Written by Dr. John Carosso
To Believe or not to Believe?
We are deluged daily with research findings concerning everything from A-Z. The findings often come from prestigious journals and universities and from people with lots of letters after their names. However, can we trust the findings?
The Short Answer
No, we can’t.
The Long Answer
Oh, you’re looking for some elaboration. Well, there are problems on so many levels it’s tough to decide where to begin. If, by the grace of God, the research study actually used a sufficient sample size, an adequate research design, stringent statistical methods, and has been replicated (all of which not uncommonly is not the case), the subsequent headline touting the findings still may be misleading.
Examples?
You’d hurt your back picking-up all the articles and books chronicling flawed research. The less strenuous approach of any quick Google-search will demonstrate myriad studies targeting everything from vaccinations and autism, vitamin D and cancer, anti-depressants and depression/autism, climate-change analysis and global cooling from the 1970’s (remember being told we were all going to freeze to death?) and caffeine and Alzheimer’s that have proven inaccurate and/or misleading. Moreover, it seems that the more money and politics involved, the more invalid the research finding.
Recent investigation into this matter, from UCLA and Harvard, found that, for example, between 27% and 37% of the studies of various medications utilized outcome measures that were misleading. For example, the finding that a medication may prevent heart disease by 50% but also increases cancer deaths by the same percentage (guess with statistic was touted); or that a medication reduces risk of heart attack by 50% when, stated another way, the medication lowers risk from two-in-a-million to one-in-one-million (again, guess which statistic was head-lined).
Speaking of Media Hype
I subscribe to a number of listserv journal outlets that email well over a hundred research headlines per week in the mental health and medical arena. I’ve found many of the headlines misleading. Those same misleading headlines are touted all over the news media. When I’ve looked past the headlines to read the actual research article, almost always there are vital distinctions and discrepancies that are not included in the headline and neglected in the subsequent news article. Example: recent finding that mothers with diabetes are more likely to have a child with autism. The media often excluded the lack of statistical significance of that finding. I could provide countless examples of headlines that completely missed the boat.
What to do?
The following might help:
• Don’t rely on headlines; rather, read the actual research article (most are easy to find on-line).
• Look to see if it’s a one-time finding, or replicated.
• On a more technical level, you want to see large sample sizes, control groups, and randomized and double-blind assignment to groups.
• I don’t want to sound conspiratorial, but also consider the source of the research and remember that money and politics can be a corrupting influence.
A healthy Skepticism
There’s a difference between being cynical and skeptical; try for the latter. Don’t get lazy and don’t get caught-up in the hype.
Despite concerns, there are quality research findings that help immensely in our understanding of disorders and best-practices in treatment; you just have to look hard for them.
Please share your comments; I’d love to hear your opinion. God bless you in your quest for the truth.
Written by Dr. John Carosso
Water in the face, Tabasco sauce…
There have been some recent stories about parents and teachers using ‘aversive’ techniques to ‘punish’ autistic children for misbehavior. One boy was stuffed in a bag and another was squirted in the face with water. I’ve also heard stories of parents using Tabasco hot sauce on the tongue of a child. So, is this the way to go, or not so much?
The rationale?
Some time ago, aversive techniques, including mild electric shock, were thought to be quite useful and appropriate. In some respects, practitioners found that, for example, shocking a person for a particular behavior can, in fact, actually stop that behavior (no kidding); but at what cost? The child or individual becomes angry, fearful, and the behavior can resurface when the aversive stimuli is removed given there has been no training of a substitute behavior or coping strategy. In more recent times, we’ve become a bit more civilized (arguably) and ethics panels have justifiably frowned on such strategies.
Taking the easy way out…
Despite our newfound civility, the temptation to “shock” raises its ugly head every now and then; heck, it sure is easier to squirt a child in the face rather than take the time to think-through the function of the behavior, precipitating triggers, ways to effectively redirect the behavior, teach replacement (substitute) behaviors, experiment with different approaches for a period of time, collect data, analyze the results, and ultimately determine an effective game-plan.
No choice?
Now-a-days, practitioners sometimes use aversive techniques as a last-resort to avoid self-injurious behavior when there has been no response to other strategies. It would seem that stopping a child from permanently self-injuring would appear to be a compelling justification.
A reflection of mental laziness?
Except in the most extreme of circumstances, I would argue that the reliance on aversive techniques reflects a clinician’s lack of gumption to ‘think through’ the problem, be creative, think outside the box, and develop an effective treatment protocol relying primarily on the use of reinforcement. Moreover, to a lesser extent, I would suggest the same for ‘punishment’ including time-out and loss of privilege though both of these strategies can be quite effective and definitely have their place in any discipline approach. However, the reliance on “punishment” tends to be counterproductive; more often than not, no one wins. If the misbehavior is actually reduced, such is accomplished with the child’s accompanying ‘bad attitude’, negative feeling, and a potential fracture in the parent-child relationship, especially if the punishment is frequent.
