Community Psychiatric Centers

Monroeville, Greensburg, Monessen, and Wilkinsburg Pittsburgh

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Written by Dr. John Carosso

Focus in Treatment?

Children with mild autism are treated with a very specific approach that involves clearly delineating the problem behaviors and tendencies. In that respect, we need as much detailed information about what goes wrong, and what goes well, in what situations, to what extent, for how long, and how frequently? Detailed written descriptions or, even video can be helpful. The more we know, the more effective the treatment plan.

A specialized or neuro-typical context?

There are social skill groups for children with autism that can be quite helpful. However, for some children with very mild symptoms, being segregated into groups with other children with autism is not entirely helpful. These kiddo’s need to learn skills amongst neuro-typical peers. So, in those instances, we take one challenging behavior at a time and, in-session during therapy, we practice, role-play, redirect, rehearse, and praise success over and over again, and transfer these skills and strategies to parents (and to the kiddos) to practice in Live situations with age-mates during the week. That one one behavior is targeted and the practicing continues until mastered; the mastered behavior is then placed into a maintenance schedule, and we move onto the next behavior or tendency.

Too simplistic? Is this Effective?

Well, maybe that is somewhat simplistic because, yes, it can get complicated. Some kiddos with mild autism are not entirely in-tune with the need to adhere to adult expectations and daily responsibilities. They have their own agenda and, consequently, getting compliance to role-play or practice can be tough but the child is not being defiant, they just ‘don’t get it.’ In those situations, we may use what’s called ‘pairing’ to promote completion of daily tasks, and rehearsal, and to get the kiddo onboard with the program. There are a host of other behaviors that may surface, and subsequent strategies that can be employed but, ultimately, the approach described above can be quite productive. In fact, treatment for mild autism is very effective and the outcome for these kiddos is exceedingly promising.

Stay in touch

I trust you’ll find that this targeted approach will be helpful but please feel free to contact me with any specific questions about your child’s progress, treatment regimen, problematic behaviors, or specific strategies. God bless.

Written by Dr. John Carosso

Let’s set the stage

The process of diagnosing autism is rather straightforward, such that it’s a wonder that so many kids are misdiagnosed. It may come as a surprise to you that, from my clinical experience, the issue is under, not over-diagnosis. In that respect, time and time again I have kids in my office for whom there has been ongoing struggles and difficulties in the home, school, and in the community, and parents are dumbfounded why their child is having such difficulties. In that respect, their child has been evaluated elsewhere and diagnosed usually with anxiety, ADHD, or ODD. However, again, time and time again, parents come to me with a suspicion that ‘something more is going on’ and, by and large, they’re right.

Why?

Okay, why does this happen, especially when, in some cases, the prior evaluation incorporated ADOS testing, which is considered to be the ‘Gold Standard’ in autism diagnosis. Well, it happens because children with mild autism usually present pretty well in the structure of an office. They will do well in the areas assessed on the ADOS including eye contact, social referencing, topic maintenance, empathy, general quality of social rapport, and play skills. Also, while the ADOS is supposed to be objective, at times it can be quite subjective as to whether the kiddo actually is, or is not, showing those abilities. This is why a score on any specific test, including the ADOS, is usually not a particularly good barometer of whether a child has autism. I’ve found, countless times, that the ADOS, GARS or CARS may indicate not having autism when a child does, in fact, have autism, or vice-versa. It’s vital that the practitioner use their judgement and experience while conducting a comprehensive evaluation when making these determinations and not rely solely on the outcome of any individual test protocol.

What are we looking for?

