A version of this post appeared in Spring of 2021.
It’s May and the summer break from school will be here before ya know it. I would hate to have you awaken that fateful day in early June with the incessant “I’m bored”, or loud screaming that typically accompanies siblings being home together all day.
Oh, the joys of summer.
There is much to think about, and all kinds of activities to do. It can be overwhelming just trying to fit everything in the few short months before summer ends. On the other hand, it can seem like, without the schedule of classes and school activities, some kids are in a hopeless state of boredom over summer break.
A very effective way to plan for the summer while squeezing out every drop of fun you can is to get a calendar and plan the entire summer out, week-by-week. You may have some day-long, or week-long camps; the annual summer vacation to the beach or Disney, your kid’s sporting events, a trip to Aunt Rhoda’s… Once you have those regular events scheduled, you can start getting creative. Oh, by the way, if your child has special needs, contact the Park (Disney…) they formerly provided passes to avoid long wait times.
I’ll bet your family has a bucket list of fun and ‘different’ things you all would like to do, but haven’t. Often, we don’t do fun things because we don’t plan for them. So, plan the activities and get that small flower garden planted, bake some cookies, go camping in the backyard, go on that day trip to Gettysburg, project a movie on your garage door and have a homemade drive-in, do some star-gazing, start an annual neighborhood kickball tournament and, of course, can’t forget about getting a net (not a Wiffle bat) and catching lightning bugs.
You may include some things in the summer agenda that aren’t necessarily fun but are still worthwhile. Summer is an excellent time to home your kids’ skills such as math, writing, or reading. If your child has special education services, talk to the Principal now about whether your child qualifies for Extended School Year (ESY). We also offer intensive summer online programming through DyslexiaTreaters.com. Teach the kiddos how to do various chores around the house (how to wash the family car…) or do a family project such as cleaning out that garage. In fact, sometimes those ‘chores’, if done together as a family, can be a bonding experience. Especially when the outcome is achieved by everyone’s hard work.
If your child is on the spectrum, the summer break from school is a time you can be a bit more indulgent in your child’s obsessive interests (sharks, star wars, etc…) but only after nonpreferred is done, and don’t overindulge! Also, in the same vein, there can be a tendency to isolate and avoid social encounters; be sure to incorporate supervised social encounters into the calendar. You may find it helpful to plan trips to the zoo, local library, autism-friendly theatre, and bookstore. Also, don’t forget for all kiddos: daily running around and lots of physical activity.
Babysitters and childcare tend to get filled up pretty quickly, so don’t delay in connecting with that local teenager who does a great job with your kids, or that daycare provider who comes highly recommended by your friends. Reserve the spots and make deposits, based on the schedule mentioned earlier. Also, start now to reserve spots for summer camps: they fill up very quickly. If your child has special needs and will be attending a therapeutic camp, call your child’s case manager for an updated list of camps, and contact your child’s psychologist to obtain a current prescription. If you want to enroll your special needs child into a typical camp or activity, and believe he’ll need individualized attention, you may be able to obtain IBHS (formerly ‘wraparound services’) to provide such attention. Contact their psychologist to further discuss this option.
Summer is time for relaxation, being laidback, and being more flexible and free-flowing. However, too much of a good thing can be a bad thing. Maintaining some semblance of routine can be helpful, especially if it involves getting past the less favored tasks (chores, academics) to move on to more fun, sun-filled activities. If your child has special needs, maintaining a consistent routine is even more important. In fact, be sure he knows about the schedule, what to expect, and answer any questions ahead of time. A picture schedule is also very helpful!
I hate to write about the summer ending when it hasn’t even begun, but keep in mind the importance of getting more and more into a school routine as the summer comes to a close. The last week of summer should be very close to the school routine in terms of bedtime and wake-up.
Have a wonderful summer!!!
We’ll continue with our ‘How We treat’ series, this time targeting ADHD. In this post, I’ll describe the nature of ADHD, how it’s diagnosed, and how it’s treated.
ADHD is considered to be of disorder of the pre-frontal cortex, which is the most advanced part of our brain, and a subsequent deficiency in the executive functions. In that respect, the pre-frontal cortex of the brain is responsible for vital tasks including attention, emotional control, working memory, organizing, planning, shifting attention and mental flexibility, impulse control, and time management. I’ve written a prior post describing, in more detail, the aspects of these executive functions: ADHD: What’s Executive Functioning Got To Do With It?
And more about the connection between the executive function of ‘emotional control’ and ADHD:
ADHD & Executive Functions: Emotional Control!
It is hypothesized that in those with ADHD, areas of the pre-frontal cortex are not working to their fullest potential, and the subsequent executive functions tend to be lacking.
