Let’s look at the numbers.
The more current CDC autism prevalence estimates are for 8-year-old children across 11 monitoring sites in the Autism and Developmental Disabilities Monitoring (ADDM) Network.
The general explanation for the increase in autism rates over the past few decades is typically related to a number of factors. It's the same story told over and over. These factors include that practitioners are becoming more capable of diagnosing mild autism that would have been missed years ago. Moreover, children who were misdiagnosed years ago, such as with ADHD or intellectual deficiency, are now being accurately diagnosed with autism.
Another line of thinking is that rates of mild autism are increasing because mild autism would have been missed years ago (similar to what I mentioned above), but the rates of severe autism are about the same. However, that’s not accurate. Rates of autism are skyrocketing, and the rate of ‘profound’ autism is also increasing. In that respect, data shows that about one-quarter of children with autism have profound autism. I’m not so great with math, but one can cipher that if the rate of autism is increasing, so too is the rate of profound autism. Given that ¼ of the autistic population has profound autism and each year the targeted population size increases.
Is there any possible connection between the reason for increases in autism and similar increases in rates of ADHD, childhood allergies, general developmental disorders, and learning disorders among a slew of other childhood conditions? It’s even more disconcerting that the general health of our kids is progressively worsening.
I conduct autism evaluations numerous times daily. These children are delightful and endearing, and it’s expected that they will make substantial progress in their course of treatment. However, not uncommonly these precious kiddo’s are quite compromised and the parents are justifiably very worried and stressed. The road ahead for them is quite challenging, especially in the case of moderate to profound autism.
I recall how everyone was astounded 20 years ago at the 1/150 rate. At the time, it was headline news on a daily basis. I wish it could be explained how the rate is now 1/36 and this situation is not headlined daily as a national emergency and a number-one priority at the CDC. If you recall, it wasn’t so long ago that we shut down our society for over a year due to a condition that was not known to impact healthy children. Are the big guns like Autismspeaks running daily ads for us to call our government representatives to pressure the CDC to laser-focus on this issue? I don’t see this concern even being broached much these days in the national or local media.
A better question is what shouldn’t be investigated? Is there anything off-limits? There seems to be a focus on genetics, and that’s warranted, but how would genetics explain the increase? How about toxins in our environment, air, or water? Processed foods? Additives like high fructose corn syrup, aspartame, BHA and BHT, food colorings, MSG? All would seem to be worthy targets.
Sadly, there are some areas that are taboo and cannot be mentioned without being called a quack, so most practitioners and researchers don’t even go there. Of course, one taboo subject would include vaccinations. It’s difficult to get past the fact that, when I was a kid, there were like 8 vaccinations by 18 months of age (and what was the autism rate in the 1960s?), and now it’s over 60 vaccinations administered in dozens of shots by 18 months.
Whether or not those vaccinations are necessary or effective is irrelevant – I’m not suggesting you don't get your child vaccinated! But you have a right to know whether there is a potential negative impact. Isn't there a potential negative impact of every medication? However, we’re told unequivocally and emphatically that there are no ill effects from vaccinations.
Does that sound reasonable? You have a right to know if there is a way to reduce any conceivable potential negative impact. Possible things could include further spacing-out the administration schedule, or are there some vaccinations for illnesses that are so rare that the vaccination can be discarded? In this current climate, these are questions that can’t even be asked let alone explored. I wonder if these questions will be asked when the rate is 1 out of 20?
If I’m off-base or ill-informed, or you have a different perspective, feel free to email and correct me at DrCarosso@aol.com or respond to me on Facebook.
This is a fascinating and frequently–asked question. We often hear that autism and ADHD are both on the neuro-divergent spectrum and therefore have an inherent connection. However, after 35 years of seeing these conditions firsthand, I will tell you that while there are similarities in how the condition impacts children’s daily functioning, ASD and ADHD are clearly different and distinct.
When considering the core symptoms of the two conditions, the differences become clear. The core symptoms of ADHD are impulsivity, distractibility, and overactivity. The core symptoms of autism include persistent deficits in social communication social interactions, and restricted, repetitive patterns of behavior, interests, or activities.
In regards to the core symptoms, those with autism can be quite attentive and focused on their favorite activities. Moreover, children with ADHD are not obsessive or repetitive in their behaviors.
