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.
Today we will target and dispel the facts and fallacies regarding Attention-Deficit/Hyperactivity Disorder, or ADD/ADHD. Some of the common fallacies addressed include:
First, let's review the primary symptoms of this condition and how it appears. There are three types of Attention-Deficit/Hyperactivity Disorder:
The most commonly diagnosed types would include the Inattentive and the Combined Types, and the reason for that is it's rather rare for a child to be hyperactive and impulsive and not be inattentive at the same time.
These children tend to be fidgety, struggle to remain in their seats, they’re always on the go, have poor interpersonal boundaries at times, have trouble occupying their time appropriately and quietly, and tend to blurt out comments and questions in the classroom. These children tend to have difficulty waiting for their turns, are inattentive, have difficulty following instructions, and have a propensity for being disorganized, losing items, and being forgetful.
These signs and symptoms must be present before seven years of age. They also have to be evident in two or more settings and they have to be evident over the course of at least six months. Most importantly, the symptoms must cause significant impairment in the child's life.
Attention-Deficit/Hyperactivity Disorder occurs far more frequently in boys than in girls and it seems to run in families. Also, this is a very common condition; Attention-Deficit/Hyperactivity Disorder is present in three to five percent of all school-age children, making it a common diagnosis and problem that all children face.
We often hear from teachers and parents that children are underachieving in school, don’t listen, can’t pay attention, fall behind in their class work, and are at risk for failure. One of the fallacies that we need to address is that ADHD diagnosis is an excuse for underachievement.
ADD/ADHD can be a challenge, but it’s certainly not an excuse. At CPC, we go to great pains to work with children to help them understand that they can utilize coping strategies and teach themselves to self-monitor, pace themselves accordingly, and use a host of other coping strategies. We also work with parents and teachers to help them utilize various accommodations in the environment so that the child can be more successful. A successful child is not looking for excuses, so in that situation, everybody wins.
It is not uncommon for the treatment process to include aspects of medication management, and there are a host of fallacies and concerns about medication issues: is medication effective? Is it safe? Practitioners have been treating Attention-Deficit/Hyperactivity Disorder with stimulant medications since 1938. Ritalin is probably the most studied of medications used in childhood populations. There have been no reported deaths by overdose of a stimulant medication alone.
In general, this is a very safe medication. There are some side effects that need to be closely monitored, which can include decreased appetite, trouble falling asleep, some moodiness that can come and go, as well as tics that especially need to be closely monitored. These are short-acting preparations and if the child does not get that medication on the next day, most if not all of the medication is out of their system and any of the side effects are usually gone. Research has shown that this is a very safe medication in general.
Some would suggest that all these children really need is to lay down the law’ and parents are simply being too lenient, which is why they’re having behavioral problems. This idea is misguided. Yes, these children need consistent routines, predictability, clear expectations, and a firm approach. The approach needs to be based on positive reinforcement, high expectations, and lots of positive regard and patience. However, a large portion of these children’s behavioral difficulties are beyond their control. They struggle with impulsivity and need improved coping strategies and lots of extra structure and support in their environment.
Keep in mind that this is a biological condition that a child inherits, sometimes from their parent, probably caused by a chemical imbalance in the brain that deals with dopamine or norepinephrine transmission in the brain. At Community Psychiatric Centers, we combine the use of medication with other treatment modalities, which might include individual therapy with the child, behavior modification techniques that are implemented in the home and school settings, the use of social skills training for the child to learn how to adapt and adjust to their symptoms, and the use of family support groups and family therapy to help the family deal with a child that is often quite hyperactive and sometimes 'climbing the walls’, impulsive, and involved in risk-taking. Once the set treatment modalities are implemented, the family stress is often greatly reduced.
Another common myth is that teachers are pushing parents to medicate their children when they see attention problems in their classrooms. Maybe there are some situations where a teacher expresses concern to a parent and mentions that medication may be helpful. Of course, that shouldn’t happen, as teachers are not medical practitioners and they shouldn’t be making those types of recommendations. We’ve found, however, typically that’s rather rare.
What we have found is that teachers tend to be invaluable resources in the assessment process. They tend to be excellent judges of whether a child is having genuine attention problems. Consequently, if your child’s teacher expressed some concerns to you about your child being off-task or easily distracted, it’s probably best not to get defensive about that but, rather, simply contact us here at Community Psychiatric. Again, teachers can be excellent resources in this process and they tend to know what’s going on with your child in terms of attention and concentration.