It is recognized that people are born with ADHD and the cause is primarily genetic. In that respect, ADHD tends to run in families. However, there are other potential causes including head/brain injury, exposure to drugs/toxins/heavy metals (including and especially in-utero), premature delivery, and low birth weight.
There are three different types of ADHD and each is rather self-explanatory: Hyperactive/Impulsive Type, Inattentive Type, and Combined Type. Here are the diagnostic criteria:
These signs need to be seen before 12 years of age and notably impact a person’s life.
The evaluation process is comprehensive; I’ve explained the specifics in prior posts:
How is ADHD Diagnosed? (and is it over-diagnosed?)
The process includes assessing for the signs and symptoms that have been observed over a long period, in multiple settings, that the condition is getting in the way of the child’s life, and the signs are not better explained by another ailment. We also look for genetic predisposition.
There is no blood test or medical work-up, except to rule out a medical cause. There are diagnostic tests that include various tasks that measure the extent of attention, concentration, impulsivity, hyper-reactivity, and delay in response. These tests are vulnerable to a false negative when the individual performs well on the assessment, but are quite helpful in providing additional evidence for ADHD when the assessment results suggest there is a problem.
I’ve written a lot about structure, including the following post: What is “Structure” and What Does it Look Like?
It’s clear that structure is vital in helping your child with ADHD function to their fullest potential. Of course, our goal is to decrease the amount of structure necessary over time and increase your child’s ability to accomplish tasks on their own. That is a slow-but-steady process but key to helping your child independently accomplish daily tasks.
It’s important to teach your child coping skills so they can self-monitor and adjust their behavior based on their circumstances. Children can learn to use visual reminders, lists, and timers. A consistent schedule and daily routine are important aspects of structure, and routine can become habitual and therefore be internalized and function as a coping strategy. Your kiddo can also come to recognize times and situations when they are more vulnerable to distractibility, such as an especially boring class, or when they are tired or hungry, and learn how to find the drive, and use effective strategies, to work-through those situations.
There may be some hesitancy to consider medication, with parents being concerned whether the medication will have negative side effects, or be effective. Well, in terms of the latter, I’ve written quite a bit, and here is a relevant post in that respect: Is ADHD Treatment Effective?
Yes, there may be side effects, such as loss of appetite, and such can be closely monitored by the prescribing physician with adjustments made, as necessary, to the dose and type of medication being prescribed. Most children tolerate the medication quite well.
A primary aspect of any therapy is talking with parents about structure and, in that respect, those situations when it’s better to lovingly stay in close proximity and guide the child through any given task, and when to set limits and use consequences. Parents often feel bad about punishing their child for something that is not in their control; making that distinction is an important part of effectively managing a child with ADHD. Sometimes it’s a gut feeling that your child is simply ignoring you rather than being genuinely distracted, but we try to make informed decisions based on experience, the current situation, the complexity of the task, and your child’s mood and disposition at the time.
Parents often blame themselves for their child’s behavioral difficulties. You may do the same and lament that, if you were properly parenting, your child would not have these difficulties. However, it’s important to understand that, in these circumstances, you have your hands full; the situation is genuinely challenging and the traditional behavior management approaches often don’t work so well. If they did work, you wouldn’t be seeking help. So, take a deep breath, don’t be so hard on yourself, and realize that your job, at this point, is to delve into the learning process on how to effectively parent your child with ADHD. It’s a trial-and-error approach, far more hands-on, and such can be stressful.
Note that frustration is based on expectations; if you have the proper expectations - you won’t get as frustrated. I don’t want you to lower your expectations, just make them more realistic for the current situation. If you expect that your 8-year-old child will independently follow your first directive that involves stopping a favored activity, walking across the room, cleaning up a big mess that involves putting a bin full of toys away, then taking some clothes to his room, and then coming to dinner, you likely will get frustrated when that does not transpire.
We may start a bit less ambitiously and break down the task into smaller chunks. Stay in closer proximity, praise along the way, maybe step in and help when you see your child losing focus, and keep prompting along the way. The expectation is that, over time, you’ll be able to back off but, in the meantime, oversight likely will be necessary.
It’s not so bad; someday your child will be grown and leave the home – and you’ll miss him; here’s your chance to spend time with him and build that relationship. It’s important to take a few deep breaths, remind yourself of these aspects cited above, and maybe even recite some Scripture that, for many, is a vital source of peace and strength. Verses such as Philippians, 4:13, “I can do all things through Him who gives me strength” can literally be a God-send.
Okay, that provides an overview of the ways we effectively treat ADHD. I hope you found the information helpful – don’t hesitate to reach out at DrCarosso@aol.com with any questions. In the meantime, happy parenting!
