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When Santa Lives Paycheck-to-Paycheck

Many parents are concerned about how to provide a wonderful holiday experience for their family when money is very tight.  This entry is designed to provide strategies to provide magic on a budget. (Much of this material is discussed from a Christmas perspective, but is easily adapted to other traditions.)

• Kids need and value time with you much, much more than presents. Give decorated coupons for fun activities and trips together (e.g., good for one trip for an ice cream cone, good for one bike ride/walk around a local lake, good for two hours of board game playing, good for one fishing trip, etc.).

• Remember: crisis = pain + opportunity. Yes, it hurts to not have the money to spend on presents to a degree that you are used to. Give that pain its due. But, when you’re done, wonder what opportunities await you and your family because of this pain.

• The magic of the holiday season can be created, expanded and enhanced with very little expenditure of money. For instance:

√ Get a cheap stuffed elf, reindeer or snowman and declare that it is a magical creature that travels to the North Pole each night with a report on how your child behaved that day, only to then return in the morning for a new day of scouting (there is a commercial product that does this titled Elf on the Shelf). Kids love looking for the new location each morning.

√ Encourage your child to write letters to Santa as often as he or she likes, asking questions throughout (e.g., what is Mrs. Claus’ favorite desert? What do you do when the reindeer get into arguments?) Tell them Santa wants to get to know her or him as a person so the letters should not just be about requests for presents. Then, put the letter(s) in your outgoing mail receptacle, or tape them on your door (make sure to use Santa’s address and a “magic stamp,” which can be a sticker of your choosing that you make magical by dipping it three times in reindeer food, which can be oatmeal in a pouch); later swap out the letter with a return letter from Santa.

√ Buy another cheap stuffed creature and leave it for your child, with a letter from Santa, declaring that it is a magical being that gets warmer whenever Santa is in the vicinity. Practices such as this can cause bigger pupil dilation than many presents.

√ Arrange for your family to give service to others. Many churches, soup kitchens, and charitable agencies could find something helpful for your family to do. These kinds of experiences can create a degree of warmth and magic that no present can touch.

√ Check out the website www.noradsanta.org, especially on Christmas Eve (they offer regular video updates of Santa’s travel around the globe).

√ Establish as many joyful rituals as you can: sing holiday songs at home, bake cookies from scratch, create photo montages, join a group that travels from house-to-house singing carols, make holiday decorations, offer to help your local town or church decorate, and so forth.

When it comes to actually buying presents, consider the following:

• You can get more bang for your buck at discount and dollar stores. The visual image of lots of wrapped presents, each of which can be very modest in cost, can help to create that response I know many of we parents want from our kids when they first look under the tree.

• Use websites that compare the pricing of a wide assortment of retailers (e.g., www.pronto.com, www.pricegrabber.com). Also, be sure to do an internet search for coupons for the retailer you have chosen.

• Lots of families chase the hottest, current generation of electronics. This means that the reseller market (e.g., as found in this newspaper, on ebay, and on craigslist) is often jammed with opportunities to purchase the previous generation(s) at slashed prices.

• Look for sellers who offer refurbished items, or ask retailers if they have floor models or open box items they are willing to sell at discounted prices.

When all is said and done try to avoid sacrificing your wellness on the altar of commercialism. Your child benefits much more from you being well than from some gizmo that will lose it’s charm after a short period of time. Moreover, no research exists, as far as I know, that correlates child happiness and wellness with the amount of money spent on a kid’s presents. But, plenty of research associates child wellness and happiness with the quality of the parent-child relationship, the presence of enjoyable rituals in the family’s life and the wellness of the parent(s). As the poet e.e. cummings noted, the world is mud-luscious and puddle-wonderful. Money is not required to enjoy this wonder and magic, even during the holidays.

Ten Tips For Getting the Most out of Family Vacations

Ever feel stressed by a family vacation? This can be very surprising when it happens as we think of vacations as the antidote for stress, not the cause of it. In order to increase the odds that you will get the intended results from your next family vacation, consider the following 10 thoughts:

  1. Savor the moment. Ask yourself, “where’s the beauty in this moment?” Is it in the expression on your child’s face? Is it in the colors of the landscape? Is it in the skill being brought to bear by someone serving you? It’s so easy to rush past beauty and precious moments and to not notice them. As you focus your attention only in the here-and-now, try to do only that and breathe gently into your lower stomach. Observe the peace and contentment that grows within you.
  2. Appreciate that some things just about always don’t go as planned and that such moments offer opportunities.  That is, crisis = pain + opportunity. I’ve never known of a vacation that went exactly as planned. When flights are delayed, or its rainy out, or you don’t get the seating you wanted or someone gets sick, acknowledge that pain as you would a guest in your home. But, then look for the opportunity that pain always brings with it, and try to capitalize on that. Doing so models wisdom for your children.
  3. Love matters more than everything else. We parent-lunatics (see the first post in this blog) want so much to give our children the best of everything, including the best vacations. This is a natural and normal impulse. However,  so often what our children most need from us is to be connected. So, try to grab those moments on your vacation that allow your relationship with your child to grow. (Such moments are often cheaper anyway!)
  4. Stress happens. Our bodies are stressed when we experience bountiful pain and bountiful joy; while the former is obvious the latter can surprise us. How many families are surprised when a wedding, a family reunion, a baptism, or, in this case, a family vacation brings with it grouchiness or arguments or other kinds of relationship ruptures and challenges? When these sorts of things happen in painful moments we usually understand what is going on. But, when they happen during a family vacation, especially when a lot of time and resources have been brought to bear to make it happen, it’s easy to become disgusted with  family members for what seems to be their selfishness and lack of appreciation. Instead, try to remember that such moments are usually inevitable and that they can be minimized if everyone both realizes that and also tries to get healthy doses of sleep, nutritious food and physical activity during the vacation.
  5. Contemplate goals. Ask yourself what realistic goals this vacation can accomplish. If I tell myself, either consciously or unconsciously, that I expect my pliers to be able to cut down a tree, I will suffer disappointment or worse. If I try to use a vacation to correct a major family problem, to engender a significant upgrade in the harmony in my family life or to cause family members to love and to appreciate me more, I may end up very disappointed and hurt. However, if I tell myself that the goals are to appreciate and enjoy whatever moments come our way and the presence of my family in my life, I may end up feeling fulfilled and peaceful.
  6. Avoid rushing. “Let’s go we must be there 30 minutes early!!” “C’mon we’ll miss the appetizers!!” “If we’re not there in 15 minutes they’ll start without us!!” When we’ve paid a lot of money, and invested a lot of time planning, it’s so easy to treat a vacation like it is a hill to be charged: bayonets attached, troops organized and people on the receiving end in trouble! And, participants, including the one(s) barking orders, often feel more like they are engaged in battle than a vacation. If a given activity is very important to be at on time, try to give yourself sufficient time so that no one has to rush. If rushing becomes necessary, take a poll among the family regarding which they would rather do: rush, be late, or do something else. This way if there is a decision to rush at least the soldiers will feel less like they are being pushed.
  7. Avoid creating future stress. It’s so easy to spend money I don’t have because I tell myself that doing so will give my kids things or experiences that will be meaningful to them. However, if I do this spending in a way that compromises my future wellness, then there may be less of me available to my children when we return home (e.g., I have to work more, or I’m more tense, or I have more need to unwind with alcohol to manage my financial worries) and ultimately the scales tip more towards my children being stressed than benefited.
  8. Experiment with the path less traveled. When on such paths it can sometimes be easier to connect with each other and to have unique experiences. Try safe activities that either the crowds don’t do (e.g., swimming in the ocean when it’s raining, going to a restaurant off the tourist circuit) or which are a departure from your usual behavior (e.g., get a temporary tattoo, dance like no one is watching, volunteer to do a karaoke number). Then, really try to savor these moments.
  9. Begin your vacation before you leave. Anticipation can be so much fun, especially if it is shared. The internet, bookstores and libraries abounds with resources. Engage willing family members in this anticipation.
  10. Continue your vacation after you return. Every true benefit that can be garnered when at a vacation site can be garnered at home: good food, good fun, good relationships, fun activities, etc. are all available to all of us with sufficient creativity and persistence. In other words, there is no kind of brain activity that Paris can create that Toledo can’t.

By the way, if you had access to a time machine, you could go back in time and see me making just about all of the mistakes suggested by this article: I can still see myself acting like a general at Walt Disney World, treating the Unofficial Guide like a master battle plan! So, if you fall prey to performance problems when on your vacation, you’re in a huge club (i.e.,  those of us who sometimes act like Clark Griswold when on a family vacation). So the 11th suggestion is to cut yourself some slack in these moments: you’re trying the best you can and no angel in heaven means better.

Related post: Five Tips for Keeping Long Car Trips From Becoming Hell on Earth

Five Tips for Keeping Long Car Trips From Becoming Hell on Earth

Many of us take longer than usual car trips in the summer time. The starting point for keeping a car trip from becoming hellish is to determine if the length and nature of the trip is likely to leave your child, or children, regressing (i.e., annoying the heck out of you). If yes, consider these five tips.

Tip #1: set up a reward program. I once saw a documentary of a family that had to drive from Manhattan to Orlando. The parents gave each child $250 to spend on their vacation; however, they told their children that they would deduct $10 for each argument. By the time they reached Virginia the kids were bankrupt and the parents were ready to put them up for adoption. A better approach would have been to divide the total mileage (or the total estimated time in the car) by $250 and to give the each child that amount of money for each period of time they went without a fight. So, in this example, each mile driven without an argument could have earned .25¢. Keep in mind that there are many other kinds of rewards (e.g., experiences on the vacation, choices in dining along the way, access to electronic pleasures in the automobile, etc.). The idea is to describe the desired behavior and what is earned by hitting the mark.

Tip #2: build in entertainment. Being entertained makes the time fly. I’d suggest alternating activities and electronics. There are many kinds of family activities: license plate games, everyone describes the top five things they’d want the family to do if you won the lottery with a prize to the person with the best voted idea (no one can vote for their own idea), everyone says what they are most looking forward to about the upcoming vacation, and so forth This helps to make the drive a part of the pleasant memories and not just something that has to be endured. Electronics can also be shared either by everyone (e.g., an audio book that everyone is interested in) or parts of the family (DVDs). Keep in mind that most portable music players contain both the capacity to have audio books loaded onto them (e.g., through iTunes) and to be played through a car’s audio system (e.g., by purchasing a device that plugs into the cigarette lighter; for instance see http://www.belkin.com).

