Our Christmas Gift: The Wonderful Counselor

December 23rd, 2014

Written By Dr. John Carosso
Merry Christmas and Happy New Year!!

It’s a tradition to run this post for the Holiday; hope you enjoy it, and wishing you and yours a blessed Christmas and Holiday Season.

What I’m expected to do…

As a psychologist, I’m expected to talk about traditional and clinically-relevant approaches to help kids, and parents, work through difficulties. This of course would include helping people to think in more reasonable ways (cognitive therapy), behave in ways that are productive and healthy (behavioral approaches), be emphatic (Rogerian techniques), stay in-the-moment (Gestalt), incorporate the family (systems approach), and use praise in systematic ways (Applied Behavioral Analysis).

Is there more?

Well, yes there is. I’m usually not expected to discuss spiritual options but, in some cases, it’s like watching somebody drown and tossing a small life preserver when I have ready access to a large life-boat. Don’t get me wrong, the life-preserver is effective but, well, wouldn’t you rather be in a boat?

Seems only fitting

During this Christmas season, it seems fitting to offer a reminder that God gave His Son not only to rescue us from sin, but also to rescue us from ourselves and, in the process, heal us, soothe us, and relieve us during our times of stress, burden, and strife. Think about it, in Scripture, He’s referred to as our Advocate, the Almighty, All in All, Breath of Life, Comforter, Counselor, Cornerstone, Creator, God Who Sees Me, Goodness, Guide, Hiding Place, Hope, Intercessor, Keeper, Leader, Life, Light of the World, Living Water, Loving Kindness, Maker, Mediator, Our Peace, Physician, Portion, Potter, Teacher, Refuge, Rewarder, Rock, Servant, Shade, Shield, Song, Stone, Stronghold, Strength, Strong Tower, Truth, Wisdom, and Wonderful to cite just a few of His names. Hmmm, I wonder if maybe God is trying to tell us something about turning to Him for help?

Tap into the Source

Those strategies I cited above (cognitive-behavioral…) are undoubtedly worthwhile and helpful. God gives people like me lots of ways to help and give relief (not to mention that most of those strategies have a basis in Scripture). However, there is something quite powerful and life-changing about tapping directly into the Source (another one of His names, by the way). Give it a try, what have you got to lose? May God deeply bless you and yours during this Christmas season. I’d love to hear your comments at: jcarosso@cpcwecare.com

Full-Day Preschool Better Than Half-Day? Really?

December 4th, 2014

Recent Research

Findings out of the Institute of Child Development and Human Capital Research Collaborative (say that three times real fast) at the University of Minnesota found that kids who were involved in full-day preschool ended-up being more prepared for Kindergarten than those kiddos who went half-day. As per the reported highlights of the study, the former had better scores in math, language, socio-emotional development and physical health tests. The headlines might make a parent think they need to immediately enroll their 3 year-old in a full-day preschool program. Think again.

Deeper look at the results

As I’ve preached on many occasions, you can’t simply look at headlines and brief descriptions of research; that’s too misleading. First, let’s look at the subjects: 409 4 and 5 year-olds, in urban Chicago schools. Next, let’s look at the significant differences; for socio-emotional functioning, the disparity in scores was 59 vs. 55; language, 40 vs. 37; math, 40 vs. 36; health, 36 vs. 34; total score, 298 vs. 278. Non-significant findings were found in the areas of literacy and cognitive development. Looking at those scores and the subtle differences, is there anyone concerned that their child, if not immediately enrolled in a full-day preschool, is going to be ill-prepared for Kindergarten compared to kids going full-time?

The “Obviously’ and ‘So What’ Factorsudrban

My initial thoughts after reading the results of the study was, ‘well, obviously’ and then, ‘so what’. Okay, the first thought; it is perfectly logical that kids in school 7 hours a day for one or two years, compared to kids who are in school ½ that time, would be a bit more better-prepared for Kindergarten. They’ve simply had more practice at school-stuff. However, I have no doubt that the other kids catch-up very quickly, and lots of research supports that notion. This also leads to my second thought of ‘so what’; a child a few points higher is not a big deal and, again, the others catch-up rather quickly. Lastly, take note that these findings are not entirely applicable to all kids (those raised outside of an urban area), which is something that needs to be considered when applying the results to any given child.

Who is feeling guilty?