“Hope is the thing with feathers that perches in the soul and sings the tune without the words and never stops at all”. - Emily Dickinson.
It’s hard to overstate the importance of hope. The more hope, the stronger the drive, and it doesn’t dare to ever stop, nor even feel the need to. Hope drives everything in our lives from completing daily tasks to reaching our goals, dreams, and ambitions. It is the fuel that carries us over the ridge and up the mountain. Hope is the light that carries us through the darkest of impasses. Laina Taylor described that “hope can be a powerful force. Maybe there’s no actual magic in it, but when you know what you hope for most and hold it like a light within you, you can make things happen, almost like magic.”
It’s well-established in the research that hope is the foundation of a person’s resilience and ability to experience struggle and strife without giving in. Often, the best predictor of whether a person will commit self-harm is not a troubling situation or sadness, not even if they feel depressed. No, the best predictor is a lack of hope. If we instill hope, we instill life; the more hope - the more zeal for life. As it has been said, “hope is the only bee that makes honey without flowers” - Robert Ingersoll.
“Hope is a verb with its shirtsleeves rolled up” - David Orr.
We all face tough times, challenges, and situations that seem daunting. We may be facing a major obstacle, but it’s far more manageable if we have hope of a positive outcome. Or we hope that, slowly but surely and step-by-step, we can make a positive impact and move the ball forward. Hope makes all the difference! We see its power during such difficult times. “Hope is like a star – not seen in the sunshine of prosperity, and only to be discovered in the night of adversity”. - Charles Haddon Spurgeon
Christians celebrate this time of the year – Easter (also known as Resurrection Day) as the holiest of our holy days. Clearly, if not for Easter and the resurrection, there would be no Christianity. Easter represents the essence of hope, especially hope in the time of darkness. Through Christ, and the overcoming power of Easter, we have hope for the forgiveness of our sins, power over the carnal, and faith that we can overcome and be triumphant, just as Christ.
As Christians, this hope is a gift. As Jeremiah tells us “For I know the plans I have for you, declares the Lord, plans to prosper you and not to harm you, plans to give you hope and a future”. Yes, it’s a gift, but this hope is also instilled within us, as Paul writes in Romans: “May the God of hope fill you with all joy and peace as you trust in Him, so that you may overflow with hope by the power of the Holy Spirt”. Easter reflects that hope, with faith, is the most important of the Christian virtues.
We gain hope through our celebration of Easter; moreover, God gives us resources that too can instill hope. It’s always my goal, and the goal of everyone at Community Psychiatric Centers, to instill hope by educating and providing guidance on how to manage emotions, calm thoughts, and effectively redirect challenging behaviors.
I invite you to tap into these resources that can make your life, and that of your child, far more meaningful, hopeful, and successful. If you need any guidance in that respect, feel free to email me at DrCarosso@aol.com.
May God deeply bless you and your family and instill a full measure of hope during this most sacred of Christian holidays.
We’ll continue our series on how we treat particular behavioral health conditions. In my last article, I provided an overview of how we treat child and adolescent depression and anxiety. In today’s post, I’ll 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.
Autism impacts a child’s ability to effectively communicate and socialize. These children may speak in short phrases, not understand the rules governing conversations, and struggle with receptive language. They tend to be aloof or are socially awkward. They also engage in repetitive behaviors such as flapping their hands (especially when excited), lining up their toys rather than playing with them, pacing or walking in circles, or obsessing on topics, fears, or concerns. Children with autism also tend to struggle with sensory issues; they cover their ears in response to mundane sounds, are very finicky during mealtime, and can find it difficult to find clothes with which they feel comfortable.
The challenge with treating autism is that its symptoms are so diverse. I can show you a hundred children or youths with autism, and while each may have the core symptoms, they may present very differently. In comparison, a child with depression invariably has depressing thoughts and accompanying behavior; so, we treat the thoughts and behavior and we’re well on our way to the child’s recovery. However, it’s far more complicated to treat a condition that shows up in different ways; one child with autism may be nonverbal and socially aloof, another fully communicative and friendly but obsessive, and another speaking in truncations, wants to play with peers but is socially awkward, and has severe sensory challenges. Each child would require a completely different treatment plan.
