Part of the How We Treat Series; this article talks about the unique challenges related to Adult Autism and the services Community Psychiatric Centers offers to help treat and support it.
There has been a growing challenge in meeting the needs of adults with autism. In that respect, in-home services are available for those with autism, through a service provided by Community Psychiatric Centers called Intensive Behavioral Health Services (IBHS – formerly known as ‘wraparound services’) from early childhood through 21 years of age. However, at 21 years of age and beyond, the service options have been minimal. To that end, Community Psychiatric Centers is positioned to treat adults with autism, through the Adult Autism Waiver. We can provide a host of services to help adults with autism reach their fullest potential.
Autism Spectrum Disorder is categorized based on severity level, with Levels 1, 2, and 3, from mild to more severe, respectively. At Community Psychiatric Centers, our primary focus is the person’s adaptive levels of functioning, specifically in the areas of home living, learning, community use, employment, health and safety, and social activities. As part of our evaluation process, we assess each of these adaptive skills and adjust the treatment plan accordingly.
There is no known cause for autism but many suspicions including genetics and toxins; however, again, such is speculation. You can learn more about Autism and its severity levels here.
Individuals with autism are at risk for other complications and co-occurring conditions. In that respect, individuals with autism may also meet the criteria for Intellectual Disabilities Disorder, or IDD. Moreover, one study found between 73-81% of individuals with autism also met the criteria for a psychiatric disorder.
Our goal is to help individuals with autism reach their fullest potential. We treat those of any age; children and adults. However, specifically for adults with autism, we focus on the aforementioned adaptive skills so that, no matter the level of functioning, each is capable as possible to care for their home and living space, learn from experience, take full advantage of community resources, get and keep a job, maintain health and keep safe, and develop and maintain social pursuits. We work directly with individuals in the home and community to directly meet their individualized needs.
Community Psychiatric Centers is uniquely prepared to address any co-morbid mental health issues such as depression, anxiety, attention problems, or trouble with anger management. A primary aspect of our treatment program is counseling and behavioral support to promote healthy living. This support is provided directly in the home and can transfer to our outpatient clinic program where we can also provide medication management. It’s not uncommon that individuals with autism struggle with loved ones – they don’t always see eye-to-eye in terms of carrying out household duties, maintaining grooming and hygiene, and consequently there may be some trouble getting along - we also address such issues and promote family communication and harmony.
Check out more details of our Adult Autism program at Community Psychiatric Centers. You can also call to make an appointment for an evaluation at (724) 850-7200 or email me at DrCarosso@aol.com and we can work toward establishing a diagnosis and starting services. The same holds true if a diagnosis is already established – call us and we’ll discuss service options including connecting with a Service Coordinator and getting services started.
May God bless you and your family as you pursue services for your loved ones. I hope this post helps in that effort to clarify the resources available for those with autism. We look forward to answering any questions along the way and meeting your family’s needs. Don’t hesitate to call or email.
Part of the How We Treat Series; this chapter dives into the ways CPC supports and treats IDD.
Intellectual Disability is a condition whereby the individual has an overall intellectual quotient (IQ) and adaptive functioning that falls, on standardized and accepted measures, below 70, and such occurred before 18 years of age. These individuals subsequently struggle with reasoning, problem-solving, judgment, academic learning, and learning from experience. Moreover, in terms of deficits in adaptive functioning, some challenges significantly interfere with the individual’s ability to meet developmental and sociocultural norms and standards for independence and taking-on age-appropriate responsibilities.
As would be expected, there are mild, moderate, and severe levels of the disorder. Those within the mild range (obtaining a standard score of 60-69 on intellectual and adaptive measures) can learn basic life skills but simply need more explanation, repetition, and oversight - these individuals can become somewhat independent in life. Those with Moderate to Severe IDD (59 to 50) will need far more support and oversight but can learn to complete simple activities of daily living while those with severe IDD (49 and below) will need close supervision and guidance for the duration of their lives.
Individuals are assessed in terms of home living, learning, community use, employment, health and safety, and social activities. An individual would need to score at a deficit in at least four of these areas to qualify for services.
Any number of factors can cause an individual to experience intellectual and adaptive deficits. In that respect, for example, prenatal exposure to substances (Fetal Alcohol Syndrome), brain infection, traumatic brain injury, maternal infections, hypoxia, or hemorrhage. Genetic factors are also contributory, including Down Syndrome (Trisomy 21), and Fragile X. However, many cases of IDD are of unknown origin.
