High Functioning Autism: Promoting Social Abilities. If you have a child with high functioning Autism, you may find that your (more…)
Written by Dr. John Carosso
What is the placebo effect?
A placebo is something that has no active therapeutic properties and is given to a patient to make them think they are getting the actual medication. The placebo effect is that some patients, interestingly, actually get better when given the placebo. Medications are compared to placebo because, if not better than placebo, then what’s the point.
What’s hope got to do with it?
If a person is given a placebo and gets better, then it could be argued that the power of hope is coming into play. The person is hoping the medication will work, and maybe even feels confident it will; consequently, they get better. I suppose you could say it’s ‘mind over matter’. The power of words instills hope, especially from somebody we trust, and powerful things can happen. There was a recent study showing that patients did better after discharge if the discharge summary had more positive words in it. What’s more, research has shown that the more confidence the patient has in their doctor, and the more the doctor emphasizes the placebo will work, the better the outcome.
Okay, so what?
So we all agree this is interesting, but what’s this got to do with helping your kids? We must keep in mind that the words we use have great power, can make a big difference in your relationship with your children, and how our kids behave.
Speak of what you want, not only of what you see
Your words shape your child’s behavior, for better or worse. So, be careful when calling your child “bad” or, less aversely, saying your child’s “behavior is bad”. Instead, consider stating the admonishment in a manner that positively highlights your child’s strengths while expressing clear expectations… “Mary, you often do really well getting along with your sister, and I appreciate how much you can be patient with her, so I know you can get along better than you are now, show me what you’re capable of…” Compare that statement to… “Mary, you’re always so bad and rude, you drive me crazy, you can never get along with your sister…” If you want to instill a self-fulfilling prophecy, which is the better way to go? Moreover, the latter statements leave everyone feeling down and miserable.
Similarly, you can enthusiastically talk to your child about how you’re looking forward to seeing him follow directions, clean-up, and get-along. Words have power, as do positive expectations, especially from somebody we really care about.
Some wonderful resources
Two excellent resources that provide examples of speaking to children in this firm yet positive way includes How to Talk so Kids will Listen, and Listen so Kids will Talk. The other is Siblings without Rivalry that focuses on how to curb your kid’s fighting with one another and there are clever phrases to use with your kids that you’ll find very useful.
Making medication work
The same thing holds true in terms of making medication more effective. Explaining to a child how their medication is going to help and doing so with conviction and enthusiasm can go a long way to help increase the effectiveness of the medication.
Now go and instill some hope
Every time you speak to your child, be reminded to speak in a manor that instills hope, high expectations, clear expectations, and that you know they can rise to the occasion. You’ll feel better, and so will your kids. God bless.
Written by Dr. John Carosso
Types of chores
I’m often asked what types of chores are most appropriate for my child based on age, and whether to pay for the child completing chores?
Ages for chores?
Of course the type of chore depends on your child’s developmental level, but children as young as two can start helping to clean-up their toys, and 4-5 year-olds can clean their room (with direction and oversight), and help clean-up around the house. Between ages 7-10 many kids are more than capable of emptying the garbage, putting away the dishes, vacuuming, dusting, and wiping-up the floor. Teens can start doing laundry, cooking…
Allowance for chores?
That can be left up to you, but you may want to consider that children do not get paid for chores that are part of ‘all of us live here together and need to pitch-in’. However, it may seem reasonable to pay for chores that go above and beyond such as washing and waxing the family car, doing windows, cutting the grass, shoveling snow, cutting the hedges… Some of you may not consider these chores to be ‘above and beyond’, which is fine, and others provide an allowance for daily chores such as emptying the garbage - whatever works for you.
Just do it!!
It’s not so much what chores or whether you pay, it’s that you ‘do it’ in terms of enforcing your kids doing chores, becoming more responsible, not relying on you, pitching in, and having a sense of accomplishment. Think of being on your hammock with your lemonade while your kids take care of the housework 😉
Your feedback
As always, I’d love your feedback regarding what works for you to get your kids to do chores, if you pay, and how that’s working for you? You can email me at jcarosso@cpcwecare.com. Thank you and God bless.
