Written by Dr. John Carosso
We tend to describe and explain ADHD by its outward appearance and core symptoms: impulsivity, hyperactivity, and distractibility. However, that does not explain ‘what is ADHD’ or what causes the disorder.
If we look beyond and beneath the signs and symptoms, and consider the cause of ADHD, we can get a much better grasp on effective strategies.
ADHD is a condition where the pre-frontal cortex, which is the area of the brain that is the most advanced and responsible for the highest-order and executive of functioning, is not quite doing its job. The pre-frontal cortex can be said to have a number of ‘executive functions’ that help us to carry-out our daily routines with increased effectiveness and efficiency. These ‘executive functions’ include:
If some of the child’s executive functions don’t work so well, we then need to externalize the function(s), or make the function occur, for the child, in the natural environment.
Well, that takes quite a bit of creativity, and any given strategy will be tailored and individualized for the child. However, in general, here are some general strategies and principles to consider:
Immediate feedback and consequences
Children with ADHD tend to be under control of the moment (they have trouble looking into the future, or focusing on the end-goal), so become part of the moment by your presence, praise, and encouragement. When involved in a boring or challenging task, these kids feel an urge to do something else, so make the task more rewarding. Quick rewards and feedback are vital. Praise, affection, rewards, tokens… Make it immediate. Look for the ‘good’ behavior and praise it. Give immediate consequences as well.
More frequent feedback
Kids with ADHD need more immediate and frequent feedback; best to give often especially in the beginning. Give feedback (praise, tokens…) periodically during the task, not just at the end. Use visuals to remind yourself to check on your child to give feedback.
Use larger and more powerful consequences
Use more powerful consequences than with other kids, because they must overcome more to reach the goal or complete the task; they simply need more motivators.
Use incentives before punishment
Praise before you punish, or you’ll be punishing far too often. Too much punishment only interferes with your relationship with your child. “Positives before negatives” and Praise what you want to see. Find replacement behaviors to the negative behavior, and praise when you see the replacement behavior. Punish consistently but selectively; only punish the one targeted misbehavior.
Externalize time and bridge time where necessary
Children with ADHD have a disturbed sense of time; consequently, they struggle with time-lines. They subsequently live in the ‘now’ and are better when they have external reminders about time. Use a timer, or a visual timer, (large time-timer), watch with alarm, or a recorder with your voice… Longer time intervals: bridge time, i.e. break into small daily steps. See A.D.D Warehouse for helpful items and materials.
Externalize the important information at the time of the task
Working memory is impaired, so place helpful information out in the open, where the work is being done. Use a list of rules and reminders (read directions, double-check work, pay attention…). Take aside your child before their friend arrives and remind/practice to: share toys, take turns, ask friend about her interests…
Externalize the source of motivation during the task
There can also be trouble with motivation. Consequently, increase the motivation and make it obvious by giving incentive or reward. Create a win-win situation; offer to get reward when work is done, or when segments of work is done.
Make thinking and problem-solving more manual or physical
Keeping information organized in their thoughts is tough, so it’s best if the kiddo can see or feel the problem or solutions. For example, type all the points on the computer screen to capture every idea. Child can then expand using the prompts. Use index cards, tangibles, symbols, and other types of cues to remember the specific points. Make the problem tangible so child can see or touch it, such as seeing the plans for a house, or how the furniture will be arranged in a room.
Be consistent
Must use same strategies every time. Be consistent and persistent. Respond in same fashion even when setting changes. Both parents respond same way. Use for at least two weeks before deciding something does not work.
Do not rely on your words, or your emotion
Don’t pester, rely on your actions and consequences. The issue is not a lack of information.
Plan ahead for Problem situations
If you can predict the problem, plan for how to manage the problem. Clear expectations, share the plan with your child, and follow-through. Five-step plan: stop before entering site or encountering the problem; review with child 2-3 rules (brief), ask to repeat; set-up reward or incentive; explain punishment; follow the plan.
Hope you found this information to be helpful. Consultation with a therapist can be advantageous to work on improving the child’s coping strategies, and helping parents to refine their behavioral plan. Feel free to call the office at 412-372-8000 or 724-850-7200 to arrange such a consult. Also, feel free to email me with your thoughts and questions at jcarosso@cpcwecare.com. I’ve also found the book, Taking Charge of ADHD, by Barkley, to be helpful in terms of its comprehensive and practical approach, and some of the aforementioned strategies are highlighted and detailed in that resource.
See you next time when I’ll provide some more strategies to help with ADHD. God bless.
Written by Dr. John Carosso
Wishing you and yours a blessed Christmas and Holiday Season. I hope you find this annual 'Wonderful Counselor' post to be comforting and that it helps to refocus what this Holiday is really all about.
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
Did you see that movie?