What I see in children whom are I ultimately diagnose as mild on the autism spectrum is, first and foremost, a subtle but notable social awkwardness; in that respect, the child may be quite social and engaging but their manner, affect, and sometimes even posture has a rigid if not mildly robotic quality. It’s interesting to note that, in many circumstances, especially when younger, these children may have lots of friends. In that regard, despite being somewhat quirky, these kiddo’s can be well-accepted by peers though being perceived as somewhat “different.” However, parents are often unaware that their child is perceived as a bit unusual by their age-mates. Sometimes this social issue becomes more of a challenge in later grades when peers are less forgiving. Second, almost invariably, these children have a distinct and notable classic autism speech cadence. Third, while they can often maintain topic and are quite conversational, they tend to ramble, are detail-oriented in their conversation, and are not especially mindful of the need for back-and-forth conversation. However, some of these issues can be very subtle; in that respect, if overt, then the diagnosis would be clearer.

So, if the signs are subtle, how do they meet diagnostic criteria?

That’s a great question, given that a diagnosis cannot be made unless the signs and symptoms are actually causing problems. This is where the history and parent-report come into play. In that respect, parents are instrumental in providing the details about what appears to be only minor social awkwardness in the office but, in the real-world, manifests in the child being alienated. What appears to be minor rigidity in the office may, in actuality, be driving parents nuts with routines and compulsions that must be played-out to precision to avoid a tantrum, and on and on it goes. The ADOS, for example, focuses on what is happening in the office between the child and the practitioner; but that’s just one piece of the puzzle.

Self-stims?

Children with mild autism are less likely to overtly hand-flap, toe-walk, or spin. They may demonstrate those behaviors but, if they do, they are likely easily diagnosed without confusion or misdiagnosis. In that respect, it’s tough to miss such blatant signs. However, more often these kiddo’s do not demonstrate those classic signs of autism but, rather, are obsessive; they tend to fixate on a particular interest, fear, need for reassurance, or change in routine. They may also be quite particular (everything needs to be in a particular place), be routine-oriented, rule-oriented, and sensory sensitive.

The challenge for parents

Parents see their child from birth to the day of the evaluation. It’s not uncommon that peculiar behaviors and tendencies, seen every day, become mundane and not so peculiar. Also, it’s often easy to explain-away these behaviors and find alternative rationales, especially if a practitioner also provides an alternative diagnosis. Consequently, my heart goes out to parents who are often annoyed, confused, and understandably skeptical when told different things, and provided different diagnoses about their child by different practitioners. My goal is to conduct a very thorough evaluation, with a detailed history and understanding of the current behavior and explain my findings with such detail that it’s easy to comprehend and accept.

Hope that helps

I hope that explanation helps to some extent to explain the process, variables, challenges, and reasons for false-negatives. You can always email me at jcarosso@cpcwecare.com with any questions about your specific concerns or questions; never hesitate to do so. God bless you.

Next, we talk about treatment of mild autism.

Written by Dr. John Carosso

You get into an argument with your spouse. You know your point is valid but you’re having trouble getting your mate to acknowledge your view; instead, he just wants to “move on” and “forget about it.” So, he tries to change the subject and you’re left feeling unheard and misunderstood. You’re simply not ready to “move on” and you feel ‘stuck’ and frustrated. As you’re stewing over the problem, you think that, if only your point of view was acknowledged, even in disagreement, you’d feel more at-ease and prepared to move-on. Well, the same thing happens every time you want to “move on” past your child’s disappointment, frustration, anger, or problem.

Okay, here’s the scenario: your child complains that he does not want to stop playing that new video game, you just purchased for him, to empty the trash. You abruptly respond, in irritated fashion, for him to follow your direction “NOW” and ignore his obvious frustration. Okay, I know what you’re thinking; there are situations when there is simply no time for discussing the matter; nevertheless, you may find that, just as with your prior argument with your spouse, that a simple ‘reflective’ comment, acknowledging your child’s feelings, would help him to more quickly move beyond his feelings and carry-out the assigned task. For example, a comment such as “I understand it’s frustrating to be taken away from your new game. After you finish the chore you can return to playing” may prove to be quite helpful. Feeling ‘heard’ is extraordinarily powerful; it bolsters a sense of comfort and then allows for moving beyond, and past, the problem at hand.

