Support Group for Parents/Caregivers of Children with Special Needs

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The National Autism Association is excited to announce the return of our
Manhattan-Based Monthly Evening Support Group for Parents/Caregivers of Children with Special Needs

with our new moderator
Adam J. Holstein, P.D., L.P.

Monday, December 7, 2015
7:00pm to 8:30pm
at
Atlas Foundation for Autism
252 W. 29th St., 3rd Floor (off of 8th Ave.)
New York, NY 10001

PLEASE NOTE: THIS GROUP IS ONLY FOR PARENTS AND CAREGIVERS but we have many events for others connected to the autism community as well!

The support group is moderated by Adam J. Holstein, PhD, LP. He has a Master’s degree in School Psychology from St. John’s University and a Master’s degree in Developmental Psychology from Yeshiva University. Mr. Holstein obtained his license as a Psychoanalyst after graduating from the Washington Square Institute for Psychoanalysis and Mental Health. He has been involved in the field of early childhood development and education for 30 years. In this time, he has worked in therapeutic schools, daycare centers, private homes, and private practice settings. The primary focus of his professional career has been on assisting families whose children demonstrate behaviors that interfere with the learning process, particularly those diagnosed with Autism Spectrum disorder.

Space is limited for the support group sessions.

Please RSVP to and you will receive a confirmation email back. We will send out a monthly reminder. Please remember to RSVP each month. Please indicate in your RSVP that you are attending the Queens group.

After the December 2015 meeting, Mr. Holstein will go to a “first Monday of every month” schedule. While we will make every effort to adhere to our “first Monday of the month” schedule, please understand that there may be times when the moderator needs to reschedule a meeting. If this occurs, we will post any changes to our website and notify directly (by e-mail) those who have already sent us an RSVP for that meeting.

If you would like more information, please visit the NAA NYM website. Please circulate this invitation to family, friends, and colleagues.

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Facilitating Emotional Development by Being Consistent and Emotionally Constant

Synopsis

We will review some of the potential outcomes where a child who has had a positive or negative, but consistent environment as opposed to a child who does not know what to expect from his environment. The impact of a psycho-dynamic “feeling” approach verses a behavioral approach using applied behavior analysis, ABA, will be reviewed.

We all assume a child will learn what behaviors will elicit love or approval and which will elicit withdrawal or anger. How is this communicated from infancy and over the years developmentally? This is a complex process. Evidence indicates that this communication starts in the first hours of life and is pivotal to a healthy emotional adjustment to others and society. Parents being emotionally supportive, constant in their feelings and expectations, allow for healthy development emotionally.

Addressing behaviors on the manifest level using Applied Behavior Analysis the word “consistently” is paramount to a successful outcome. When a behavior program is consistently implemented, in spite of what the child is feeling, the child’s behavior will change. But what about the feelings?

Have you met a child who;

  • acts out and gets to go to the principal’s office and does so throughout the day but most often at 9:30 AM? All the teachers get upset, so they decided to put an assistant with him at 9:00 AM throughout the time in school to prevent him from acting out?
  • is aloof avoids eye contact, is often seen moving his lips and staring into space? (Does not communicate his needs or desires other than pointing or becoming upset when he does not get what he wants or his way. He lines things up but not reliably, he plays repeatedly with same toys but in a functional manner over protracted periods of time?)
  • does not speak to anybody but his parents? (He is receiving speech therapy)
  • cries from the time he walks in the door of the day care till the time his parents pick him up? (He is inconsolable. At best he will sit quietly on his own, but when approached, or even eye contact is made, he will begin to cry.)
  • when being dropped off says; “Bye Mommy.” Is fine during the day, engaged socially and academically consistent with his age?
  • has violent temper tantrums when he does not get his way or what he wants? (When he plays with others he has to be the leader and subtlety coerces others to do what he wants.)

How do we understand these problems? (How we understand these problems directs how we treat them.)

Some Definitions

Object Constancy: How do you understand the emotional development of children? Psycho-dynamically we refer to both the child’s emotional innate emotional development based on separating from his primary caregivers and forming their own identities. (The environment includes of course parents as well as the physical, social and cultural environment with corresponding expectations.) When we talk about object constancy we are talking about the child’s emotional ability to cope with world by drawing on its internal resources. The ability to cope and adapt emotionally is based on the history of parent child interactions and feeling safe and secure in that interaction. To feel safe and secure the child must have been able to draw reasonable expectations about their world. If the child starts out emotionally in an unpredictable world fraught with anger, rejection and fears of abandonment or in the worst cases fears of annihilation, their ability to cope and adapt will be compromised. Bottom-line, the healthier the child’s connection to the parent the better the child will be able to cope, adapt and address the world and its stressors without emotionally and perhaps physically, falling apart. In this paper Object Constancy refers to the gradual emotional ability to;

  • separate fantasy from reality.
  • take into their mind and heart the image of a reliable loving, (positive) caregiver and draw on that love when they are under stress to make adaptive, socially appropriate choices in their lives which enhance their lives and those around them.
  • see others as being emotionally different from themselves and to effect a compromise in their relationships with others.
  • ultimately have control over their feelings and not be dominated by them.