The Incredibles is a great flick; probably one of the best animated movies. This family starts out as this dysfunctional unit who can’t communicate, are at-odds with one another, feeling no confidence or competence, but end-up coming together as a fighting force ready to take on the world and then some.
What do the Incredibles have to do with your family, or talking to your kids about terrorism, you ask? Well, more than you might think. There are two sides to this talk, and the Incredibles can teach us a lot about the one side.
Probability: The other side of the coin
Okay, so one side is being like the Incredibles (we’ll talk about that later), the other side is “probability”. In that respect, when talking to kids about terrorism, or the many dangers inherent in our world (robbers, hurricanes, tornados…), we tend to start with a few basic facts:
However, we offer realistic assurances:
In this way, we soothe ourselves, and our kids, regarding any potential angst; by reminding ourselves, and our kids that terrorism or bad things can happen anywhere and anytime, but likely will not. Otherwise, we’d cower all day under our beds.
So, tell me more about what the Incredibles have to do with this talk?
The movie ends with the family being completely in-tune with each other, working together in a coordinated fashion, each having and being able to use specific talents and skills, and feeling super confident to face just about anything that may come their way both individually and together. Okay, I know, they’re fictional characters but, nonetheless, their attitude and preparedness may be worth emulating.
How to be confident like the Incredibles?
First, you get busy getting prepared like they did. You make sure you are able to rattle off that list to your kids of why they can feel ‘safer’ in a dangerous world. The longer that list, the better for you and your family. As far as the Incredibles-mentality, preparedness would also include a self-defense/safety class and learning how to protect yourself, teaching situational awareness, practicing a safety plan, and having a stock of survival supplies. I don’t want to come across as an alarmist, and you would not convey that sentiment to your children, but you would convey, to your kids, that you’re all prepared for whatever may come your way so no need to fret. In fact, you could even toss-in some bravado (kids love bravado) such as ‘bring it on’ and that any robber or terrorist is picking the wrong family if they pick yours, Hoorah!
Your ‘tone’ matters a lot
Keep in mind that kids mirror the tone of their parents. If Mom and Dad are showing themselves to be calm, secure, confident, and in-control of the situation, then kids will stay far calmer and secure as well. .
He's got the whole world in His hands...
It’s also super reassuring to emphasize to your kids that, no matter how chaotic the world may appear, God has everything under control, that He looks after his children, and comforts and holds our hand through every adversity. You know the verse, If God is for us, who can be against us..., Romans, 8:31.
The Incredibles and Beyond
I hear they’re coming-out with an Incredibles II, which should be fun to watch. You can bet that this dynamo family will again meet-up with some super-power nemesis, will falter at times, and will appear all but defeated but, in the end, they’ll work together to out-muscle and out-smart the would-be ‘terrorist’. You can also bet that ‘Dash’ and ‘Violet’ (oh, c’mon, you remember the two Incredibles’ kids) will be far more confident in this second go-around and won’t be fretting like they did in the first movie. Do you want the same for your kids? Yea, me too. So, lets get busy, Hoorah.
Your ideas?
I'd love to hear about your approaches and experiences when talking with your children about weighty topics such as terrorism. Feel free to email me at jcarosso@cpcwecare.com.
P.S.: Check-out my earlier post "Treating Anxiety and Obsessions" by clicking here that provides even more details about alleviating childhood anxiety and fears.
P.P.S.: For those unfamiliar with the term, "Hoorah" is a military term used to emphasize exuberant acknowledgement, agreement, and being onboard with the mission.
Written by Dr. John Carosso
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, and parent may or may not follow-through. If the parent follows through, child pesters incessantly to get the video-games back, which causes more frustration for parent. 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 else) results in worse behavior due to the child’s emotion stirred-up at losing the favored item, the child’s subsequent pestering to get the coveted item returned, and the parent 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 ‘number one’ of all punishments, then time-out is a very close second. However, how does time-out work for your child? You put your child on the steps or in a corner; it 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…), they won’t stay there, and finally maybe they “complete” time-out after maybe a few minutes of being quiet, if you’re lucky.
Is this a common problem?
I’ve heard 10,000 times (maybe more) “I’ve tried that, it doesn’t work” when suggesting these discipline strategies to parents. I don’t blame them; they’re right; these strategies, as they are typically implemented, 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.
Let’s start first with the most effective ‘punishment’
I’ll start with best ‘punishment’ that a parent has in his or her arsenal. Just to clarify, I think rewards, kudos, and the softer-and-closer approach are far more effective than any punishment, but at some point a parent has to set 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 – go to your room”) and absolutely no emotion. There is no arguing, fussing, or carrying-on no matter the child’s reaction; rely on the consequence (time-out), not on your words or your emotion.