Dr. C's Morning Minute
View Dr. C's Morning Minute Video Getting Your Kids To Do Their Chores Part 1 for more information about this topic by clicking here.
See more of Dr. C's Morning Minute on our Video Blog Page
Written by Dr. John Carosso
Are you feeling like the unpaid help?
Do you find yourself relentlessly cleaning-up, picking-up, putting-away, cooking, transporting, washing, re-washing, doting and doing just about everything else while your kids seemingly are on vacation, watching TV, playing video games, playing with their friends, and not even remotely lifting a hand to help you as they watch you work to the bone? To make matters worse, you never get a thank-you, and perceive that your kids feel entitled that this is the way it should be, with no guilt or remorse. If so, well, if it’s any consolation, you’re not alone.
You know it needs to change…
Okay, you know that this scenario is frustrating for you, makes you feel unappreciated, and it’s not healthy for your kids. You know that, at some point, it needs to somehow be communicated that ‘we’re all in this together’, that everyone needs to ‘pitch-in’, and they need to learn how to care for themselves.
What’s it take to change?
Take heart that this situation is not necessarily difficult to change. You’ll need to be diligent, firm, and consistent. Well, okay, maybe this will be kinda difficult. No matter, have faith in yourself to rise to the occasion.
One step at a time
The first step is to communicate what is expected in a clear, concise manner. Put it in writing for each child and a time when the chore needs to be completed each day.
A few options
If you decide to use a chore chart, then you may want to write down the specific chores, what each chore entails, and the time of day by which the chore needs to be completed. You’ll convey that the chore’s completion will be monitored by you and a sticker, star, or point or whatever will be allocated on the chart accordingly. You will not discuss the matter; either the chore is done, or it’s not. The number of stickers, stars, or points earned each day will determine privilege level the following day; this way, each day starts anew.
Another way
If the aforementioned sounds too ambitious, then there is a simpler method. Lay-out the chores as described above, but use the ‘when/then’ prompt…. “when the chore is done, then you can do….” This way, unfavored comes before favored activities. The same can be said anytime your child asks you for something (a thousand times per day); you’ll honor the request after the chore is done.
Stick to it
The biggest problem is that parents find it’s easier just to do it themselves than fuss about the chores. I can sympathize with that sentiment, but it’s just causing more frustration and angst, and putting-off the inevitable. So, you might as well just stay firm and get it over with. Once your kids know you’re serious, and get into a routine, it will become much easier and you’ll feel more supported, more loved, and the entire household will be more harmonious. Sound good?
Next time
In my next post, I’ll be focusing on what types of chores are most appropriate, at what ages, and whether to pay for chore completion.
Please email your feedback
Let me know what you think about this plan, what you’ve tried, what works for you, and if you try this plan, how it works for you. Your feedback is super helpful at jcarosso@cpcwecare.com. Thanks again, and God bless.
Dr. C's Morning Minute
View Dr. C's Morning Minute Video Getting Your Kids To Do Their Chores Part 1 for more information about this topic by clicking here.
See more of Dr. C's Morning Minute on our Video Blog Page
Written by Dr. John Carosso
Yes, it’s that time
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.
Summer vs. 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.
What to do (tips for parents of children with autism, and typical kiddos):
I'd love to hear any suggestions or tips you have about how you prepare your kids for back to school. Feel free to email me at jcarosso@cpcwecare.com. Thanks!!
God bless and enjoy the rest of the summer
Written by Dr. John Carosso
I was recently asked an excellent question from a parent with an adorable, nonverbal child with autism. The concern is that the kiddo does not seem to understand consequences such as time-out, and loss of privilege has little impact. The aggression reportedly often stems from, for example, a sibling being in close proximity, not getting what she wants, or related frustrations.
