in its absence.
More is better? Presumably, but it depends. The goal, over time, is to need less structure. As children mature and learn, they become more independent and can handle more freedom (less rules and direction). If you impose structure when it’s not necessary, you’re promoting dependence, and being annoying, and kids will rebel. It’s a balancing act based on your best judgement as a parent. However, my advice is, when in doubt, go with structure.
“Structure” is such a commonly used term that it’s important to be clear about it’s meaning. I hope this post helps to clarify and make sense of this most important elements of managing our children’s behavior.
If you have any questions or comments, feel free to email me at jcarosso@cpcwecare.com. God bless
Written by Dr. John Carosso
Parents often quickly correct themselves after making comparisons between their kids, saying “I know we’re not supposed to do that…” It’s generally taken for granted that comparing our children is wrong.
In reality, we compare all the time. In fact, comparing helps us to understand what’s age-appropriate and expected for any given age. Think about it, it’s easier after your second, third, fourth… child because you have a much better idea of what to do, what to expect at any given age, and how much attention and monitoring your child should need along the way. You’re no longer guessing or relying solely on advice from your mother, but also basing your decision on past experience after years of direct observation of your older kiddos. In that respect, comparing is very practical.
Comparing your children is a problem when you do it outside your head. In that respect, comparing is reserved for your own thoughts, and in your private discussions with your spouse. Never let her children hear your thoughts about your comparisons between them. That type of talk rarely ends well, and usually only instills sibling rivalry. Children don’t want to hear about how their older sibling talked early, got ready for school without any prompting, practiced piano every day, and was an angel... Any such comparisons, expressed out-loud, usually results in hurt feelings, resentment and, look out in terms of subsequent fights and mayhem among the kids.
In summary, comparing your children can be quite helpful and practical, just don’t do it out-loud in front of your kids. A wonderful book on the subject is Siblings without Rivalry by E. Maxlish. Okay then, here’s to happy parenting and wishing you a wonderful, peaceful, and prosperous New Year. God bless.
Written by Dr. John Carosso
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?
May God deeply bless you and yours during this Christmas season. I’d love to hear your comments at: jcarosso@cpcwecare.com
From Dr. John Carosso
For many parents with kiddos struggling with any number of behavioral health or developmental issues such as ADHD and Autism, the Holiday Season can be an extra stressful time. Watch this Morning Minute Special below on how to prepare your child for the season. You can also find more information on my blog here.
Written by Dr. John Carosso
How beneficial is time-out, taking away the TV, or ‘grounding’ a child from going outside? Of course, as most parents have come to find, all of these discipline strategies can be effective. However, what happens if you rely too heavily on these strategies? Well, first, your household can become like a gulag; not too pleasant. Second, you and your child will be miserable. Third, the discipline strategies become less effective.
That’s why I recommend relying on the ‘softer and closer approach (see the blog, “softer and closer approach”). However, no matter what discipline you attempt, it will all go to waste, and you’ll feel like banging your head against the wall, if you don’t have a healthy, positive, and pleasant relationship with your child.
The key to parenting and discipline is you and your child doing things together, laughing and enjoying each other’s company, and spending time (quality and quantity time) in fun activities. Actually, even ‘not so fun’ activities can be quite bonding and reinforcing (e.g. helping with homework or school project, assisting in getting your child ready for bedtime…). In any case, absent a healthy relationship, there is no glue to connect a parental directive to the subsequent (hopefully) compliant behavior. Kids comply because, ultimately, they love their parents, want their parents to be happy, want to get-along and have a good relationship, and realize that ‘we’re all in this together’ so I might as well do my part.
If your child is complying predominately due to a fear of punishment, then you’re in trouble. In that case, your child’s ‘compliance’ is based in manipulation and fear, and tasks are often completed superficially and marginally.
Instead, build the relationship and you’ll have a disciple (a willing follower) and be less reliant on discipline. Don’t get me wrong; both are vital, but the former is a lot more fun 🙂
Written by Dr. John Carosso
Many years ago, starting out as a Psychologist, I came across a Principal who established a ritual with his teachers. At the conclusion of every morning meeting, he would huddle the teachers together and lead a chant “softer and closer” repeated four to five times, before sending the teachers off to their students.
I am hard pressed to contemplate a more significant or relevant mantra for teachers or parents. I have espoused the “softer and closer” approach since that time, and can think of no better way to connect with a child. Getting on the child’s level, moving-in close, and speaking in a soft tone, if not a whisper, is remarkably powerful, comforting, and bonding for a child in any situation, but especially when the child is experiencing a difficulty and needs supportive guidance.
Try it with your own child; rather than standing across the room and yelling, get close, soft, and comforting in tone, and see the difference.
I’ve also espoused time-in rather than time-out. Of course, the latter is necessary at times, but far too often we neglect trying the former. Try it, the softer and closer approach, and see the difference.