Step-by-step
-The child is directed to time-out (and is walked there, if necessary, 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 or disrupt the family. He does not return to the family until calm and ready to comply, and you decide when that occurs.
-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 for that too; just email me (drcarosso@aol.com) for specifics and I’ll walk you through what to do. In the meantime, one option if the child refuses to go to his room is to offer a choice: “one quick, 10-minute time-out, or no going-out to play the rest of the day...” Another option is a reverse time-out (you leave). There’s one other even better-option, but you’ll have to email me to get it.
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 away from each other, 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 from immediate loss of privilege that is used until a task is accomplished (the “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 until the unfavored task (chore) is done.
The other form of loss of privilege can be used over a 24 hour period. This way, each day specific tasks need to be accomplished (homework, chores, respectful toward parent…); if the task(s) are accomplished by a specific time each day (say, 7:00PM), 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 realistic based on ability level and your child’s history; otherwise, you’re dooming your child to failure.
There ya go
I’ve provided 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 consider so feel free to ask any questions at DrCarosso@aol.com. Now, go use time-out and loss of privilege with confidence and success!!
Written by Dr. John Carosso
The Controversy
Recently it was reported that James Harrison (Pittsburgh Steeler) took his kid's trophies because they were not 'earned'. This sparked an interesting debate.
Point, counter-point, and nuances
As would be expected, as with most issues, there is not necessarily a straight-forward 'right or wrong' answer given that certain nuances and conditions may exist with any given child, competition, and the type of recognition or "award."
Check out the article
To see more about this issue, check-out the recent edition of the Pittsburgh Tribune Review where I share my views on the matter with writer Kellie Gormly in the Living section. The article provides a broader perspective and what I hope you'll find to be some worthwhile points.
Here's the link:
http://triblive.com/lifestyles/morelifestyles/8930663-74/trophies-harrison-says#axzz3jGRnGS8F
What do you think?
Let's see what you have to say on the matter; share your thoughts on my facebook page:
https://www.facebook.com/dr.johncarosso
Have a great day!!
Written by Dr. John Carosso
'Dyslexia' does not have to mean 'disability'
If your child has a reading disorder, better known as dyslexia, it's vital you understand the underpinnings of the problem and where to turn for help. In that respect, you and your child need to know that the problem does not reside with him or her, but with our educational system that does not seem to recognize that these kiddos with dyslexia do not have a "disability" and need not be segregated and placed into 'special education.' Instead, what they need is for our educational system to come out of the dark ages and recognize that students should not be pigeon-holed and all instructed in the same fashion. In that respect, some kids read better using their eyes, some do better listening with their ears, some do better reading with their finger, what difference does it make as long as the information is learned?
The Answer: Let's not be rigid with the 'eye-reading only' mentality
The fact is that most kids with moderate to severe dyslexia will never read (with their eyes) on grade-level, that's just the way it is. However, many of the kids in the lowest reading group, who subsequently feel miserable about themselves, have a better vocabulary and conversational skills, are brighter, more creative, more inquisitive, and are better problem-solvers than the bulk of the students in the highest reading group. How about we do away with these antiquated grouping of kids and teach children in ways that meet their needs and adapt to their individualized styles of learning. It should be common practice that, in every classroom, a portion of kids learn via traditional teaching, but others use technology such as the intel reader, kindel, and voice recognition software to complete assignments. This way, no one is made to feel 'stupid' or inferior; and everyone is learning, achieving, and earning good grades but they're doing it in ways unique to their learning styles. Wouldn't that be something!!
Eye-Reading vs Ear-Reading vs Finger Reading
Think of it this way; here's a scenario: a fourth grade girl who is blind "reads" with her finger (braille) at a 6th grade level. Does the fact that she is using her finger to read make her reading ability any less valid? In the same respect, is a child with dyslexia, using his ears to read, any less of a reader? We need to re-think what it means to read, learn, and achieve.
By the way, a wonderful resources is the book: The Dyslexia Empowerment Plan, by Glen Foss. He also created the Intel Reader, which turns any written text into an audible format. Check it out.
Learning to Eye-Read
This is not to say that you should abandon attempts to help your child learn to eye-read. Of course there will need to be ongoing teaching using the Orton-Gillingham method. However, at the same time, ear-reading is also used and your child should be taught to master the technology that ultimately will be used throughout his or her academic career.
Hope you found this to be helpful. I'd love to read your comments; post them on my facebook page at: https://www.facebook.com/dr.johncarosso
God Bless
Written by Dr. John Carosso
God bless and enjoy the rest of the summer
Written by Dr. John Carosso, Psy.D.
I know it’s only April, but you and I both know that summer recess will be here before ya know it, so best to start planning and preparing now. There is lots to think about, and would hate to have you awaken that fateful day in early June with the incessant “I’m bored”, or loud screaming that typically accompanies siblings being home together all day. Oh, the joys of summer.