Attachment vs. Bonding: Even though both bonding and attachment highlight a connection between the infant and the primary caregiver, there is a slight difference between the two. In psychology we speak of these two concepts broadly. Bonding can be defined as the attachment that the primary caregiver feels for the infant. On the other hand, an attachment can be defined as an emotional connection the child feels, between themselves and the primary caregiver.

Consistency as defined in ABA / Behavior Modification: When working within the hypothetical constructions of Applied Behavior Analysis or Behavior Modification we are talking about the need to be as consistent and/or reliable in delivering positive reinforcement and /or consequences as possible. The rewards and consequences are viewed as shaping all behavior. Failure to be consistent becomes extremely problematic. Behaviorally speaking behavior will not change without the application of consistent rewards and consequences. Feelings have nothing to do with the intervention. We know that if we are not consistent in our responses the child will not know what to do and be dependent on others to determine what to do.

The Theories of Applied Behavior Analysis on the basis of theoretical underpinning constructs are mutually exclusive.

From an ABA approach the sum of the parts equal the whole. As far as ABA is concerned the emotional world is unimportant in changing behavior. That is to say, if either the rewards or consequences are great enough, and they are consistently applied, any behavior can and will change. All of the cognitive approaches are based on learning theory.

From a psycho-dynamic perspective the sum of the parts is greater than the whole. From this approach we have beliefs that we develop over time about ourselves and others, which is based on our previous emotional interactions. These past interactions shape and potentially distort our perceptions of the world and interactions with others going forward. The feelings can be so strong as to be ridged and be imposed on others thus be self-defeating in terms of relationships with others with respect to love and work.

The importance of ROUTINES and Patterns: The idea of routines and patterns, similarities verses differences is perhaps something that is not considered enough across various areas of research in child development. We study child development from these different perspectives or domains but don’t often consider the impact of a delay in one domain on the other domains, if any. For this paper the 8 domains are defined as;

  1. Parent’s biological contributions
  2. Prenatal Care (parent discipline and care of infant during pregnancy and routines during pregnancy)
  3. Neurological development, (5 senses, hearing, vision, taste, touch, feelings)
  4. Motor (fine and Gross)
  5. Language (receptive and expressive)
  6. Emotional Development (defined by any emotional theoretical perspective)
  7. Social skills (interpersonal)
  8. Cognitive (which includes concept development and thinking processes and cuts across all domains)

The child’s development is occurring in each of these domains while interacting with significant others and the immediate physical and cultural environment simultaneously. From day one routines are established between parent/caregiver and child. There are the overt clearly definable routines surrounding social and developmental milestones. Here I am talking about establishing; sleeping, eating, toileting, bathing and dressing, routines for example.

How does the Caregiver(s) interact and establish and emotional constancy between themselves and their child? What is their character like? These routines are built around the child’s needs and disposition, ideally provided by a consistent caregiver and one who is providing an emotionally constant positive, engaging routine. These positive interactions include how a parent interacts, verbally, non-verbally, social engagements, emotionally engaged and how much cognitive stimulation is provided. Throughout the course of the child’s development there are rewards and consequences on microscopic levels shaping manifest behaviors and emotional development. The early learning is the foundation for social emotional development and social success later in life.
The ability to establish these patterns by the parents and to be recognized by the child is central to the developing child’s emotional well-being. Consistency and constancy are both concepts that rely on recognizing patterns, learning what to expect from the environment and to develop, physically, emotionally, socially and cognitively. An inability to provide consistency or constancy, (by the parent or if the child has delays which compromise their ability to grasp routines and/or attach to their primary caregiver) adversely impacts on the child’s development. As we study human development the complexity of all these interactions makes the richness of the human experience difficult to comprehend and organize. It makes knowing what the right decision to make for our children difficult and frustrating.

Over the course of time, as the child’s skills in the various domains emerge, they are recognized and responded to in a supportive manner while encouraging even further development. This is accomplished by changing the routines and expanding them. But not so much as to overwhelm the child. IF over the course of the child’s development expectations are increased inconsistent with his abilities, or are increased inordinately the developing child becomes upset, overwhelmed and perhaps traumatized.

