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.
Interestingly, transitions can be a challenging prospect. For neurotypical and atypical/diverse kiddos alike, transitioning from favored to disliked tasks, or even from any given activity to another, can be daunting and met with resistance, emotion, defiance, and tantrums. In fact, difficulty with activity transitions is a top-three complaint from parents regarding their kiddo’s.
Well, there are likely a number of reasons. Really, who wants to transition from a fun and enjoyable task (playing with toys, watching TV, drawing, playing with technology) to emptying the garbage, doing homework, or having to sit quietly and attentively for dinner? The same is true for adults. How much do we want to stop reading our favorite book to do the laundry or cut the grass? And how much do we appreciate pestering and cajoling to do so?
However, what about moving from one fun task to another equally fun activity? For example: moving between activities or transitioning to circle time in a preschool or Kindergarten. There could be any number of issues to consider in that case. Included in this, children with autism having a strong need for ‘sameness.’ Moving to a different activity is ‘change’ and perceived as unsettling. They often feel the need to fully complete a task before moving to another.
Let’s review some options. We often focus only on the first phase of any transition, which is a good start, but insufficient. So, in this post we’ll take a look at all three phases, and the differences between younger and older children.
Targeting the three phases of activity transitions:
This is the most-often discussed phase. Most of us are pretty aware of how to prepare and prompt a child to make activity transitions. We may give verbal warnings; 5 minutes, 3 minutes, and one-minute out. Or even the more helpful visual timer so the child ‘see’ the time elapse. A child-friendly song or bell that emits when time elapses can help too. Move closer as the time draws closer, so the verbal warnings can be a whisper in their ear as you get ‘softer and closer’.
Even better is a written or visual schedule. This way the child can ‘see’ the next activity that features the child smiling and having fun in the next project. We keep very consistent routines so the next activity is expected and anticipated.
Now it’s time to make the move; what to do? There are any number of options. It may be helpful to use a visual cue such as flickering the lights on-and-off, or an auditory cue like singing the clean-up song. A fun song can play as a further auditory cue (with a brief time of dancing before clean-up and transitioning to the next task). You can ‘prime’ for the next activity by giving the child a fun/enticing item for the next project (while still cleaning up) to reinforce the move.
For example, if the next activity is finger painting, you may show the child the colorful paints that are going to be used, or completed paintings from others. You can even have a child from the finger-painting walk with the child while explaining how much fun it is.
Children also like to help, so have them carry some items that will be needed to complete the next activity. Interestingly, kids seem to like the challenge of carrying heavier or larger objects, so try to incorporate something that is a challenge. We can also make the transition more activity-based. As we move from one activity to another, we see how many times they can bounce a ball on the way to the next activity, or do a hula-hoop, skip, or jump on one leg… anything to make it fun.
If the task is very disliked (homework), you can prime by giving an example of the homework while still ending the prior task. The example homework would show a subject of interest and strength, and the child would be reminded he’ll get a break of 10 minutes to do a favorite activity. If the homework is about sharks, the child can be given a toy shark on the way to the homework table. Children can also be reminded of the importance of earning stickers and what can be purchased with the stickers upon completion of the task.
Phase 3 depends on the activity. If it is potentially equally favored (moving to dinner) then include a favored meal item and have it front-and-center on the table or plate (back to Phase 2: give your child a picture of the favored meal).
If it’s favored to disliked, then that’s a bit more of a challenge. The same steps can be used for Phases 1 and 2, and once the child has encountered the disliked task, make it pleasant as possible. Use your imagination: if it’s homework, break it down into smaller segments and start with the easiest and more fun assignment. If it’s a chore, remind your child of the sticker chart and make it a game; set a timer to see how fast they can get it done compared to you or a sibling. If it’s a series of tasks (getting off to school in the morning) keep it fast-paced, stay close, give lots of kudos, and most importantly remove all distractions.
You may need to deal with a sibling so you can’t always remain in close proximity. In this case, use a recorder (or Alexa) to verbally prompt the child every 30 seconds (“Hi Joey, finish getting dressed…”). A recorder can also be used to provide verbal reinforcement every few minutes (“Joey, keep working on your homework…”).