Practitioners formerly used several diagnoses to reflect the varying severity levels of autism, which included ‘Autistic Disorder’ and ‘Asperger’s Disorder’. The former denoted a more severe form of autism, while the latter reflected milder symptoms. However, with the DSM-V, practitioners have but one diagnosis that encompasses the entire spectrum: Autism Spectrum Disorder (ASD). However, there are specifiers and different ‘levels’ of autism: 1, 2, and 3, to denote the level of severity. In that respect, a child may be diagnosed with or without intellectual impairment, and with or without language impairment. Moreover, the three levels are described below:
Level 1 ASD is the mildest, or the most "high-functioning," form of autism and reflects what formerly was known as Asperger’s Disorder. Children with level 1 ASD have a hard time communicating appropriately with others in that they may not say the right thing at the right time or be able to read social cues and body language. A person with ASD level 1 usually is able to speak in full sentences and communicate but they may obsess on topics or present as overly bossy. They may try to make friends, but not be very successful. They may also have trouble moving from one activity to another or trying new things. Additionally, they may have problems with organization and planning, which may prevent them from being as independent as other people their age.
These children tend to be quite emotional and reactive because they have a difficult time understanding social nuances and expectations, which can then prove to be quite frustrating. However, it’s notable that children with autism, at all levels, tend to be more emotionally reactive.
Children with ASD level 2 will have more obvious problems with verbal and social communication than those diagnosed with Level 1. Likewise, they will find it harder to change focus or move from one activity to the next. Children with level 2 tend to have very narrow interests and engage in repetitive behaviors such as hand-flapping, scripting from videos, or getting stuck on certain topics that can make it difficult to function in certain situations. These children may pace back and forth or ask the same question over and over. A person diagnosed with ASD level 2 tends to speak in simple sentences and also struggles with nonverbal forms of communication.
Level 3 is the most severe form of autism. Children in this category will have many of the same behaviors as those with levels 1 and 2 but to a more extreme degree. Problems expressing themselves both verbally and nonverbally can make it very hard to function, interact socially, and deal with a change in focus or location. Engaging in intense repetitive behaviors is another symptom of level 3 ASD. A person with ASD level 3 will have a very limited ability to speak clearly and will rarely initiate interactions with others. When they do, they will do so awkwardly and are often intrusive. They may accept their peers approaching them, but again, will ‘not know what to do’ as the interaction proceeds.
On our Blog site, HelpForYourChild.com, you’ll find posts and videos I’ve written and produced regarding how we treat autism. Here is a link to our Autism Articles
I’ll present some more specifics in this current post, delineating the treatment options based on the severity level.
To provide effective treatment, at each level, as with any condition, we first have to answer a number of questions to ascertain what behaviors are most problematic, the trigger for the behaviors, how often the behavior occurs, under what conditions, and what tends to help improve the outcome. These questions are highlighted in my following post – here’s the link: The Behavioral Therapist Detective
Once we have those questions answered for each problematic behavior, we can move into the treatment phase.
At level 1, the interventions are largely in the form of:
The focus in level 3 entails the aspects described above but primarily includes being able to respond to prompts and simple directions, pay attention, complete simple tasks, identify objects, model others’ behavior, and master similar simple behaviors. There is no better way to accomplish these goals than the utilization of Discrete Trial Teaching (DTT). I’ve written at length about DTT; here are some links to those posts:
Comparing Autism Treatments: The Relationship Builders vs The Skill Developers
Let’s Talk About How We Diagnose And Treat Autism Part III: Treatment of More Severe Autism
It’s notable that Applied Behavioral Analysis (ABA) has become synonymous with the treatment of autism. However, ABA is, in reality, a very broad set of interventions that can be used for every and any behavioral health condition. ABA is often confused with DTT; in that respect, DTT is based on ABA in that DTT utilizes the principles of ABA but DTT does not represent the totality of what ABA encompasses. To clarify these aspects of ABA, here is the link to my eBook on Applied Behavioral Analysis (ABA) and the use of DTT with accompanying teaching videos:
Many children respond very favorably to the aforementioned intensive, repetitive, but child-friendly in-home or in-school services (IBHS Services) that can be provided numerous days per week. IBHS services are offered here at Community Psychiatric Centers, as well as weekly outpatient counseling at our clinic, as-is medication management.
Medication can be invaluable to treat some of the symptoms of autism including anxiety, repetitive behaviors, and emotional reactions. If your child is receiving services through Community Psychiatric Centers, you can make an appointment for a medication consultation.
You will face many demands and challenges as you raise your child with autism. You’ll be tempted to blame yourself but try to accept that your child’s condition has nothing to do with your parenting. However, you now have the challenge of learning how to better manage your child’s tendencies. As you learn more, you’ll feel better-equipped, more confident, and less frustrated. Many parents benefit from a support group; we offer such a support group at Community Psychiatric Centers; if you wish to participate, feel free to email me at DrCarosso@aol.com.