The best routines are developed between a parent and child such that the routines are built around the child’s biological and developmental needs. Of course the parental expectations and needs play a roll. Broadly speaking though, the younger the child there should be greater deference to the child’s needs. The deference to the child’s needs changes over time as the child learns to meet their own needs and become generally more independent.

Child’s Emotional Development: How hard is it to be a good parent or teacher? How do you know when you are doing the “right or wrong thing?’ Here are some thoughts in the forms of questions I find myself asking when I want to know if I am doing something right or wrong:

  1. Are parents or teachers imposing patterns in spite of child needs protests? If the child is protesting I then ask; “What am… I…me….myself, as the parent doing wrong? This is my problem not my child’s.
  2. Are parents or teachers letting the child rule and/or dictate the routines in spite of the parent, teacher/classroom needs? I ask myself – why is the child feeling like the boss? I ask; why are you letting your child tell you what to do? Why do you say your child thinks he’s the boss? Is it true that he is the boss? How do you think it makes your child feel, being in charge? How do you think it makes him feel that you are NOT in charge?
  3. Is there an ebb and flow between child and parent, a compromise, in part based on child’s age, unique needs, and unique disposition? To this I say; “good job.”
  4. What are the parents or teachers doing and feeling while going through the daily child care routines? Here I ask about general happiness, mood, contentment activities, and friends and so on. Then I ask how they think the child is responding to the parent’s moods and routines?

Conclusion

We as parents just have to be “good enough”. Children as they develop are very flexible emotionally. They can and do can cope and adapt to a great deal of stress and/or changes throughout their lives and come out being able to form loving relationships and work. Children who grow up in a negative environment so long as it is consistently negative and they know n what they are going to hear and get the same negative response, they too can love and work. (Perhaps not optimistic by nature but they will be able to function socially with like-minded people.) It is in the worst scenarios that children begin to demonstrated difficulties that if left untreated manifest difficulties being social as adults. Growing up their environments are volatile and inconsistent. They feel stressed and anxious as they don’t know want to expect in their world. The parents or caregivers of these children can difficulties coping in their worlds and do not provide appropriate models for their children and/or care for the children in a consistent and emotionally constant manner.

I would like to make reference to two papers:

  1. Dr. John Brauer, Goals of Parenting: http://www.wellminds.org/index.php/articles/parenting/90-parenting-goals. Dr. Brauer in this paper talks about being a good role model teaching children by engaging them and supporting them. The need for patience and to be constantly mindful of teaching them, not losing patience and sustaining a positive love and affection for the child. This of course is not always possible and perhaps is not even ideal. However, the love, acceptance of failure, patience and being consistent and reliable has to predominate the relationship.
  2. AJ Marhi, is a counselor who wrote a paper where there was problems in parent child bonding and the consequences being a Borderline Personality Disorder. Lack of Object Constancy In BPD: http://borderlinepersonality.typepad.com/my_weblog/2008/06/lack-of-object.html. This is a technical paper but it basically details the consequences of poor parenting whereby the parent and child are not able to relate to one another and bond. There is a lack of security in the relationship, little to no trust. This can and does happen when parents are too angry, explosive and inconsistent in their expectations and responses to the child’s expressions of emotion and/or behaviors. The child becomes anxious and defensive. There is a lack of “object constancy” whereby the child takes into themselves, identifies with the parent, a way of relating with the world that basically disables them.
 

Psychology Today Blog Interview with Adam Holstein

Adam Holstein, P.D., L.P., was recently interviewed by Amanda Friedman, MSEd, SBL, co-founder of The Atlas Foundation For Autism, for her blog article Answers: Beliefs About ABA, featured on the Psychology Today website. Ms. Friedman is a special education teacher with over 10 years experience and a co-author of several books on autism including Cutting Edge Therapies for Autism, 1001 Tips for the Parents of Autistic Boys, and 1001 Tips for the Parents of Autistic Girls.

The article focuses on the pros and cons of Applied Behavior Analysis (ABA) as Mr. Holstein sees them, as well as other behavior therapies for the ASD community.

Amanda-Joy-Friedman“The following interview with expert Adam Holstein was both refreshing and intriguing in its candor and balanced sensitivity.” – Amanda Joy Friedman, MSEd, SBL

Read the full article on the Psychology Today blog.

 

The Complex Process of Implementing ABA Behavior Programs

With some recent families I have been contracted to help parents evaluate behavioral interventions, which utilize applied behavior analysis (ABA) for their children who have behavioral challenges. As a consultant I review, evaluations, IEP’s and behavioral programs that are in place to assure their child’s needs are being met consistent with best practice. The problems I find are numerous. They result in inadequate interventions and protracted periods where time is lost helping children be successful in school and easing difficulties in the home.