There is no single test to establish a diagnosis. There is no blood test. We do know that there are factors that can help confirm the diagnosis, including the direct signs and symptoms evidenced in different settings, over a long period of time, and significantly impairing daily functioning. It also is compelling if a blood relative parent has the condition too. Other factors can include prenatal effects of drug and alcohol abuse, trauma in a parent prenatally, or problems during birth. When the child is evaluated at Community Psychiatric Centers, we take all these factors into consideration. The child is observed for a considerable length of time, an objective assessment is completed by various observers, and a comprehensive history is obtained. It’s also vital to rule out other factors or conditions that might look like ADD/ADHD, including an anxiety disorder.
Another common question is “Will my child grow out of this”? What does the future hold?” There are several quality follow-up studies that suggest that about seventy percent of children who are diagnosed with ADHD in childhood will continue to have that diagnosis in adolescence. Between fifteen and fifty percent of those adolescents will then carry the diagnosis into adulthood. What that suggests is that some kids do grow out of it. However, there are quite a number who continue to have the signs and symptoms into adulthood, which would of course reflect the need for ongoing treatment and monitoring.
A child who is untreated can develop problems in school, fail in their subjects, be labeled as a ‘problem child’, and experience social difficulties with their peers. Research has shown that, as they grow older, these individuals experience increasing rates of divorce, job loss, drug and alcohol abuse, and problems with driving including a greater number of accidents. It’s very important to have this condition treated, sometimes for one’s entire life, to avoid some of these complications. In fact, with treatment, the prognosis is quite good.
The last fallacy that we need to address is that Ritalin has been overproduced and that there has been a 600% increase in the production of this particular medication. While the production rates of this drug have increased, the question is still open as to who is getting this medication. A large portion of it is probably being administered to adults and geriatric patients, who use it for treatment of other conditions such as narcolepsy or memory loss. Moreover, of the three-and-a-half-million children who are diagnosed with ADD/ADHD in the United States, only about half of them are being treated with medications. The number of children treated with medications is still far below what it could be. It’s certainly not an overproduction of the medication or a pushing of it to children who don’t need it.
“My nine-year-old’s teacher says my child is off-task, distracted, and not completing schoolwork. ADD has been mentioned. However, he also seems sad and worries about a lot of things. What do you think?”
This brings up an excellent point; we always rule out competing contributors to a child’s off-task behavior and attention deficit issues. We need to rule out anxiety problems, depression, or a child who has possibly been traumatized in some way. A child who has these difficulties tends to be off-task; the child is preoccupied and, subsequently, distracted. It’s vitally important to rule out any other possible contributors to a child’s distractibility and treat accordingly.
Children who are depressed can often appear distracted and inattentive. They can look like they have ADD/ADHD but in actuality they are depressed. A child can also have both depression and ADHD or Bipolar Disorder and ADHD together. So those need to be ruled out and treated appropriately.
Contact us here at CPC. We hope you found this resource to be helpful. Don’t hesitate to call or email with any questions along the way. We’re always available to answer questions, evaluate, treat, and provide ongoing consultation. Thanks and God bless.
Sharing this post is one of my favorite traditions. This Christmas blog post was first put up on HelpForYourChild.com back in 2012. It has been helping families recognize the role Faith plays in helping families and childhood difficulties. For this Christmas, I have expanded upon this classic article, starting with the section titled "Christmas Bonus Post: What Makes Christmas so Special?"
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 a good listener (Client-Centered techniques), stay in the moment (Gestalt), incorporate the family (systems approach), and use praise in systematic ways (Applied Behavioral Analysis).
Well, yes there is. Help for your child is sometimes more than just a clinical approach. I’m usually not expected to focus on spirituality but, sometimes, it’s like watching somebody drown and tossing a small life preserver when I have access to a large lifeboat. Don’t get me wrong, the life-preserver is effective but, well, wouldn’t you rather be in a boat?
During Christmas, it's good to remember 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?
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 life-changing about tapping directly into the Source (another one of His names, by the way). As a practicing Christian, tapping into that life-changing Source entails following Romans 10:9. Give it a try, what have you got to lose?
Christmas is the celebration of the birth of Jesus, and the beginning of what has become known as “Christianity”.
To suggest that the ‘Christian’ movement has been impactful would be an understatement; however, detractors remain. There have always been questions about veracity, reliability, and authenticity.
This post will address those questions.
Since the beginning of time, dating back to Aristotle, people have asked deep philosophical questions about the meaning of life. Clearly, these questions are worthwhile, however, before we can answer the loftier philosophical questions, there are foundational questions that first need answered. The answers to these basic questions lay the foundation for subsequent philosophical inquiry. In fact, one could argue that the loftier philosophical questions are moot until these basic questions are answered, such as:
Who created the universe? It can be legitimately argued that something cannot come from nothing.
Did “God” create the universe and therefore, in doing so, create our current existence and reality?