Some of the above suggestions regarding Phases 1-3 can also pertain to some older children and teens. However, with teens, we tend to rely more on reasoning and negotiating, and natural consequences. In that respect, in this sense, with teens, we’re getting away from dealing directly with ‘transitions’ and simply targeting task completion.
In that respect, a sit-down with the teen, discuss the task(s) that need to be done, negotiate an agreement regarding how and when tasks will be completed, and the natural consequences when they don’t get done. What’s a natural consequence? Any outcome that is a natural outcome of the child’s behavior. For example, speeding results in a ticket, not doing homework results in failing grades (having to repeat), not bringing laundry downstairs results in having no clean clothes… Or, more generally, if the youth does not help out around the house, then you remove your services from them.
Parents often don’t realize how much their teens depend on them, for everything. If your teen is not holding up their end, they can do their own laundry, prepare their own meals (and of course, you’re not going to purchase their favored food and snack items), and find their own transportation, of course they won’t have a phone or video games because how will they pay for them? And you have to buy them clothes, but it’s up to you where you buy them from (Nordstrom or Goodwill?). Your child asks you for something… “So, you want me to drive you to your friend’s house, hmmm, I recall how you responded this morning when I asked you to make your bed…”). May sound tough-love-ish, but those are natural consequences. Their participation in your expectations is a way to help prepare them for adulthood.
It’s vital that your reaction is without any emotion, no pestering, and matter-of-fact. This approach can be used for neuro-diverse teens who are more challenged, as with Level 2 autism, but the ‘natural consequences’ may be more child-oriented and more ‘when/then’ in nature (see below).
Moving from an electronic activity can be difficult at any age. Especially so for older children and teens who become emotional, throw tantrums, or even be combative when told to stop screen time. In these instances, the following is advised and can be used for a child of any age:
A tried-and-true method of compelling compliance to transitioning is the ‘when/then’ approach. This entails calmly and nonchalantly expressing that upon transitioning, ‘when’ a task is done, ‘then’ the child can have access to a given favored activity/item. In this scenario, the time frame may not necessarily be important or enforced. Rather, it's simply a matter of getting a particular task completed before access to another favored activity is granted. I.e: "you have to empty the garbage before you can go be with your friends"… Or, “When you complete your homework, then you can play video games”.
Activity transitions can be difficult and sometimes there is simply no way around the resistance and outburst. You simply compel the issue, ignore it, and carry on. However, the aforementioned tips can possibly remedy the issue, or at least make it less averse and problematic. Feel free to check out more tips at HelpForYourChild.com, where you can also make an appointment. Or, reach out at DrCarosso@aol.com with any questions. God bless.
Re-posted from an article back in 2021, this post recognizes the importance of the role fathers play in a child's development. It has been updated for today.
We all fully recognize the importance of a mom in a child’s life. Indeed, no one can surpass the love, compassion, caring, empathy, and tenderness of a mother. Dads can demonstrate those traits, but not always to the extent of their female counterparts and, one could argue; that’s not what dads are for anyway. It seems clear that when God devised the family, He delineated very special and specific roles for each member that divinely complement one other to provide a child all that’s necessary to grow in a healthy and well-rounded way.
This post is an open letter to all fathers out there. Please share it with your husband - or any male for that matter - to the dads who read these posts: I hope you find it informative. In any case, there are a few things dads need to know, and I aim to tell them. So, here it goes:
I’m not sure you realize just how important you are in your child’s life. The relationship between both parents is very important. You may think your wife picks up the slack, among other things, and that moms are the true nurturing force, and you may be right about that. However, your role is invaluable and irreplaceable.
In fact, your presence in your child’s life makes all the difference in the world for your child. For example, did you know that your engagement in your kid’s life results in your child being more engaged in school (almost 50% more likely to earn better grades and the same percentage less likely to repeat a grade; 60% less likely to get in trouble at school or drop-out, and twice as likely to go to college), are more likely to stay out of trouble (80% less likely to spend time in jail!!!), avoid high-risk behaviors, and to hold off intimacy with the opposite sex (75% less likely to have a teen birth!!).