Individuals with IDD are clearly at-risk for other complications and co-occurring conditions. In that respect, individuals with autism often also meet the criteria for IDD. Moreover, one study found upwards of 57% of individuals with IDD also met the criteria for a mood disorder, anxiety, ADHD, or schizophrenia.
Our goal is to help individuals with intellectual disabilities reach their fullest potential. We treat those of any age; children and adults. We focus on the aforementioned adaptive skills so that, no matter the level of intellect, each is capable as possible to care for their home and living space, learn from experience, take full advantage of community resources, get and keep a job, maintain their health and safety, and develop/maintain social pursuits. Then, we work directly with individuals in the home and community to meet their individualized needs.
Community Psychiatric Centers is uniquely prepared to address any co-morbid mental health issues such as depression, anxiety, attention problems, or trouble with anger management. A primary aspect of the Intellectual Disabilities Disorder treatment program is counseling and behavioral support to promote healthy living. This support is provided directly in the home and can relocate to our outpatient clinic program where we can also provide medication management. It’s not uncommon that individuals with intellectual deficits struggle with loved ones – they don’t always see eye-to-eye in terms of carrying out household duties, maintaining grooming and hygiene, and consequently, there may be some trouble getting along - we also address such issues and promote family communication and harmony.
Check out the details of our IDD program at cpcwecare.com. You can call to make an appointment for an evaluation at (724) 850-7200 or email me at DrCarosso@aol.com. Together, we can work toward establishing a diagnosis and starting services. The same holds true if a diagnosis is already established – call us and we’ll discuss service options including connecting with a Service Coordinator and getting services started.
May God bless you and your family as you pursue services for your loved ones. I hope this post helps in that effort to clarify the resources available for those with Intellectual Disabilities. We look forward to answering any questions along the way and meeting your family’s needs. Don’t hesitate to call or email.
I originally published this post in late 2014; it's one of my favorites and I hope one of yours. I'm reminded daily of the power of family on a child's life, especially that of a mother and father working in tandem. This Valentine's Day, this is a good post in regards to the importance of the mother/father - husband/wife relationship as the foundation of the home, and the springboard for what creates healthy and secure children. The celebration of Valentine's Day serves as a great reminder to foster and bolster that relationship all year round. So, without further ado:
A Dad and his son were fishing in a boat. The son looked toward his Dad and inquired, “Dad, if Mom and I fell out of the boat and were drowning, who would you save first?” His Dad, without hesitating, responded “Son, I’d have your Mother in the boat, and dried off, before I’d even think about coming after you.” The son, astonished, looked with eyes wide and was about to exclaim his disapproval but stopped, appeared contemplative, then grinned and said, “Yea, that’s the way it should be.”
The son came to understand that the strength of the home, the foundation of the family, is Mom and Dad, together in harmony, close in their relationship, working for the family, strong in their bond, and on the same page with the kids. It’s true, there is no stronger glue to hold the family together than when Mom and Dad are secure in their relationship, which helps the kids to also be secure with themselves. Secure kids are far more likely to be calmer, more compliant, and easier in disposition. Of course, we don’t want to interpret the story literally, any number of factors may contribute to the Dad rescuing his son first (his wife is a better swimmer…) but, of course, that’s not the point of the story.
If you’re a single parent, for whatever reason, then you’re undoubtedly doing the best you can, and God bless you in your efforts. The sentiment of this post in no way diminishes your diligence and love for your children or suggests that your child is not healthy and happy. The basis of this story is simply to express the importance of parents remaining strongly committed, and there are advantages of having two loving, committed, and harmonious parents working together with the kids. In a single-parent situation, when possible, it’s optimal that both parents remain highly involved with the children, civil with one another, and work toward having consistent expectations between the homes.
Simple; do whatever you can to maintain the sanctity, security, commitment, closeness, and bond in your marriage. Place your spouse first in your life (well, technically, second to God, but He too understands the importance of two becoming “one”… see Genesis 2:24). Live like it’s you two against the world, and you’ll always be ready for that overboard plunge.
Raising a child with developmental issues, or who is quite strong-willed, can be quite taxing for parents, and it can be difficult to 'stay on the same page' and continue working together in that team-like fashion. If you need some help in that respect, don't hesitate to contact me at DrCarosso@aol.com.
This website functions as a sort of library for all the videos, articles, Quick-Reference Guides, and in-depth eBooks that I have created and collected over the years. Today's post is a mini tour of all the helpful information we have to offer parents and caregivers. Check out the latest helpful parenting resources!