Also, it can be invaluable to utilize family support to help with the care of your child, but also to give you somebody with whom to share your thoughts, feelings, and frustrations, and to have people to lean on. It can also be helpful, calming, and reassuring to maintain a spiritual connection. In that respect, your relationship with God during difficult times can be literally a God-send as you rely on your relationship with God and use scripture to provide reassurance, such as “I can do all things through Christ Who Strengthens me” or “Do not fear or be dismayed… The eternal God is your refuge… When the righteous cry for help, the Lord hears…” A daily devotional, with meditation on scripture and prayer, can be a wonderful way to start the day.
Don’t forget to exercise and eat a balanced diet. You need to maintain your fitness to be fully available to help your child. Also, set aside scheduled and special alone time with your spouse or partner – you two need each other, so nurture that relationship!
I hope that helps to clarify some of the interventions used to treat autism, based on the level of severity. If you have questions, reach out 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 it’s uplifting to know that there are practical and very effective strategies to improve the situation. Let’s review them today. 😊
First, Let's review what causes depression and bouts of anxiety. This is a complicated topic, but we can simplify it: there are two reasons – situational and genetic.
Situational: in terms of depression, there is a situation, or a series of events, that leads to a loss in a child or youth’s life and this loss contributes to feelings of depression. This could be a loss of a loved one, a relationship, or self-worth, among other things. In terms of anxiety, there are situations the person finds anxiety-provoking, which could be anything from problems that would be seen by anyone as problematic, to mundane events that, nevertheless, are anxiety-provoking.
Genetic: in this instance, depression, mood disorders, or anxiety run in the family, and the child or youth is subsequently vulnerable or predisposed to having issues with his or her mood. The depression or anxiety usually surfaces during a time of stress, which takes us back to the ‘situational’ element cited above. However, more notably, regarding a depression or anxiety that is considered genetic in nature, the condition manifests ‘out of the blue’ and often without an observable cause. Depression and generalized anxiety can persist for days, weeks, or even longer. However, acute panic attacks only last a few minutes.
Bio-Chemical: you may hear that depression or anxiety is caused by a ‘bio-chemical imbalance’. Here’s a brief overview of that theory: there is research suggesting that the manipulation of specific neurotransmitters can improve depression and anxiety, hence, anti-depressant/anti-anxiety medications. However, there is ongoing debate about which came first; an imbalance, the genetic vulnerability, or the negative situation? Also, is it really an “imbalance”, or does the person simply feel better when serotonin levels are increased? Moreover, we really don’t know what’s the optimal ‘balance’ of neurotransmitters for any given person. All we know is that, for some people, increasing the abundance of certain neurotransmitters makes them feel better.
The protocol for treating depression or anxiety targets the following:
Let’s look at each of these.
You’ve probably heard of ‘cognitive-behavioral therapy’, considered to be the clinical standard-of-care for depression and anxiety. The first word, ‘cognitive’, refers to what we think. Moreover, people who struggle with depression and anxiety tend to have depressing and anxiety-provoking thoughts; lots of ‘what-if’s’, catastrophizing, perceiving one minor set-back as generalized failure, and so-on. The remedy is to attack one’s thoughts and replace such maladaptive thinking with more accurate and healthy self-talk. We can do that in lots of ways. A therapist can help to bolster healthy-thinking and, at home, we can, for example, post notes with lists of healthy thinking on the bedroom wall to remind of the successes in the child’s or youth’s life as evidence to support the notion that “I got this!!” in terms of managing whatever problem may arise.
The second part of ‘cognitive-behavioral’, the ‘behavioral’ part, refers to what a person does or how they behave. So, with that in mind, we alter how we act. The subsequent strategies in this category are endless and could involve simply getting out bed, attending to our grooming and hygiene, hanging out with good friends, joining a club, going to church, or going for a walk. This step involves doing the exact opposite of whatever the depression or anxiety is telling us to do. The positive impact of ‘doing’ is also greatly enhanced by ‘doing’ for other people. In that respect, there is nothing more edifying than to ‘get out of our own head’ and help others. This could involve reading stories to younger kids, visiting a nursing home, volunteering at an animal shelter, or whatever floats your boat.
I suppose this aspect falls in the ‘doing’ category, but I’ll present it separately. In that regard, we’re referring to taking care of our body. If we don’t eat right, and exercise, we’re going to feel bad. Moreover, the research is abundantly clear that remaining active, and even moving into elevated aerobic pace, is a wonderful antidote to anxiety and depression.
You might be confused: why am I including ‘breathing’ on this list? Of course, breathing is fundamental to life, and tends to cause us problems as we begin to feel stressed. In fact, a primary symptom of a panic attack is disturbed breathing, or what’s sometimes called ‘hyper-ventilating’. Surprisingly and interestingly, when we control our breathing, we control how we feel. The regimen is called ‘mindful-breathing’, and here’s how it looks:
You’ll find mindful breathing to be very calming; it slows things down and it’s like rebooting a computer. Mindful breathing is very powerful and can be accompanied by closing one's eyes and imagining oneself in a peaceful and pleasant place. With practice, you can become better at mindful breathing and more quickly move into a deeper state of relaxation. Mindful breathing can be done in-the-moment of experiencing anxiety or done throughout the day to lower baseline anxiety. Give it a try!