As if that’s not powerful enough, it goes even further: your presence and attention results in your child having a much greater chance of becoming a successful adult with a better-paying job and healthier relationships. Incredibly, with you being in your child’s life, your kiddo is more likely to have a higher IQ and be emotionally more stable than otherwise. You probably didn’t know that infants with involved fathers have been found to have higher cognitive scores by one year of age than those without their father’s involvement.
That’s not optimal, but clearly, it’s surmountable. Stay engaged with phone calls, letters (the old-fashion handwritten kind), emails, texts, attending games, regular visitation, and balanced custody arrangements. A child simply knowing their dad cares is huge and is super impactful. However, you gotta realize that there is no substitute for your presence; buying gifts simply won’t cut it, and likely will make the situation worse. It’s very simple; your child wants and needs YOU, not stuff.
Your child likely has a mom, and that’s immeasurably important, but you bring some special things to the table. Think about it: without you, how is your son going to know how a man is supposed to act? In the absence of watching how you treat her mother, how will your daughter know how she should be treated by her husband? Yeah, I know, this may sound stereotyped, but is it untrue? Without you, how will a boy learn to be tough and masculine and, at the same time, a gentleman? Of course, kids without fathers figure it out, but it’s not an easy path and doesn’t come as naturally.
What about my daughter, you ask? Well, you’re no less important to her. There is a general sense that a father’s presence is equally important for son and daughter till puberty; thereafter, your presence helps immeasurably to keep your daughter from being sexually active. Girls with dads in their lives have less of an internal drive to act out sexually, have more self-control, and are generally less inclined to become sexually active at an early age. Daughters with attentive dads learn lots of important things including that they don’t need to be sexual to deserve a male’s attention.
Moreover, your daughter sees you respecting her mother and learns how a woman is supposed to be treated in relationships. Your kids learn, directly from you, about dependability, work ethic, how a man is supposed to handle anger and emotions, and how to care for a family. You also have a profound impact on your child’s spiritual life. You are called to reflect God's fatherhood for your child; and to be a model of strength, leadership, love, faithfulness, grace, and mercy. Moreover, your child will follow your spiritual lead in that respect, which further shows the importance of your influence.
Your job as ‘father’ and ‘dad’ is the best and most challenging of positions. It can be daunting, may seem impossible, and you may feel like you’re failing at times, but staying in the game and ‘being there’ is how you win, and how your child wins.
Okay, so what if you’ve been out of your child’s life? That is a difficult situation. Re-engaging with your child is a worthy pursuit, but rebuilding trust is usually a process. There may be multiple barriers to overcome including some legalities. The process usually begins with writing letters, which can be effective. Remember: it’s very comforting for a child to know that their father cares, even if they don’t have contact. However, there are some situations where re-engagement can be counterproductive and even harmful. It’s important to be sensitive to the history between you and your child. If you’re not sure how to proceed, feel free to reach out to me and we can talk: DrCarosso@aol.com.
I hope you find this letter to be heartening and inspiring. As a dad myself, I find it important to be reminded of our God-given role and place within the family, our paramount importance for our kids, and the need to strive to be our very best. I commend you for doing the same, and I wish you the best....
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. 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.
If your child is involved in therapy, you may wonder about the approach of your child’s therapist, to what extent you’ll be involved in the therapy, and how those decisions are made. This post will shed some light on that process.
Therapists use different therapeutic approaches in the therapy process, such as client-centered (reflective listening) and cognitive-behavioral (CBT). Interestingly, how these approaches are utilized, and how they are implemented, depends on essential factors or aspects of their client. When working with an adult, a therapist may need to deal with some degree is resistance. But there is a general expectation that the adult will arrive for therapy and engage in a back-and-forth exchange. However, when working with children and teens, all bets are off. In that respect, a child therapist will be prepared for a wide range; from a five-year-old child with ADHD to a 15 year who doesn’t want to be in treatment. Of course, in each case, the approach will need to be quite different. This post will highlight the formula I developed that helps therapists navigate through those differences and utilize the correct approach for your child.