Do we exist subsequent to evolution (by chance), or at the intentional hand of God?
There is, in fact, overwhelming evidence for God and Intelligent Design. Among a litany of other questions including the origins of the Big Bang, secularists still need to answer who wrote all the complex and voluminous ‘code’ (DNA) that’s in every cell of every living organism directing the cell on precisely what to do.
If there is a God, and He created everything, then is it not logical that He is the authority of the nature of our reality and existence.
If God Created the Universe, and is authoritative, how does He speak to us, and can we trust that it’s true and accurate?
Does God inform us – does He tell us what He wants us to know about our reality and existence? If so, how does He inform us? In what ways? Are these ways authoritative, convincing, and based in clear evidence as opposed to relying on ‘blind faith’?
God speaks to us through His creation – this fact is rather self-evident, or at least it was until evolution muddied the waters.
It could be argued that the world, universe, earth, people, organisms, plants, formations… are beyond compare and breathtakingly complex. The entire eco-system is inter-connected and exquisitely balanced. Creation is beyond our understanding and, as it’s clearly indicated in the Bible, He intended that we would be in awe of Him with every glance at what He created.
The heavens declare the glory of God, the skies declare the work of His hands, day after day they pour forth speech, night after night the display knowledge. There is no speech or language where their voice is not heard, their voice is heard through all the earth, their words to the end of the world. Psalm 19:1
From the beginning of creation, God’s eternal power and divine nature, though invisible, has been understood and known by the things He has created. Therefore, they are without excuse (for not believing). Romans 1:20
God communicates with us through his creation. He also communicates with us through His Word
God provided us a clear and concise owner’s manual, and an understanding of our history and our future – through the Bible. Take time to read the Bible, and see for yourself.
All Christian denominations acknowledge the same 66 Books of the Bible. Remarkable, these 66 books were written over thousands of years, by over 40 writers of at least three different languages, spread over three different continents, yet the Bible is inextricably interwoven to tell ONE coherent, logical, inerrant description of God and His personality, His people, what He wants for and from us, and His plans for us. The Bible has many writers, but only one Author.
It’s also important to appreciate how wonderfully and powerfully the Bible is written – its phrasing is beautiful and poetic, and the most complex spiritual and philosophical concepts are clearly explained by people who were not exactly trained in writing and literature. For example,
In the beginning was the Word, and the Word was with God, and the Word was God, He was with God from the beginning. Through Him all things were made, without Him nothing has been made that has been made. In Him is life, and that life is the light of man. The light shines in the darkness, but the darkness has not understood it. There came a man sent from God, whose name was John (the Baptist), he himself was not the light, he came only as a witness to the light. The true light, the light of every man, was coming into the world. He was in the world, and though the world was made through him, the world did not recognize him. He came to that which was his own, but his own did not receive him. But to everyone who did receive Him, whomever believed in his name, He gave the right to be called children of God; children born not of natural descent, or human decision, or a husband’s will, but born of God. The Word became flesh and made His dwelling among us. No one has ever seen God, but God the One and Only, who is at the Father’s side, has made Him known.
The Bible is derided by some as unsubstantiated fiction, however, there are over 24,000 early manuscripts of the Bible dating to within 100 years of Christ’s death. By comparison, the works of Homer, Ceasar, Plato, Tacitus, Thucydides, Herodotus and many other ancients are often accepted as truth in secular culture and are taught in school. However, there are only 7 copies of Plato’s work from 1,300 years after his death; Ceasar – 1000 years and only 10 copies; Aristotle 1,400 years after his death and only 49 copies; Homer – 500 years with 643 copies; Thucydides 1.300 years and 8 copies… there is really no comparison. It is clear that the Bible is accurate, true, and authentic dating back to the original text.
Between His creation, and His Word, God made is crystal clear that He is God, that He is real, and that we can know Him.
But He did not stop there.
No other theological book has such prophecy to back-up its authenticity.
There are about 2,500 prophecies in the Bible, and about 2000 have already been fulfilled to the letter. The remaining 500 are regarding our future, and we can rest-assured Jesus is coming back to fulfill those as well.
The odds of these prophesies having been fulfilled by chance without error is less than one in 10 to the 2000th power (1 with 2000 zero’s after it).
Look to Genesis, Exodus, Daniel, Isaiah, Jeremiah, books of Kings and Second Kings, actually, it’s hard to find a book in the Bible that does not have prophecy, and they all came to pass. There are also prophecies fulfilled in the New Testament – Jesus fulfilled hundreds of Old Testament prophecies and He also made many others – too many to recount here in this post.