Autism and ADHD are similar in how they impact a child’s functioning in life. The conditions impact particular areas of life in the same way but for different reasons. For example, children with ADHD tend to be overbearing, super enthusiastic, “over-the-top”, and rambunctious. Their behavior may be seen as “too much” and therefore peers may shy away. Children with autism also have social difficulties but for different reasons. For example, a child with autism may struggle with social interactions because they talk incessantly about their favorite topic, or may stand too close, abruptly begin or end an interaction, or not understand how to navigate through a social encounter. The child with autism, however, often does not pick up on social cues and presents as somewhat socially peculiar and awkward. This is often not the case with children diagnosed with ADHD.
A child with ADHD obviously struggles with distractibility, which is the cardinal feature of the disorder. Children with ADHD often want to pay attention, are trying to pay attention, and have every intention of doing so. It is just really hard for them to do so.
However, a child with autism typically is preoccupied with some other internal stimuli such that they don’t pay attention because they simply want to focus on something else instead. They may be thinking about dinosaurs or trains, or have their own agenda - there’s no intent to disrespect, it’s just that they have their own agenda and tend to stick to it.
It’s quite clear that children with autism or ADHD tend to be more emotional than other kiddos - they both have a hard time controlling their reactions. However, again, the reasons tend to be different. Children with ADHD have difficulty with rejection and redirection, and simply have a hard time controlling their emotions. Keep in mind that ADHD is considered to be a disorder of executive functions, one of the executive functions is ‘emotional regulation’. We often see, with medication management, and the subsequent improvement of executive functions, that a child is more attentive, focused, and more emotionally under control.
Children with autism also tend to struggle with their emotions because of the inherent signs and symptoms of autism. In that respect, a child with autism tends to be quite rigid and has a strong need for sameness. When the routine is interrupted, the kiddo has a hard time and can become quite emotional. Children with autism often have their own agenda and have their own way of doing things - they marched to a different beat. Consequently, when redirected, there is a propensity for emotion because “they just don’t quite get it”. Consequently, as one might expect, the treatment process is quite different between these two conditions.
Those are three primary areas where ADHD and autism tend to differ. Both conditions present challenges in regard to sociality, distractibility, and emotions, but they do have several different factors. I hope this post helps to clarify and it stands to reason that, as a result, the treatment process would be different between a child with ADHD and a child with autism. If you have any questions or wish to pursue an evaluation or treatment, feel free to follow up at DrCarosso@aol.com and see more posts at HelpForYourChild.com and the AutismCenterofPgh.com.
There is always a search for remedies for symptoms of ADHD. Children with ADHD struggle with distractibility, impulsivity, and being fidgety if not outright hyperactive. These difficulties can interfere greatly with daily functioning. This includes in the classroom, but also at home with getting through homework, getting off to school in the morning, or doing chores. Some parents use textured stickers, bubble Pop-it sensory toys, fidget spinners, or squishable balls in an effort to refocus the fidgeting. There are a host of behavioral interventions that can be helpful but it’s always important to determine whether any given approach is actually helpful for your child.
There are all types of things you can do to improve focus when doing a task at home. Standard strategies to assist with improving attention include, for example:
In the child's classroom, it can be harder to eliminate all the distractions. Other children can often be sources of distractions. But there are still ways we can still help the child focus on the tasks or instruction. We may have a child sit in the front row, use noise-canceling headphones, or use a Carrell when completing tasks to block out external stimuli.
It’s been established that movement activities and breaks help children with ADHD. Taking a break after a while allowing the child to run around and burn off some steam, and then return to the task has been a long-standing and effective strategy. A modified version of that would include the child being able to, for example, stand beside their desk, move around, and stretch while or before completing a task. These approaches have tended to work quite well and are commonly used to help children with ADHD in the classroom or at home.
However, what about more subtle movements such as using fidget spinners or a squishy ball? Do these more nuanced movement approaches work? Well, it depends. Research and my own observations have shown that, for some children, using various devices such as fidget spinners helps to promote attention and task completion. However, for other children, it actually increases their distractibility and results in less task completion. So, it’s a mixed bag.
What this means is that, just like with most other strategies, any given game plan or treatment plan needs to be individualized and child-specific. In that respect, what works for one child may not work for another. That’s why we always take a well-thought-out, child-specific approach that is based in data collection, experimenting with different approaches, and closely assessing what works and what doesn’t work.