Autistic children who are quite young, nonverbal, and have notable developmental delay often do not respond well to consequences such as time-out and loss of privilege. They have trouble understanding cause-effect (understanding that their behavior led directly to a punishment), they live ‘in the moment’ and are not anticipating a negative reaction to their behavior, and their expressive language issues are often accompanied by receptive language deficits that interferes with the child’s ability to understand and accept reasoning and problem-solving.
Given these challenges, it’s difficult to develop a ‘one-size-fits-all’ protocol to alleviate the emotion and tantrums. Any given protocol will be highly individualized based on the developmental level, motivations, and reasoning ability of the child. Nevertheless, there are some general principles that can be followed.
In these situations, always start with the ‘triggers’ for the misbehavior and try to avoid these triggers whenever possible. A ‘trigger’ is what tends to cause the misbehavior in the first place, eg. siblings standing too close… However, over the course of time, attempt to desensitize the child to the trigger by having the child experience the trigger in small increments (i.e. sibling stands far enough away to not cause a tantrum, but close enough that it catches the child’s attention). Over time, slowly increase the extent to which the child experiences the trigger. It’s also helpful to pair the ‘trigger’ with something the child enjoys and prefers (“pairing”); for example, the sibling stands close, but is holding the child’s favorite treat and gives the treat to the child. These scenarios can be expanded and generalized to many other ‘triggers’ and, before you know it, the child is consistently tolerating even close encounters with her sibling.
A more common cause (trigger) of tantrums and aggression occurs when a child is removed from a favorable experience (local park, TV…), if a favored item is taken away (loses a toy), or if the child is being punished (time-out). As indicated above, if the loss of privilege or favored item is a punishment, and the child does not fully understand the “punishment”, then what’s the point? Instead, rely on avoiding triggers, distraction, redirection, and replacement behaviors (helping the child to use their words) if the child has at least some verbal skills. However, in the event of aggression, for example, when removing the child from a favored place or taking away an iPad so the child can eat dinner (transitioning from favored to unfavored), then we rely on a few other options. This would include trying to make the transition a bit more gradual and slow, giving both visual and auditory reminders and warnings, and pairing the favored and unfavored and then slowly withdrawing the favored. These protocols are often ‘trial and error’, and based on the child’s individual preferences and tendencies. Consequently, working with a behavioral therapist is vital to develop an individualized and effective protocol and, even then, the protocol often needs regular ‘change-ups’.
In some case, you have to quickly transition from a favored to an unfavored task, and there is no time to make the transition more appealing, and you know your kiddo is going to have a fit. In those instances, you’ll use pre-determined techniques to help your child calm as fast as possible. These techniques will need to be determined ahead of time in that, over time, you’ve learned what strategies are more effective in helping your kiddo to more quickly calm. This may include putting your kiddo in a quiet and safe area to let the emotion run its course, simply snatching-up your child and moving-on toward the next activity, or distracting with favored item or toy (but be careful not to reinforce the problematic behavior). A picture schedule can be very helpful so your child can see themselves, in the picture, having fun in the next activity and this helps to increase motivation to move-on with the routine. It’s vital to have a quiet, safe, out-of-the-way area for your child to tantrum where they cannot get hurt, cannot hurt others, cannot destroy property, and will more readily calm. Sometimes parents have success with a secure car-seat, high-chair, or play-pen. I’ve talked with parents about creating a playpen that is padded and secure, or a small room from which is removed any potentially dangerous objects. It’s often advisable to avoid restraining your kiddo for long periods of time given this often can result in someone getting hurt, and the attention the child receives from the restraint can be reinforcing. A behavioral therapist can be invaluable to guide you through this tricky process. Clearly, however, if the tantrum is brief and with no accompanying aggression, then often it’s best to let it run its course and move forward with the next activity.
This post provided some general ideas of how to manage the challenging issue of tantrums and aggression, and I hope you found it to be helpful. I highly recommend that any parent with such challenges seek consultation from a trained behavioral therapist (feel free to contact me at jcarosso@cpcwecare.com or check out my fb page) where, either in an office setting or through in-home support (wraparound) a thorough functional behavioral assessment can be completed and an array of effective strategies can be determined. God bless.