Otherwise, we tend to feel ‘stuck’ in the argument. Reflective listening is vital in all relationships, for topics that are both positive (“I’m so happy for your accomplishment, you worked so hard…”) and negative (“you’re feeling sad that your friend didn’t show-up, that can be disappointing”). In regards to this latter situation regarding the friend not showing up, the child will sense his feelings were acknowledged and more likely be willing to move forward to problem-solving, e.g. “why don’t you call your friend Timothy and see if he wants to come over instead.” In the absence of reflective listening, there is a tendency for your child to become argumentative (“I’m not calling Timmy, I wanted Jim to be here…”).

You can more readily avoid such conflicts with your child, and with any other person in your life, by listening for, and acknowledging, their feelings. Try it; you may find yourself feeling happier too. God bless.

Written by Dr. John Carosso

The change of season blues

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 depression differs from it’s more typical counterpart in that the onset is rather predictable, usually around September or October, and corresponds with the shortening of daylight.

How Common?

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.

Kids and Teens affected too?

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 may be because of how a child is light-programmed from early-on their life.

What to do?

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.

Hope that helps

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 412-372-8000. 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.

During this very special time of year, in what has become a tradition, I am happy to re-post this special Christmas message. Here's wishing you and your kiddos a wonderful and blessed Christmas Holiday.

What I’m expected to do…

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).

Is there more?

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?

Seems only fitting

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?

Tap into the Source

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

Written by Dr. John Carosso

Good Tidings…

The Christmas and New Years Holiday really 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.

But…

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.

Father (and mother) knows best

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.

Shopping

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.

Keeping the schedule

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.

Gifts and Toys

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.

Some other tips

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.

Don’t miss the Season

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.

Written by Dr. John Carosso

What are the keys to teenage success?

There are lots of considerations, but the primary key is keeping your teen busy and on a regular schedule. You know the saying, "idle hands are the devil’s workshop." That’s as true for teens as for adults. If teens have too much downtime, they typically do not use it wisely and, paradoxically, they use their time less wisely than those who are busy. So, if your teen is earning less than optimal grades and using time unwisely, here are some things to consider:

First things first...

Establish a consistent after-school routine. There needs to be time set-aside for extra-curricular activities, homework, study, chores, mealtime, with some free-time mixed-in. Once the routine is established, it runs on auto-pilot. In the beginning, write-out and post the schedule.

How much oversight for a Teenager?

You’d prefer that your teenager is independent, taking care of daily homework and other responsibilities, and not need your oversight. Yes, that is preferred by everyone. As a parent, ultimately it’s your decision whether to back-off and let your child 'sink or swim' as an older teenager, or continue to provide the level of monitoring and cajoling you did when he or she was younger. This is not an easy decision, but if your teen is floundering and you don't provide some degree of discipline, it may not get better. However, some teens will independently rise to the occasion before completely coming off the rails; sometimes it’s a gamble and a nail-biter for the parent, but you know your child best and 'the best predictor of future behavior is past behavior.' In that respect, if your child has typically been a stellar student, then it's less likely you'll need to intensively intervene (but you may need to implement some structure, and assess the problem-at- hand that led to the decline in the first place).

What if my teen rebels?

I’ve found the when/then scenario is most helpful. In that respect, no access to video games, or hanging with friends, or whatever, until after homework and study-time. True, they won't like being treated like a child, but you may have little choice if they are going to act like a child. Also, note that, in spite of your kiddo being a teen, you still hold all the cards. There is very little they have, or want, that you don’t provide, and could withhold.

What else?

A strong moral compass is vital; it sure helps if your voice is not alone in the background reminding them to ‘do the right thing’, and nothing better than getting to church or synagogue to bolster the spiritual side and, as well, involvement with the youth group. A mission’s trip is a nice touch too. I know you’re more than aware that ‘birds of a feather flock together’ so it helps to get your child involved with kids who are productive and focused. In the meantime, a part-time job is admirable, as is involvement in sports, clubs, groups, and other adult-supervised activities.