Implementing a behavior program is a challenge. In order to affect a program that is going to appropriately address the needs of the whole child, schools should follow procedures to maximize the interventions they implement. Unfortunately the time, cost and availability of qualified staff is often limited. Often times the reality is that school districts cannot meet the needs of the behaviorally/emotionally challenged child. The procedure for developing a behavior program in its simplest form breaks down as follows:

A Psychological Report or other report from a doctor provides a diagnosis and/or evaluation which identifies behavior(s) that interfere with learning and recommends behavioral intervention.
Typically the psychological report will identify the challenging behaviors and ideally discuss the intensity, duration and frequency, either based on anecdotal reports or actual data and/or observations.

The Early Intervention Coordinator, CPSE or CSE Chairpersons Coordinate a Meeting Recommending that these Behavioral Challenges be Addressed by a Behavioral Program

In the IEP that is generated, “preliminary” goals both long term and short term are generated. I say “preliminary” due to the fact that most times no actual data has been gathered prior to the IEP meeting. As such goals are not individualized, as required, and they are often too broad and the criteria inappropriate, as the goals are not behaviorally defined. Also required but rarely produced is the behavior program. Once the need for a behavior program has been established the following steps should be followed:

A Functional Analysis of Behavior, FBA, has to be Performed

The child should be observed in various settings and over a sufficient period of time to observe the child performing optimally and to obtain a measure of the frequency, duration and intensity of the challenging behaviors. Ideally these observations are performed at school and home. The primary intent of an FBA is to assess the motivation for the behavior.

A Baseline Needs to be Performed

A baseline is a measure of the challenging behaviors with respect to its frequency and duration without any intervention to change the behavior in place. The baseline will ideally support the findings of the FBA with respect observations documenting the motivation of the behavior. But its intent is to measure the effectiveness of the behavior program in reducing the challenging behaviors when compared to conditions without the intervention.

Behavior Program Design and Intervention

Based upon the evaluations, FBA and baseline data a behavior program is designed. Each program is unique based on the operational definitions of the challenging behavior(s) demonstrated and how, when and where the program is being implemented. Designing a comprehensive program is a time consuming process and should address AT A MINIMUM proactive as well as reactive strategies. Based on the frequency of the behaviors, daily, weekly or monthly reviews need to be carried out to assess the effectiveness of the program with respect to progress or the lack of progress in reducing the challenging behavior and teaching competitive behaviors. There are many dimensions to good program design which need to be part of every program, but unfortunately too often are not. In all cases, teachers and parents need to be trained on how and when to implement behavior program and how and when to collect data. (Training is often not performed and this is yet another potential area where a program can breakdown.)

Data

DATA is important. Is the program working or not? Without real data documenting the frequency of the challenging behaviors, all the above efforts are to no avail. Review of data is critical and progress has to be assessed in a timely manner. If the challenging behaviors are not decreasing the reason has to be explored. I have found data needs to be collected in two or more ways to support implementation of the program. But if there is no data or the data is only anecdotal than no real scientific assessment and decision can be made if there is no change in the challenging behaviors. If there is no change, time is lost and the child continues to suffer as does the family.

Parent Involvement

As both a Psychoanalyst and Behavior Therapist I cannot EMPHASIZE enough that any behavior program has to include the family. There are many reasons that this is true but I will only address the most basic for the purpose of this outline. First if the behaviors occur at home or not, the parents need to reinforce pro-active interventions. If the behavior does occur at home they have to implement reactive interventions. Failure to gain parent participation will most likely result in the breakdown of the programmatic intervention where it is being implemented and will result in the child’s failure to generalize the skills being taught.

This is a short list of a very complex process of developing behavioral interventions using applied behavior analysis (ABA) to address behavioral challenges. Unfortunately, most behavior programs also fail to address the feelings of the child and family.

If you have questions or concerns about your child’s behavior program and his or her progress I am available for consultation. Please email mail me at or call, 516.297.5705.

 

Reflections on Being a Parent

Being a Parent is a tremendous responsibility and challenge. “Getting it right” whatever that means, will tax you intellectually, emotionally and perhaps financially. “Getting it right” when you have a child with special needs can be even more challenging.

As a Certified School Psychologist with an additional Master’s in Developmental Psychology AND as NYS Licensed Psychoanalyst AND with having 30-plus years practicing as a clinician AND 27 years “practicing” as a parent I have boiled it all down to 4 Levels of Listening!