There was a day when parents who sent their kids off to daycare/preschool for long hours felt guilty for doing so. I believe that any such guilt is silly; if you’re a parent in that boat, you’re working your butt off to meet your family’s needs and doing what you have to do. Many a parent would much prefer to be home with their kids and families, but reality gets in the way. Research suggests that your children turn out just fine (and some would say they turn-out even better, as per the above-cited research), so no harm, no foul. However, by the same token, there is no reason for headlines to mislead and give the impression that being away from your child all day is ‘better’ for your child. That too is silly. Kids like to be with their parents, and parents like to be with their kids; and this can be especially important for three and four year-olds. If you’ve arranged to be at home most of the time with your young child, then fine; no harm, no foul.

Okay, that about sums it up

Hope you all had a relaxing Thanksgiving, and that you have a blessed and joyous Christmas and Holiday Season.

Dr. John Carosso

Get Your Questions Answered Now!!!

December 2nd, 2014

It’s your turn

Please let me know what topic(s) you’d like me to cover in upcoming blog posts, or questions you have about how to manage a particular situation with your child, or anything about kids you’ve been wondering about and want more explanation.

You’re not alone

Believe me, when you ask a question, you’re not alone. To be sure, plenty of parents have a similar question or problem, so my answer to your question can potentially help lots of families. Of course, everything is confidential (no personal details will be divulged in my answer) so no need to worry about that. Also, any and all questions are good questions.

I’m looking forward to hearing from you

Just drop me an email to jcarosso@cpcwecare.com and ask whatever’s on your mind. I look forward to hearing from you and getting those questions answered.

Have a blessed and peaceful Holiday season

Dr. John Carosso

Is Your Child Depressed? Here’s What To Do

November 4th, 2014

Why do kids get depressed?

I work as a child psychologist, so obviously I come across quite a number kids struggling with feeling ‘down’ and with low self-esteem. There are common themes to this problem, and common causes. In many cases, there is long-standing genetic predisposition to the disorder (depression ‘runs in the family’) and the child is subsequently more vulnerable to bouts of sadness and being ‘down in the dumps.’ In other situations, there has been loss and strife in the child’s life, and they’re reacting as would mostly anyone. Finally, some kids have both components (heredity and tough environmental situations) that contribute to the problem.

What to do?

You won’t go too far in your research of managing depression before coming to ‘cognitive-behavioral’ interventions, which target cognitive (targeting thoughts) and behavior (changing behavior) to uplift one’s mood. In this respect, there is telltale ‘depressed thinking’ that people who struggle with depression tend to experience, such as “I’m never any good,” “I always do things wrong,” or “it will never change.” Changing those thoughts (especially the ‘nevers’ and ‘always’), making them more realistic and healthy, goes a long way to improve the child’s mood. We also change ‘behavior’ to ensure that kids with depression don’t behave in a way that people with depression tend to behave, e.g. withdraw from friends and family, and avoid activities they formerly enjoyed. Working with a therapist is often helpful, but it clearly takes the entire family, working together with the therapist, to ensure the child thinks in healthier ways, and remains active, engaged, and involved. We also incorporate coaches, teachers, kid’s Pastors, neighbors, relatives, and anyone else who has a close relationship with the child to help in the effort.

What else?

Parents often ask about improving their child’s self-esteem, which of course is vital. It’s important to remember that people bolster their self-esteem through accomplishment; it’s no free gift. Kids are no different from adults; they gain a sense of competency and self-confidence by doing and accomplishing something meaningful. This could include catching a fly ball, getting an A or a B on a hard test, making a new friend, finishing a book, or just having fun running around playing outside with friends on a sunny day. Accomplishments such as these give a child a chance to look back and think ‘look what I did today – I’m better than I was yesterday”. Even if a child tries and doesn’t do well (drops the fly ball), at least they tried – they put themselves ‘out there’ and took a risk; that fact needs to be emphasized for them. It’s vital to find your child’s interests and passions, and tap into them.

Sitting on the couch playing video games, or watching TV, just doesn’t cut it in bolstering self-esteem, nor of course does sitting in one’s room texting and isolating.

Of course, it’s also vital that parents provide positive feedback to their child, maintaining the balance between encouraging their child to be the best they can be, while not being critical, demeaning, or overly demanding. For more on this subject, see my prior post ‘the recipe for ruining a perfectly good kid.’

It’s also vital to promote a balanced and healthy diet, daily vitamin, and lots of exercise.