In fact, even if the research suggested that something was quite effective across the board, that doesn’t mean it’s gonna work for your child or vice versa. You never know until you try. However, again, each strategy needs to be well thought–out ahead of time, implemented strategically, and assessed quite thoroughly and intensely to determine its impact. It’s almost always the case that any given strategy needs to be fine-tuned and tweaked with time. So you won't know if fidget spinners will work for your child unless you try.
Effectively managing ADHD, in any setting, is a challenge and takes ample thought and strategizing. I’m always here to help and that’s what we do here at Community Psychiatric Centers and the Autism Center of Pittsburg. We work with kids and teenagers and are well-versed in managing the signs and symptoms of ADHD. If you need help, don’t hesitate to reach out at Dr.Carosso@aol.com. I hope you found this post to be helpful. Have a great week, and God bless you and your kiddos and your family.
At Community Psychiatric Centers, we diagnose and help treat many different childhood issues. One of the disorders that we specialize in is Autism Spectrum Disorder or ASD. When a parent suspects their child may be on the autism spectrum, one of the most reassuring things to do is to gather information. I am often asked some excellent questions about autism, including:
Okay, here are the answers:
Autism typically shows up as early as 18 months of age. In fact, I’ve had many parents tell me that they noticed something was ‘different’ about their child in early infancy, even after only a few months of age. They noticed that their child was not particularly cuddly, did not want to be picked up, would arch their back when touched, or seemed content being left alone. These events are often described as their child being exceptionally calm and quiet.
Sometimes odd behaviors will surface by age two. Behavior like poor eye contact, flapping of hands, spinning in circles, jumping, or related behaviors. It’s important to note that, in mild autism, signs may not show until four, five, six years of age, or later. Here’s what happens in those circumstances: when a child has mild autism it is not uncommon for the child to be friendly, engaging, and pleasant. The child may get along quite well with their age mates, at that young age, because not much is expected in regards to play skills in terms of simply getting along and running around and playing games such as chase.
However, as children get older, the level of sophistication of social interactions greatly increases. Much more is expected and sometimes it’s hard for children with even mild autism to keep up. They may fixate on various topics rather than have a free-flowing back-and-forth conversation. They might fixate on the solar system or some other topic to the extent that other children may find it off-putting. The kiddo may stand too close or not pick up on social cues. As they get older, these types of behaviors become less tolerable and more noticeable.
Sometimes the child’s pleasant demeanor and sociability outweigh their oddities such that they get along pretty well and there is little in the way of complaints from parents or teachers. In some circumstances, they grow into a teen or adult and get along relatively well with only some mild “quirks”. It would be questionable if, in such a case, the condition is even diagnosable. Again, it’s when those “quirks” become problematic and notably get in the way of a person’s life that something becomes diagnosable.
Can Autism Show up Later in Life?
Can autism start later in a person’s life? No, not so much. The symptoms of autism first present in the early developmental period. However, the actual signs and symptoms may not become fully manifest, or fully noticed, until later in life. Sometimes not till later childhood that social demands exceed social capacities or ability to mask. The general understanding is that autism is an early developmental condition. If signs of autism “show up” later in life, it’s because the subtle signs were missed during early childhood. There are some medical conditions that can have some accompanying signs of autism. For example, Down Syndrome, as well as an array of other medical and chromosomal conditions, but such invariably shows up quite early in life.
I am also often asked if a child can grow out of autism. I tell parents that it’s not so much a matter of “growing out of it”, but that their child will progress and show fewer symptoms over time. That really is what treatment is all about. The idea is to target the signs and symptoms of autism, improve them, and reduce the severity, intensity, and infrequency of the signs and symptoms. Then the condition improves and the child presents as less autistic over time.
What about the next question: Can the condition get worse over time? By and large, I found that, with treatment, the condition does not get worse, it gets better. However, that also depends on the severity of the condition. In that respect, a child with very mild autism can demonstrate notable improvement and, in a few years, may barely meet the diagnostic criteria. It’s rare that the condition worsens though there typically are ‘ups and downs’ in the treatment process.
For example, when a child is going through puberty sometimes there is an increase in emotional volatility, but that can also be true for neurotypical peers. If a child with autism is going through a difficult time, if there is a family disturbance or bullying at school, or if treatment is interrupted for whatever reason, then the condition can worsen for a period of time. But it’s also expected that the child will rebound when things stabilize.