A powerful way to help somebody struggling with strong feelings is to validate those feelings. We may believe the child or youth is overreacting but, if we want to help the person to calm down, 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 or youth) 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. Find the feeling being conveyed and reflect that feeling. You may reflect 4-5 times before moving into problem-solving.
If you move on to problem-solving too soon, before the child or youth feels as though you have fully heard and understand their feelings, it will only cause frustration as a result. In that respect, it is very calming and reassuring for any of us to feel that we’ve been heard, and that the person is on-the-same-page as us. That’s as true for you as for your child.
We are, by our very nature, spiritual beings. Upwards of 90% of people around the world believes in a higher power; there are over two billion Christians, just under two billion Muslims, almost 20 million Jews, over a billion Hindus, and 84 million Buddhists. Any number of research findings and even a recent meta-analysis that included 48 longitudinal studies show that spirituality is significantly associated with positive mental health outcomes. The research is clear, those who consider their walk with God as an important aspect of their lives have far lower rates of depression, anxiety, suicide, substance abuse, and have greater self-control, self-awareness, empathy, concern for others as opposed to preoccupation with one’s-self, and an enhanced sense of comfort and calm.
Of course, this makes sense. When you have an all-knowing, all-powerful God who is by your side and in your corner, well, that’s kind of reassuring. I am a Christian, so that’s my frame-of-reference. In the Christian walk, God is more than just ‘in your corner’; you become an actual adopted child of God and His Spirit is inside you, changing you from the inside-out. As it’s written in 2nd Corinthians, “if anyone is in Christ, he is a new creation, the old has passed away; behold, all things have become new”. The ‘new’ is different from our old self and our old ways of thinking and doing; instead, we become increasingly free from sin, but also free from our fears and sadness.
Of course, it’s not that we don’t experience tough times as a Christian (we still live in the same corrupt and difficult world), but we have a different perspective and inner-power to better-manage those tough times. I wrote above about the ‘cognitive’ strategy of reminding about positives and strengths in a child’s life; this is where memorizing scripture becomes super calming and comforting, such as “The Lord is my rock, my fortress, and my deliverer, in whom I take refuge” Psalm 18:2. If you’re not sure where to start, I’d suggest a church youth group, or children’s ministry for your youth or child. It gets them involved and active in a structured and uplifting environment.
It’s clear that for more severe cases of depression and anxiety, when the strategies listed above are working but not to the extent we’d prefer; medication can be very helpful. The more severe the depression and anxiety, 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 depression and anxiety through the use of prescribed medications.
There you have a summary of the strategies to effectively treat depression and anxiety. I hope and trust you found this overview to be helpful. It’s typically best to obtain professional guidance in walking through these steps, and all of here at Community Psychiatric Centers would welcome 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 kids.
I regularly get questions from parents about how to manage their child’s behavior. We welcome such questions and look forward to working with parents to help improve the situation. I might hear something like, “my child is having lots of tantrums and is really hard to manage” or “my child won’t do anything I ask!” These are, in fact, difficult situations and worth reaching out to somebody like me for answers. I believe I can speak for all the therapists at Community Psychiatric Centers when I convey that this is our job. This is what we do, so we welcome the opportunity to help children control their impulses and parents feel more confident in managing their kids.
As the famous detective, Sherlock Holmes, often exclaimed, “you know my methods, Watson." Yes, Behavioral Therapists have methods too, and they begin similarly: gathering clues (i.e. information), which we call collecting 'data.' We can’t get enough data or clues, and the clues can’t be too specific.
So, we may drive you crazy by asking lots and lots of questions. Not to mix characters, but another famous detective, Jack Webb, was known to say “just the facts, Ma’am." We’re the same way - the more facts we have, the better we’ll be able to help. We want lots of facts, then we’ll put those pieces together to solve the case, so to speak. To the extent that if we don’t have adequate facts we are feeling our way in the dark. Therefore, we are not using the most effective strategies, wasting valuable time, and it’s a whole lot harder to ‘solve the case.’
To help develop effective strategies for your child, there are various factors or aspects, we need to consider. It all starts with these three. They are considered the cornerstone of our detective work to determine the ‘what’ of the behavior:
We need to know as much as possible about each of these aspects. They would include how often the behavior occurs, how intense is it (what it looks like), and how long it lasts. If we know those three things, we’re well on our way to knowing the ‘what’ of the behavior.