LEVEL 1: Listen to Your Inner-Self

Listen to your inner thoughts. In other words, listen to those fleeting thoughts that fly through your mind in a quick millisecond. Often, these are the thoughts that make us feel guilty, angry, confused, or ashamed with ourselves. Catch these thoughts, repeat them to yourself, and consider them. Some examples:

  • “What’s wrong with him?”
  • “He is not listening.”
  • “He’s not getting it!”
  • “He is so angry, why?”
  • “He thinks he is in charge. Who does he think he is?”
  • “He is not looking at me, why?”
  • “He does not like to be touched, what’s wrong with him?”
  • “I’m just like my parent.”
  • “I’ll do anything to avoid a melt-down.”
  • “He should be doing this by now, but he’s not, what’s wrong?”

LEVEL 2: Listen to Your Feelings When Talking About Your Child

When you talk about your child with others, do you question whether your son or daughter is developing at an age-appropriate level?  What emotions do you feel? Do you become embarrassed? Annoyed? Listen to, and recognize, these feelings as they arise.  Remember that these feelings may display themselves when you are interacting with your child until these feelings are resolved.  Some examples:

  • “I don’t feel connected to him”
  • “I feel so helpless, I don’t know what to do!”
  • “I feel so depressed.”
  • “I feel so angry, I could kill him!”
  • “I feel so guilty, what am I doing wrong?”
  • “I feel so lost.”
  • “I love being with him all the time”
  • “He is perfect.”

LEVEL 3: Listen to Yourself When Talking to Your Child

As previously mentioned, sometimes our inner feelings display themselves while we are interacting with our children. We reach our breaking point, become angry or apathetic, and act-out towards our children. As parents, we must realize the impact that our words have upon our vulnerable and impressionable children. Some examples:

  • “If you stop, I’ll give you anything/everything.”
  • “Aren’t you listening?”
  • “What’s wrong with you?”
  • “I’m tired of fighting with you. I give up, do whatever you want!”
  • “You’re doing it all wrong!”
  • “Maybe if you paid attention, you would get it right!”
  • “That is not what I said, first do this then do that!”
  • “I’ll give you something to cry about!”

LEVEL 4: Listen to Your Child

Children are communicating with us from birth in ways that are consistent with their development. From the earliest days of childhood, if there is something developmentally wrong, a child’s communication (non-verbal then verbal) will be out of sync within the interaction and/or context. Children are more emotional than intellectual, at first, and they are expressing those emotions one way or the other. Typical child developmental areas including motor skills (fine and gross), cognitive development, language development (first receptive then expressive) and social/emotional development, are well documented. Your child may be communicating important thoughts and feelings for you to hear, for example:

  • “I can’t help it!”
  • “You said this, not that!”
  • “I didn’t understand you!”
  • “I hate you!”
  • “I’m trying but I can’t do it!”
  • “You’re not listening!”
  • “I’m the boss!”

A Side-Note:

Each parent has learned how to be a parent from how they were raised. From the time we are born, we are learning how to be a parent from our parent(s) and caregivers. That amounts to thousands of seconds, minutes, hours, days and many years of possibly learning detrimental parenting techniques. Within a “typical family,” parents are generally “good enough”. However, many children that come from “typical families” develop significant behavioral and emotional problems. When a special needs child is born, the “typical parent” has difficulty adjusting all of his or her learned parenting skills to meet his or her child’s special needs. All of the “typical parents'” feelings, actions, and thoughts (conscious and unconscious) go haywire. By the time the special needs child enters school, the educational support system kicks-in and, generally, takes over. By this point, the parent of the special needs child has been traumatized. Too often, the parent does not deal with the emotional impact raising a special needs child can have. Although the loving parent knows that he or she must treat the special needs child differently, the parent may unconsciously slip back into the pattern of parenting behavior that he or she is used to from his or her own childhood. Or, a parent may slip back into the pattern of parenting behavior that he or she uses to parent his or her non-special needs child(ren).

At times this unconscious parenting can create significant emotional and behavioral difficulties with special needs children. This is an all-too-common problem.

Our parenting practices have evolved from many generations and are deeply ingrained. In light of the profound effect our parents’ parenting style has had on us, changing one’s parenting style is no easy task. Listening to ourselves and our children, from the minute facial expressions, to the physical and emotional messages, is a crucial factor in our ability to change our parenting behavior. It is only after we listen to these emotions and communications that we can achieve deep and lasting change. Listening and hearing all of these subtle, and not-so-subtle, forms of communication opens us up to the possibility of responding more appropriately and effectively to our children.

There is rarely any harm done speaking and working with a qualified clinician to help you work through your feelings and thoughts.

 

Why Do Kids Have Tantrums & Meltdowns?

We have to be mindful that while Applied Behavior Analysis (ABA) is integrated into how first responders; Early Intervention Providers, CPSE, and CSE work within their interventions and disciplines, it does not address the whole of the motivations of a child’s behavioral difficulties.