An extension of my regular blog articles, the Parent Resources Page showcases these five categories:
For more than 30 years I've honed my experience as a Clinical Child Psychologist and Certified School Psychologist. In my mission to share my knowledge with the parents and caretakers that I speak to in my practices, I wrote a book to outline and address the five most challenging health conditions that people seek my help for. This page talks more about my book, Managing The 5 Most Challenging Childhood Behavioral Health Conditions Of Our Day, what information it contains, and how to pick up your own copy wherever you live.
Sometimes a subject deserves a more focused article to narrow down the information needed. The Focused Articles Section of the Parent Resources Page highlights some common questions parents have for our treatments and diagnostics.
My EBooks are comprehensive, interactive digital magazines with videos and links. Covering some of the most popular childhood challenge subjects, they are packed into an easy-to-read and share format for your convenience. They are in the blog archives and listed with the blog articles as they are posted, but they also have a handy home on the eBooks Page. Here is the list at this time (more are added regularly):
I like to share my advice and answer questions from the public directly on my professional Facebook Page. It also has daily tips and suggestions about parenting: https://www.facebook.com/dr.johncarosso. Send me a message, and share something you've learned or liked!
If your child struggles with reading, see the Dyslexia Diagnostic & Treatment Center at DyslexiaTreaters.com for our dyslexia resources and online Reading Therapy. Here, you can easily set up an appointment for a diagnosis, learn more about recommended treatment options, and schedule our Reading Therapy sessions from the comfort of your own home.
I trust you'll find these resources to be helpful and informative. Feel free to email me with any questions at DrCarosso@aol.com or call to schedule at (724) 850-7200. May God deeply bless you and your children.
An all-too-common situation (especially since Covid) 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, but he or she continues 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 tendency to avoid that which makes us anxious. In this situation, the prospect of attending school, or 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, 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 home work, which helps to keep up some assignment completion but clearly it’s not a long term solution and does not facilitate your child is not receiving a proper education. Some parents will consider a cyber school, which isn’t necessarily a bad option under the following condition:
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 house bound. 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.
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.
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?
This “How We Treat” eBook will target the five most common reasons that parents seek help from me for their children. What are these most common issues? Drum roll please… they are childhood depression, anxiety, autism, ADHD, and explosive outbursts. This series will highlight each of these challenges and provide a parent-friendly description of the condition, its causes, and a step-by-step approach to how it's treated.
I trust you’ll find this eBook to be informative and helpful in managing your child. Feel free to browse more of my posts at HelpForYourChild.com where you can also schedule an appointment, and you can reach out to me for help at DrCarosso@aol.com.
As one would expect given my occupation, I’m often approached by teens and their parents about feelings of depression and anxiety. It’s troubling to see a child or adolescent struggling. But you should know that there are practical and very effective strategies to improve the situation. Chapter One reviews those strategies and provides helpful insights.
In this chapter, I tackle how we treat autism. Autism is a developmental disorder, which is a condition that impacts a child’s ability to achieve and demonstrate developmental milestones and expectations. The cause is unknown, but in this writer’s estimation, it likely has genetic underpinnings.
In Chapter Three, I describe the nature of ADHD, how it’s diagnosed, and how it’s treated. ADHD is considered to be a disorder of the prefrontal cortex and a subsequent deficiency in executive functions. In this respect, the prefrontal cortex of the brain is responsible for vital tasks, including attention, emotional control, working memory, organization, planning, shifting attention, mental flexibility, impulse control, and time management.
One of the foremost concerns expressed by parents is often regarding their child’s emotional sensitivity, overreaction, and subsequent emotional outbursts. It’s troubling to see your child or adolescent struggling. But it’s good to know that there are practical and effective strategies to improve the situation. Chapter Four is a helpful review.
You can read the interactive eBook on my Substack!
For more parenting resources or to set an appointment, check out the Community Psychiatric Centers' website. Please feel free to reach out to me with any questions at DrCarosso@aol.com.
Dr. John Carosso's ebook: ABA in a Parent-Friendly Format.
Dr. John Carosso's ebook: The Steps to Improving Your Child's Behavior
Dr. Carosso’s eBook: The ADHD Diagnosis, Severity Level, and Treatment Options
Dr. Carosso’s eBook: The Most Common Discipline Methods Don’t Work: Here’s Why and How to Make them Work
The holiday season is a time for lots of family and celebrations. It can feel like the modern world emphasizes the excesses of festivities and gifts that often come with those celebrations. In a season where material things are advertised at every turn, how do you provide a balance between helping your children be thankful for what they have, and providing them with that ‘Christmas morning magic’ of a pile of presents? It’s a tough balancing act!