No other religion has such compelling evidence – how can all these prophecies be explained except that they came directly from a God who wants us to know, without a shadow of doubt, that He is real - wants us to know about Him and that He wants to engage with us if only we’ll open the door to Him.
God makes Himself ‘real’ in our lives through the Holy Spirit; by adopting us, being our Father and friend, and changing our lives.
The testimony of changed lives
It’s difficult for unbelievers to understand this concept of the Holy Spirt and His impact on our daily life – it’s like trying to explain the breathing of air to a fish, which is sad because this ‘breath of life’ is beyond compare and there is nothing as powerful, satisfying, rewarding, or convincing as the Holy Spirit directly impacting one’s life. There is no mistaking or denying the presence of the Holy Spirit that is without compare and life-changing.
For the message of the cross [the Gospel] is foolishness to those who are perishing, but to us who are being saved it is the power of God
1 Corinthians 1:18
God changes lives - there are countless Christians who testify that their relationship with Jesus changed their life, delivered them from sin and any number of addictions, changed and renewed their mind, and opened their eyes to a new spiritual reality. Christians describe their experience and world as unequivocally ‘different’ after encountering Christ - not perfect, but getting better and different from the old self. Sometimes that ‘difference’ is extraordinarily, sometimes more subtle, but always there is a change.
Therefore, if anyone is in Christ, he is a new creation; old things have passed away, behold, all things have become new. 2 Corinthians 5:17
Judeo-Christian teachings, values, and tenets shaped and guided Western culture and civilization as we know it today. We take-for-granted our God-given freedoms, rights, and civil-liberties that have changed the course of human history. The Declaration of Independence, our Constitution, and capitalism - all driven by Judeo-Christian concepts and teachings; and our very concept of morality – what is right and wrong, comes from the Bible - how else do we genuinely know what’s ‘right’ unless God tells us; otherwise, it’s only opinion. Also, our concepts of marriage, the family, respect for women, racial equality and equal treatment for all – come from the Bible. The abolishing of slavery was spear-headed through the work of Christians (the abolitionist movement was largely a Christian movement and churches often served as hiding spots that made-up the Underground Railroad). Our justice system and due process is based on the Bible, as-is our current hospital and university system (most hospitals were started by churches and many of our top universities began as seminaries). Our current foster and adoptive care system is based on the work of the church. In fact, the concept of a middle-class work-force is based in Christianity; prior, there was only the very rich, very poor, and slaves and that model, by the way, continues to exist in most of the non-Christian world. What about respect and care for children – yep, a Biblical standard. Moreover, the world’s greatest artists, musicians, writers, and architects all claim their work as inspired by God. Moreover, the greatest scientists were inspired by God and His creation. Not to mention that most charity work is Christian-based. Finally, of course, no one has sacrificed more, and changed more lives for the better than Jesus Christ.
Those are just a few things that make Christmas so special. He came humbly to this earth as a baby in a manger, but no one has so dramatically changed lives and changed the world. He left us with His Spirit and His church; and His Word has been shown to be true and authentic. So, in the light of this glorious Christmas Spirit, I wish you the happiest and merriest Christmas season, and that you and yours would not only know about Him, but personally come to know the one whose birth we celebrate - all you have to do is ask.
“When you come looking for me, you will find me”
Jeremiah 29:13
Merry Christmas.
As part of our December holiday tradition, we are sharing an older post with lots of excellent advice on how to make the holidays a little bit merrier and brighter.
The Christmas and New Years Holiday is magical and fun; a wonderful time of year that spreads warm feelings and cheer in families and communities throughout the world. The celebration is well deserved, and we all tend to look forward to this very special time of year.
Yeah, there is a ‘but’ for many parents with kiddo’s struggling with any number of behavioral health or developmental issues such as ADHD and autism. In those homes, the hectic and often-times over-stimulating nature of this holiday season can bring about all sorts of behaviors, meltdowns, over-activity, and fixations.
First, remember that you know your child best. Given the frequent changes in routine during the holiday season, you know whether your child fixates on the routine and if it’s best to not convey the daily schedule till the last minute, or if your child thrives on knowing the routine in advance and finds the information to be comforting. You also know whether it’s best to do all the decorations quickly, all at once, to get it over with; or if your child responds better to a slow and steady approach.
You’ve also shopped enough with your child to know the best approach. The challenge during the Season is that these shopping trips are usually a bit longer, so it’s even more important to take breaks, have fun items to keep your kiddo’s busy, and work your way into each store maybe a bit slower than usual. Some kiddo’s respond well to headphones and darker tinted glasses. However, an added challenge is the necessity of masks, which some kids find intolerable. In that case, you’d likely have to avoid taking your child to the respective store unless you can convince your kiddo to wear a visor. Also, for younger children, some stores may forego the mask mandate.