Wrap-up
So, to recap, autism is generally an early developmental condition with signs and symptoms manifesting by 18 months of age. In the event of more mild autism, sometimes symptoms do not noticeably interfere with the child’s life until late childhood but, when looking back, most parents can see that the child presented with some idiosyncrasies even during the early childhood years. The condition does tend to improve over time, especially with proper treatment, and it’s unlikely to worsen. I’ve seen children diagnosed with mild autism who after a few years of treatment and much improvement, no longer meet diagnostic criteria for autism.
The Autism Center of Pittsburgh is part of the family of CPC practices. If you would like to learn more about how we diagnose and treat Autism, visit our website. I hope you found this post to be helpful. If you have any questions, or if you’re seeking treatment for your child, feel free to reach out to me at DrCarosso@aol.com.
Can screen time cause ADHD? It’s safe to say that we all have concerns about screen time. We see our kids spending way too much time on their electronic devices and it seems as if they are consumed by it. We worry that technology may be harming their development, thinking, and general functioning. Parents worry that video games and technology may be decreasing their child’s ability to maintain attention to task over a long period of time, or possibly be worsening their child’s ADHD symptoms. So, is there actually a cause/effect relationship between screen time/technology/video games, and ADHD or worsening attention problems? Let’s take a look.
There have been a number of studies on the connection between screen time and attention issues. One more recent study, with a large number of five-year-olds, seemed to show a connection between children who played video games for more than two hours a day and having a greater number of ADHD symptoms. This is not to suggest that the video games caused ADHD, or that the children ultimately met diagnostic criteria for ADHD. Still, compared to children who played fewer video games, the other kiddos had more symptoms of greater intensity. In that respect, they were more distracted and impulsive.
Let’s say you have two kids. One spends hours per day playing chess, and the other plays video games. The child playing chess has to attend and concentrate for a long period on a slow-moving endeavor that provides a limited amount of stimuli and feedback at any given time. The activity is ongoing, tedious, at times frustrating, and takes an extraordinary amount of persistence and concentration. The other child is spending hours playing video games that are highly stimulating, active, give tons of feedback every second, are fast-paced, and are very rewarding on a second-by-second basis.
Which child do you think, ultimately, is going to have better attention, concentration, perseverance, and frustration tolerance? Which child is going to be better prepared to complete boring or tedious homework, or sit through a long boring lecture in class? I suppose we could think of attention, concentration, perseverance, and frustration tolerance as a muscle that needs to be built up or a skill that needs to be developed. The more we practice, the better it gets, or the stronger it becomes.
Of course, attention, concentration, perseverance, and frustration tolerance can be built up in lots of different ways. Chores like gardening, homework, practicing a sport, and anything that requires sustained attention and is not bombarding us with stimuli and immediate reinforcement are great for this. It’s important to note that these more tedious and mundane activities can still be rewarding and fun. In fact, it can be quite rewarding to do a good job and see the fruits of one’s labor. However, clearly, these activities simply don’t have as much immediate reinforcement as video games or being on electronics.
We can make a similar case for tik-tock or YouTube Shorts which are also mind-numbing in that they provide immediate reinforcement for seconds and then move on to the next one – there is no need for sustained attention or concentration. Our children are inundated with this type of stimuli such that their "attention muscles" can become weak and ineffectual.
I know I’m largely preaching to the choir, but you parents also know the other ill effects of electronics. Countless times I’ve heard parents lament that kids who play video games for extended periods tend to be more agitated and easily set off. And of course, what happens when you try to remove the video games?
Are there any positives to electronics and video games? Well, we are living in what’s known as the “informational age”. Our children have at their fingertips an enormous amount of information. One can make a case that our kids are better informed, for better or worse, than any generation has ever been. Research has also shown that some video games are, in fact, somewhat slower-paced, require deep thought, planning, teamwork, creativity, and some degree of ingenuity. Minecraft comes to mind in that respect, and I imagine there are others. It is not uncommon that video games, across the board, require contemplation, planning, thinking ahead, and quick reflexes. We could argue these are important skills.
Another perspective is this: think back to when we were kids (depending on how old you are). We were often playing outside, likely more than our kids do, but our ‘screen time’ was watching TV. That too is kinda mind-numbing and not entirely challenging to our intellect. In fact, one could say that video games are better than TV. With video games there is active participation, planning, and the aforementioned teamwork (when children play as a team).
Nevertheless, at least a movie requires sustained attention and is less stimulating. You also have to sit through the boring parts! As with everything, it’s a mixed bag. I think we can all agree that electronics in excess can be a problem and could contribute to any number of difficulties for our kids. Limiting the time allocated to electronics is the key.