Written by Dr. John Carosso
Go ahead, you can admit it; it’s kinda scary…
On one hand you’re excited for the start of summer and to have far more access to your kids. If you’re a SAHM, then you’re home all day with the little darlings and the sky is the limit in terms of the potential for fun-in-the-sun!! Even if you work, it’s most likely you’ll be seeing your kids quite a bit more over the next few months. Of course, you’re thrilled; they’re your kids and you want nothing more than to be around them and enjoy their company. However, deep down, you’re also a little scared because you’ll be, well, trapped, all day, with the little stinkers, and they’ll all be together tag-teaming against you, not to mention tag-teaming against each other, and you’ll have to play referee, teacher, cop, and playmate possibly all within any given 5-minute period.
By the way…
Not to get off-topic, but what’s the deal anyway with this three-months- off-thing over the summer? Are we all still farmers and need our kids help to work the family farm? I like a little vegetable garden as much as the next person, but three months seems a bit extreme. But I digress…
Okay, so what’s the game-plan?
Well, that’s just it, ya gotta have a game-plan. I suppose you could just wing-it, and many do, and they seem to do okay. However, especially if you have kids with special needs, the more routine, structured, planned, and predictable you can make the summer, oftentimes the better it will go. Not that every minute will be planned (summer is about spontaneity, freedom, and fun) but for some kiddos going from a highly regimented daily school routine, to a free-for-all, can be rather unsettling. Many parents find a nice balance between the two, some structure for part of the day, and some planned activities and trips, and a more relaxed and free-flowing part of the day (and even this “free-flowing” portion of the day can be planned).
Some things to help the summer go smoother
You go to Hawaii and hire a full-time nanny to watch the kids (just joking, sort of). First, get a Family Calendar with daily and monthly activities and events planned in advance. This gives the kids things to look forward to, lets them know what is planned for any given day or week, and reduces the pestering about ‘what are we doing today…’? You may want to use lots of visuals and pictures to convey information about the activity or event(s).
Lay back a bit on the chores
You may want to be a bit more accommodating and less rigid with chores and expecting a super clean house. Having everyone home, all day, is going to result in more messes and whatnot, and your frustration likely will skyrocket if you’re expecting complete order and a pristine environment. However, by the same token, clearly defining rules (maybe even posting summer-time rules on the wall) that include not getting out other toys or items until the first are put-away, will be helpful.
You may need a break (swap a kid or too)
Since other parents have their kids home too, take advantage of them and give them your kids for an afternoon (or a few days?). Of course, you’ll have to return the favor, but the kids can enjoy playing together (or not) and you get a break every so often.
Get some ideas
Set out a bucket for suggestions, and get a ‘bucket list’ from your kiddos to find out things they want to do over the summer. They likely will have some good ideas for local trips and activities you can do at home or in the local neighborhood.
Send them away for the day?
Many of you have arranged day and/or week-long camps for your kids. Your kiddo usually has a great time, and it also gives you a break. However, keep the family fun going; remember, you only have so many summers with your kids, while they’re still kids, so don’t forget to savor these moments in time (that reminds me; take lots and lots of pictures and you’ll have them for your scrolling home-screen the rest of the year).
Academics?
Your kids are going to hate me for suggesting this, but it’s important to set-aside some time, weekly if not daily, to keep-up on academics. Take advantage of Extended School Year (ESY) if your child is eligible, or simply crack some books at home for 30 minutes to an hour a day. Or, even better, introduce your child to child-friendly short stories and novels where they can get ‘lost’ in their imagination and experience far-away adventures without even leaving the home. Reading together is even better. Experiential trips are also fun, such as to the library or museum, art show, aviary, and don’t forget about VBS.
Before the school year is over…
Get the names and phone numbers of kids with whom your child will want to visit and play over the summer. Otherwise, you may not have a way to contact them, and many opportunities for fun play-dates will be lost.