Seek help:
If you’re stuck in a rut of relying heavily on using punishment (child is in time-out all day, frequently screaming and yelling at your child), and even considering anything aversive (Tabasco sauce on the tongue, soap in the mouth, spanking…), then drop me an email (jcarosso@cpcwecare.com) or Comment here at the Blog and request some help or email me at jcarosso@cpcwecare.com. Believe me, there is a better way. Parents often need some assistance to game-plan, but it’s time well-spent. Don’t be bashful, contact me for some guidance. God bless you and your kiddos.
Written by Dr. John Carosso
Tragedy happens: what can we say?
Whether it’s a school shooting, car crash, natural disaster, or a natural death of a loved one, we must regularly face the pain of tragedy and loss. I am often asked by parents how they can relieve the pain and fear experienced by their child. That’s a tough question; there is no way to completely alleviate pain, worry, and suffering from this life, but there are ways to help. Here it goes.
Time heals all wounds?
It may be true that time heals, but there are ways to help and speed-along the healing process, increase resiliency, and put things into perspective to promote acceptance of hardships. It makes a difference if a child is fearful of a tragedy they see on TV, or if they are directly experiencing the event. We’ll touch on both here in this post.
Worriers
I often work with kiddos who struggle with “what if’s” and fears that the worst will occur (someone will break into the house, a tornado will strike, the house will burn down, Mom or Dad will die…) and usually these fears are exacerbated by some recent tragedy witnessed on TV. Children who have a history of worry and anxiety are obviously more vulnerable to such fears (may be best to turn-off the TV).
Bolster the ‘Truth’ Army
We use the ‘truth’ to manage this problem; plain and simple. We’re honest with kids that bad things happen at times, and that there could be a robbery, or a tornado, or fire. However, the truth of the matter is that the likelihood is, generally speaking, remote. Other reassurances include that Mom and Dad are sleeping right down the hall, they are both healthy and show no signs of illness, we have an alarm and locks on the doors, there has not been a tornado around here in the past 50 years, we live in a relatively safe neighborhood, we’ve never been robbed (given these things are true)… During the countess encounters I’ve had with worrying kiddos, I’ve often found them to be ill-prepared to counter worries with such truthful and reassuring thoughts. So, we need to bolster the ‘army’ of reassuring self-talk through reminders, postings on the wall, and journaling, all of which invariably has a calming effect.
What else is there?
Children are remarkably perceptive to life events and realities. On many occasions young children have explained to me a recognition, on varying levels, that life is difficult and loss is to be expected, and there must be something more. To help children deal with loss, clinically, we’ve found that children experiencing loss need lots of extra attention, empathy, reassurance that their needs will be met, ongoing consistency and predictability in their environment (to the extent possible), patience, extra love, and adults who are emotionally strong and ‘keeping it together’. From a spiritual perspective, I have found the Judeo-Christian perspective quite helpful, which explains, in no uncertain terms: we live in a fallen world where bad things happen; we try to make the world a better place by showing God’s love; this world is not where we belong, this is not our home – we’re just passing through on our way to a better place; we will go through bad times; God will help us through the bad times; we all will die someday; and we have hope of all meeting together again in Heaven. This reality does not take away the pain, but helps kids (and adults) to recognize the realities of life, and squelch the destructive mentality of “why me” or “why did this happen”.
What not to say?
I’ve read that we should not tell kids who have experienced a loss of a loved one that, for example, “Grandpap is in a better place.” Well, I’m not sure we shouldn’t say that. It depends on lots of factors, but I think that we all take comfort believing our deceased loved ones are in a “better place” awaiting our arrival. This has been helpful for me, how about you? Of course, we also need to provide the reassurance I suggested above, both in what we do and say. People deal with loss in different ways; the goal is that we demonstrate resiliency, after a time of mourning, by ‘keeping on’ with life and finding joy where you can.
Now what?
There are no magic words to help a person heal. It’s a matter of listening, empathizing, at times being quiet and ‘just being there’, providing comfort and affection, and reminding that you’ll all be working together to move on with life, no matter how hard it may seem at the time.
I hope you found this to be somewhat helpful. I’d love to hear what has worked for you in managing your child’s fears or loss. Feel free to Comment here, or email me at jcarosso@cpcwecare.com. God bless you.