I hope this post helps to clarify some of the dynamics relative to electronics and the pros and cons in that respect. If you’re struggling with your child’s distractibility and lack of perseverance, feel free to reach out at DrCarosso@aol.com. We are experienced in treating ADD/ADHD and other attention issues. God bless.
People have asked about what makes therapy sessions "good". The idea of "good therapy" hinges on sessions that are ultimately beneficial to the child. Children are expected to bond with their therapist, discuss their thoughts and feelings, work on coping skills, and make gains in therapy. However, it doesn’t always play out that way.
When meeting up with parents for an evaluation of the child, it’s not uncommon that the child will already have been in therapy. However, it’s also not uncommon that the therapy “didn’t go so well” and the parents decided to discontinue. Clearly, that is unfortunate given the hopes and expectations of enrolling your child in therapy in the first place. How can you avoid that from happening to your child? How can you better ensure that your child has a positive experience in therapy and a positive outcome?
In this post, I’m going to be targeting the structure of therapy, not so much the mechanics of therapy in regards to technique or clinical matters. To learn about what specific techniques a therapist will use with your child during the therapy process, and how those decisions are made, please see my prior post "The Formula for Successful Therapy". When I refer to ‘structure’, I am targeting how the therapy is conducted, with who, and how often.
Before we can closely consider what constitutes “good” therapy, let’s take a look at what may be perceived as less-than-optimal approaches. In that regard, it’s all too common that a parent brings a child to the office, the therapist picks up the child in the waiting room, takes the child back to the therapy room, meets with the child for 45 minutes to an hour, brings the child back out to the waiting room, and says “goodbye” to the parent and “see you next week.” It could be argued that this approach is all too common and not entirely advantageous. In fact, I would strongly advise against it.
When working with children, the situation gets a bit complex. As a parent, you are typically the one who initiates therapy for your child. In that respect, it’s rather uncommon that a child requests to go to therapy to talk about their problems and work on coping skills. Clearly, it’s the parent who gets the ball rolling in that regard. Consequently, from a therapist’s perspective, the child is the “client” but, in lots of ways, the parent is too.
I found that, almost invariably, a parent brings a child to therapy because there are challenges at home regarding the child’s behavior, emotions, noncompliance, or something that is disruptive or difficult in some way. There are those instances where a child is brought to therapy purely because they seem down or anxious. But even that typically manifests in some type of agitation or social avoidance, panic, or something that too is behaviorally problematic. In any case, the bottom line is that you, as the parent, are seeking help with and for your child. You need guidance, suggestions, and a sense of 'what to do' when your child is having a hard time.
I tell our therapists at Community Psychiatric Centers that is vital to work intensively with the parent as well as with the child. Consequently, there is an expectation that the parent will be significantly involved in therapy sessions. Of course, the child will have an opportunity to work individually with the therapist, but the parent must be involved to discuss situations and work on problem-solving with the child. This is a vital aspect of therapy and is something that you, as a parent, should expect in the therapy process.
Of course, when dealing with a teenager, the situation changes a bit. A teen aged 14 or older has to sign permission for the therapist to talk with the parents. Most teens are acquiescent and it’s not much of a problem. In fact, it’s especially vital to work with parents when the client is a teenager because often there is much to discuss, negotiate, and compromise in regard to problem-solving in the home
One of the pitfalls that affect whether sessions with a therapist will be successful is how often the sessions occur. At Community Psychiatric Centers, sessions are conducted every week. We find that it’s necessary to conduct weekly sessions to gain traction and more quickly get moving in the right direction, especially at the outset. As things begin to improve and stabilize, we can move to every other week and then, as we are beginning to fade, move to monthly. However, I’ve heard of some clinics providing therapy, from the outset, on an every-other-week basis. That is simply too infrequent, especially for children. In fact, at times it’s even necessary for twice-per-week sessions to address difficult times and periods of extra stress.
Therapy is all about communication – working toward better communication with your child and as a family. However, it’s also important to have open and regular communication with the therapist. In that respect, it’s vital that the therapist is regularly inquiring about your thoughts and feelings regarding the process. You need to express any concerns about the therapy direction, and whether you believe it is effective. Otherwise, the direction does not change and then most parents just stop taking their child to see a therapist. That’s unfortunate because with some open communication, that outcome could have been avoided. Consequently, expect and ask for such communication with the therapist.