The formula begins with the therapist acting as a Behavioral Detective to fully understand the specific issues that bring a child or teen into therapy. In that regard, there are dozens of questions that need to be answered to help the practitioner understand the history of the condition and the current behaviors and emotions. The therapist then prioritizes the problematic behaviors to determine which to target in treatment, and in what order.
In Step One – the therapist must know the specific behaviors/emotions that need to be targeted in treatment. The therapist must be laser-focused on the specific behaviors that led to the child being in therapy in the first place.
Prior to beginning therapy and before any session with your child, the therapist must have a clear understanding of the specific behavior(s) that needs to be addressed. This could include, for example, the child demonstrating outbursts when asked to do a chore.
Once the practitioner fully understands the specific problematic behavior that needs targeting in the session, the next step is to determine the specific 'best-practice' treatment protocol to treat that specific behavior. This usually includes teaching any number of coping skills, improving communication, and helping the parent to implement behavior management.
Next, your child’s practitioner will determine how to implement that treatment protocol based on three factors: the child's or teens’ level of insight, openness, and attentiveness.
Insight denotes the extent to which a child or teen realizes that they have a problem and understand the dynamics of the problem. In that respect, some kids can, for example, explain their tendency to quickly become emotional and understand that their reaction ‘goes way too far’, while other kiddos have a far more difficult time in that respect and tend to only blame others.
Openness to treatment reflects being ‘open’ and willing to talk and discuss the issue, as opposed to being resistant, guarded, and defensive. You can see that insight and openness overlap to some extent. However, a child can have great insight but not be open to treatment, or have poor insight but be more than willing to participate in treatment.
Attention simply indicates the extent to which the child can pay attention, focus, and remain on-topic for a back-and-forth conversation and explore any given issue. As you would expect, a child with more severe ADHD would struggle with attention.
All children and teens can be rated on these three aspects. Here’s how your therapist uses this process:
Your child or teen's therapist will score these three factors from 1-10 (1 is low, 10 is high, or well-developed).
Plug the score into the scale below, and the scale guides the therapy approach:
High Score: Traditional talk therapy - talking "with" the client; give-and-take, reflective listening, back-and-forth dialogue talking about coping skills.
Medium Score: More so talking 'at' the client and psycho-education. Teaching, explaining coping skills, and discussing scenarios that are similar to the client's issues is common. Explaining how other clients overcame a similar problem is sometimes used. This is similar to using a 'social story' but in a more mature context. The therapist may also negotiate with a teen client to elevate them higher on the scale. They may say: "if you are cooperative, we can work on the problem so you don't have to come to therapy anymore..." The therapist will also rely on involving the parent in the sessions to address communication and behavior management.
Low Score: It’s more common for a younger child to earn a lower score, especially a child with ADHD or autism with poor insight. The child may be open to treatment but can't pay attention. In this instance, an activity-based approach will predominate such as utilizing games and activities, and play-oriented therapy, to directly target and improve attention, frustration tolerance, sharing, turn-taking, and emotional regulation. Social stories and the use of pictures and art is also common to promote attention, interest, and learning skills. Parent involvement and working on behavioral management during sessions are vital.
A therapist will combine approaches because clients may not fall into any one area and may change in terms of openness from session to session. Moreover, aspects of all the approaches will be relevant for all clients. In addition to utilizing a more traditional talk-therapy approach, therapists will involve parents. They will discuss behavior management, incorporate psycho-education, and use games and activities to work on feelings and coping skills. This formula indicates those approaches that the therapist will predominately rely on during therapy sessions for any given client.
I hope this post helps to clarify how your child’s therapist decides on the treatment protocol and how to implement that protocol with your child. At Community Psychiatric Centers, your involvement, as the parent, is always vital and instrumental! We’ll always ensure you’re a large part of the process and understand all aspects of your child’s treatment. If you have any specific questions, feel free to email me at DrCarosso@aol.com. To make an appointment, feel free to call 724-850-7200. God bless you and your family.