Now that we know the ‘what’ of the behavior, to gain some insight into ‘why’ the behavior is occurring, we ask:
Once we have these questions answered, we’ll have a much better understanding of why the behavior manifests. We’d learn, for example, whether there is a predictable event or person that tends to trigger the tantrum. If the tantrum occurs every time or only at certain times of the day or in specific situations? Has this been going on for years, or only the past few weeks? Does the tantrum occur 5x per day, or once per week? Does the tantrum persist for one minute or 30 minutes? Is the behavior very intense with subsequent destruction of property, or only mild emotion and sobbing? When does the tantrum not occur?
Next, we need to know the ‘how?’ We need to know what’s been tried, and what each intervention ‘looks like.’ For example, if we hear that you’re utilizing time-out, we’d need to know precisely how time-out is used. Same for loss of privilege, ignoring the misbehavior, or trying to talk to the child and problem-solve. Knowing the specifics is vital since there are, for example, dozens of ways to implement time-out.
Regarding predictability or a pattern of behavior, we often find there are two or three specific situations that are proving to be difficult, such as the morning routine, or bedtime, or specific chores. So, we’ll break down each of those situations accordingly to get these questions answered.
Once we know the answers to these questions, it’s simply “elementary” as quoted from our friend, Detective Sherlock Holmes, to fit the pieces together and determine more effective ways of intervening.
It’s important to note that entire chapters can be written about each of these facts, or clues (i.e. frequency, intensity, duration, triggers, predictability…), and the answers help to drive the planning of specific strategies. This reflects the complicated job of a detective, er, I mean a Behavioral Therapist. There is a lot of data to gather and analyze from which to determine a game plan. It takes training and experience to effectively pull it all together.
There are many famous detectives who are fun to watch as they gather evidence and solve the case (maladaptive behavior). This is dating myself, but we can recall the aforementioned Sherlock and Webb, and who can forget Columbo, Marlowe, Reacher, Perry Mason (okay, so Mason was not a detective, and Reacher wasn’t either, but they sure could solve the case).
A behavioral therapist’s job is no less fun and challenging in gathering all the information and ultimately putting the pieces of the puzzle together. However, in our situation, given that kids and situations are ever-changing, the solving of the ‘case’ is also an evolving process and does not always involve a one-time concluding event. In that respect, when working with a behavioral therapist at Community Psychiatric Centers, it's not as simple as Professor Plum using the candlestick in the library. Actually, before writing this post, I didn’t realize the abundance of detective references; we sure enjoy solving mysteries, don’t we? In any case, our Behavioral Therapists will continue to monitor the situation and modify the plan as things evolve.
Our Behavioral Therapists will recommend effective intervention strategies that may focus on the trigger (modifying the approach to the child) or the behavior (finding an effective consequence). Not to complicate the matter even further, but a child’s diagnosis also comes into play. When a child has autism, we may focus more on the triggers, and modify how we approach the child. Alternatively, we may focus more on consequences for a neuro-typical child who tends to be oppositional.
Yep. After we gather the information, we come up with some hypotheses regarding what is fueling the problematic behavior, and the best ways to intervene. Next, we experiment with some different approaches to test the hypotheses.
The same pieces of data that help us, also help you. The more aspects you’re aware of, the better you’ll be able to provide this information to a behavioral therapist and also use that information yourself to make more informed decisions on how to manage your child. Think of it this way: say you notice that your child tends to get emotional and tantrum daily. These last for approximately 5 minutes. The tantrums happen upwards of 3/5 days per week, directly after school when redirected from playing a game to doing homework, especially if there is math homework. Okay, so this is an easy one, and pretty ‘elementary’, but it makes a good point. Having this information is vital to experiment with some different approaches based on your hypothesis.
These experiments may include modifying the trigger by changing the time of homework (later in the afternoon), working with the teacher to modify the math homework (so the harder math work is completed in the classroom), helping to improve your child’s math skills so they are less math-averse, beginning homework with any subject besides math (using what’s called ‘behavioral momentum to get the math done), or talking with your child to see how they want to handle this conundrum and see if they have any good ideas. You can also deal directly with the behavior by using a sticker chart for homework completion to increase motivation, or taking away computer time if your child tantrums. So, there are lots of options, but all these options are based on the evidence you’ve gathered as a parent-detective.
I hope this post has helped to uncover the clues necessary for effective behavior management. We reviewed the importance of the following steps:
As you gain comfort and confidence in collecting these clues, you’ll find yourself becoming an increasingly effective and efficient parent-detective. You will be able to make the necessary adjustments to manage whatever behavioral problem comes your way. However, it’s always helpful to get professional assistance, from a trained and experienced behavioral therapist-detective, who can guide you along the way. Feel free to contact me in that respect at DrC@cpcwecare.com. Happy detecting!!