Written by Dr. Carosso
Is it good to talk to yourself?
Sure it is. In fact, this is how we, as humans, problem-solve and work through our difficulties. We learn, beginning at a young age, how to ‘talk things through’ in our head, which helps us to process our feelings, experiment with potential problem-solving strategies, and rehearse resolutions.
Go on, let it out
How often have we heard young children ‘talking out loud’ in their play, or when working through some difficulty? In fact, as adults we not uncommonly do the same thing, but are more discreet about it (you know what I mean; talking out loud while driving home from work and hoping other drivers don’t think you’re strange). However, it’s not until about seven year old that children begin thinking more in words, quietly in their head, as opposed to out-loud and in pictures, the former of which tends to be more efficient and effective.
What’s this got to do with autism?
As we know, children with autism struggle with expressive language. Children who struggle with talking to others also struggle with talking to themselves. In fact, a recent study out of Durham University (Development and Psychopathology, January 26, 2012) found that 2/3 of children with autism experience significant difficulty with self-talk, even if they had some level of expressive language capacity.
Lets talk this out
So, what do we do about this skill deficit? Well, for starters we take every opportunity, in the presence of children with autism, to ‘talk out’ our thoughts as we plan our day and problem-solve, and we give children the words to problem-solve on their own. We do so as simply as possible, using as few words as possible depending on the age and language skill-level of the child.
Younger the better
To help young children and those with more severely compromised language, we use visual cues and schedules with actual pictures of the child or item. However, it’s important to transition, over time, to symbols, then symbols with written words, then only written words with speech, we then rely solely on speech; all of which builds the foundation toward inner speech.
20 Questions
This process is no game, but you’ll present it that way. We build foundations of self-talk by asking questions, during games and activities, which promote planning and ‘thinking things through’. Such as: “what can you do with that puzzle piece?” “What will you need next to finish the puzzle” “Where can you find that piece?” “What will happen after you’re done? Sometimes the questions can be posed to direclty promote self-talk, “I wonder what will happen next if you do that…?”
Turning action into words
The approach I find to be invaluable is ‘parallel talk’ that involves playing alongside a child and talking through what he or she is playing (putting actions into words, which is exactly what we want the child doing to plan and problem-solve). This is also helpful to enhance play skills.
Summing it all up
It is vital that children are able to utilize ‘self-talk’ to plan and problem-solve; it’s a skill that all children need to master but is usually quite deficient in children with autism. These strategies can help to increase your child’s ability to ‘talk to themselves’ and thereby more effectively plan and problem-solve.
Questions?
Please comment, or Email me with any comments or questions at jcarosso@cpcwecare.com or DoctorC@AutismCenterofPittsburgh.com. Your feedback and individual experiences are welcomed and will be invaluable to share with others. Thanks again and God bless.
Written by Dr. John Carosso
Proud to Announce:
I am very pleased to announce that I’ve taken-on the role of Director of the nonprofit Autism Center of Pittsburgh (ACP). Of course, I’ll be continuing at Community Psychiatric Centers, with Dr. Lowenstein, conducting evaluations, providing consultation, and overseeing clinical matters.
Thrilled to be part of the ACP team:
I could not pass up this opportunity to be a part of such a dynamic and altruistic Center. ACP has been around for ten years, founded by Cindy Waeltermann, who fortunately is staying on-board and we’ll be working together to continue providing support to children with autism and their families. ACP also has Becca and Kris answering the always-ringing telephones and responding to parent's questions as well as managing the on-line store full of practical and enticing items. Initial and re-evaluations continue to take place for autism assessments, and ACP also touts a 900 member on-line chat room where parents provide support to one another. ACP has proudly provided service dogs, sponsored conferences, Holiday parties, and provided respite opportunities for parents, and there’s more to come.
Check it out:
Come visit ACP at autismcenterofpittsburgh.com and autismlink.com the latter of which is a national database for autism services. Join the listserv at AutismLink and receive autism-related updates and pertinent news. Don’t forget to check-out the ACP store as well.
Join ACP’s support network:
I hope you’ll consider supporting ACP; we accept on-line donations and would appreciate your generousity; I trust you’ll join us in upcoming fundraisers. We'll keep you informed. Also, all proceeds from the store support children with autism.
Keep us in your thoughts and prayers:
We appreciate any ideas you may have to improve autism services, and welcome input about unmet needs for your child. Please let us know if there is something missing in your child’s treatment regimen, maybe we can help or develop a service program to close the gap. Feel free to email me directly at DoctorC@AutismCenterofPittsburgh.com. Finally, and most importantly, please keep ACP in your prayers; we feel privileged to do God’s work through this nonprofit effort, and need a daily boost of wisdom and discernment. Thanks again and God bless.