Written by Dr. John Carosso
Well, it’s really not so subtle. It’s the difference between labeling your child, or simply describing an annoying and transient behavior.
When we call our kids “lazy," “rude," “liars," “thieves," or whatever, we are defining their character, and suggesting that this is their enduring quality. Okay, so now you’re saying, well, they are! That may be true, but I’ll bet you can think of lots of times when your child is motivated, nice, told the truth, and did not steal. Even if the particular behavior is somewhat enduring, your child is still young; their personality is molding and shaping, and you’re in a strategic position to help shape it in the right direction.
Okay, here’s a scenario for you; you’re young, impressionable, don’t have a solid grasp or sense of yourself as a person, and have a tendency to believe what you’re told especially when told by the most important person in your life. In this scenario, you’re consistently told that you’re “lazy” or a “liar” or whatever. One can imagine that you may come to personally identify and internalize these traits, and expect to consistently behave in that way. Note that kids, and people, often live up (or down) to expectations.
Here’s a better option for you; label the behavior, rather than the child. Quite simply, for example, say “you’re lying” rather than “you’re a liar" or "you’re being lazy" or "you’re being rude." This option is definitely better than directly labeling the child, but it’s still not the best option.
Yes, there is an even better option. Instead of labeling the child or the behavior, simply redirect the behavior, describe very specifically what you want to see, and use the situation as a teachable moment. Think about it, calling your child “rude” does not teach; it simply degrades and disparages. Instead, if your child calls you a name, rather than call him “rude," describe the behavior as unacceptable, explain how he could have better-expressed his frustration, maybe even have him repeat the more appropriate words, and then implement a fair consequence. Same holds for “lazy." Rather; tell your child exactly what you need to see him doing, set a firm limit for him to get started, and then implement a consequence if necessary.
If your child has a particular problem with not being especially motivated, or telling mistruths, or taking items, then pay very close attention to her behavior and praise big-time when your child demonstrates the pro-social alternative. Remember, if you consistently praise a behavior, it is much more likely to be repeated. Sticker charts also do wonders.
You want your home to be a happy, pleasant, and cordial environment, right? Of course. You’ll go a long way to making that happen after dropping labels, describing behaviors you instead want to see, relying on firm consequences without yelling and emotion, and using lots of praise. Not to be redundant, but think about it, how do you feel when you’re called lazy, rude, or a liar? Would you do better calling your spouse “lazy” or simply telling him or her exactly what you need and that they'll suffer a consequence (they know what you mean) if they do not immediately help you?
Hope this was helpful. By the way, if you have any helpful personal experiences, or other good alternatives to labeling, please share at jcarosso@cpcwecare.com. Thanks.
Written by Dr. John Carosso
It’s that ‘back to school’ time. Yes, it’s sad to see the summer coming to a close and definitely time to get back to the school routine.
Need I mention the difference between summer and school-year routines? If you start about 2-3 weeks out, it’s much easier to ship your kids into shape. Otherwise, it’s a culture-shock for your child, and not too pleasant for you either.
God bless and enjoy the rest of the summer.
Written by Dr. John Carosso
One of the biggest challenges facing a parent of a child with autism is, what’s the most effective form of treatment? The choices seem endless and differentiating one from another can be a daunting task. Parents often rely on therapists to know and carry-out these programs, but many parents want to learn as much as they can and be in the best position to help their child. The most common treatments include speech/language and occupational therapy, counseling (for higher-functioning kiddos), and social skill groups. However, from that point onward, to choose between the options can be quite overwhelming.
It seems that there are two primary camps when it comes to treatment focus. One camp focuses on helping the parent and child build their relationship, i.e. working on making the parent ‘center-stage’ in the child’s world (as opposed to the child fixating on some random object) and working toward ‘joining’ with the child and becoming an integral part of the child’s sphere of interest.
The other camp focuses on helping the child to learn the basics and developing specific skill-sets such as mimicking, labeling, following simple directives, increasing attention to task, being able to request a desired item, expressing short phrases…
Some of the more popular commercial programs that focus on building the relationship include Relationship Development Intervention (RDI); Greenspan’s FloorTime; The Son-Rise program; and the Early Start Denver Model. There are other options including the aforementioned traditional outpatient counseling, and social skill groups, but the former programs tend to be the more well-known of the publicized commercial models.
The primary strategy for building specific skills is Discrete Trial Teaching (DTT), which focuses on skill development via repeated trials that reinforcement specific responses. Some may say that DTT also helps build relationships given that many of the skills are, in fact, relationship-building (sustaining eye contact), but ultimately there are marked differences between the two camps.
As a side-note, don’t confuse Applied Behavioral Analysis (ABA) with DTT. In that respect, DTT is a specific approach based in principles of ABA, but ABA is far broader in scope than DTT in that ABA is set of systematized techniques to analyze behavior and determine effective treatment regimens that typically rely on differential reinforcement.