Sharing this post is one of my favorite traditions. This Christmas blog post was first put up the 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 emphatic (Rogerian 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 discuss 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). Give it a try, what have you got to lose?
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 over-stimulating. 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 make the outing more pleasant.
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 than long trips 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 (or 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 favorite toys, food, or familiar item. Have them help plan out the day with you when you put together the outing.
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, happy…). Take along a wish list. If he sees something he can’t have, add it to a wishlist. Share enthusiasm for desired items. Try to avoid tempting places, or keep in small doses.
Sometimes it can feel frustrating, especially if the outings are to somewhere with challenging distractions. Develop ‘Social Stories’ about public outings, and encourage your child’s involvement with the process. Try to prepare with a visual schedule well in advance. Go at off-hours (6-7 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 even busy stores to be stimulating, if not over-stimulating. 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, 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.
Here are some tricks to effectively redirect your child to what you want him/her to do, rather than what you don’t want:
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?
I hope these tips prove to be helpful and keep your outings merry. Happy Holidays!!
The holidays are a wonderful time of year. There are so many fun and festive opportunities to get together to celebrate the season with your family or community. It’s no wonder it’s the favorite time of year for most children. But for parents of kiddos struggling with any number of behavioral health or developmental issues such as anxiety, ADHD, or Autism, the holidays can be an extra stressful time. Anything from gift shopping, to crowds, to the sensory overload of decorations, to changes in schedule and disruption of school routines can make an overwhelmed kiddo miserable. My classic Dr. C's Morning Minute Special below helps talk through how to prepare your child for the challenges you might face. My tips are presented in an easy-to-follow video format. You can also read more about what you can do on my blog here.
Or, you can watch it on YouTube here.
Selective mutism is a diagnosable condition that significantly interferes with a child’s ability to adapt and function in social situations. It’s defined as a failure to speak in situations where the child is expected to speak. The child perceives the situation as uncomfortable and usually with a degree of social pressure to interact. Novel situations are especially difficult; however, a child with this disorder may, for example, not speak in the classroom for an entire school year, long after they’ve had an opportunity to ‘warm-up’. A less severe variant may manifest in a child needing a few weeks before they are willing to speak and, even then, possibly not engaging in more than brief responses. However, in situations found to be more comfortable, such as at home, the child speaks freely.
Selective Mutism is considered to be rather rare; less than 1% of the population. However, it’s important to note that this disorder is considered to be an anxiety disorder and there is substantial overlap between selective mutism and social anxiety, the latter of which is found at upwards of 7% of the population. Social anxiety and selective mutism are considered to be two separate conditions. From my clinical experience, all children who have selective mutism also have social anxiety; although not all kids with social anxiety will present with selective mutism.
No, it’s not. But there can be a fine line, depending on the level of severity. Shy individuals are usually hesitant to speak or engage at times, but when they need to do so they can. Children with selective mutism find themselves literally unable to speak in those uncomfortable situations.
It’s important to note that the child is not being defiant. The child wants to talk, but the anxiety literally ‘clams them up.’ The condition is largely genetic and evidenced when anxiety runs in the family. There was a time when the culprit was believed to be a traumatic experience: we’ve all seen the movies where a person experiences trauma and thereafter presents as mute. That type of reaction is feasible but rare and, far more often, this disorder is congenital. Invariably, parents will say that their child has always been quiet and timid.
It’s important to seek professional treatment given that selective mutism can be quite debilitating to the child and is challenging to treat. The condition is addressed similarly to social anxiety in terms of bolstering the child’s coping skills (healthy self-talk), deep breathing, lots of practice and role-plays of social situations, and gradual exposure to actual anxiety-provoking situations. This entails practicing and role-playing social situations, over and over, in a fun and playful way, and gradually working your child into the real situation. A professional therapist is invaluable in that respect; call to schedule at (724)-850-7200 to be seen at any of our five offices, or virtually.
I also want to introduce you to a wonderful 11-series Podcast on Audible “Selective Mutism Help”, which does a great job in providing an overview of the disorder, and helpful tips and suggestions from parents whose kids have suffer from it. Accessibility to the podcast would entail subscribing to Audible. Disclaimer: I have no financial nor clinical stake in Audible or its products; I just found the podcast to be helpful and think you may as well.
Selective mutism is a confusing and vexing disorder. However, it is treatable with a patient, mindful, and step-by-step approach. If you have any concerns about your child, don’t hesitate to reach out at jcarosso@cpcwecare.com. God bless you and your kiddo(s). 😊