Written by Dr. Carosso
No Drama Outings:
As many of you are too well aware, taking your kids out to the store, or restaurant, can be as adventure-packed as any Indiana Jones movie. However, those are occasions you’d rather do without the drama.
Get some help:
If you want some help to improve your child’s behavior during outings, just go cpcwecare.com, click on Parent Resources, and you’ll find a downloadable packet that provides dozens of tips and suggestions to help improve your child’s public behavior. While you’re there, you’ll also see a bunch of other free and downloadable packets and e-pamphlets targeting childhood:
-Autism
-ADHD
-Mood problems
-Dietary considerations
-Toilet training
-Attachment Disorder and the Traumatized Child
-Encopresis (may not want to read that one before a meal)
-Helping the over-indulged child (I’ll need that for my kids)
-Dyslexia, and more.
Hope you find the packets and e-pamphlets to be helpful. Feel free to refer a friend. Please let me know of any other topics you want covered. God Bless.
Written by Dr. Carosso
The Diagnostic and Statistical Manual is the primary manual psychologists use to diagnose. The upcoming Fifth Edition will have some significant revisions to how autism is diagnosed, and I’m hearing concerns from parents that this could effect insurance reimbursement and services.
Well, there are some significant changes; gone are the current diagnoses such as Autistic Disorder, PDDNOS, and Asperger’s. Instead, the more global term “Autism Spectrum Disorder” is used, but the specific diagnostic criteria, and qualifiers, seem to be quite explicit and appear to cover the necessary bases. Severity criteria is also forthcoming to help differentiate between the former diagnoses. Some might say the upcoming diagnostic criterion is more user-friendly and specific. Of course, between now and release in May 2013, some things could change, but have a look for yourself:
Autism Spectrum Disorder
Must meet criteria A, B, C, and D:
A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:
1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,
2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people
B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:
1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).
3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).
C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
D. Symptoms together limit and impair everyday functioning.
I'll keep you informed of any other changes but, in the meantime, I hope this helps to squelch some fears. We’ll look at this further as the release date nears.
Please feel free to comment or ask any questions.
God bless.
Hair-loss prevention
The behavior of children with attention deficit and hyperactivity can cause parents to pull out their hair. So, before you become bald, which clearly would add insult to injury, you may want some pointers. Fortunately, I have an approach to treating hyperactive kids that might save what’s left of your hair.
I love you just the way you are!
Remind yourself to love your child the way he or she is. Accept that your child is more active and easily distracted than most, and subsequently needs more attention, guidance, support, and love. Nevertheless, there are some specific things you can do to help.
Softer and closer yet again
First, the ‘softer and closer’ approach is vital (see my earlier post by that name). Hyperactive kids need individual attention, close proximity with eye contact, speaking firmly but softly, and to be taken by the hand and walked-through through their responsibilities including chores. I’ll be describing some specific strategies to promote independence but, no matter, for the time being, don’t expect your child to go upstairs, brush his teeth, put on his pj’s, clean-up after himself, and come downstairs without you repeating step-by-step directions and providing ample oversight. Your individualized attention is invaluable and vital. Enjoy this time of bonding. Don’t become frustrated but, rather, enjoy the opportunities to spend extra time with your child, helping him to complete daily tasks and to make good decisions. Keep in mind that there will be a day when he’ll be out of the home and, believe it or not, you’ll miss this time. In the meantime, in trying to promote independence, here ya go:
Top-Tips:
1.) keep the daily schedule and expectations as routine and consistent as possible. Your child will carry-out tasks easier if the responsibilities are completed at the same time, done the same way, and in the same manner on a daily basis; no guesswork.
2.) Use schedules, both written and visual; such cues are invaluable as reminders of ‘what to do next’ and can include, for example, to ‘turn out the light’ either in writing or a picture of your child turning out the light.
3.) Get eye contact, give direction in short phrases, and ask child to repeat the direction before beginning.
4.) Allow opportunities for ‘blowing off steam’ (ample time to run outside…). Provide vigorous exercise prior to expecting prolonged seat-work such as homework.
5.) Keep the homework area quiet, distraction-free, well-organized, and allow breaks as needed (complete one page, take a break...). Ironically, some children perform homework better with some background music.
6.) One more tip (here's a bonus tip); don’t forget behavior charts!! For example, child completes homework and gets a sticker that can be ‘cashed-in’ later that evening to watch his favorite show. Kids love it and it's increased motivation to stay on task.