During the holidays, the daily routine that you’ve worked so hard to maintain usually becomes more unpredictable, but do your best to keep some semblance of routine and order. Social stories, written schedules, and visual schedules, and reminders can be very helpful.
It can be helpful to wait until the last minute to arrange the gifts, given the temptation your child may face to open ahead of time. However, again, you know your child best and some find it very enticing and pleasant to see the presents, and would not dare open any until the designated time. Also, with that in mind, turn-taking to open presents can be coordinated by passing an ornament to whose turn it may be to open a present. Also, offering a quiet, out-of-the-way place for your kiddo to play with his new toys may also be helpful to avoid grabbing at other’s toys, becoming overly upset if somebody touches his toys, and causing disruption.
If your child has food sensitivities or is very finicky, you may want to bring some food along to Aunt Jennie’s house for the celebration. Also, before arriving, it may also help to show your kiddo pictures of who will be there, and what to expect every step of the way. Sometimes children respond better if they gradually mix-in with the crowd as opposed to all at once; and provide a ‘safe-haven’ if it becomes too overwhelming. You’re the best judge of how much your child can tolerate, so you’ll be keeping a watchful-eye, and intervening when necessary. Also, regarding the family, prepare them for what to expect from your kiddo and how they can help the situation rather than make it worse.
These were just a few tips to consider during this Christmas season. Most importantly; enjoy this time with your children, family, and friends. Relish these opportunities, no matter how chaotic or stressful they may become at times. In years ahead, you’ll look back and miss these days. Don’t miss them now. God bless you and your family during this blessed Christmas Season.
This article is well-loved among parents; with timeless advice and tips that apply-year round. First appearing on HelpForYourChild in December of 2021, it has been updated for this year’s holiday season.
The holiday season often includes busy public outings with your child. Grocery runs, visiting family, shopping at the mall - These can be quite tricky and challenging! Children sometimes find the new environment, whether it be a store or a crowded holiday event, to be overstimulating. They try to carry out the outing ‘on their terms’ rather than on yours. However, if you make a plan in advance, there are some strategies to improve the situation and plan successful outings.
Just like anything else, behavior in public is a skill that is learned over time. Role-play at home (set up a mock store or restaurant). Start with short stints, then increase exposure. Quick daily outings (in and out, but longer over time) are better at first. For example a brief trip to a local deli, then to a restaurant…
Outline an explanation of where you are going, expectations for behavior, and the rewards/consequences if things go well, or not so well. Make sure your child understands what your expectations are. Expectations should be simple, achievable, and age-consistant.
What will happen during the trip, where you’ll be going, what they will do (park, walk, go to a particular store, ride in a cart, take a snack break, meet new people…) and how long it will take? Show photos ahead of time of where you’re going, if possible. Remind them of what part you are at during the excursion, and what comes next. A picture schedule can be very helpful.
Holding an adult’s hand, staying close, etc. Frequently tell them how they’re doing and offer tons of praise and give little tokens for good behavior whenever you see good behavior, or every so often during the outing. They can trade in the tokens for desired items.
Ask questions! If shopping, your child can help find items – keep them occupied. You can even give them money to make purchases. Bring along their favorite toys, food, or familiar item. Have them help plan out the day with you when you put together the outing. Develop ‘Social Stories’ about public outings, and encourage your child’s involvement with that process.
We all have "Social Batteries" that can get run down if we get physically tired, hungry, or frustrated. Limit how often, length, and where you shop depending on your child’s tolerance level. Keep trips short, take breaks, and use a stroller. Make sure they are not tired or hungry (either of you). Be careful of your attitude and fatigue (keep upbeat and happy). Take along a wishlist: if he sees something he can’t have, add it to the wishlist. Share your child's enthusiasm for desired items. Try to avoid tempting places, or keep those places at small doses.
Sometimes, even with all the preparation, difficulties are unavoidable. It can feel frustrating, especially if the outings are somewhere with challenging distractions. Visit at off-hours (6 to 7 PM or early in the AM, or early in the week). Know the store/destination layout in advance (bathrooms, exit, food, water fountain, babysitting, fire extinguishers (that was a joke)…). If possible, have another adult with you, especially if taking multiple kiddos. In certain situations, you can ask a psychologist to prescribe accommodations at a holiday event or similar destination.
Many children find busy stores to be exciting, if not overstimulating. And neurodivergent children can struggle even more so. Here are some things to think about if your child tends to get overwhelmed in some environments:
Problem behaviors can be a form of communication. Note the triggers, problem areas, and anything that makes it predictable. If you can predict it, you can prevent it! Some issues to look out for are boredom, overstimulation, hunger, and fatigue (it’s tough for those little legs to keep up).