The paradox

School and academics come first, but often teens who are busy with jobs, sports, and clubs make better and more efficient use of their time compared to those who have too much time on their hands. In that respect, the latter group finds it too easy to procrastinate, often till it's too late, while the former has no such luxury. However, if you see you teen’s grades suffering because they just can’t manage all the activities, then time to set structure and limits for them.

ADHD...

If your teen struggles with ADHD, anxiety, or mood-related issues, then it's still potentially beneficial to keep them busy and active, and it's even more important to help them structure their time with a consistent routine, a distraction-free environment, organizational skills, and soothing/calming self-talk.

Leveraging the family and community-resources

Use family and community-based resources to add more structure to your teen's life. The idea is to allow for limited free time hanging with friends by keeping them super busy with school work, studying, going to church youth group, sports and, if a male, doing things with Dad (during the late pre-teen and teen years for males, the relationship with Dad, or a stable father-figure, is the key). If that prospect does not go well, and kiddo is rebelling, then it may be best to pursue some outside counseling. Some parents may have the kiddo talk with church youth pastor first, or maybe a trusted aunt or uncle. Either way, ideally, add structure and routine to your youth’s life (as I mentioned, most of the time, kids going down the wrong path have way too much free time). If the youth rebels when redirected, and refuses structure, then again you could leverage your power in the relationship (see above), have your child talk to the trusted family member, or youth pastor, and then, if necessary, arrange an appointment with me before things get too far off the rails.

Can be a challenge

Believe me, I know first-hand that raising a teen can be a challenge. The balancing-act between allowing the obligatory freedom while continuing to provide oversight and discipline can feel like walking a tight-rope over Niagara Falls. If you feel the walk is becoming too precarious, don’t hesitate to drop me an email with any questions at jcarosso@cpcwecare.com or feel free to call the office to make an appointment.

Have a wonderful Christmas and New Years.

Written by Dr. John Carosso

Recent article in the paper

Mr. John Rosemond, a psychologist who writes a syndicated article in the local paper, is increasingly driving me nuts, and he’s at it again. You may have seen his recent article in the Trib; he writes that children diagnosed mildly on the autism spectrum are largely just ‘quirky’, and summarily and unnecessarily diagnosed.

Very frustrating to read such nonsense

Ridiculous comments such as that do nothing but cause parents confusion and strife. Practitioners go to great lengths to ensure a child, when diagnosed, is done so accurately and reliably.

Are there false-positives?

When a child has mild symptoms, determining whether the child meets all the diagnostic criteria can, in fact, become challenging. However, even in those situations, the ‘mild’ and ‘borderline’ symptomology is thoroughly explained to the parent as just that, as well as the likelihood of an excellent prognosis. In order to error on the side of caution, all too often the child is not outright diagnosed as having autism and, in fact, mild autism is under, not over-diagnosed.

The symptoms must be ‘getting in the way’ of the child’s day-to-day functioning

The DSM-V specifies, for autism spectrum disorder, Criterion D, that “symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.” Put another way, the symptoms, no matter how mild, must be ‘getting in the way’ of the child’s functioning. In that respect, parents who bring their child for an evaluation do so for a reason. It’s not because they’re bored and have nothing better to do. It’s because their kids, even if presenting with only “mild” symptoms to the casual observer, are appreciably struggling in some ways. It is vital to spell-out the extent to which autism symptomology is contributing to these struggles, and provide the necessary treatment. Casting doubt on this process only hurts children.

He’s “done a lot of reading…”!

Mr. Rosemond naively and arrogantly claims to have “done a good amount of reading on this issue” and that’s how he has come to his conclusion. Instead, he should spend a week with you, and me, and kiddos directly experiencing these struggles, and maybe then he would get a clue.

Hope that helps to clear up that misinformation

God bless you as you continue to pursue what’s best for your child and the very best in treatment options. Please feel free to let me know of any questions or concerns you have along the way, and how I can further assist you in that effort.