Tip #3: build in stops that rejuvenate everyone. A part of effective pre-trip happy hispanic familyplanning is to find interesting and low key experiences to have a long the way. This can be as simple as determining where the best of a certain type of food in a state can be found (e.g., ice cream, steak), or where the best place to take pictures might be. A stressed kid (and parent) is much more likely to act out. We all do well to heed the counsel of movie character Dirty Harry: “A man has got to know his limitations.”

Tip #4: try to have realistic expectations. Major family trips are something that we usually plan for, and look forward to, for a long time. This can make us like Clark Griswold in the Family Vacation movies: full of idealistic expectations that defy our family’s capacities. No matter how prepared we are every family member is likely to get grouchy and snappish from time-to-time. Just consider this to be the psychological equivalent of dust mites. Yeah, it’d be nice to be rid of ‘em but such is just part of life on planet earth.

Tip #5: If the long car trip is a return from a vacation, try to plan something to look forward to after arriving back home. As much as it can feel comforting to return to one’s home and routine, it can be a let down to go from Disney World to main street. And, if there is nothing to look forward to on the drive home, everyone’s vulnerabilities may be even higher. So, it can be nice to have something fun arranged for the weekend after one returns home, as long as such isn’t unduly taxing.

Related blog entry: 10 Steps for Reducing Stress During a Family Vacation

Four Holiday Stress Busters for Parents

Of course, the holidays are quite stressful, even as they offer us joy. There is less light. The weather is colder. Your life’s circumstances may not be in concert with a “joy to the world” message (e.g., you’ve suffered a recent loss, your child is ill). You may be faced with having to interact more with people with whom you have less than a peaceful relationship. There is a lot of hustling and bustling and, of course, financial pressures often mount. So, I’d like to review a few stress busters. I’m not going to cover obvious ones such as maintaining a good diet (avoiding processed foods and intoxication and eating fruits, veggies, Omega-3, etc.), getting enough sleep (8-9 hours/night) or getting enough physical activity (as one clinician put it, get some physical activity on any day that you eat). Instead I’d like to cover a few that may be less in the front of your mind. I’ll first review a common trap and then suggest one potential antidote.

Trap #1: To overspend

Antidote: Focus on relationships

Discussion: At some point in time it got embedded in our collective parental psyches that acquiring a lot of expensive stuff for our kids is the way to give them a magical holiday experience. And, if we don’t, we guilt ourselves with the notion that we may be depriving our kids. However, our research indicates that shared positive experiences with us is much, much more important to our kids’ happiness. For many years I’ve been asking people, up and down the age spectrum, for their best and worse memories. I can’t remember the last time someone told me that a best memory was the acquisition of some expensive thing. But, I’ve had countless people recount a family ritual or interpersonal moment as a best memory. For some ideas on ways to promote holiday magic, mystery and meaning for your kids, on pocket change, click here.

Trap #2: Act like you don’t have limitations

Antidote: Kind declines

Discussion: We know that our possessions all have their limitations and we are not surprised when our things break if we ignore those limitations. Many of us are also aware of our kids’ limits and likewise try to not exceed them. However, we often act like we are the only humans on the planet who don’t have limits. We work, serve, transport, host, donate, wrap, bake, cheat sleep and pin-ball around creation like frenetic hamsters on crack. On a related note, it is interesting to me that when I suggest to parents that one way to become more fulfilled and happy is to love more effectively many will respond with things like “how can I be expected to give more?!” Or,” My veins are empty doctor so I have no more to give!” However, this may be more of a western, industrialized bias as many other traditions realize that loving and cherishing oneself goes hand-in-hand with loving others. Sometimes one of the most loving things we can do for those around us is to realize our limitations and graciously decline invitations and pleas for us to exceed those limits.

Trap #3: Letting one’s mind or body be tense for extended periods of time

Antidote: Daily calming

Discussion: I don’t know how much the Dali Lama would be willing to participate in the crazy busy lifestyle many of us lead during the holidays. But, if he did, even he’d likely experience a tense body and mind. When our minds and/or bodies remain in a tense state for extended periods of time we become more susceptible to an assortment of physical and psychological symptoms (e.g., headaches, irritability, stomach pain, sadness, worsening of illnesses, anxiety). One way to combat this is to create a daily practice of calming ourselves and focusing just on the moment before us in a non-judgmental way. Some sample ways of doing this include starting a meditation practice (e.g., click here), using biofeedback strategies (e.g., for a device you can purchase click here), doing a pleasing and relaxing activity that limits our focus (e.g., knitting, going for a walk in nature) or just trying to sit still and quiet for a few minutes (e.g., click here). Even 10 minutes a day portends to offer dividends over time.

Trap #4: Maintaining unrealistic expectations

Antidote: Acceptance

Discussion: Despite years of experience that would suggest the value in throttling down our expectations, many of us go into the holidays expecting to engineer heaven on earth for ourselves and others. As the old saying goes “people make plans and God chuckles.” I think its fine to make plans, and even ambitious ones (as long as the previous traps are avoided). However, we do well to accept whatever comes along knowing that obstacles, surprises and changes are woven into the fabric of our lives. (To read more about how this antidote applies to holiday meals with family, click here.)

