Written by Dr. John Carosso
The Essential Ingredients
-Start with a fun-loving, intelligent, inquisitive child who wants nothing more than to please his or her parents.
-Add-in a demanding, critical parent.
-Keep adding the parental demands and expectations.
-Add only a pinch of some subdued praise, and praise only for the highest of achievements.
-Add a few hundred cups of ‘you should have done better’ no matter the accomplishment.
-Add a few hundred more cups of admonishment, even when the child achieves.
-Add modeling of a workaholic lifestyle, achievement at all cost, and no room or tolerance for failure.
-Stir-in a perspective that everything is a competition.
-If someone complains this combination of ingredients is bitter, add a rationalization that “it’s the only way my child is going to become somebody” and “they’ll thank me some day for this…”
-Add a dash or two of parent being emotionally detached, especially for any positive interactions.
-Mix these ingredients together for fifteen years, beginning at a very young age, and try to keep ingredients from boiling over (won’t be easy).
Viola
Just like that, you’ll serve-up a completely neurotic, anxious, panicked, overwhelmed teenager who must earn straight A’s or it’s ‘the end of the world’; not only has to be in every club and sport but must be the captain of the team and president of the club; and does not know how to relax or calm themselves. You’ll have a teenager who ends-up in my office, experiencing panic attacks, feeling depressed, having trouble with friends because everything is an Olympic-style competition, and feeling that no matter what they do, no matter how much they achieve, that it’s simply not good enough; a feeling that will haunt them their entire lives.
If this sounds too familiar; if you think it’s time to change your order and put-out a new menu, contact me at jcarosso@cpcwecare.com
God bless
Written by Dr. John Carosso
Nothing to fear…?
Y’ know, Franklin Delano Roosevelt may have been on to something. You see, anxiety is considered to be based in fear and, more often than not, there really is nothing to fear but the fear itself. Anxiety can manifest in worry, obsession, irrational fears (phobias), compulsive behavior, school avoidance, fear of sleeping alone, and social withdrawal. Anxiety disorders can stand alone, but often accompany depression, autism, bipolar, and trauma.
Not sure I understand the ‘nothing to fear’ part?
Yea, I suppose that can be somewhat confusing. The idea is that anxiety is the great con artist; it cons people into believing that something is legitimately worrisome when it’s really not. Of course, sometimes we’re worried about real-life and legitimate issues, but far more often that’s not the case when it comes to phobias, OCD, and similar types of fears. Rather, I see children like the two I saw last week, washing their hands over and over for fear of germs, or checking locks before bed, over and over, for fear of being robbed despite living in a safe neighborhood, the doors clearly being locked, no history of being robbed, parents being dutiful and responsible, and having two big dogs in the home. Most fears of that nature are, by their very nature, irrational, silly, and nonsensical but, by the same token, profoundly troubling and bothersome.
Okay, so what’s the treatment
Like I said (okay, like F.D.R. said), there’s nothing to fear but fear itself; so, first we clearly identify the enemy. I often refer to anxiety as a ‘monster’ that whispers to the child any number of anxiety-provoking things. In treatment, we help the child to bolster their reasonable and rationale thinking to help them combat those anxiety-ridden thoughts. This is especially important because children (and adults too for that matter) who struggle with anxiety often have ill-equipped platoons to do battle. Meanwhile, the ‘monster’ is well supplied with an abundance of anxiety-provoking thoughts that can leave the child feeling overwhelmed. However, by the time we’re finished in treatment, the child’s army is fully prepared to counter those anxiety-provoking thoughts with self-soothing reminders that, for example, they’re safe, competent to problem-solve, and that whatever bad thing they think is going to happen, in reality, is extraordinarily unlikely to occur and not worth fussing about.
Anything else?
Yes, there is more. In some cases, it’s also vital to have the child actually be exposed to whatever scares them. This could include, for example, a spider, elevator, sleeping alone in their own bed, dirt (and not washing their hands right away), or whatever else. The exposure may be all-at-once, or gradual. At the same time, they are taught to use soothing self-talk to calm themselves and recognize that they’re going to be okay and that, really, there is nothing to fear. We also use deep breathing, imagery, reassurance, and ongoing parental support to ensure success. In those instances that the child is too overwhelmed with anxiety to allow for any exposure, there are medications that can be quite helpful.