Behavior management is the key; remain consistent and remember that what works at home, will often work in public as well. Try to be consistent with behavior management in all settings (between home, school, and community). Reinforce good behavior (you get what you praise, and be specific in that praise). When misbehavior occurs, intervene and make eye contact as soon as it happens, and then redirect to replacement behavior. Use time-outs in the store, or take a break outside. Avoid losing your cool. A time-out does not need to be a “punishment” but, rather a quiet moment outside the store to calm down.
Here are some tricks to effectively redirect your child to what you want him/her to do, rather than what you don’t want:
Stores are like oversized classrooms that just happen to sell things. Make a trip a learning opportunity. This strategy also helps to keep the child busy and keeps their attention. Here are some ways to use that learning enthusiasm as a way to engage your child:
Sometimes, when you are in a public place with your child, people find it necessary to put in their ‘two cents’; especially if your child has a learning or behavioral difficulty. Here are some ways to deal with that frustration:
It’s important to stay safe while having fun excursions together. It’s important to remember snacks and warm clothing, but what else? You should never leave your child alone unsupervised in a car. Keep your child close (hold hands, or steer the cart, or hang onto the cart). You might consider a name tag if your child has trouble communicating, and practice a plan in case you get separated. Some parents have had success using a harness and tethering device (“leash”) that can be used in more extreme situations where safety is an issue. However, it is important to ‘phase’ out the leash for increasing periods while using high levels of positive reinforcement. If possible, it might be beneficial to have a Service K-9 for a child who needs that additional support.
I hope these tips prove to be helpful and keep your outings merry this holiday season. If you would like to schedule an appointment or would like to know more about all our services, please visit http://cpcwecare.com/. Happy Holidays!
Many people find Thanksgiving to be one of their favorite holidays. It’s simple, no gifts to buy, no fuss. It’s just family and friends coming together with a recognition that we have a lot to be thankful for.
I imagine many of us try to keep that sentiment of thankfulness at the forefront of our minds and would prefer our kids do as well. However, do we find that, at times, our kids don’t seem so thankful? They have less than a strong sense of gratitude. Ironically, the more you do for your kids, the less thankful they may seem.
It’s sort of a trap. We love our kids so much and want them to be happy and content. At the same time, we live in the most prosperous and affluent country in the history of the world, so we have ample opportunity to give our kids lots of stuff.
So what transpires? As we give them more, we find that they tend to expect more. There comes a sense of entitlement and more expectation as opposed to a gracious and genuine “thank you!!”
Yes, it’s true, and clearly evidenced in our daily lives. The more someone gets, often the less gracious they become. Moreover, the lower the expectations to be able to obtain items (don’t have to work for it), the higher a child’s sense of entitlement.
People who feel entitled and come to expect things without a strong sense of gratitude are typically unhappy people. In that respect, gratitude is a barometer for happiness. The more gratitude a person feels in life, the happier they are going to be. It’s hard to be happy when you ‘expect’ more, and aren’t happy with what you already have.
Here are some ideas:
In that respect, we don’t give a child everything for which they ask. Remember the old adage: “give a child everything they need, but very little of what they want.” (who said that?)
This can be through an allowance, and they can save their money. It's worth considering that there are two different sets of chores in any home; those chores that are done because we all live together and have to pitch in to run the household, such as cleaning one’s room, emptying the garbage, running the sweeper… and those chores that may be considered ‘above and beyond’ for which an allowance will be considered: such as raking leaves, pulling weeds, shoveling snow, washing the car, cleaning windows… for younger kids, the list of chores for which an allowance will be allotted may be a bit longer, but as a child gets older, that list will get smaller so it will be harder to earn an allowance.
Local churches have myriad opportunities for this type of service, and in that respect, we can sign up our kids (and we go along) to volunteer at a shelter (with direct parent oversight), at the Goodwill, or go on a mission’s trip. This offers an opportunity to give back, see how good they have it, and see firsthand how others are living.
We make sure that, weekly, they write down all the things for which they are grateful. Also, it is good to get them in the habit of writing well-thought-out and gracious thank you cards for any gift they receive.
Get your kiddo to church, synagogue, or temple (wherever you worship). at least once if not twice a week. Most churches have a kid’s program that also meets Wednesday evenings). If a church is doing its job, the preacher(s) are teaching about gratitude, thankfulness, self-sacrifice, the 10th Commandment (okay, I’ll give you a hint – that one about not-coveting and, rather, being happy with what God's given you), love, patience, humility, being meek, and caring for others. Can you think of better messages for our children?