Self-esteem from the inside out

It could be said that, as human beings, we have inherent worth that needs to be respected. However, this concept only gets us so far (have you seen what horrible things of which humans are capable?). I’ve found what’s more impactful is the Spiritual avenue; in that respect, knowing that you’re a child of the King of kings, Creator of the universe, chosen and adopted into His royal family, and ‘the apple of His eye’ is about as self-esteem bolstering as it gets. Moreover, knowing that the King is jealously guarding and protecting you is comforting and empowering. One could argue that nothing else better-answers the question of ‘what is our purpose in life’ and provides a sense of direction and hope.

Where does that leave us?

Kids are prone to become depressed, just like adults. The usual cause is loss, family difficulties, and/or genetics. The remedy is changing dysfunctional thoughts (with the help from a trained therapist), altering unhealthy behaviors, promoting activity and accomplishment, and looking toward spiritual growth (preferably as a family). To help the process along, medication can also be instrumental to speed the recovery process. These steps have an 80% success rate. Not convinced, or if you have questions, feel free to email me at jcarosso@cpcwecare.com. God bless.

Dr. John Carosso, Psy.D.

To Spank or Not to Spank?

September 23rd, 2014

Given all the recent news regarding spanking and using a ‘switch’ to “teach children a lesson”, I thought it would be a good time to revisit one of my earlier posts on this subject. Please pass it along:

Does Spanking Work?

Okay, as a professional I’m supposed to tell you that corporal punishment (spanking) is a no-no and you shouldn’t do it. I’m supposed to tell you that it’s ineffective and simply does not work. Well, I’m not going to tell you that; or at least not that it doesn’t work. Think of it this way, I imagine most of you men (If any men actually read this blog) would think twice before crossing a guy three times your size. Well, likewise, your kiddo isn’t stupid and realizes when he’s been out-gunned; which is why spanking “works”.

Sure, it can make your kid’s obey, but….

Of course, many of us have our own experience with being spanked, and recognize first-hand the potential effectiveness of the back-hand. However, once we move past the recognition of spanking being effective in getting kids to obey, we are left with some potential problems. I hear you saying ‘I knew you were going to say that…” Well, ignorance can be bliss, but maybe not so blissful for your kids, especially if you rely on spanking as your primary form of discipline.


What are the problems? First, do you really want to hit your kids? Is there not something inherently wrong with hitting anyone, let alone somebody you love? Also, are we not trying to send appropriate messages to our kids. Do you like the message of ‘when somebody frustrates you, hit them.’ If your child is prone to be aggressive, e.g. hits his sister when angry, then does it help to tell him “no hitting” and then hit him?

Going too far?

How does a parent feel while spanking? Obviously, they’re angry and frustrated; is it a stretch that an angry parent, in the heat of the moment, might hit too hard, or too many times?

Teachable moment lost

Does spanking teach the child more appropriate ways of behaving? Is time-out, loss of privilege, the softer and closer approach, or behavior charts more effective? Does spanking create good or bad feelings; does it promote a positive, or negative, tone in the family? Is spanking consistent with Jesus’ command to do unto others as you’d have done to you? These are questions to ask yourself; the answers will lead you in the right direction. Oh, by the way, since I brought-up Jesus, you may be thinking about that ‘spare the rod, spoil the child’ Bible verse. However, God’s “rod” provides comfort (24th Psalm: “Your rod and Your staff, they comfort me”); rods were used in Biblical days to guide sheep, not beat them.

Let’s teach, guide, and love our kids

We want to guide our children; love them, teach and comfort them. The manner in which you carry out those duties, in a consistent, loving, and firm way, maybe even with a sense of humor, will serve you well in raising your kids. Now, go get softer and closer with your kids. God bless you and yours.

Dr. John Carosso

What Type Of School Is Best For My Special Needs Child?

September 9th, 2014

So many from which to choose

There are many school options for parents; brick-and-mortar public schools, public cyber schools, private schools, specialized alternative placements, and homeschooling to name a few. Parents are often left wondering which is the best option for their child, especially parents of children with special needs.

The Public Option

Public school has many advantages given that, by law, the public school system must provide a “free and appropriate education”, and implement special education services if the child meets special education criteria. Public schools are largely compelled to educate no matter the condition (as opposed to expel your child), and ultimately meet your child’s needs or transition to a facility that can, and pay for it.