Is this approach helpful?
Yes, it’s super helpful, with over 80% success rates. It’s used with phobias, OCD, generalized anxiety, isolated obsessions and worries, separation anxiety, fears of sleeping alone, social anxieties including public speaking, and frankly anything related to any anxiety or fear. If you’re interested in more technical terminology, the approach is referred to as exposure and response prevention.
If you want more information about these techniques, email me at: jcarosso@cpcwecare.com
Also, don’t forget to follow me on facebook (drjohncarosso) and twitter (drcarosso) for daily tips, suggestions, and research. God bless.
Written by Dr. John Carosso
Gotta like Tim McGraw
All of you Tim McGraw fans know his song, Drugs or Jesus, where he sings:
In my home town
For anyone who sticks around
You’re either lost or you’re found
There’s not much in between
In my home town
Everything’s still black and white
It’s a long way from wrong to right
From Sunday morning to Saturday night
Is it as simple as that?
Well, people in Tim’s home town seem to think so.
C’mon, isn’t that rigid and narrow-minded?
I suppose that’s up to you to decide. However, ask yourself; is morality synonymous with basic ‘truths’ or facts like math; or is it bendable according to our preferences, like whether today I prefer vanilla ice cream?
What’s better for our kids?
Children respond much better when presented with straight-forward ‘right and wrong’ morality. Gray is not good for morality, or our kids. There are plenty of research studies to support this notion, most recent out of the Journal of Experimental Social Psychology, conducted by researchers out of Boston College. They found that when approached with the idea of morality as fact, as opposed to being flexible, increased moral behavior followed.
But kids will do bad things anyway
Some may, but we underestimate the fortitude and will-power of kids and teens to resist ‘bad’ options. If presented, from a young age, with the notion that particular behaviors are simply ‘wrong’, and if provided with oversight to help them be strong, you’d be surprised how well they’ll do. Of course, it’s important for parents to demonstrate that same fortitude.
Well, I did that when I was a teenager, so how can I tell my teen not to do it?
I imagine we’ve all done things that were mistakes and ‘wrong’, especially when we were younger. Now that we know better, do we want our kids repeating our past mistakes?
But who decides what’s right and wrong?
Yes, that is the 64,000-dollar question, isn’t it? Children pick-up quite early that relying on our own judgment opens the question; 'who says you’re right and I’m wrong'? It also opens the door to the ‘might makes right’ quandary. However, children seem to intuitively acknowledge and accept the logic and rationale that what’s ‘right and wrong’ is best left to the auspices of someone higher and wiser than mere humans.
Is that all?
Yea, pretty much; morality and wisdom have a simplicity that is very appealing and stark, like Tim’ McGraw’s lyric, “it’s a long way from wrong to right”. So now, as Dr. Laura used to say, go do the right thing.
God Bless
Written by Dr. John Carosso
Been saying for years...
I’ve been espousing for years that children with mild autism can demonstrate substantial progress and, in a few years, no longer meet diagnostic criteria for the diagnosis.
Now some back-up
New research findings in the Journal of Child Psychology and Psychiatry looked at 34 children who were diagnosed with autism but later in life functioned as well as their neuro-typical age-mates.
Inaccurate initial diagnosis?
Nope; the researchers found that, in fact, the initial autism diagnosis was accurate.
Common occurrence?
Entirely losing the diagnosis may not be commonplace, but it’s more common than some practitioners believe, and more common than parents are typically told. In fact, a 2007 study in the Journal of Autism and Developmental Disorders also found that symptoms of autism tend to improve over time. The reasons why some children’s symptoms subside is not entirely clear. It would seem that early intervention is vital, as well as treatment that is intensive, comprehensive, and implemented by competent practitioners. However, ultimately, as was explained by Dr. Insel, the Director of the National Institute of Mental Health, which funded the study, “Although the diagnosis of autism is not usually lost over time, the findings suggest that there is a very wide range of possible outcomes.” That reality, and hope, is what I, and the parents with whom I work, hang our hats on.