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. Developing a work ethic is an important life skill.
Local churches have myriad opportunities for this type of service; 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. Donating toys/ items that the child has grown out of can be a powerful motivator to keep an uncluttered household, and it helps to cement the idea of helping the less fortunate.
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. This can start at a very early age, even if they are not yet able to write the cards themselves.
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. 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 Holiday Season with your family and friends, and with your ever-increasingly grateful children. For more tips on surviving the challenges that can come up during this time of year, check out my post: Managing the Holiday Season.
😊 God bless you.
A very popular article here at HelpForYourChild, this article appeared in December of 2021 - and has been updated for this year’s holiday season.
Thanksgiving grocery runs, day trips to visit family, shopping at the mall - the holiday season often includes busy public outings with your child. 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 (achievable) expectations are.
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.
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!
One of the foremost concerns expressed by parents is often regarding their child’s emotional sensitivity, overreaction, and subsequent emotional outbursts. It’s troubling to see your child or adolescent struggling, but it’s good to know that there are practical and effective strategies to improve the situation. Let’s review them today.
First, Let’s review the causes of emotional escalation, which tends to be multi-faceted. In that respect, interestingly, a primary component of many childhood disorders is being overly emotionally reactive. More specifically, in my clinical experience and observations, the reason kids/individuals tend to be hyper-reactive, emotional, and prone toward outbursts includes the following, in no particular order:
In that respect, for example, if Bipolar Disorder, panic, and anxiety, or severe depression runs in the family, then clearly the child is genetically vulnerable to having emotional reactions and being ‘moody’ and reactive. The child may never actually be diagnosed with a mood disorder, but they may, nonetheless, display some similar tendencies, which can stem from the aforementioned genetic predisposition but also from observing heightened emotionality in the home.
A depressed child often presents as more irritable than depressed, which can then manifest in outbursts.
A child with an anxiety disorder will often display emotion and tantrums when feeling anxious or uncomfortable, such as when encountering a new situation, going to school in the morning, or encountering an unexpected change in routine. They may have difficulty calmly expressing their anxiety, so they act out with an emotional episode.
Individuals with PTSD tend to be far more emotionally reactive.
If the individual is in his or her teens or is an adult, and trauma has been evident since early childhood, then an underlying personality disorder may be developing such as Borderline Personality Disorder whose core symptom is hyper-reactivity.
Children on the autism spectrum tend to be highly emotional and reactive. This would include both low and high-functioning on the spectrum.
The protocol for managing emotional reactions is as follows:
Let’s look at each of these.
It is paramount that you remain calm. This can’t be emphasized enough or overstated. No matter your child’s reaction, you must maintain your composure, and present yourself as calm and in control. I call it being the ‘James Bond’ of parents. No matter how harrowing the situation, Bond is always calm and even has a sense of humor; definitely worth emulating.
Being “calm” means your voice volume, tone, facial expression, and bodily stance. You’ll practice your coping skills (see below) to ensure you remain calm. Clearly, two out-of-control people (you and your child) are not going to help the situation. Your job is to model calm and effective problem-solving for your child.
A powerful way to help somebody struggling with strong emotions is to validate their feelings. We may believe the child is overreacting but, if we want to induce a sense of calm, the first thing we do is validate those strong feelings.
So, instead of saying something like “why are you getting so upset, it’s not that big a deal” (which only serves to further infuriate the child) instead we say: “I can see that it makes you really upset/sad/angry/frustrated when you lose that game… a friend says something mean to you… did not get an A+ on the exam… you have to stop playing video games…“ whatever the issue may be. Identify the feeling being conveyed and reflect that feeling. You may reflect 4-5 times before moving into practicing coping skills and then moving on to problem-solving. Validating also entails being fully ‘present’ with eye contact, remaining calm, positioning toward your child, and being fully attentive.
If you move to problem-solving too soon, before the child or youth feels as though you have fully heard and understood their feelings, it will only cause frustration. It is very reassuring for any of us to feel that we’ve been heard and understood. That’s as true for you as for your child. So, instead of being frustrated by your child’s behavior, you’re going to be too busy with validating/being fully present.