Okay, so I know what you’re thinking. It’s too late. That’s water under the bridge – your child is already an over-indulged tyrant who is running the household. Well, even in that seemingly dire situation, it’s not too late. You may need to take it a bit slower, but you can do it!! Follow the pointers above and, slowly but surely, things will begin to change. Your child will not be happy as you begin this process, they will fuss and try to wear you down. If you need help and guidance along the way, and maybe some moral support, that’s what I’m here for (and your local church with help from the Children’s Pastor). If you want to make a change in the direction of enhancing gratitude, you have to start sometime. How about today?
Here is wishing you and yours a relaxing and delightful Thanksgiving Holiday with your family and friends, and with your ever-increasingly grateful children. 😊 God bless you.
Your child’s treatment plan is the foundation of moving things in the right direction and seeing progress in your child’s behavior. It’s vital that you’re a large part of this process (of preparing the plan), in identifying the primary concerns that need to be targeted and to ensure that the goals are clear, concise, and achievable. In that respect, this post will target the creation of clear baselines, and writing achievable objectives.
You want there to be a clear indication of the problem behavior, how the problem behavior is manifesting (the baseline), and an objective that will show progress by the end of the treatment period (usually 3-6 months). The ‘treatment period’ is simply a period of time to assess progress, it does not refer to discharge. There can be many ‘treatment periods’ before discharge occurs.
These terms are often used interchangeably, but the goal is often broader and vague, while the objective is very specific.
There are 5 steps to this formula – will review them now.
What are the typical issues that cause difficulties in the home? Almost invariably, they include a child having problems with:
Your child’s therapist will operationally define the ‘issue’ into measurable and observable ‘behaviors’. Once you know the issue(s), the next step is to transform the issue into an identifiable and concise behavior as clearly and specifically as possible - in measurable and observable terms, which means you can actually observe the behavior, and measure it. In that regard, “emotional”, which is far too vague, is operationalized into specific ‘behaviors’ that can directly be observed and measured, so we can assess over time and see if there is progress. So, here are some examples of vague vs specific:
Specific Terms (Observable and Measurable):
yells and screams/whines/cries/runs off
hits mother on the arm/throws things/gestures…
yells ‘no’/ignores/says will do it, but does not
Time-sampling or permanent product/task completion:
Social
avoids social interactions / “socially awkward” is too vague, instead – stands too close, monopolizes…
Once the measurable and observable behavior is identified, the next step is to quantify the extent of the behavior so the behavior will be seen in ‘measurable’ terms. For example:
Your child’s therapist will then create the ‘Baseline’ by combining the specific problematic behavior with the measurable term. The Baseline is the extent to which the behavior is seen before treatment begins. A baseline can be written in lots of different ways, whether how many times the behavior is seen, or how often seen in a number of opportunities…
Is the baseline truly measurable and observable? We use the two-person test: would two people agree on what the behavior looks like?
Next, we create the objectives (based on the baseline). You and your child’s therapist decide what is realistic to be achieved by the end of the treatment period, and use the same behavior and measure as what was used in the Baseline.
Baseline: Michael yells and resists, for upwards of 10 minutes, when directed to a task 50% of the time.
Baseline: When directed to his chore, Michael yells ‘no’ 5x per day, (4/5 occurrences).
Baseline: When directed to task, Michael yells ‘no’ and screams, at an ear-piercing level, 5x per day.
Baseline: When given a direction, Michael says ‘no’ and refuses to comply 4x per day (needs 6-8 prompts).
Baseline: When given a direction, Michael ignores and does not comply 70% of the time (7/10 times).
Baseline: When given a direction, Michael needs 5-6 prompts to comply, at least 60% of the time.
Baseline: Michael has yelling episodes (define yell) 3x per day - persisting for 20 minutes each.
Baseline: Michael yells at a severe level (define “severe yell”) for at least 10 minutes, 3x per day
Baseline: Micheal screams, in an ear-piercing manner, for 15 minutes, 3x per day.
Baseline: Mary completes 1/5 assignments per day (this is using permanent product).
Baseline: Mary needs 5 prompts every 10 minutes to complete a (specific) task (tough to monitor).
Baseline: Mary needs 10-15 prompts to complete the morning routine (define morning routine).
Baseline: Mary is off-task 50% of the time during time-samplings (define time-samplings - how, where, when).
Objective Goal: Mary will comply with parental directives within 2 prompts in at least 4 out of 5 presented opportunities.
Objective Goal: Mary will improve self-control as evidenced by no aggressive, destructive, or self-injurious acts at least 5 out of 7 days a week.
Objective Goal: Sally reduced controlling behaviors (telling others what to do or being bossy, attempting to negotiate, etc.) to 2 out of 5 times by the end of the treatment period.