The Cyber Option

There are situations where parents believe the public school system is failing their child, and the alternative specialized placements are not seen as appealing. Parents may then decide to cyber-school, which can be an excellent option if it’s important for your child to have an individualized environment, a more flexible daily schedule, and be able to work at their own pace. However, parents need to recognize that the “individual attention” is likely going to be provided by them (the parent); and that you may find yourself in the challenging situation of being your child’s ‘teacher’; i.e. sitting with them and providing the prompting, praising, guiding, and cajoling to get your child through their school assignments. If you have the time and gumption, then this can work, but it can be quite an undertaking.

The Home Schooling Option

Whatever is indicated as challenging above under “The Cyber Option,” multiply that x2 for Home Schooling. Not only is the parent compelled to provide individualized attention, the parent also must investigate, obtain, and implement the proper curriculum. Sometimes this works just fine but, again, similar with cyber-schooling, a parent serving as both ‘Mom’ (or Dad) and ‘Teacher’ can be tough for both Mom and the child.

A Private School?

A Private School can be a wonderful option. Private schools typically offer smaller classrooms, sometimes are more flexible than public schools in modifying structure, and teachers are often very accommodating. Moreover, parents often appreciate the spiritual elements inherent in such a setting. However, private schools are not legally compelled to educate your child and can expel if proving to be too difficult, and they are not required to provide ‘special education’ services. Also, at times such schools have the attitude of ‘our way or the highway’, which may not work so well for special needs children.

What about specialized or typical preschools?

Children with developmental issues often thrive in specialized preschools such as through DART/IU programs. However, parents often appreciate their child being in a regular preschool setting so as to model after neuro-typical kiddo’s language and play skills, but have concern that their child may not do well with 15-20 other kids in that typical preschool class. Deciding between the two school options can be quite a dilemma, which is often resolved by doing both. In that regard, enrolling part-time in a specialized preschool, and part-time in a typical preschool but with individualized attention such as from Therapeutic Staff Support. In this way, the child gets the best of both worlds.

So which is best?

Of course, there is no singular answer to this question; it depends on your child, the situation, and the time-frame. In terms of time-frame, I often see parents of a child with an anxiety disorder, for example, ultimately choosing to home or cyber-school their child due to ongoing anxiety and school-refusal. These children often subsequently perform well in the home setting, but the problem is that their anxiety disorder is often not addressed given that the standard mode of treatment for anxiety is having the child confront their fear (go to school). Nevertheless, the cyber or home-schooling experience can be advantageous for a few semesters as the child receives therapy and bolsters their coping mechanisms. However, a return to a more traditional school setting, at some point, would be optimal. In the same sense, many children with special needs flourish in smaller private school settings and home/cyber-school situations and parents relish the opportunity to assist in meeting their child’s educational needs, and have no reservations about the time and energy if it’s seen as beneficial. In those situations, everyone wins. It’s important, however, that parents know ‘what they are getting themselves into’ prior to undertaking the endeavor to avoid any regrets. It’s also vital to thoroughly interview school officials to be sure exactly and precisely what is expected, and what will be provided to meet your child’s needs. It’s also helpful to observe classrooms when possible. These decisions are often complex and multi-faceted; I invite parents to contact me at jcarosso@cpcwecare.com to discuss their child and help them with such decision-making. God bless you in your efforts to meet your child’s needs.

Dr. John Carosso, Psy.D. Child Psychologist

Child Won’t Sleep In Her Own Bed? Here’s What To Do.

August 21st, 2014

How it all starts

It usually begins innocently enough; your child isn’t feeling well and wants to sleep in your bed. One night turns into two, then three… Or your infant child has colic and is difficult to soothe and you find yourself often falling asleep with your child, year after year. In either case, as well as countless other potential scenarios, the end result is the same; your child is consistently sleeping in your bed and won’t sleep alone in her own bed.

What’s the big deal?

Interestingly, some parents don’t seem to mind, and there is even a movement by some groups to suggest that this is a healthy arrangement. If you’re in that group, I guess you can stop reading. Otherwise, if you’re a parent who actually wants to be alone with their spouse, is tired of constantly being kicked in the stomach during sleep by their forever-moving child, or is somehow aware that a healthy child is able to sleep comfortably alone in her own bed, then definitely keep reading.

Is it best for my child to sleep alone?