Written by Dr. John Carosso

I decided to re-post this post because, as of late, this issue has repeatedly been broached during my talks with parents. I hope you find this to be helpful.

Taking away video-games (or TV, or a toy…) doesn’t work? Say it ain’t so!

Sorry to be the bearer of bad news, but the tried-and-true discipline method of taking away video-games, a favorite toy, or whatever else, is largely ineffective and, in fact, counter-productive. How can that be, you ask, when taking away a favorite activity is probably the most commonly-used behavior management strategy parents have in their arsenal? Well, here’s the truth the matter.

Taking away privileges often makes the situation worse!

Here is the scenario, a child does not do their chores or back-talks; parent yells and then takes away the video games “for a week!!!”. Child yells back, negotiates, parent may or may not follow-through. If the parent follows through, child pesters incessantly to get the video-games back. If parent removes the games at all, it’s definitely not for an entire week. The next time the child misbehaves (an hour later or the next day…) the parent does not have video-games to use as a punishment (they’re already taken away).

So, in that scenario, the threat of taking away video games (or whatever) results in worse behavior due to the emotion stirred at losing the favored item, the subsequent pestering, and not having the games to use later as a punishment. Does that sound effective?

What about other punishments (such as time-out)?

If taking away privileges is the ‘numero-uno ‘ of punishments, then time-out is a very close second. However, how does that work for you? You put your child on the steps or in a corner; takes 15 minutes of yelling, cajoling, and emotion to get them in time-out in the first place, they fuss once there (yell-out when is it going to be over, get teased by their siblings, seek attention from you…), won’t stay there, and then finally they “complete” time-out after maybe a few minutes of quiet, if that.

Is this a common problem?

I’ve heard 10,000 times (maybe more) “I’ve tried that, it doesn’t work” when suggesting discipline strategies to parents. I don’t blame them; they’re right; these strategies, as they are typically used, don’t work. This is why counseling with a professional who can offer solid suggestions is so important given that implementing punishments the right way is not easy thing.

Lets start first with the most effective ‘punishment’

I’ll start with best ‘punishment’, if used correctly, that a parent has in his or her arsenal. Just to clarify, I think rewards, kudos, the softer-and-closer approach… are far more effective than any punishment, but at some point a parent has to set serious limits, and nothing beats time-out if used properly.

How to make time-out work

The key to time-out is that it’s used without any pestering (just say “1”, “2”, “3”) and absolutely no emotion. There is no arguing, fussing, or carrying-on no matter the child’s reaction; rely on the consequence not your words or your emotion.

Step-by-step

  • The child is directed to time-out (is walked there in a calm manner)
  • Time-out is in their room, not in a corner or on the steps. This way, the child is out of sight and can’t seek attention.
  • The child is informed, ahead of time, that the door will remain open if they remain calm. If they yell, the door will be closed. If the child will not stay in their room, well, there are some good options but that’s beyond the scope of today’s post; email me and we’ll go into that further.

Why time-out in a child’s room is most effective

The nice thing about time-out in the room is that it immediately ends the emotion, gives a chance for everyone to calm and, when it’s over, it’s over and you move on!!! The child can do whatever he or she wants in the room except electronics. You can take away toys and books to make it more aversive if necessary.

Okay, so now I understand how to use time-out, what about loss of privilege?

Loss of privilege can be effective, but there are specific ways to make it work. First, differentiate between immediate loss of privilege that is used until a task is accomplished (premack principle, or “when/then”). In this manner, ‘when’ your child has cleaned his room or done his homework, he can ‘then’ go out to play. The ‘not being able to go out to play’ is the loss of privilege, and is withheld immediately until the unfavored task (chore) is done.