Here’s wishing for a meaningful holiday season for you and those you love. And, if you have other ideas for holiday stress busters I’m very interested to learn about them.

Seven Tips for Coping with Homework Hell

So, the first quarter report cards have come home. If you’re fortunate your progeny has done well. Otherwise, you may be wondering if the homework hell you’re experiencing has anything to do with the lower than expected grades. Here ere are seven tips to help.

• Tip #1: incentivize effective homework completion. First define what effective homework completion means (e.g., a certain amount of time legitimately exerted without hassling anyone). Then establish what reward your child will earn by effectively completing the homework. The more problematic the behavior the bigger the incentive and the more it should follow immediately upon homework completion. For instance, if Aiden lives for his X-box One, that might be earned by completing homework effectively each night. Be careful to put this as a reward, instead of a punishment. Xbox is earned, or not earned, not taken away. After so many days of effective homework completion Aiden might be allowed to earn a bonus (e.g., a new X-box game).

• Tip #2: Consider an excessive violation of the 10-minute guideline to be potentially problematic. Research suggests that there is often a diminishing academic return when students spend more than 10 minutes a night on homework times their grade in school (i.e., a 5th grader spending 50 minutes, a 7th grader, 70, and so forth). If your child is spending much more time than this consider tips #3 and #7. (NB: if your child is a high school student taking honors and/or advanced placement classes, this guideline will probably not apply. However, if the report card is suggesting that there are problems, perhaps take this question to an expert–see tip #7)

• Tip #3: Consult with your child’s teachers when homework is problematic. For instance, your child’s teacher(s) may not realize that your child is spending an excessive amount of time completing homework, especially in the middle school years and onward (i.e., teachers may not be coordinating their expectations). For example, asking your child’s teacher(s) what he/she/they believe is a reasonable amount of time to spend on homework each night can begin a productive dialogue.

• Tip #4: Try to avoid getting hung up on methods if the goal is being reached. Sometimes we parents try to over control how our child does his or her homework without considering whether or not he or she might get it done well using his or her preferred method(s). Some kids like music on, or to do homework on a bed, etc. As long as the homework gets completed, that’s okay.

• Tip #5: If your child isn’t being truthful about what the homework is, see if the teachers put the homework online. If the homework isn’t online, or a given teacher is spotty about compliance, add a communication system from school to home. This daily communication should include the grades that were returned that day (if any), the homework for the night and any long term assignments that are due; you might also add a report on any behaviors that might be of concern (e.g., treating peers with respect). Compliance with this system should also be incentivized. (This can be a complicated system, so see my parenting book for a step-by-step break down of the how-tos.)

• Tip #6:If you can afford this, and your child needs it, consider hiring a tutor to help with homework (not to do the homework, but to help with it). There are many well trained educators looking to do such work; you might also get names for tutors from your child’s school or PTA.

Tip #7: If your child is working at it, but floundering, consult with a child psychologist. It may be that your child has a learning disability or a psychological obstacle that is at play (e.g., a mood problem that s/he has been keeping from you). A skilled child psychologist can get to the bottom of things and suggest an effective remedial plan. For a referral, click here.

 

Defiance in a Young Child Needn’t Be Tolerated (usually)

defiant boyAn important study was published a couple of months ago in the Journal of the American Academy of Child and Adolescent Psychiatry titled “Psychosocial treatment efficacy for disruptive behavior problems in very young children: A Meta-analytic study.” The first author is Boston University professor Dr. Jonathan Comer. This study of studies examined 36 studies investigating 3,042 children. The high points from this study support the headline for this entry.

Backdrop for the study

The authors first reviewed some key findings in the research literature:

• About 10% of preschoolers meet criteria for a disruptive behavior disorder. These conditions exist across cultures and are associated with debilitating outcomes (e.g., profound family disruption, continued psychopathology).

• The rates of psychotropic medication treatments for preschoolers has experienced between a two and five fold increase despite the fact that “…controlled evaluations of the efficacy of antipsychotic treatment for early child disruptive behavior problems have not been conducted…(and) potential adverse effects of antipsychotic treatment in youth, including metabolic, endocrine, and cerebrovascular risks, have been well documented.”

• While only a minority of children with disruptive behavior problems have ever tantruming girlgotten evidence-based treatment, there is evidence of a decreasing trend of kids getting needed mental health care.

Results

When considering if interventions work, researchers calculate an effect size. A “0” score means no effect; .2 means a small benefit; .5 is a moderate benefit and .8 represents a large benefit (what one well known statistician described as “whopping”).

The average effect size was .8! Remember, this is across 36 studies and more than 3K kids.

• The largest effect sizes were found for treatments that took a behavioral approach (see the commentary section below).

bipolar child• There is evidence that many treatments offered to youth with disruptive behavior problems are not the ones with the most evidence supporting their use; moreover, when these treatments are compared to evidence-based behavioral treatments there is a large difference in favor of the behavioral treatments. As the authors note “…widely used approaches rarely show support.”

• “Treatment effects were consistent across samples of varying compositions of racial/ethnic minorities.”

• “These findings provide robust quantitative support for consensus guidelines suggesting that psychosocial treatments alone should constitute first line treatment for early disruptive behavior problems. Against a backdrop of reduced reliance on psychosocial treatments in this age range, and increased reliance on pharmacological treatments in the absence of controlled safety and efficacy evaluations, the present findings also underscore the urgency of improving dissemination efforts for supported psychosocial treatment options, and removing systematic barriers to psychosocial care for affected youth.”