Good therapy entails a positive and solid rapport between your child and his or her therapist. But significant parent involvement, weekly sessions, and regular communication about ‘how everything is going’ is also important. In the absence of any of these, the therapy will likely be less effective. If you’re seeking therapy for your child and have concerns about the process, feel free to email me at DrCarosso@aol.com. I wish you and your child the very best. God bless.
Celebrating the 4th of July is one of those fond traditions of summer. This post from 2021 talks about how the principles our country was founded on can be used to teach the characteristics that will help them be well-rounded and successful adults.
The Fourth commemorates the unanimous adoption of the Declaration of Independence from Great Britain, by the second Continental Congress in 1776. This declaration culminated in our revolutionary war that ended in 1783. It was then that Britain recognized the United States as an independent and sovereign country.
We want our kids to know our history, and how we ‘came to be.’ However, there’s more. The same principles on which our country was founded are the same characteristics we want to develop in our children.
Here is a run-down of those principles:
A primary goal of the American Revolution was the pursuit of liberty. As was so eloquently phrased, “We hold these truths self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are life, liberty, and the pursuit of Happiness.” Liberty is different than freedom, with the former comes a measure of personal accountability and responsibility. Above all, our Founders strongly believed that with liberty, comes personal accountability. You want to instill those same values in your children – we have unimaginable freedoms in our everyday life, but we also have a responsibility to our family and fellow citizens and should expect to be held accountable for our actions.
Another founding principle is that we all have moral worth, and each should be valued to make one’s own decisions. This is accompanied by the principle of individualism; we are individuals apart from the collective and each has to make his or her own way in life. Yes, we have an obligation to behave morally and help our fellow citizens when we can, but each of us is responsible for our own well-being. We make our own decisions and therefore take responsibility for the outcomes, good or bad, and expect to be accountable for those decisions. It would behoove us to raise our children with this understanding and appreciation, which will serve them well into adulthood.
Appealing to Virtue, a Higher Power, and Morality
Our Founding Fathers believed that the ability to govern ourselves rests with our individual and collective virtue (or moral character). This virtue stems from a Higher Power, or God, from Whom originate our rights. As was written by John Adams, “it is religion and morality alone which can establish the principles upon which freedom can securely stand. The only foundation of a free constitution is pure virtue.” We want our children to stand firm in the knowledge that without a strong sense of morality, a firm sense of ‘right and wrong’, based on a Power Who stands above us, we will fail on a personal level and as a society.
Our Declaration of Independence and our Constitution allowed for growth and a trend toward improvement as a society. The concept that ‘all men are created equal’ was among our founding principles. It provided a foundation that compelled our country in the direction of increasing freedom and equality. Has not the United States trended in the direction of increased inclusiveness and is a far different place than in the 1700s? How about compared to the 1800s? In addition, how have we grown as a nation since the 1950s? What about over the past decade? Is there any other country as diverse as the United States that has progressed as much and as quickly? Is there any other diverse country that is freer and with as much opportunity for all? If so, which country is that? – I suppose we’ll all move there.
We want our children to know that our country has made immeasurable progress in a remarkably brief time. You want your kids to know that they too, as individuals, are expected to learn from their mistakes. They are expected to grow and mature, learn and evolve. Above all, they should aspire to become something better and improve America.
I hope you have a fun and relaxing Independence Day as you had cookouts with family and pondered the remarkable aspects of our country. I wish you the very best in your ongoing pursuit of teaching your kids these founding principles and helping them live out these aspirations every day. If you need any help along the way, never hesitate to reach out; you can find out more at HelpForYourChild.com. May God bless you and your children, and this wonderful country in which we live.
A version of this post appeared in the Spring of 2021.
It’s Spring, and the summer break from school will be here before you know it. I would hate to have you awaken that fateful day in June with the incessant “I’m bored”, or loud screaming that typically accompanies siblings being home together all day. Oh, the joys of summer.
There is much to think about, and all kinds of activities to do. It can be overwhelming just trying to fit everything in the few short months before summer ends. On the other hand, it can seem like, without the schedule of classes and school activities, some kids are in a hopeless state of boredom over summer break.
A very effective way to plan for the summer while squeezing out every drop of fun you can is to get a calendar and plan the entire summer out, week by week. You may have some day-long, or week-long camps; the annual summer vacation to the beach or Disney, your kid’s sporting events, a 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…) they formerly provided passes to avoid long wait times.