Yes, it is. The process of falling asleep is rather complex and particular skills are involved. For example, a child needs to be able to clear their mind, turn off their thoughts, calm themselves, and allow themself to comfortably drift away into la-la land. This is no easy task, especially for kids who find themselves, at bedtime, away from everyone and alone in a dark room. The process of self-soothing is a learned skill, and is also subsequently used during the day to calm when in a stressful situation. It’s a skill that definitely comes-in handy. In fact, countless times I’ve seen kiddo’s appear more mature, relaxed, and confident after they learn how to fall asleep alone at night. Not to mention parents appearing a lot happier.

What to do?

If you find yourself consistently sleeping next to a very small person who, nightly, finds their way into your room, you’ve probably tried the common strategy of taking the child back to their bed only to find the child back in your bed when you awaken in the morning. Or maybe you’ve attempted to reason with your child, or use sticker charts, and other rewards. If you remain consistent, these are all commendable approaches, and it can also be quite effective to use these commonly applied approaches:

1. Talk to the child during the day, pleasantly explaining the expectations and rewards for sleeping on their own.
2. Keep a consistent bedtime routine.
3. Answer any fears the child may have.
4. Comfort your child at bedtime while sitting beside the bed as they begin to relax and fall asleep.

However, it’s vital you do not fall asleep with the child, or have the child fall asleep while you’re beside the bed (the goal is for the child to fall asleep alone). Yes, your child may fuss, cry, and call-out for you, but it’s vital you allow your child to learn that ‘everything is okay’ and he or she can fall asleep on their own. The first few nights may be tough, but hang in there.

What if?

Okay, I hear your big question: what if my child simply will not remain in her bed, tantrums, and won’t stay in her room? What then? Okay, here’s the hard part; you have two choices. 1.) keep-up with the slow but progressive approach of walking your child back to their bed, getting them comfortable, and then leaving. You may make that trip many times, but consistency is the key. Do not verbally engage, and remain with your child for as little time as possible (the less attention, the better). Of course, that approach is quite taxing, especially after you’ve worn a path in the carpet between her room and yours.

What else can I do?

Well, this next tip can be tough for many parents, but it’s also quite effective and faster as a remedy to this problem. Here’s what you do: you tell your child the expectations for bedtime and offer all the aforementioned reassurances. Explain that you’ll be leaving their door open, and yours, so that she can feel comfortable at bedtime. You’ll explain, however, that if she won’t remain in her room, that you’ll close her door. If she still won’t remain in her room, you’ll explain that you’ll be securing the door from the outside or in some way confining in their room (by using a gate, or ¾-door…). Of course, you won’t confine your child until you’re sure that the room is safe, and that she won’t tantrum in a manner that will cause her harm. You may even drill a peep-hole in the door so you can always see what’s going on in there. However, ultimately, if necessary, you’ll close and secure the door or use some type of gate that keeps your child in the room. Of course, she’ll tantrum, cajole, complain, threaten, and may even kick the door. However, you’ll stand firm and you will not provide any verbal feedback (you want her to think you’ve fallen asleep and can’t even hear her). What will happen next? Your child may tantrum for an hour or so the first night, but you’ll see the tantrums reduce appreciably the next night. In fact, most kids don’t tantrum after the first night; they’re not stupid and don’t want to be confined in their room. However, I want to emphasize again that safety is the key; it’s vital to ensure the room is safe and that your child will not become self-injurious when tantrumming. I usually advise starting with the first approach (walking the child back to their room…) before moving to confining your child, and I imagine your kiddo will appreciate that latitude. Also, if your child is prone to violent tantrums and extreme emotional reactions, it’s best to contact me to discuss, at jcarosso@cpcwcare.com or call me at one of the offices, before moving forward with the approach of securing your child in their room. However, in the vast majority of cases, with typical kids, it works out just fine.

The three ticket strategy

On a different but related note, if you have a child who gets in bed but then pesters for everything under the sun including a drink, a hug, to go to the bathroom or to get something to eat, or any number of other things to keep you around and to keep from going to sleep, here’s a strategy you may find helpful. Of course, you can simply ignore these requests, or you can give your child 2 or 3 “tickets” that can be traded for something they want. However, after getting the drink, for example, they give-up a ticket. After 2 or 3 times, they have no tickets left and no more requests are indulged. I’ve found, and research results support this observation, that many kids will ultimately use none of the tickets and simply go to sleep. They find that having the tickets is comforting and knowing they can use them, if necessary, is enough for them.