• “Roughly 50% of U.S. counties have no psychologist, psychiatrist or social worker.”

Comment

Readers of this blog will note how much this study is consistent with a primary ball and chain runningpoint I’ve been trying to make (and quoting from my own previous entry):

“Psychological problems are akin to medical problems in so many ways: they are nearly universal by the time a kid reaches adulthood (about 90%), most of the time they are treatable in a short period of time, they are easier to treat the earlier they are caught and, if they are left unchecked, can cause very stressful and costly consequences. However, unlike medical problems, only about 20% of youth who need evidence-based mental health care get it.”

This is profound social injustice and it needs to stop!

character holding checkmark-bulletWhat can you do to help?

• Ask your pediatrician if s/he screens all children for mental health problems in her/his practice on well visits. If not, ask him or her to reconsider. If s/he says that s/he doesn’t screen because s/he would have no one to refer such children to, make a counterpoint and a suggestion. The counterpoint: parents deserve to know if their child could benefit from a mental health evaluation. So, even if no help can be found, the problem has been upgraded. The suggestion: contact your state’s psychological association and ask if they can help to identify a provider to whom your pediatrician may refer; it is highly likely that that they will be passionate in their efforts to assist. Should you convince your pediatrician to grow in this way, a quickly administered pediatric mental health screening tool is available in the public domain (i.e., it’s free): Pediatric Symptom Checklist.

• If your child’s defiant or disruptive behavior is causing anyone distress, get him or her help for it today. Besides tapping your state’s psychological association, you may also try here .

• Ask the mental health professional you interview at least two questions:

√ “In what types of problems do you specialize?” (This is a better question than question mark over brain“do you specialize in working with children?”) If you hear kids listed, that’s good. If not, ask if s/he knows of someone who does. Of course you may live in a community where this person is your only choice. So, you can ask if s/he has had success treating this problem.

√ Once you identify a viable clinician, ask “You obviously can’t know if my child has Oppositional Defiant Disorder at this point, but what is your treatment approach when you have diagnosed a child with Oppositional Defiant Disorder(ODD) and that’s the only problem?” There are synonymous terms for a good answer: “behavior modification,” “parent training,” (an unfortunate term in my view but it’s used), “behaviorally oriented family therapy,” and “behavioral treatment.” The clinician might also name some specific treatment manuals/approaches such as “Parent-Child Interaction Therapy,” “Incredible Years,” “Helping the Noncompliant Child,” “The Triple P-Positive Parenting Program,” and “The Defiant Child Program.” I would be very concerned if the first line of approach were a different one, including the use of medication treatment.

key in lockJust to give you an idea of what you might be in for, when I have a child who has ODD, and that’s the only problem, the treatment phase of the work (i.e., not including the evaluation phase), takes 8 sessions. In my own practice this cures the problem over 90% of the time. And, the two most common reasons I’ve found it doesn’t work are (1) the parent(s) don’t apply the techniques, usually because of personal pain and limitations or (2) there was another or different problem interacting with the ODD (e.g, the child really was suffering from an emerging case of bipolar disorder, the child was privately sniffing glue on a regular basis, a parent was substance dependent but tried to hide that). If a child truly has just ODD, and the parent does the techniques, it works.

The truth I/m reviewing here still seems to be too much of a secret, at least from most parents, teachers and pediatricians I’ve known. This leaves kids, parents and families suffering needlessly. As Jerry Garcia once noted: :Somebody has to do something, and it’s just incredibly pathetic that it has to be us.”

In closing let me share that you can also find multiple behavioral strategies in my parenting book as well as suggestions for identifying, and affording, quality mental health care.

How do I get my kid to sleep in his or her own bed?!

mom frustrated by depressed daughterFirst I should state that co-sleeping, or kids sleeping in the same bed as their parents, is a culture bound phenomenon that is inherently neither healthy or dysfunctional. So, if you’re from a culture where this is common, and none of the caveats I describe below are in play, no worries. However, there are instances when co-sleeping is symptomatic of an underlying problem. In my experience, the most common of these are marital disturbance, adult loneliness, anxiety–in the child and/or the parent(s)–or some combination of the three. The purpose of this post is to suggest strategies for dealing with situations when you wish for your child to sleep in his/her own room but s/he is freaked out about that (the other problems could be addressed in counseling; you may also find articles pertaining to those topics within this blog site).

Avoidance is rarely an effective strategy for coping with fears that your child has regarding developmentally appropriate activities or situations. As none of we engaged parents are happier than our least happy child, it’s natural for us to support avoiding those (developmentally appropriate activities or situations) that distress our child. But, avoidance is a jealous strategy; the more it is used the more it pulls to be used. Plus, avoidance doesn’t deal with the underlying problem. Keeping in mind that you may need professional and tailored consultation, here are some strategies to try on your own (some of these are merely strategies for promoting sleep hygiene).