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 the activities 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 lightning bugs.
You may include some things in the summer agenda that aren’t necessarily fun but are still worthwhile. Summer is an excellent time to home your kids’ skills such as math, writing, or reading. If your child has special education services, talk to the Principal now about whether your child qualifies for Extended School Year (ESY). 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 together as a family, can be a bonding experience, especially when the outcome is achieved by everyone’s hard work.
If your child is on the spectrum, summer break is when you can be more indulgent in your child’s obsessive interests. But only after the non-preferred 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. You may find it helpful to plan trips to the zoo, local library, autism-friendly theater, and bookstore. Also, don’t forget for all kiddos: daily running around and lots of physical activity.
Babysitters and childcare tend to get filled up pretty quickly, 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 the 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 case manager for an updated list of camps. You should also 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 IBHS (formerly ‘wraparound services’). Contact me at DrCarosso@aol.com to further discuss this option.
Summer is a 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. This is especially true if it involves getting past the less favored tasks to move on to more fun activities. If your child has special needs, maintaining a consistent routine is even more important. In fact, be sure he knows about the schedule, what to expect, and answer any questions beforehand. A picture schedule is also very helpful!
I hate to write about the summer ending when it hasn’t even begun. But one should 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.
Have a wonderful summer!!!
As this school year comes to a close, I speak with many parents who have struggled with school refusal and are worried about managing the next school year. This post describes the nature of school refusal and some strategies and considerations to address this challenging situation.
An all-too-common situation (especially since COVID-19) is a child being reluctant or even refusing to attend school. This post will focus on anxiety-based refusal; the child is refusing to attend school due to genuine anxiety reactions. Consequently, the night before school your child is fretting about the next day, and the mornings are fraught with drama and emotion as you try to convince your child to attend. And commonly they continue to resist and present as emotional, maybe even to the point of vomiting.
Does your child complain of stomachaches, headaches, and vague pains, or simply not feeling well especially the morning before school? This is quite common. Anxiety often manifests in somatic complaints that further complicate the situation given you’re not sure if the complaint is genuine or simply to avoid school.
This problem can be seen as simply a manifestation of an anxiety disorder. In that respect, anxiety shows itself in lots of different ways but a primary aspect of anxiety is a tendency to avoid that which makes us anxious. In this situation, the prospect of attending school, leaving home/mom, or both, is causing undue anxiety and panic reactions. People are often genetically predisposed to anxiety.
There are number of steps to address this issue, depending on the age/size of your child and the severity of the problem.
The goal is always to rely on the carrot, rather than the stick. In that respect, we want to rely on praise, rewards, encouragement, and incentives rather than punishments. Consequently, we offer extra rewards for going to school, and often we’ll remove enticing past-times if the child refuses school, such as toys and video games. However, if your child continues to refuse and your child is small and manageable in that respect, you may find it necessary to physically escort or literally carry your child to school. You may want to enlist some help, such as mom and dad working together in that respect, but the message is ‘you’re going to school one way or the other’.
Once your child realizes that their avoidance and emotion is futile, usually you’ll notice improvement and less resistance. If your child refuses to get dressed in the morning, some parents have had success informing their child that they will be taken to school in their pajamas, if that’s necessary, and they can change in the nurse’s office. In that respect, this is a solidly no-nonsense approach to school refusal.
Things get more complicated when your child is larger, and you can't physically escort or carry them into school. It’s advised to utilize counseling, which will be discussed further below. Also, reinforcement for attendance and we also make the home life (during the school day) as boring as possible to entice school attendance. However, what if that doesn’t work?
In these situations, it’s helpful to utilize professional support such as a therapist. At Community Psychiatric Centers, we can utilize outpatient counseling, in-home support, and medication management to help the situation. The therapist will work on coping skills, deep breathing, healthy self-talk, and desensitization techniques. The latter involves getting your child out of the house daily and in the presence of others that could include a sport, club, group, church, or anywhere there are people. There should not be a day that goes by that your child is not out of the house.
Even better, play at the school’s park, meet up with friends from your child’s classroom for play dates, and ask for videos or Facetime from his or teacher with enthusiastic and fun messages. Medication can also be considered to reduce anxiety and improve general emotional stability.
Counseling can also take the form of in-home services (IBHS…). This approach can be helpful if the practitioner can come to the home in the morning and assist in getting the child to school. Here at Community Psychiatric Centers, we offer such in-home support, which can be invaluable. The Youth Advocate Program also offers an in-home truancy prevention program that can be worth exploring.