These strategies can be faded as your child uses more mature coping strategies and becomes increasingly independent. Follow these steps, see the difference, and keep the hair on your head. Now, go and get softer and closer with your kids.
For more information on understanding and managing ADHD, request our new E-Pamphlet: Facts and Fallacies about ADHD. Request in the 'Comment' section of this blog, or email me at jcarosso@cpcwecare.com and I’ll get you the pamphlet pronto. God bless and Merry Christmas.
Written by Dr. Carosso
It’s not uncommon that kids may become overly emotional, even tantrummatic at times. Parents typically ignore such behavior and send the child to their room to calm, which can be an effective and appropriate strategy.
To isolate or not to isolate?
For kids who show more severe emotion, banishing to the room may not be entirely effective. In some cases the child, in their room, may become destructive or self-injurious. Moreover, sometimes these kiddos refuse to go to their room, leaving parents in a quandary.
What to do?
Here is a ten-tip prescription for success:
Remain Calm
Do not lose your cool, raise your voice, or become overly emotional, it only worsens the situation. Two out-of- control people certainly doesn't help. Rely on the softer and closer approach espoused and explained by me in a prior post (see ‘the softer and closer approach’).
Pick your Battles Carefully
Some battles simply aren't worth it. You may have to decide whether your child picking-up their toys is worth a three hour battle that may ensue.
Accessing Antecedents
It’s often possible to predict emotionally volatile situations before they occur. If the problem can be predicted, it can often be avoided. For example, if your child tends to tantrum soon after returning home from school in response to contact with a sibling; you may keep the two apart for 30 minutes after the return from school, and provide a structured routine of after-school activities to slowly bring them back together on your terms, not theirs.
The Struggle for Power
Some kids are especially strong-willed and looking for a fight. If you butt heads, you may win the battle but find yourself losing the war if your home is turning into a battle-zone. Instead, avoid power-struggles by providing choices, using humor, starting the chore with your child, making a race of the chore (who can get done faster…), using hand-over-hand, utilizing the softer-and-closer approach, tag-teaming with your spouse (take a break and let your spouse intervene), reminding of good consequences for compliance, walking away and dealing with it later, giving a choice between a quick ten-minute time-out or losing TV for the rest of the night, and a host of other options. The larger your tool box is, the better-prepared you will be.
The safety zone
It’s sometimes necessary to turn the child’s bedroom in a safe and secure place for your child to calm. Otherwise, parents may find themselves restraining their child for extended periods of time, which often leads to someone getting hurt. If you find yourself in this situation, contact this psychologist, for guidance, at jcarosso@cpcwecare.com.
The Beauty of Behavior Charts
Yes, sticker charts can be a pain, but they sure can provide children with extra motivation to control themselves. When they don’t work it’s often because they’re being used incorrectly. It can be more complicated than people think to figure-out how often, how much, and for what should stickers and rewards be given. For example, it’s all for naught if you give a 4 year-old stickers once per day, and extra rewards once per week (a four year-old often needs reinforcement far more frequently). I’ve found it best that parents seek professional guidance to devise a chart but, in the meantime, see my earlier post explaining behavior charts.
The Medication Malady
Parents are usually hesitant to consider medication. However, many children who struggle with more extreme emotion respond very favorably to various medications. In more severe situations, it may be wise to consider seeing a psychiatrist and such can be arranged with Dr. Lowenstein here at CPC.
What About Autism?
Many of these strategies also pertain to children with autism. However, we would also want to target sensory issues, language difficulties, and socialization deficits that can quickly lead to heightened emotion. It’s vital that we avoid sensory overload, find ways for children with autism to communicate their needs and wants, and avoid social situations that we know will likely contribute to frustration. I’ll write a separate post on managing meltdowns for children who have autism.
The Spiritual Connection
Get your child involved in activities that enhance spiritual development (church services, Sunday School, Children’s Ministries, Youth Group, Retreats, listening to KLOVE (98.3FM), playing with Spiritually-Minded friends…). It is comforting to be reminded that God loves, cares, is a protector, comforter, helper during times of frustration, and that He's only a prayer away (see my prior post, "the argument squelcher").
Praise without Ceasing
Always be on the look-out for good behavior, self-control, and cooperation. Praise whatever you want to see more of. Don’t miss an opportunity to praise your child for handling a situation without excess emotion, or for calming-down quicker than usual. Big hugs, high-fives, a big smile, and words of praise go a long way to increase your child’s motivation for next time.
I hope you find this post to be helpful in your effort to calm and comfort your child. If you want some more guidance in dealing with your kiddo’s emotional issues, don’t hesitate to email me at jcarosso@cpcwcare.com. In the meantime, God bless.