• Set up an incentive program for sleeping alone. If your child is younger, or the asian boy looking up white backgroundproblem is a mild one, a star chart may suffice (i.e., each successful night earns a star on a chart). Make it so that that your child earns something s/he desires after so many stars are on the chart. If your child is older, or the problem is more significant, it may be more effective to establish a daily incentive program (i.e., sleeping alone earns the privilege of watching TV the next day). There are multiple possible permutations of this that I review in Chapter Five of my parenting book. However, the bottom line idea is to make it in your child’s best interest, as s/he perceives such, to sleep alone.

• If your child is showing a lot of distress about this, you could use the technique of shaping. With your incentive program in place, let the first phase be a reward for something that is a small step forward from where you are at now (e.g., you lay with your child helping her/him to fall asleep in her/his bed, then leave, for a week; then progress to being in a chair in her room as s/he sleeps; then you are in the hallway, etc.).

child sleeping in bed• Install a nightlight if that comforts your child.

• Allow your child to fall asleep to soothing music or to an audio book of familiar material (you don’t want him/her trying to stay up to hear the next development in the plot line); just make sure it shuts off after a designated time. Alternatively, you could read your child a book. (You could also use shaping for both of these strategies).

• Your child may find a lavender aroma in the room to be soothing.

• A bath or shower before bed can be relaxing and prepare your child for sleep.

• Try to keep your child from consuming caffeinated beverages in the afternoon and evening. A balanced diet is also something that can make a positive contribution to most behavioral problems that kids display.

• Try to ritualize the hour before bedtime (i.e., usually the same procedures followed in the same order).happy jumping black boy, white background

• Having had at least an hour a day of physical activity (i.e., sweating and breathing hard) can facilitate a good night’s sleep.

• Try to avoid intellectually demanding or exciting activities the hour before bedtime.

If these strategies don’t resolve the problem in a short period of time, and in consultation with your child’s pediatrician, it would usually be advisable to seek out the services of a qualified mental health professional. Click here for a referral.

Seven Myths about ADHD

child trying to get through glassThere are three kinds of ADHD: a child has significant concentration problems but is not significantly hyperactive (ADHD, Predominantly Inattentive Type), vice versa (ADHD, Predominantly Hyperactive/Impulsive Type) and both (ADHD, Combined Type). About 75% of kids with ADHD have ADHD, Combined Type while the large majority of the rest have the inattentive type.  Below are seven common myths about ADHD. Following those I list core guidelines for evaluation and treatment.

Myth: ADHD is not a real disorder. This is akin to saying that diabetes isn’t a real disorder or asthma isn’t a real disorder. To my knowledge, no reputable scientist or professional organization subscribes to this position. About four to six percent of youth suffer from this biological disorder. Studies of the brain indicate that these youth show poor functioning in the parts of the brain responsible for impulse control and sustained attention to boring tasks.

Myth: ADHD, Combined Type can be caused by poor parenting or being upset male college studentraised in adverse circumstances. While significant attentional problems can be caused by an assortment of problems (e.g., trauma, depression, anxiety), the degree of sustained hyperactivity required to diagnose ADHD is usually not caused by environmental stresses (I say “generally” as even a broken clock is right twice a day, but I’ve never seen a case like this or read about a case like this). ADHD is a biological disorder caused by either genetic transmission (i.e., it runs in the family) or significant insult to the brain (e.g., mom smoking cigarettes during pregnancy).

Myth: ADHD is caused by what a child ingests. Certainly what a child eats could affect just about any condition. Moreover, correcting an unbalanced diet, or eliminating allergens or toxins, would be part of a helpful treatment plan for just about any disorder. However, nothing that youth put in their mouths has been established as a primary cause of ADHD.

girl paint all over herMyth: A positive response to medication treatment proves that a child has ADHD. Many children will experience improved concentration on low doses of stimulant medication, whether they have ADHD or not. Our culture is replete with examples of people, who do not have ADHD, using stimulants to accomplish some desired effect (e.g., pilots during the Korean war took dexedrine in order to be able to focus better during long bombing runs).

Myth: Youth suffering from ADHD, who are treated with stimulant medication, are at higher risk to develop substance abuse problems as a function of taking the medication. Actually, the exact opposite seems to be more likely: having ADHD, and not receiving effective treatment for it, seems to double to triple the odds of substance abuse in adolescence. Moreover, the number one cause of death and serious injury among teens and young adults are accidents and youth with untreated ADHD are at a much higher risk to experience those.

Myth: ADHD can be treated effectively by enhancing a child’s motivation. defiant boyAs I wear corrective lenses I use the following analogy with my clients: “if I told people I wasn’t willing to wear glasses but was interested in other treatments, they might try to make the light brighter for me, cheer me on, or suggest that I get closer to things I’m reading. However, nothing is going to help nearly as quickly and effectively as my just putting on my glasses. And, my not putting on my glasses could eventually make me think that my problem with reading is a problem with my effort. And, if I go there in my thinking, I’m probably going to make myself very, very upset and sick.”

Myth: People outgrow their ADHD. It is true that a small percentage of youth with ADHD reach the point that their symptoms are not significantly impairing in adulthood (these are usually the milder cases with multiple protective factors at play). So, in that case this myth has some truth to it.  However, testing on those individuals will usually document the lingering presence of the disorder; it’s just not causing impairment anymore, secondary to the protective factors and brain maturation.