While you’re trying to get your child to school, your child needs to be educated. How will that take place? Often the school district will send homework, which helps to keep up some assignment completion but clearly, it’s not a long-term solution and does not facilitate your child to receive a proper education. Some parents will consider a cyber school, which isn’t necessarily a bad option under the following conditions:
An alternative school placement is often considered such as a school-based partial program or alternative school. The idea is that the alternative placement will offer smaller classrooms and more support to help your child feel comfortable. This option has merit and can be quite helpful in the short term! The goal would be to progressively get your child back to regular school. However, what I’ve found, is that we can’t get the child to the alternative school any more than we can get them to regular school.
Managing school refusal can be quite a challenge. We use multiple strategies, with the ultimate goal of getting the child back to a brick-and-mortar school classroom. Otherwise, we run the risk of the child becoming increasingly anxiety-ridden and housebound. While we’re working on attending a regular school, there is involvement in daily out-of-the-home activities. In the meantime, a cyber school may be attempted, but such would be time limited with a step-by-step approach to a return to regular school. Counseling and medication can be helpful, especially in-home support. Alternative school placements can be very effective if you can get your child to the placement.
Don’t hesitate to email any questions to DrCarosso@aol.com or call for an appointment at (724) 850-7200. God bless you and your kids.
Today's post was shared previously but serves as a reminder of how important hope is for all children, especially children and families who struggle with behavioral or emotional issues.
“Hope is the thing with feathers that perches in the soul and sings the tune without the words and never stops at all”. - Emily Dickinson.
It’s hard to overstate the importance of hope. The more hope, the stronger the drive, and it doesn’t dare to ever stop, nor even feel the need to. Hope drives everything from completing daily tasks to reaching our goals, dreams, and ambitions. It is the fuel that carries us over the ridge and up the mountain. Hope is the light that carries us through the darkest of impasses. Laina Taylor described that “hope can be a powerful force. Maybe there’s no actual magic in it, but when you know what you hope for most and hold it like a light within you, you can make things happen, almost like magic.”
It’s well-established in the research that hope is the foundation of a person’s resilience and ability to experience struggle and strife without giving in. Often, the best predictor of whether a person will commit self-harm is not a troubling situation or sadness, not even if they feel depressed. No, the best predictor is a lack of hope. If we instill hope, we instill life; the more hope - the more zeal for life. As it has been said, “Hope is the only bee that makes honey without flowers” - Robert Ingersoll.
“Hope is a verb with its shirtsleeves rolled up” - David Orr.
We all face tough times, challenges, and situations that seem daunting. We may be facing a major obstacle, but it’s far more manageable if we have hope for a positive outcome. Or we hope that slowly but surely and step-by-step, we can make a positive impact and move the ball forward. Hope makes all the difference! We see its power during such difficult times. “Hope is like a star – not seen in the sunshine of prosperity, and only to be discovered in the night of adversity”. - Charles Haddon Spurgeon
Christians celebrate this time of the year – Easter (also known as Resurrection Day) as the holiest of our holy days. Clearly, if not for Easter and the resurrection, there would be no Christianity. Easter represents the essence of hope, especially hope in the time of darkness. Through Christ and the overcoming power of Easter, we have hope for the forgiveness of our sins, power over the carnal, and faith that we can overcome and be triumphant, just as Christ.
As Christians, this hope is a gift. As Jeremiah tells us “For I know the plans I have for you, declares the Lord, plans to prosper you and not to harm you, plans to give you hope and a future”. Yes, it’s a gift, but this hope is also instilled within us, as Paul writes in Romans: “May the God of hope fill you with all joy and peace as you trust in Him, so that you may overflow with hope by the power of the Holy Spirt”. Easter reflects that hope, with faith, is the most important of the Christian virtues.
We gain hope through our celebration of Easter; moreover, God gives us resources that too can instill hope. It’s always my goal, and the goal of everyone at Community Psychiatric Centers, to instill hope by educating and providing guidance on how to manage emotions, calm thoughts, and effectively redirect challenging behaviors.
I invite you to tap into these resources. They can make your life, and that of your child, far more meaningful, hopeful, and successful. If you need any guidance in that respect, feel free to email me at DrCarosso@aol.com.
May God deeply bless you and your family this Easter. May you be instilled with a full measure of hope during this most sacred of Christian holidays.