I know it may sound a bit OCD-ish, but a very effective way to plan for the summer, and to get every drop of fun you can, is to get a calendar and plan the entire summer week-by-week, if not day-by-day. You may have some day and week-long camps that you can easily plug-in; the annual summer vacation to the beach or Disney, your kid’s sporting events, the trip to Aunt Rhoda’s… Once you have those regular events scheduled, you can start getting creative. Oh, by the way, if your child has special needs, contact the Park (Disney…) ahead of time to request a pass to avoid long wait-times.
Yea, creative. I’ll bet your family has a bucket-list of fun and ‘different’ things you all would like to do, but haven’t. Often, we don’t do fun things because we don’t plan for them. So, plan for them and get that small flower garden planted, bake some cookies, go camping in the backyard, go on that day-trip to Gettysburg, project a movie on your garage door and have a homemade drive-in, do some star-gazing, start an annual neighborhood kickball tournament and, of course, can’t forget about getting a net (not a wiffle bat) and catching lightening bugs.
You may include some things in the summer agenda that aren’t necessarily fun, but are definitely worthwhile. Summer is an excellent time to get your kids boned-up on things such as math, writing skills, or reading. In fact, if your child has special education services, talk to the Principal now about whether your child qualifies for Extended School Year (ESY). Also, teach the kiddos how to do various chores around the house (how to wash the family car…) or do a family project such as cleaning out that garage. In fact, sometimes those ‘chores’, if done as a family, can be quite a bonding experience especially when the final outcome (a really clean and organized garage) is achieved by everyone’s hard work. If your child is on the spectrum, the summer can be a time you may be a bit more indulgent in your child’s obsessive interests (sharks, star wars…) but only after nonpreferred is done, and don’t overindulge. Also, in the same vein, there can be a tendency to isolate and avoid social encounters; be sure to incorporate supervised social encounters into the calendar, and you may find it helpful to plan trips to the zoo, local library, autism-friendly theatre, and bookstore. Also, don’t forget, for all kiddos, daily running around and lots of physical activity.
Babysitters and childcare tends to get filled-up pretty quick, so don’t delay in connecting with that local teenager who does a great job with your kids, or that daycare provider who comes highly recommended by your friends. Reserve the spots and make deposits, based on that schedule mentioned earlier. Also, start now to reserve spots for summer camps; they fill-up very quickly. If your child has special needs and will be attending a therapeutic camp, call your child’s casemanager for an updated list of camps, and contact your child’s psychologist to obtain a current prescription. If you want to enroll your special needs child into a typical camp or activity, and believe he’ll need individualized attention, you may be able to obtain wraparound services (Therapeutic Staff Support) to provide such attention. Contact this psychologist to further discuss this option.
Summer is time for relaxation, being ‘laid back’, and being more flexible and free-flowing. However, too much of a good thing can be a bad thing. Maintaining some semblance of routine can be helpful, especially if it involves getting past the less favored tasks (chores, academics) to move-on to more fun, sun-filled activities. If your child has special needs, then maintaining a consistent routine is even more important. In fact, be sure he knows about the schedule, what to expect, and answer any questions ahead of time. A picture schedule is also advised.
I hate to write of the summer ending when it hasn’t even begun, but keep in mind the importance of getting more and more into a school routine as the summer comes to a close. The last week of summer should be very close to the school routine in terms of bedtime and wake-up.
1. Relationship, Relationship, and more Relationship.
If you don’t have a fun-loving and enjoyable relationship with your child, then you’re in for a really tough time. The goal is that your child wants to follow your directions, and wants a happy and harmonious home-life and, consequently, is more willing to comply.
2. A calm approach.
If you’re relying on emotion; yelling, fussing, and carrying-on to get your child to comply, then you’re undoubtedly frustrated and annoyed. Instead, no matter how you feel inside, stay calm and unemotional. Your child will perceive you as stronger, more ‘together’, and in-control, all of which will get his or her attention, in a good way.
3. Use as few words as possible.
Pestering will get you nowhere, except to feeling ineffectual and worn-out.
4. Rely on consequences, not pestering.
Instead of using lots of words, rely on firm and consistent consequences. I prefer time-out to the child’s room because it’s easy to implement, time-limited, and effective. However, loss of privilege is also a useful option.
5. Praise, then praise some more.
If you want to see more of something, lavishly praise it.
I hope you find these top 5 to be helpful for you as well. Okay, they’re not exactly “easy” but they can lead to a much easier time with your kids. I imagine you have questions about how to make them work; feel free to email me at jcarosso@cpcwecare.com, and don’t forget to check our helpful videos, which provide helpful insights into all these matters, at appletreeinstitute.com. See you next time.