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Evaluation guidelines

Keep in mind that in order to qualify for an ADHD diagnosis a child must show unusual and impairing inattention (usually to tasks that bore him or her) or hyperactivity/impulsivity at both school and home for a period of at least six months. The common standard for “unusual” is the 93rd percentile (i.e, having the symptom worse than 92% of the youth’s peer group). Moreover, the onset of the first impairing symptom should be before the age of seven and no other viable theory can explain the symptoms that are being demonstrated (i.e., ADHD is a diagnosis by exclusion).

The methodology for determining the presence of the disorder is determined by a cost/benefit analysis. As I consider the myriad of factors at play, I’d suggest the following be the default standard for ADHD evaluations: a family interview, a child/teen interview, the completion of parent, teacher and child–if the child’s reading level is sufficient–behavior rating scales, a comprehensive review of school records and a review of any other relevant records. (The behavior rating scales should include broad-band measures that endeavor to assess for a spectrum of disorders as well as narrow-band measures that try to rule out ADHD specifically.) If one of these elements is missing, I’d worry about the increased odds of an inaccurate finding. If these sources of information leave the diagnosis in doubt, I’d suggest adding a computer based continuous performance test (e.g., the Test of the Variables of Attention). (There is a reasonable argument to be made for including a continuous performance test  in every evaluation for ADHD, so I wouldn’t differ with those clinicians who do.) In instances where a learning disability is suspected, additional cognitive and achievement testing would usually be in order.

anxious teen african-american

Treatment guidelines

The large majority of children with ADHD have at least one other co-occurring condition (e.g., Oppositional Defiant Disorder). The configuration of the co-occurring problems would normally have a substantive impact on an evidence-based treatment plan. However, for ADHD itself, medication is the primary treatment of choice (i.e., the scientific evidence supporting its efficacy is overwhelming). It is also very common to need behavioral treatments, at both school and at home, to augment the primary treatment. As a primary treatment, the following would typically not be indicated: dietary manipulations, chiropractic treatments, play therapy, art therapy, music therapy or basically any interventions that does not have a sound scientific foundation to support its usage as a first line intervention.

For more science-based information on ADHD, consider any of the following websites designed for lay people:

www.chadd.org, www.add.org or www.help4adhd.org

Also, on 12/4/12, from 1 to 2 PM EST, there will be a Twitter chat on ADHD. (I will be one of the panelists.) This will be hosted by Dr. Richard Besser, Chief Medical Editor for ABC news. Just go to #abcDrBchat at that time.

What Can I Do If My Kid Freaks Out About Routine Dental or Pediatric Appointments?

Trips to the pediatrician and dentist are commonly feared by kids. This fear ranges from mild discomfort to debilitating anxiety. Let me offer six strategies to help:

#1: Avoid unhelpful reassurances. As I’ve written in other entries, a reassurance is a cue that danger is approaching. While parents don’t intend for their reassurance to be heard this way, kids often hear “okay, time to start freaking out.” Think about this for a second. If you were meeting with me in my office and I told you not to be worried about the ceiling collapsing on our heads, you, of course, would start to wonder about the security of my ceiling. Wait until your child shows distress before reassuring, and then keep them brief and proportionate. If they don’t work, as they often don’t, try the other strategies listed below.

#2: Prepare. Confronting fears is like swimming in a cold lake. At the end of the day, it is sustained exposure to the feared object that calms a person down (i.e., one gets used to it).  Some people know this intuitively and are inclined to cannon ball in. But, many prefer to go in slowly, getting used to the water as they go. This is what preparing your child for the appointment is akin to. If you go to Amazon and type in search terms like “kid, dentist” under books, you’ll get a myriad of choices that will allow you to discuss what the medical appointment might be like. You can also get books that generally help with anxiety. My favorite along those lines is the Scaredy Squirrel series by Melanie Watt. (I have the entire series in my office, including a Scaredy Squirrel puppet.) A related technique is to visit the office on a day when your child doesn’t have an appointment, spending time in the waiting area while doing the next strategy.

#3: Relax your child. A relaxed body and anxiety are like oil and water: they can’t mix. So, you can try to train your child to flush anxiety out of his or her body. The three elements to this are breath, muscles and mind. I tend to focus on the first two with kids. I ask kids to pretend that their lungs are in their lower belly, instead of their chest, and to breath deeply, but comfortably, in and out from there. I also ask them to try to make all of their muscles like a cooked, rather than an uncooked, piece of pasta as I walk them through their muscle groups in a soothing voice. There are also resources you can acquire to facilitate your child’s training along these lines. One of my favorites is the relaxation CD that my friend Dr. Mary Alvord and her colleagues have created. Also, and if the cost benefit ration seems worth it, you can acquire a small, portable biofeedback device that can help your child get into a relaxed state; I like the emWave2 for this purpose.

#4: Distract. Once in the office, try to distract your child with something interesting. I was on the sidelines of a baseball game recently when a young girl, who was barefoot, stepped on a wasp. She started crying in terror and pain. I broke out a couple of magic tricks (I keep them with me) and distracted her, reducing both her pain and her anxiety (and delighting her mother). There are an endless number of ways to do this: read a story, play an electronic game, discuss the details of a fun activity coming up that weekend, and so forth. If the medical procedure your child is going to receive allows for this, distract your child during it as well; if it doesn’t, ask if he or she can listen to a portable music player that you provide.