My experience
I too have found kiddos with mild signs of autism respond very favorably to treatment and can be indistinguishable from age-mates after a few years. Moreover, even in the case of more severe symptoms, ongoing progress is the norm and justifies intensive support and treatment.
Keep on fighting for your child’s treatment, and expect progress
Given all these realities and factors, it’s vital to never give-up the fight against those entities that interfere with children receiving all they need to reach their fullest potential. Fight to keep your child’s services; ensure your child’s treatment staff is experienced and competent, and keep an open mind to alternative treatment options. Feel free to contact me at jcarosso@cpcwecare.com to review your child’s treatment and to ask any subsequent questions. I hope you found this post to be helpful and heartening. God bless.
Written by Dr. John Carosso
Get them talking, not hitting
When hearing of toddlers and preschoolers becoming aggressive, the first question I ask is usually related to language; how well can the child communicate his or her frustration? It stands to reason that a child who has difficulty ‘using his words’ is more prone to hit or shove.
Recent Research
A new longitudinal study out of Pennsylvania State University found that children who had better language skills as toddlers expressed less anger by age 4; and were better-able to occupy themselves.
So what?
Treatment focus for aggressive toddlers and preschoolers needs to focus on improving communication skills. If your child is struggling with language and at times is also aggressive, ramp-up the speech/language sessions to both Private and County-based. Also, work with your behavioral–health staff at Community Psychiatric to utilize reminders, visual prompts, picture-cues, short-phrases, visual schedules, and star charts to facilitate communication and subsequent problem-solving. We've consistently seen excellent response to such an approach.
Don't hesitate to ask for help
Email me at jcarosso@cpcwecare.com or call the office at 1-877-899-6500. Also, for daily tips and suggestions, follow me on Facebook and Twitter!!
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, 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 1-877-899-6500. 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.
Written by Dr. Carosso
New Years Tradition
It’s a time-honored tradition to stay awake on New Year’s Eve to welcome the new year. However, now that New Years is over, it’s time to get our kids to sleep on-time, and ensure they stay asleep.
A Common Problem
Wish getting to sleep were that easy. Sleep issues are amazingly common for kiddo’s and adults alike; upwards of 40 million struggle with poor sleep, and it’s especially common for children with autism. The cause is often unknown; we often simply don’t know why some children can’t get to sleep, or stay asleep. Of course, at times we can pin-point triggers such as too much stimulation at bedtime, various anxieties, napping during the day, some children fighting sleep, or low melatonin levels. However, often the reason evades us.
The unlikely culprit, especially for kids
Sleep apnea affects upwards of 18 million people; mostly overweight men. In fact, we often associate sleep apnea with obesity. However, most people don’t know sleep disordered breathing is relatively common in children, and it has nothing to do with their weight. For example, in a recent study published in the European Journal of Pediatrics, it was found that upwards of 10% of all six year-olds have sleep-disordered breathing due to enlarged tonsils, crossbite, and convex facial profile.
Symptoms
Signs of disordered breathing range between mild snoring to obstructive sleep apnea syndrome. Interestingly, these difficulties can impact day-time behavior and contribute to hyperactivity, behavioral and learning problems, and compromised growth.
Get it checked-out
So, what’s the bottom line? If your child is having trouble with sleep, definitely have him or her checked for any facial, bite, or throat-related problems. Once that’s ruled out, then you can pursue behavioral strategies and/or over-the-counter remedies.
Pleasant dreams, and Happy New Year!!
Written by Dr. John Carosso
Recent events and speculation
The recent events in Connecticut are abhorrent and troubling beyond words. Our thoughts and prayers go out to the parents, families, and all those affected.
This incident is also raising speculation and fears that people with autism, or more specifically Asperger’s Disorder, are more likely to be considered dangerous or violent. Of course, we don't know the condition or diagnosis of the perpetrator; nevertheless, let’s begin now to squelch such foolish speculation.
Is it true that people with autism are more prone toward violent crime?