Prepare for whatever may happen
Role-play with your child what to do if they get lost, or need help in some way. Keep medications and first-aid kits handy. Always have an epi-pen handy as well!! You never know who may be allergic to insect bites and stings.
Be prepared to ‘divide and conquer’
When the kids get to bickering and carrying-on, prepare places for them to go to play separately. Separate rooms or areas of the house, or one plays outside while the other inside; whatever it takes. Prepare activities for them to do separately to keep them busy and to at least temporarily end the fussiness. The more structured and planned the activities and play-areas, the more likely such diversionary tactics will work.
Other ideas…
If your child has challenges with catching a ball, the Velcro-ball and Velcro catching pad is a wonderful option; frankly, even if your kiddo catches just fine it’s still a fun activity, as is a trampoline, bicycle riding (or tricycle ride), taking the dog for a walk, having a picnic in the back yard, family hike, catching lightning bugs (we used to use wiffle bats when I was a kid…), going for a swim, stargazing, zoo, kennywood, board games, making a bird feeder and watching the birds, listening to an audiobook, going fishing, jumping rope, blowing bubbles, playing miniature golf, flying a kite, playing badminton, climbing a tree (not too tall), or watching a good movie. Whatever you do together is meaningful and makes a memory.
Have a wonderful summer
I hope you found this post to be informative and that it inspired some ideas. Here’s wishing you and yours a relaxing, safe, and memory-filled summer of fun. God bless.
Written by Dr. John Carosso
A parent on Facebook asked a good question regarding the difficulty of her other children, the siblings of her special needs child, not understanding the difference in discipline between them and their brother, and how this causes dissension and frustration. In addition, from other parents, there has been concern expressed about siblings copying maladaptive behavior, and feeling as if they are not getting as much attention. All of these issues will be addressed in today’s post.
There often is a difference in expectations and subsequent discipline between a child with special needs, and their neuro-typical siblings. It’s not uncommon that siblings pick-up pretty quickly on these differences, and lament that they are being treated unfairly (“my brother does things and there is no punishment, but when I do them I get punished!!”). The first step is to provide some degree of empathy and, in reflective comments, express that you appreciate how this might appear confusing and unfair. However, I would suggest that you next express that you’re the parent and you can be trusted to make good decisions to determine the proper level discipline for each child in the family, that each child is different, has different needs requires a different parenting style, and you’ll make those decisions to meet those needs. You can remind your child that those decisions are based on lots of things including age but also on the ability to show self-control, and based on other strengths and weaknesses. You can explain that if one of the members of the family has hard time controlling their actions, they are given a bit more leeway and support until they learn how to show more self-control. You can explain that you have a very good idea to what extent each of your children can control themselves, and you’ll discipline accordingly. Also, you could ask your child if they would trade for their sibling's struggles to get less discipline?
Usually this entails a younger siblings copying the emotion and any odd behaviors of their older sibling. This too is handled in a pretty straight-forward manner; explaining that any behavior that is inappropriate will be managed with limit-setting and consequences, and pro-social behavior will be handsomely rewarded. Remain consistent with punishments, and lavish in praise. However, it’s important to note that, in some cases, the emotional escalation from a sibling is not copying their special-needs sibling, but simply a demonstration of built-up frustration that the special needs sibling's behavior is disrupting the home environment. In that instance, it’s important to provide the kiddo with an empathetic ear (maybe even a professional counselor), a safe place to play in peace and quiet, and to work diligently to restore the family structure and reduce the extent to which the sibling is overly emotional and disruptive to the family harmony.
If your child feels this way, it is likely the truth, which is a common reality in many families. The fact is that your special needs kiddo needs more attention than your other children, and you have to provide it. There is no way around that. However, there are a few things to consider including setting aside time weekly, if not daily, even a few minutes, that is you and your child’s “special time” to sit together, do something fun, talk, go for a walk, or do whatever they want to do. It’s also important to make your special-needs child’s trips to the doctor’s office, or other appointments, that your other child attends too, as fun as possible with whatever games, bringing along a friend, and special rewards to being a good brother or sister. Also, it’s important to continue to emphasize that every family has to work together to help each other and that this what a family does. That may fall on deaf ears after a few years, but it’s worth repeating nonetheless. It can also be helpful to incorporate the help of the spouse, relatives, trusted neighbors who can lighten the load and give extra time for you and your other children.