Behavior is over determined. That is, there are many reasons behaviors come into existence. Behavioral issues are not necessarily a function of developmental delays such as sensory, motor, speech, or cognitive delay. While these delays may contribute to the behavioral problems, how much they contribute is an unknown until interventions have had a chance to enable the child to reach their developmental potential.  Interventions might resolve the behavioral difficulties, reduce them, or have no effect. At times, the behavioral difficulties could be so significant that the first responders are not able to clinically intervene as the behaviors interfere with their intervention and the child’s learning.

I often find that parents who have children who have special needs, may have been good enough parents with a typical child.  However, because the child has special needs, parents are not sure how to adjust their parenting to meet the needs of the child.  In some cases, the parents have significant internal conflicts and don’t use the best approach as they draw on their experience from their parents.  A parent of a special needs child has to be a better parent then most as they constantly have to adjust their expectations to the reality of their child’s abilities.  This is no easy process.  A parent’s ability to adjust their parenting style is pretty limited in most cases.  A parent’s ability to independently adjust to their child’s needs, will depend in large part how traumatic the parent’s childhood was.  In extreme cases, where Grandparents were emotionally or physically abusive; emotionally disturbed, and/or a grandparent may have been physically and/or emotionally absent, among many other potential issues, the now parent is not likely to be able to adjust to the emotions and developmental abilities of their special needs child.

In typical children with parents who have had a poor parenting experience, the child calls for help by acting out either physically, socially, or verbally. When the child has special needs, the call for help can be masked by his/her other developmental issues. There is the notion that the interventions are going to resolve, not only the developmental issues, but the behavioral issues as well. However, there is a larger context that must be considered when addressing behavioral difficulties in children. For example:

Consider the impact on a special needs child where a parent;

  •  is suffering from depression
  • grew up being physically and emotionally abused
  • grew up in a home where their parents were constantly yelling at and/or beating on each other
  • is disorganized and fails to back up their words with actions?
  • does not establish regular sleeping and eating routines?

 The interventions of speech, OT, PT, and ABA would not necessarily be addressing this child’s emotional development and needs.

Consider the possibility of a child in preschool who is constantly disrupting the classroom routines, is always in motion, and not attending. Ah, ha! ADD/ADHD, I knew it! But consider the possibility at that within this child’s first 4 years of life a sibling is born with cancer.

  • What if the mother and father are consumed with this newborn child’s survival?
  • What if one or the other parent were absent for prolonged periods of time getting help for the sibling?

What impact does this have on our thinking on our now “diagnosed child” with ADD/ADHD?

 Are behavioral interventions going to stop the demonstrated behaviors? If applied expertly, they can and should. Are we ready to move on without addressing the emotional communications of the behavior and put the “problem” to rest?

When clinicians are presented with a child exhibiting behaviors they set up positive contingencies to get the child to cooperate, engage, and learn. If they are on target the treatment outcome will be a success.   If a clinician to able to gain the attention and work successfully with a child a parent would be well advised to watch the interaction and ask; “Why their child works with the clinician and does not act out?”  Alternatively a parent can ask the clinician; “Why they think the child acts out at home?”  The parent can ask themselves the last question as well.   If they are able to both listen to the response and learn to respond differently than the acting out behaviors might diminish. 

Another potentially helpful tactic for the Parent is to ask the clinician if they can watch and then practice working with their child in the treatment session.  Ask the clinician to tell you honestly what you are doing right and wrong and provide suggestions how to do things differently. 

When behaviors don’t stop we can assume there is a problem behind the identified need(s). In conversations with other clinicians and parents, I’ve heard statements, “The child is still acting out.” Or, “His mother gets into fights with him in the waiting room.” An honest dialogue with your child’s clinician could go a long way in resolving a child’s acting out.  

By looking at the larger context (the parents’ parenting and the parents’ feelings about their own parents, as well as their feelings, attitudes, and thoughts about their child) the emotional communication(s) and needs of the whole family can be addressed.

It is my hope that in working with parents and first responders we can look beyond ABA and while behaviorally addressing the acting out, address these other motivators for a child’s difficult behavior(s). We can discuss how to emotionally intervene to resolve the behavioral issues from the inside at the same time we are addressing the manifest behaviors on the outside.

I am always available to work with parents and first responders to privately discuss concerns about a child. I find great joy in talking with parents and my colleagues, learning about their lives and work, and supporting them to help their children.

 

Why See a Therapist?

Thousands of people seek out Psychotherapy every day. Before making the call, many individuals think they can make the changes by themselves or they feel ashamed or humbled by having to seek out such help. However, over time, they find themselves back in the same dissatisfying work or love relationships. Those that finally make the call have realized that they have to take responsibility for their problems and seek the help and support they need to make necessary changes. In effect, “Life is too short to live it unhappily.