Short answer: NO
Let’s spell it out
A number of researchers including Hippler et al (2009) have found that rates of violent crime committed by individuals with Autism and Asperger’s Disorder is quite comparable to the population at large, i.e. 1.30% compared to 1.25% of the male population, respectively. Moreover, the bulk of the “violent” crimes committed by those with Autism were related to property offenses. Violence against people was found to be exceedingly rare.
Hippler points out, for example:
“…in the case records spanning 22 years and 33 convictions, there were only three cases of bodily injury, one case of robbery and one case of violent and threatening behavior.”
The researchers have also found that the more severe the autism, the less likely to commit a violent crime.
Who hurts who?
Given the inherent communication and social deficits, individuals with autism may be more prone to shout-out or shove others in frustration, but violence with intent to harm is very rare. In fact, it’s abundantly clear that people with autism are far more likely to be the victim of various forms of crime, abuse, bullying, and mistreatment than they would ever perpetrate on others.
Let’s Wait for Facts
We’ll see how this story unfolds. Either way, it’s obvious the Connecticut perpetrator was extraordinarily disturbed; in no way should we cast aspersions on an entire group of individuals based on happenstance. Now, please help others to understand that people with autism need our support and compassion; in no way are they to be feared, maligned, or stereotyped.
Written by: Dr. John Carosso
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
First, what is it, and what’s with the name?
Pica is an unusual compulsion to eat nonfood items. It goes beyond ‘mouthing’ objects to actually swallowing; most common items include dirt, clay, paint chips, chalk, baking soda, feces, hair, glue, toothpaste , and soap. However, the list of potential items is endless. The condition most often occurs in two to three year old children with developmental delays, autism, people with epilepsy, pregnant women, and those with brain injuries. The condition must persist for more than a month to be diagnosable. The name is Latin from the Magpie, that bird with an indiscriminate appetite.
What causes it?
Some suggest that the child or individual is attempting to compensate for lacking minerals, but this is inconclusive and, besides, the ingested substance does not always contain that lacking mineral. The condition may also carry-over from the developmentally appropriate tendency to mouth objects. There are also secondary gains that may sustain the behavior (attention-seeking or avoidance of an unfavored task) but these likely do not originally cause the disorder but can be helpful to consider in treatment. Pica is also being considered as a complexity within the spectrum of Obsessive-Compulsive Disorder, and there are also sensory factors that have been implicated. Moreover, ingesting nonfood items is also a cultural practice in some regions.
Is it common?
Yes, it’s surprisingly common. Among mentally and developmentally disabled people, especially those ages 10 to 20, pica is the most common eating disorder and is found in 20 percent of children treated at mental health clinics. Between ages one and six, this non-food craving disorder can be found at rates of 10-20%. The exact rate for children with autism is unclear but studies of mentally challenged adults found rates of upwards of 25%. In developing countries, the rates can be as high as 74% for pregnant women. The condition dates back to Roman times but was not clinically chronicled till 1563.
What do we do about it?
The treatment depends on whatever identifiable cause can be ascertained. We first screen for any mineral deficiencies and accommodate accordingly. Treatment protocols also assess for any toxic levels. Behavioral interventions are considered through principles of applied behavioral analysis (ABA) to determine triggers and anything potentially reinforcing. For example, if the behavior is sustained via the inadvertent provision of extra attention, or by enabling avoidance a non-preferred task, we treat by providing minimal attention and ensuring that the child cannot avoid the task. The youngster is also highly reinforced for appropriate food choices, and sensory issues are targeted by finding similar oral-sensory options. A “Pica Box” can also be helpful: a container of edible items for the child to mouth. Of course, during this process, close physical monitoring is vital to redirect the behavior. Various medications can be helpful, especially if the condition has an anxiety-related (OCDish) undertone. Aversive techniques have been used in more extreme situations but this obviously is absolute last resort.
Outcome?
Pica tends to wax and wane in severity, and subside as the child ages. However, once the condition surfaces, there is an increased chance it will resurface again later. Nevertheless, I’ve seen quite positive outcomes with behavioral approaches; keeping the condition in check and quite contained, if not extinguished entirely.
I hope that helps to understand the basics of Pica. By all means, contact me at jcarosso@cpcwecare.com with any questions or thoughts on the matter. God bless.