The other form of loss of privilege can be used over a 24 hour period. This way, every day, specific tasks need to be accomplished (homework, chores, respect toward parent…); if the task(s) are accomplished by a specific time each day (say, 8:00PM), then the next day the child earns the privilege (video games, going out to play…); if not, then the next day the privilege is not earned. Each day is a new day and dependent on what happened the day before. In this scenario, it’s vital to make sure the tasks are achievable, and that the child has a fair shot in actually completing the task; otherwise, you’re dooming your child to failure.

There ya go

There is a basic overview of why loss of privilege and time-out often are woefully ineffective, and how to improve your chances of positive outcomes. This post was a bit longer than usual but there is still so much more to say; I could write a book on this subject alone (hmmmm) so feel free to ask any questions at DrCarosso@aol.com. Happy disciplining.

Written by Dr. John Carosso

Does this lighten the mood for you?

A man speaks frantically into the phone, "My wife is pregnant, and her contractions are only two minutes apart!"
"Is this her first child?" the doctor queries.
"No, you idiot!" the man shouts. "This is her *husband*!"

How about this one:

Two kids are talking to each other. One says, "I'm really worried. My dad works twelve hours a day to give me a nice home and good food. My mom spends the whole day cleaning and cooking for me. I'm worried sick!"
The other kid says, "What have you got to worry about? Sounds to me like you've got it made!"
The first kid says, "What if they try to escape?"

We love to laugh

Yep, we love to laugh, and so do our kids. It lightens our mood, helps us to forget our worries, refocuses our problems, and helps to bolster relationships especially during times of stress. Yes, discipline is stressful for both kids and parents and what better time to lighten the mood and break the tension.

If you’re a funny person by nature

Definitely take advantage of a good sense of humor and, if you have a sense of humor, good for you!! It’s a wonderful gift, and great to use in your parenting repertoire. If you’re not so funny, you can develop the skill. You just need to look for the opportunities.

How to use humor

Here are some ideas of how to lighten the mood, but first, a few jokes:

My 7-year-old daughter asked me twice today "what poison would kill someone the fastest?" and now I'm wondering if I've underestimated her.

When my kid is screaming in a restaurant and I'm not doing anything it's because I'm waiting for a stranger to step in and handle it.

Okay, back to the topic at-hand: keep in mind that you already know how to use humor and silliness to get your child to comply. In fact, you started with your kids, when they were very young, making chores fun by introducing the task with a playful sing-song voice (the ‘clean-up song…’), being silly, making a game of it, and doing all sorts of fun things to help promote motivation (yours and theirs). As your kiddo has gotten older, yes, more independence is expected, but do we need to remove all aspects of fun and silliness from the endeavor?

Yes, it’s easier when they are younger

If you’re prone toward silliness and you have not completely lost all child-like inclinations, you can have a ball with your kiddo even during chore-time. When giving directives, you can use different voices (opera singer, John Wayne, Scooby Doo), and if your child back-talks, falling to the floor and playing dead is a hoot. Actually, falling to the floor to play dead, faking a trip and falling, or falling for any reason is something kids find to be hilarious (pretending to fall over the stuff on the messy floor of his bedroom, then bouncing back up with a pair of pants on your head…). Fake crying when your kid is giving you a hard time, crying like your child does, and really pouring it on, is funny and also breaks the tension and reduces power-struggles. Also, never miss an opportunity for a tickling session. However, as our kids get older, we tend to become less silly, which is a shame. Nevertheless, there are still many ways to use humor and change-things-up a bit.

Time for another funny story:

A man observed a woman in the grocery store with a three year-old girl in her cart. As they passed the cookie section, the child asked for cookies and her mother told her "no." The little girl immediately began to whine and fuss, and the mother said quietly, "Now Ellen, we just have half of the aisles left to go through; don't be upset. It won't be long." He passed the Mother again in the candy aisle. Of course, the little girl began to shout for candy. When she was told she couldn't have any, she began to cry. The mother said, "There, there, Ellen, don't cry. Only two more aisles to go, and then we'll be checking out." The man again happened to be behind the pair at the check-out, where the little girl immediately began to clamor for gum and burst into a terrible tantrum upon discovering there would be no gum purchased today. The mother patiently said, "Ellen, we'll be through this check out stand in five minutes, and then you can go home and have a nice nap." The man followed them out to the parking lot and stopped the woman to compliment her. "I couldn't help noticing how patient you were with little Ellen..." The mother broke in, "My little girl's name is Tammy... I'm Ellen."