#5: Reward. I wouldn’t do this unless you know that your child is going to struggle. But, if you’re confident that’s the case, tell your child that if he or she is brave, and doesn’t put up a fight, that you will reward him or her afterwards, specifying what the reward will be. Try to keep the reward proportionate to the level of challenge your child is experiencing. So, the reward can be as small as going to ride swings at a local park or as big as a trip to a water park. Then reward, or don’t, based upon how cooperative your child was.

#6: Get help. If these techniques fail please consider consulting with a qualified child mental health professional. Often these kinds of problems can be remedied quickly with treatments that beat having a couple of adults restrain a terrified child. To get a referral near you click here.

Neurotic Parental Guilt

As a child psychologist, dad and friend of many parents, I’ve noted that neurotic guilt is common among we parents. Sometimes these feelings are mere flashes while at other times they are thematic. Of course there are situations in which experiences of guilt are not neurotic as they are helpful (e.g., situations where a parent is abusing or neglecting a child and the guilt feelings motivate change). But, here I’m thinking of instances when we engage excessive self-reproach for having human limitations or for having normative human experiences. In this entry I’ll first describe some common scenarios that evoke such quilt and then suggest seven strategies for coping with it.

The first common scenario is when there is a separation at hand:

• A child leaves for college, especially if the child leaving is the first born. (Many parents report feeling shocked at how quickly this day has arrived.)

• A parent departs for an extended period of time. This commonly happens when mom or dad serves in the military, but there are many examples of it in our run-and-gun culture (e.g., as a phase of relocating to another part of the country).

• A parent is on his or her death bed.

In these and other related situations we can be swept away with thoughts that we did not get the most out of our time with our child. We can mercilessly beat ourselves up with thoughts that we should have spent more one-on-one time, done more shared activities, communicated our love more effectively or just been a better parent. A famous quote by Kahil Gibran comes to mind “Ever has it been that love knows not its own depth until the hour of separation.”

The second common scenario is after some positively anticipated event or period of time is over such as:

• A vacation is finished.

• A holiday period is concluded.

• A weekend is over. (I wonder what percentage of neurotic parent guilt happens on Sunday nights.)

In these and related scenarios I might kick myself for moments of conflict, boredom or disengagement. I so much looked forward to having a joyful or meaningful experience with my child. And, when reality almost inevitably falls short of my high expectations–what I refer to as the “Clark Griswold Syndrome”–I kick myself with self-reproach and feelings of guilt.

I believe at the root of neurotic parental guilt is the overwhelming and gut wrenching love that we have for our kids. It is so encapsulating and powerful, that it makes us lunatics much of the time. So, my fellow lunatic, let me suggest some antidotes for this neurotic guilt:

Strategy #1: Use what we psychologists call “coping thoughts.” Coping thoughts are true thoughts that provide comfort. Wearing a pair of jeans that are so tight that they hurt serves no purpose. So, sane people swap them out. This type of neurotic guilt serves no purpose, so we do well to swap it out. Here are some coping thoughts to try on for size:

√ “Everyone has moments of stupidity, impatience and frailty. There is no escaping my humanity.”

√ “I love my kid more than my life. It isn’t possible to love someone more than that.”

√ “I do (have done) all kinds of things for my kid such as….”

√ “Conflict and disengagement are woven into the fabric of human interactions. There is no being together, for any extended period of time, without them.”

√ “Life is not a fairy tale, it’s better. But, that comes with mess for everyone.”

Strategy #2: Imagine you are in the future and your child is a parent. He or she is now coming to you for help with the exact same type of guilt you are now experiencing. What advice would you offer your future child? If your like most, this can lead you to a more wise and kind stance with yourself. (This is also one way to get in touch with what I have referred to as your “wells of wisdom.”)

Strategy #3: If your child is still living with you, or lives close to you. Try hard to do at least one hour of “special time” each week. If you do this exercise consistently you are taking a mighty step towards promoting an effective relationship with your child. (Special time is different from quality time. To learn more about how to do it see Chapter One in my parenting book, or download this article that I wrote.)

Strategy #4: Write a gratitude letter for your child. Click here for a blog entry on the specifics of this method. This can be a most profound human experience. (Be careful not to expect reciprocation though. It’s wonderful if a letter comes back at you later, but no one is served if you experience resentment secondary to a frustrated expectation.)

Strategy #5: Apologize for any real mistakes that you made and, if it’s a pattern, try to both understand the underlying cause(s) and take steps to either improve or resolve the situation. Steps for improving could include such things as spiritual direction, psychotherapy, improving health habits and enhancing your self-care (i.e., parenting from the cross is rarely effective), and I speak as someone who has taken abundant advantage of each of these self-improvement measures.

Strategy #6: A more elaborate version of the coping thought strategy would be to make a list of your parenting strengths and successes. This could be a one-and-done exercise or a weekly effort. It is a list of things you have done, or do, well as a parent. It can also include evidence of good outcomes that your child experiences or has experienced.

Strategy #7: Get helpful feedback. My personal criteria for such a consultant is that (a) he or she is wise about parenting (i.e., by experience, by training or both), (b) he or she cares about me and (c) he or she is as likely to agree as to disagree with me (i.e., someone who is only going to agree with me is of little use for this service).

In closing, and to beat one of my most treasured and favorite drums, if you think you could benefit from speaking with a good child psychologist, pick up the phone! 😉

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