Executives, business owners, and professionals utilize therapy to address issues that could compromise their ability to collaborate with senior administration, colleagues, subordinates, or clients. While these individuals may currently be successful climbing the corporate ladder or running a business, they soon find there are increasing demands, expectations, and other uncertainties to deal with. While on the outside things appear to (and might really be) going great, inside one’s self there may be troublesome feelings/thoughts and increasing anxiety. These issues translate into behaviors, which ultimately interfere with growth, success, and on-going fulfilling relationships.

Still, others seek out therapy when there is increasing discontent in their family or love life. Perhaps work fills one’s life, but as the connection between those we love becomes distant and less fulfilling, there is an emptiness that grows due to family demands. This could be due to a past or current family trauma, such as a death of a loved one, the birth of a child with special needs, loss of work, and so on.

Therapy brings to light feelings and thoughts that are incongruous with the way we think and feel things should be.

Therapy Helps

  • Business executives, owners, and professionals resolve conflicts within themselves and between others. With the resolution of conflicts within themselves, and with more harmonious work and love relationships, there is more time and energy to pursue goals and meet work and relationship demands
  • Individuals listen to others in a more effective manner and help build a more effective business team
  • Individuals listen to those they love and work together, if desired, to make their home and love life more exciting and fulfilling

The Final Goal of Therapy
Enable the individual to live, love & work and lead a life that is fulfilling.

 

Conflicts in Parenting Styles – Part 2

In “Conflicts in Parenting Styles – Part 1″, I wrote about conflicts within a parent and between a parent and a child. This time, I’ll focus on the difference in parenting styles between a mother and father and the child. What I previously discussed in Part 1 is true for both parents and their interactions with the child.

Now, the “problems” become more complicated and multiply if parents are not consistent with the child and supportive of each other’s interactions with the child. It is important to note that this potential conflict, as any conflict between parents, can become an issue with a typical child, let alone a child with special needs. Each parent has an identity in the child’s mind: One is “easy,” the other “difficult.” The child learns who to go to, to get what they want. A typical child learns to negotiate these differences and manipulate the parents, as needed. When a child has special needs and one or both parents have a difficult time meeting those needs, another level of conflict is added to the parenting difficulties.

For the child, the inconsistency and/or inability of the parents to respond to their needs can result in acting out behaviors. Behaviorally speaking, the child’s behavior might be reinforced by the father’s inclination to give the child whatever s/he wants to prevent a temper tantrum, while the mother sets more limits and ends up dealing with temper tantrums which increase in intensity over time. If the parents don’t work together and show consistency, the child, emotionally, will seek to have her or his desires met by the acting out behaviors. If the parents take control together, they will be happier as a couple and the child will learn consistent limits and appropriate ways to get his or her desires met.

Once again, this is a very brief discussion of the myriad variations of conflicts between parents and their special needs children and how they impact the development of those children.

Who is the Good Enough Parent?

The good enough parent works toward obtaining both a cognitive and conscious understanding of their child’s emotional and developmental/cognitive growth. This means that the parent develops an awareness of what is expected and when. Developmental milestones such as sitting, walking, talking, and the child’s emotional development issues regarding dependence/independence, separation, and identity development are studied and that knowledge is integrated into their parenting approach. Most parents are good enough parents. The measure of a good enough parent has to do with several abilities:

  1. There is minimal conflict between the parent and child. The conflicts and issues are new at each developmental stage of the child.
  2. The good enough parent knows a great deal about his or her inner feelings and thoughts and can appropriately express to their child what they are thinking and feeling. The positive result can be a child who is able to express his or her feelings and thoughts freely and consistent with their cognitive and emotional development.
  3. The good enough parent’s words and actions match consistently. The parent says what they mean and they mean what they say (there is a convergence between words and actions). The result can be the child’s words and actions match. There is honesty between what they say, feel, and do (integrity).
  4. The good enough parent is able to be honest about themselves, who they are, their strengths, and their weaknesses. The parent is able to appropriately relate and recall their feelings, similar or not, to the child’s experiences. As the child identifies with the parent, s/he is able to make observations about their own feelings and be able to express them to the parent.
  5. The good enough parent is able to reflect to the child with more observation, pragmatism, and less affect to the child in a caring, confirming manner of how they see the child with respect to the child’s behavior, feelings, and thoughts. Conversely, the child is able, without undo defensiveness to tell the parent how they see the parent with respect to the parent’s feelings, thoughts, and behaviors and, moreover, have their perceptions validated by the parent.
  6. The good enough parent is able to validate the child’s perception of the world and encourage the child’s exploration of the world. The parent helps the child come to terms with reality and gain knowledge. That is, the parent is able to judge accurately the dependent needs and needs for independence as the child matures and gives the child responsibility, accordingly.
  7. The good enough parent is consistently able to view the world from the child’s perspective. The parent is aware of the child’s cognitive and emotional development and can teach the child that there are many ways to look at the world. There is the child’s perspective, the parent’s perspective, and others…all of which have validity. Conversely, the child develops the ability to see the world from another’s perspective and takes that into account in their meaningful relationships.
 