Other ideas

Change things up; think outside the box. For example, if your child fusses about the clothes you picked-out for her, or won’t get dressed, then let her pick-out your clothes, or tell her that, if she won’t wear them, then you’ll wear her clothes and she has to wear your clothes. Or, if won’t brush the teeth, then you tell your kiddo that you’re going to show them how, but you do it in a crazy and silly way. Another fun idea is playfully tell your child “I’m going to get you” and chase them, rather than demanding they “come here now!!! It’s fun, silly, and diverts the power struggle. I have no doubt you can think of more fun and sillier ideas than my lame suggestions (by nature, I’m not a very funny person ☹, but the important thing, is ‘that that do’ not ‘what you do’). Kids appreciate the effort, they really do. Also, kids don’t want to be outdone, so they’ll get silly right back, and you both can have a lot of fun during times that are typically stressful. Having a fun sense of humor is contagious and both parents and kids will get into the act, so to speak. It really helps to improve the mood of the home, and helps kids to want to help-out, rather than feeling forced.

Some other thoughts on the matter, and tips:

A good sense of humor, not taking things too seriously, and putting things into perspective, is a tool that kids can rely on throughout life to help them. The ability to see the humor in things will also:

  • help your kiddo’s to see things from many perspectives other than the most obvious
  • help your kids to be spontaneous and fun
  • grasp unconventional ideas and think outside the box
  • see beneath and beyond the surface of things
  • enjoy and participate in the playful aspects of life
  • recognize that life simply isn’t as much fun without being at least somewhat child-like
  • not take themselves or most situations too seriously

No time for that!!!

I know what you’re thinking; “we’re on a tight schedule, I don’t have time for all the silliness, we have to get things done….”. I hear ya; however, I’m not sure that fighting with your child, for an hour, over what she is going to wear is saving you a lot of time.

Is this reinforcing bad behavior?

It could be seen that way. However, could also be seen as being creative, thinking outside the box, avoiding the ‘gulag approach’ to parenting, and helping to get things done that usually don’t get done.

How long do I have to do that?

You may be wondering “do I act silly and use humor all the time, like every morning…”? Well, you could, but then it might lose its impact, not to mention your child would think you’re, well, wacky. However, just like with anything else, now and again and mixing-in any given strategy, including humor, can be very effective.

Some more funnies:

How sad but true is this one:

We spend the first twelve months of our children’s lives teaching them to walk and talk, and the next twelve telling them to sit down and shut up.

Another one, but not so sad (unless true for your situation at work):

Parenting tip: Treat a difficult child the way you would your boss at work. Praise his achievements, ignore his tantrums, and resist the urge to sit him down and explain to him how his brain is not fully developed – Robert Brault.

When using humor, be sure not to…

Don’t be sarcastic!! Using sarcasm is demeaning, belittling, causes bad feelings, and defeats the purpose of trying to use humor. Yes, sometimes sarcasm can be effective, but be very careful.

Now go and have fun and be silly!

Now go and be silly, happy, funny, and child-like with your kids!

Okay, some closing thoughts, an attempt at humor, and a touching quote that targets what we’re all trying to accomplish in our parenting:

"Humor helps us to think out of the box. The average child laughs about 400 times per day, the average adult laughs only 15 times per day. What happened to the other 385 laughs?"
Anonymous

"Never underestimate a child's ability to get into more trouble."
Martin Mull

“There's no one in there.”
A 6-year-old while watching his father knock on the wall to find a support beam to hang a picture frame

“When I’m too big for you to hold, I’ll hold you instead.”
Ashley, age 5

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