There is limited research to suggest one Relationship-Builder is better than the other and, in my opinion, they all pretty much do the same thing in different ways. If you spend some time investigating the different programs, you’ll quickly see that they all have their merits and notable overlap in approach. In fact, there is so much overlap that it’s often difficult to differentiate one from the other. They all have their own confusing lingo and varying degrees of structure but all target building the relationship.
As I mentioned earlier, other relationship-builders include traditional outpatient counseling, offered here at Community Psychiatric Centers, to work both individually and with the family to promote social skills through talk-therapy, role-playing, and rehearsal of social situations. There are also social skill groups that can be very productive and many children, and their parents, find such groups to be invaluable.
No, relationship-building programs are not better than DTT, they’re just different. It’s comparing apples to oranges. However, it should be noted that the only modality that is genuinely research-backed and evidenced-based is DTT. Nevertheless, in my opinion, the best approach is to use both. In that respect, the relationship-building techniques can be done any time throughout the day, during any given activity, to build the relationship. It’s true that DTT can also be carried-out any time and in a play-oriented manner, but it’s most often conducted more formerly at a table (“table-time”). Consequently, the ideal approach, from my perspective, is putting aside time, each day, to carry-out sessions of discrete trial drills to teach specific skills and use relationship-building ‘joining’ activities throughout the day when carrying-out daily tasks.
Well, actually there is. It’s called Pivotal Response Teaching (PRT), which is essentially an off-shoot of DTT in that it uses differential reinforcement protocols to teach specific skills and to development the relationship. It’s a fun approach that is structured and regimented, as would be expected from any program based in DTT, but also child-centered, free-flowing, and naturalistic. It’s an approach worth exploring. However, ultimately, I perceive PRT as more of a skill acquisition approach than relationship-building, but others may disagree.
I hope that helps to explain and differentiate some of the more common approaches. I’m looking forward to providing more details in future posts to help your child build relationships and develop specific skills. In fact, I plan on providing a live workshop in the near future for that very purpose.
Please don’t hesitate to reach out to me with any questions along the way. In fact, I’d love to hear your opinion about the strategies and programs you’ve found to be most effective, and I can share them with others; email me at jcarosso@cpcwecare.com. Thank you.
God bless you and your kiddos, your entire family and have a wonderful rest of your summer.
Written by Dr. John Carosso
We spent the past few posts discussing the diagnosis and treatment of mild autism. By the way, your subsequent comments and questions have been remarkable and very thought-provoking; thank you. At this point, you already know the general signs and symptoms of autism (if not, just check-out any number of my prior posts at helpforyourchild.com), so let’s transition to a discussion about the treatment of more notable autism. In that respect, as a parent, if you have good practitioners to help, that’s great, but you don’t want to be completely dependent on therapists for your child’s well-being. If you know the following two approaches, you will, in fact, be quite prepared and capable.
You’ve undoubtedly heard of ‘applied behavioral analysis’ (ABA) and that ABA is ‘best-practices’ when it comes to the treatment of autism. However, it’s important to note that ABA is a systematic approach to developing and implementing treatment methods, not a specific strategy per se. In any case, I’ve written about ABA in prior posts (to read one, click here) and how it is used as a foundation for the two specific strategies described below.
A specific approach I highly recommend, based in ABA, is something called discrete trial teaching. In my opinion, there is nothing better to teach specific skills including mimicking, labeling, requesting, categorizing, and the beginning of conversational skills among other things. I’ve presented and created videos about this approach on my Youtube channel and on another of our sites, appletreeinstitute.com. This approach is structured, systematic, regimented and predominately done at a table (sometimes referred to as ‘table-time’). There are countless other videos on YouTube describing this approach; check them out!! You won’t find a better method to teach specific skills to your child.
As much as Discrete Trial Teaching is formal, systematic, and regimented, the Early Start Denver Model (ESDM) is free-flowing, in-the-moment, fun, and relationship-building, with strategies that are designed to do just that, build your relationship with your child!! This is especially important in that a primary sign of autism is an aloof quality and a general lack of social engagement. This approach takes everyday events and routines such as getting dressed, eating a meal, changing a diaper, clean-up, reading a story, playing with a toy, and leverages them to become dynamic relationship-building activities that make the parent “center-stage” in the endeavor and in the child’s life. Given that, quite often, a parent’s number-one concern is that they can’t get their child with autism to properly engage with them, this approach is vital. There too are excellent videos describing this approach on YouTube, as well as the excellent resource, The Early Start for Your Child with Autism, by Rogers, Dawson, & Vismara.
So, we talked about DTT and the ESDM as two very different but complementary approaches to build and develop both specific skills and, more generally, your relationship with your child. It’s well worth your time to learn about both approaches.
If you wish to learn more about these approaches and have questions about the specific elements, don’t hesitate to reach-out and email me at jcarosso@cpcwecare.com. God bless.