Conflicts in Parenting Styles – Part 1

In the typical everyday world of raising typical everyday children most parenting is, “Good Enough.” It is a given that parenting a typical child is a very difficult task. It is also a given that while there are plenty of books on parenting they tend to simplify parenting or focus only on a period of development or a particular issue.

Another fact of life, and most of us do not like or want to admit it, is that we learn how to be parents by how we were raised. That is, our parents are our models. Some of us might say, “I am nothing like my parents! They were too strict, or lenient, or whatever! I do the opposite.” Well, in that case, the parents we had are still organizing how we are, or think we are as parents!  (Remember this thought.)

The problem that emerges when we have a child with special needs is that, all of a sudden, everything we know, everything we dreamed about, everything we have learned to expect, is thrown out of sync. Suddenly, our child is not molding to us. In fact, does not even want to be touched. Suddenly, they are very, very active. It begins to dawn on us, our child is not sitting up, walking, talking, playing appropriately, and so on. What is wrong? What are we supposed to do?

Furthermore, parenting becomes ever more complex when a child has special needs. Clearly, the logistics in terms of evaluations and services can be overwhelming. But, for this conversation, what happens to those parents who no longer have their own parents (good or bad) as a model to parent a special needs child, emotionally. Depending on the diagnosis, and there can be a great deal of overlap, parents may no longer have the knowledge to understand what is happening to their child, developmentally. So much of our knowledge (conscious and unconscious) in our parenting styles is no longer useful.

What happens to the parent who, whether comfortable or not, is like own their parent, and now suddenly can’t be like their parent? What happens to the parent who does not want to be strict when they have a child with ADHD, where limits are more important? What happens to the parent-child interaction where a parent needs the emotional engagement of their child, but that child can’t engage emotionally in the typical manner? What happens in the parent-child interaction where the family expects, or requires, great intellectual achievements and the child has cognitive delays?  Suddenly, there is a whole level of emotional struggles that each parent of a child with special needs has to accept. As the parent comes to terms with their feelings toward the special needs of their child, they will simultaneously work to gain the knowledge to help and understand their child. The point here is that sometimes what we commit to emotionally about being a better parent than our parent(s), is that the commitment to being different might conflict with the needs of the child.

 

The Multiple Layers of Helping a Child & Family – Part 3

Any behavior program that is undertaken has to be implemented both at home and at school.

A solid behavior program should incorporate an understanding of the child’s level of functioning with respect to his cognitive, receptive and expressive language, gross and fine motor, and sensory and visual skills, as well as auditory functioning and social emotional development.

The behavior program should also take into consideration the topography of the behavior, i.e., what does the behavior look like? A well-designed behavior program needs to consider the severity of the behavior with respect to duration and frequency. The program should also incorporate age-appropriate goals to ensure that competing behaviors are reinforced and inappropriate behaviors are appropriately discouraged. Last, but not least, we have to take into account the parent(s), siblings, extended family, and caretakers who are involved. How many hours do the parents work? When do they get home? Who is caring for the child and sibling? Is the father involved?

I have designed the behavior program in a way so that parents feel it is realistic and practical to implement. As a parent, you will feel heard and understood. Your desire to be there for your child, as well as related feelings, will be accepted and addressed. If you, as a parent, are not being heard, the behavior program is only going to be another stressor for you and your family. And, if inconsistently implemented, could make a problem behavior worse and create additional challenges in helping the child.

Before I design a behavior program, I review all evaluations, discuss treatments with the therapists, and do home and school observations as necessary, during treatments. After considering my observations, and the needs and goals for the child, parents, and family, a program is developed. All involved are trained and the program implemented. Quantifiable and anecdotal data is collected. Weekly visits, observations, retraining, or program revisions occur to facilitate progress. Manifestly, progress is measured by reduced frequency of behaviors targeted for deceleration, while other behaviors and competing behaviors are reinforced or accelerated.

Weekly discussions will include: Parents providing feedback and input about their child’s progress, and updates about interactions among siblings, parents, and the special needs child. As the genesis of the child’s behavior becomes increasingly clear, and as parents learn how and when to intervene, they’ll become more competent parents. They will come to see, with clarity, the strengths and needs of their child, and learn how to support them through difficulties rather than trying to protect them from challenges. Also, they’ll come to recognize their child’s strengths and on-going needs.