Okay, that provides an overview of some things to consider when dealing with these issues; however, we all know that these points just scratch the surface. Please go to my Facebook page and describe what you’ve done in response to these challenges. We can all learn together!! Thank you.
Written by Dr. John Carosso
Okay, this is the final segment of this blog series on ADHD. We started out with a discussion of what causes ADHD (disturbance of the prefrontal lobe) and the negative impact on executive functioning. We then moved into specific strategies to enhance executive functioning, and some more general interventions to make day-to-day activities go smoother. Finally, in this third segment, here are more helpful tips and suggestions I trust you'll find to be helpful:
Prior to the event during which you may be interrupted, give clear directive of expectations, give a structured fun task for the child, and praise throughout. Fade praise over time. Special praise at the end of the event. Can be used for a phone conversation, preparing a meal, having a conversation with a friend...
Provides opportunity to provide tangible reinforcement that can be cashed-in for privileges. It can then cost tokens to play video-games, watch TV, going to movie… (list the privileges and post). Make a list of chores and tasks and how much each will earn. Be mindful of the cost for privileges (if cost too much, then system loses appeal, but don’t make it too easy). Make a token-bank to store the chips/tokens. One to three chips can be earned for most tasks. Use a point system for older kids.
Do not use criticism or excessive punishment. Do not pester or become overly emotional. Children with ADHD have lack of understanding of time and they live in the ‘now’, not in the future. Consequently, they don’t appreciate how their behavior can impact the future of any relationship. Using the token system, you can ‘fine’ child by taking away tokens. However, don’t begin taking-away tokens until after using the token system for a few weeks. Do not fine too harshly, or system will lose effectiveness. Use 3/1 rule; fine once for every 3 allocations of tokens.
Remove to quiet area. Pick one or two behaviors. Do not give attention when in T.O. Give command, count to 3, if directive not completed, give one warning for time-out, count again then to T.O. if still not complying. Use gentle physical prompting. When quiet (one minute per age) can be released if agree to carry-out what was initially refused. Praise upon completion of task. Token is only given if task is done upon initial request. Fine child if child leaves time-out. Time-out to room can be used.
Keep your child busy and occupied with fun activities. Use these same methods in stores, other’s homes, and other public places. Establish a plan. Use positive attention, praise, clear expectations, clear instruction, use of tokens and other incentives, regular specific praise throughout the outing, use of time-out as needed. Punishment can be in public, or upon returning home. Find potential time-out area in the public place. Give tokens periodically throughout the trip with lavish praise.
Okay, there ya go. Hope you found this series to be helpful. Now, it's your turn!! It would be appreciated if you would share what works for you, so I can confidentially share your ideas with those who may be having a rough time. I won't take credit for the idea, but I won't reveal your name unless you give permission. Thank you!!
Written by Dr. John Carosso
We left off with the discussion of ADHD being a disorder within the pre-frontal cortex that manifests in deficiencies in what’s called ‘executive functioning’. The more a parent can externalize these executive functions, and help the child carry-out the pre-frontal cortex duties in the child’s natural environment, the more success will be experienced. In the last post, each executive function was described, and specific skills to target any shortcomings.
Listed below are even more interventions you’ll find to be helpful when managing your child with ADHD. A number of these interventions help to ‘externalize’ the executive functions and helps the child to be increasingly independent; others help to improve your relationship given that the ‘constant’ reprimand and redirection can wear thin after a while.
Some helpful strategies:
Okay, that was eight strategies to help in your daily pursuit of helping your child be the best he or she can be. I’ll have a bunch more in the next post. Stay tuned and, in the meantime, please share with me (jcarosso@cpcwecare.com) the strategies you’ve found to be most helpful, so I can share them with others too. God bless.