It will help you to stay calm if you don’t judge your child’s behavior. Try to perceive your child’s behavior in a neutral light, with a degree of indifference. It simply ‘is what it is’. If you ‘judge’ the behavior as ‘bad’ and that your child “shouldn’t” be acting this way, then you’re not helping the situation and will only become frustrated. In fact, if your child has issues controlling their emotions, and that fact has been well-established, then who says they “shouldn’t” be acting this way? Given the circumstances, it’s likely more reasonable to believe that he, in fact, ‘should’ be acting the way he’s acting.
In that light, it's your job not to judge, condemn, put down, or become emotional yourself; rather, it’s your job to remove your emotions and, as the parent, effectively manage the situation. Please note that the term “effective” is in a spectrum and may simply mean that we reduced the intensity of the outburst from a ‘10’, to an ‘8’, which may be encouraging. Similarly, not ‘judging’ also means accepting your child the way he is; accepting that he struggles with controlling emotions and that is part of his make-up, and you’re going to help him with that in a nonjudgmental and helpful way. He’s not ‘bad’; he’s just having some difficulty in a particular area.
Perspective is everything – no attempt to sugarcoat anything; we’re fully accepting the reality of the situation, but the key is we’re working on acceptance, which begets a sense of calm, and a measured and thoughtful approach. Along the way, remind yourself that this is a process – it will not change overnight.
A coping skill is any strategy you use to cope with your child’s behavior, and ways we teach our kids to cope with frustration. Regarding the former, this is the part where you fill your toolbox with loads of tools you’ll use as needed. In that respect, you’ll exhaustively read the posts on HelpForYourChild.com, among other resources, and learn ways of coping for both you and your child. These coping skills will be used before, during, and after a crisis and include specific strategies, and concepts, such as:
Practice being responsive (not reactive), and non-judgmental. Do not presume your child’s intentions. Validate their reactions by picking your battles, giving choices, and not arguing with them.
Use behavioral principles such as high levels of positive reinforcement (rewards). Rewards are not “bribes” - be specific in what you want from your child and reinforce that behavior. Describe the behavior in a specific and nonjudgement way so you’re both on the same page (“upset” and “disrespectful” are vague). Look for ‘good’ behaviors and note them, using things like sticker charts, and give access to privileges when they show that good behavior more immediately (day-to-day, as opposed to week-to-week). The use of ‘contracts’ with your kiddo might be helpful.
Use consistent and immediate natural consequences. Practice using intermittent reinforcement (finding the “right” reinforcer), planned ignoring, the process of ‘shaping’, using the PREMAK principle (if/then), and avoiding lengthy punishments.
Practice staying calm, using deep breathing (mindful breathing), a calm-down room, relaxation techniques, consistent routine, and keeping the proper perspective including ‘this episode will pass.’ Assessing the antecedent or “trigger” for the behavior will allow you to anticipate episodes, and face them more calmly as well.
Practice meditating – there are lots of different types of meditation - sometimes also referred to as ‘mindfulness’. I tend to be a proponent of meditating on calming and reassuring verses from Scripture such as “Cast all your anxieties on God, because He cares for you," 1 Peter 5:7.
These coping skills, among many others that you can read about on HelpForYourChild.com, are indispensable for dealing with a child’s emotional outbursts. In addition, there are many resources I’ve recommended such as Parenting a Child who has Intense Emotions, by Harvey & Penzo, and the ones you can learn working with your child’s behavioral therapist.
Behavioral, individual, and family counseling is very important to work on coping skills and improve family communication, effective problem-solving, perspective-taking, and general problem-solving. We’re available here at Community Psychiatric Centers to begin that process. As you can see, the above section is quite a list of coping skills, but understanding those strategies and using them effectively can be challenging, so obtaining professional help is vital.
It’s clear that for more severe cases of emotionality, outbursts, or self-injurious behavior when the strategies listed above are working but not to the extent we’d prefer; medication can be very helpful. The more severe the emotional escalations, the greater the benefit of medication. Comparatively, for example, it was found that medication works much better than placebo, and many experience notable relief in their feelings of extreme emotion through the use of prescribed medications.
There you have a summary of the causes of being overly emotionally reactive and the steps to help your child. I hope and trust you found this overview to be helpful. It’s typically best to obtain professional guidance in improving one’s coping skills, and we’re here at Community Psychiatric Centers, welcoming the opportunity to provide such support. Feel free to email me at DrCarosso@aol.com or call 724-850-7200 to schedule. May God deeply bless you and your child.