Objective Goal: Johnny will decrease physical aggression to once per week or less by the end of the treatment period.
Objective Goal: Neal will learn and use appropriate coping/anger management skills (taking deep breaths, hitting a pillow, counting to 10, etc) when upset in 3 out of 5 instances by the end of the treatment period.
Objective Goal: Nelson will improve problem-solving skills as evidenced by using his words and refraining from acting with violence in 3 out of 5 situations by the end of the treatment period.
The key to effective treatment plans is a careful process - and one that involves observations by both the family and the therapist. So there you have it; this general overview of how we prepare measurable and observable baselines and objectives so that the treatment process is more targeted and ultimately it’s easier to assess progress over time. Hope you found that helpful. Feel free to reach out with any questions at DrCarosso@aol.com. God bless you and your family.
Sticker charts can be an invaluable resource. Kids love to get stickers, which are inexpensive, highly motivating, and can be used numerous times throughout the day or week. From my professional and personal experience, I have seen first-hand how kid’s eyes light up when they earn stickers (with an opportunity to cash in for some later reward).
However, sticker charts have their drawbacks. They can be cumbersome - parents rarely stick with them beyond a few weeks. It can be tough to figure out how many stickers to give before a reward is provided. And you may wonder, how often should stickers be earned and allocated in the first place? All good questions! Here are some answers and guidelines to a successful sticker or reward chart:
Children older than 12 tend to prefer ‘point charts’ (child earns points, rather than stickers) that are added to determine if the reward is earned). Variations abound and include marbles being placed in a jar when chores are complete; if a child earns all seven jars in a week, then a weekly reward is given. Or, a marble in the jar determines if their favorite show can be viewed that evening.
Point charts are highly effective and motivating. Give them a try! Don’t worry if you only stick with it for a few weeks. In fact, you can tell your child that this “contract” (i.e. the sticker chart) is for only a few weeks until a desired reward is earned. Then you can feel free to take a break for a week or two and regroup. Also, don’t forget to get softer and closer with your child
Sticker Charts can be a very helpful tool in raising children. All you need is to follow the tips above, and of course, stickers! Here is a link to a basic sticker pack, but all you really need is a piece of paper to draw a chart, and stickers of any kind. God bless you and your little ones this fall. If you do try out a reward or sticker chart with your kiddos, feel free to leave a comment.
August is that ‘back to school’ time of year. Yes, it is sad to see the summer slipping by; but it’s time to start thinking about getting back into the school routine. It can be a difficult transition for children to get back into that schedule, with some kids dreading the end of summer. Here are some tips I've shared over the years for ways to ease the stress and get back into the swing of the school year.
Need I mention the difference between summer and school-year routines? Sometimes gently transitioning into that schedule can help. If you start about 2-3 weeks out, it’s much easier to ship your kids into shape. Otherwise, it’s a culture shock for your child and not too pleasant for you either. Below are some tips that are especially helpful for parents of children with autism but can apply to all kiddos.
1. First, begin slowly adjusting routines for an earlier bedtime.
2. Incorporate lengthier study and quiet reading sessions throughout the day and week. This could include anything even remotely academic.
3. Visit the school playground more frequently to promote your child becoming more comfortable with being at school, and on the school grounds. This is especially important if your kiddo has any anxiety issues.
4. Arrange playdates with school friends/acquaintances not seen for most of the summer, especially those kids who will be in your child’s class or grade.
5. If you can arrange a visit to the classroom and meet the teacher, so much the better.
6. It can be helpful to color-code school supplies (notebooks, file folders…). Integrate material color with a picture schedule.
7. Purchase school clothes early, wash them a few times, cut off tags, and make sure your child is comfortable with them well in advance. Therefore, they can be a 'familiar' aspect of the school routine.
8. In Addition, pick out a “cool” outfit for the first day and get a fresh haircut (first impressions are important).
10. Prepare the school with emergency contacts and any dietary issues. Moreover, you can prepare the teacher, aide, Guidance Counselor, ‘specials’ teachers, cafeteria workers, and anybody else who will listen for what to expect and how to effectively intervene if necessary.
11. Don’t forget to say a prayer with your kids before they venture off to school; they find that comforting and reassuring.
12. It may be helpful to write an "all about me" card for the teacher. This is a simple and fun way to let the classroom teacher know about your child. For example, such a card can communicate fun tidbits about your child, their interests, and preferences. Any special needs would be more formally presented during a meeting with the teacher and documented in an IEP or 504 plan.
It may seem daunting, but getting your child back into the class mindset, and settled back into that school schedule can be be done with less stress! Just remember to lat the groundwork with careful planning and help your child build excitement instead of nervousness for their new year.