That’s about it

Okay, that sums it up. You have two choices to get your child to sleep alone, both of which can be effective: the more traditional but longer approach, or the quicker albeit more stressful strategy (in that regard, it can be stressful to consider securing your child in their room). It’s advised to start with the first, and then think carefully before trying the second. Remember, safety is the key. Please feel free to contact me at jcarosso@cpcwecare.com with any thoughts or questions about this common problem, and these strategies.

John Carosso, Child Psychologist

Getting Back to School: Autism and Beyond

August 8th, 2014

Yes, it’s that time

Yes, it’s tough to even think about the Fall, but nevertheless it’s time to prepare for the ‘back to the school’ routine.

Summer vs School Routine

Need I mention the difference between summer and school-year routine? If you start about 2-3 weeks out, it’s much easier to ship your kids into shape. Otherwise, it’s a culture-shock for your child, and not too pleasant for you either.

What to do (tips for parents of children with autism, and typical kiddos):

1. Begin slowly adjusting routines for earlier bedtime.

2. Incorporate lengthier study and quiet-reading sessions throughout the day and week. This could include anything even remotely academic.

3. Visit the school playground more frequently to promote your child becoming more comfortable with being at school, and on the school grounds.

4. Arrange play-dates with school friends/acquaintances not seen for most of the summer, especially those kids who will be in your child’s class or grade.

5. If you can arrange a visit to the classroom, and meet the teacher, so much the better.

6. It can be helpful to color-code school supplies (notebooks, file-folders…). Integrate material-color with picture schedule.

7. Purchase school clothes early, wash them a few times, cut-off tags, and make sure your child is comfortable with them well in advance.

8. Pick-out a “cool” outfit for the first day and get a fresh haircut (first impressions are important).

9. Use picture schedules and social stories to prepare for the first day.

10. Prepare school with emergency contacts and any dietary issues.

11. Prepare the teacher, aide, Guidance Counselor, ‘specials’ teachers, cafeteria workers, and anybody else who will listen for what to expect, and how to effectively intervene if necessary.

12. Don’t forget to say a prayer with your kids before they venture off to school; they find that comforting and reassuring.

13. Autism-Speaks also has some nice back-to-school bulletins (I especially like the ‘about me’ activity): CLICK HERE to go site

If you have any other tips, please comment; it will be appreciated. Comment at jcarosso@cpcwecare.com.

God bless and enjoy the rest of the summer!

Dr. John Carosso, Child Psychologist

DSM-V and the Autism Diagnosis: Is The Change Hurting Children?

July 18th, 2014


Written by Dr. John Carosso
There has been lots of fuss about the DSM-V and the autism diagnosis; will it result in less children meeting diagnostic criteria and therefore less children getting the services they need? Is this concern legitimate? I’ve written about this in prior posts, but here I’ll provide further elaboration.

What’s the problem, and what is the diagnostic criteria?

Is the DSM-V Autism Spectrum Disorder (ASD) diagnosis the issue at hand, or is it another DSM-V diagnosis that might be a “problem”?

First let’s take a brief look at the ASD, the criteria includes:

1. “Deficits in social communication and social interaction” manifesting in, for example, poor back-and-forth communication, deficient eye contact, and absence in an interest in peers or inability to sustain the relationship/interaction.

2. “Restricted, repetitive patterns of behavior, interests, or activities, and/or hyper or hypo-sensitivities.

There are also specifiers for severity of the social and verbal deficit, and the extent of restricted interests. Finally, there are specifiers for “with or without intellectual impairment”, “with or without language impairment”, and “associated with a known medical or genetic condition or environmental factor”.

So, you can see that this criteria, with the specifiers, cover everything from what formerly was called ‘Autistic Disorder’ at the more severe end; ‘Asperger’s Disorder’ at the ‘high end’ and ‘Pervasive Developmental Disorder NOS’ for those in-between.

Is There Another Diagnosis?

Yes, there is another ‘competing’ diagnosis, and this is where there may be a potential “problem”. In that regard, the DSM-V has a new diagnosis referred to as “Social (Pragmatic) Communication Disorder (SCD), which entails “persistent difficulties in the social use of verbal and nonverbal communication manifesting in”, for example, difficulty “greeting others and sharing information”, using “overly formal language”, and “following rules for conversation” such as in turn-taking and rephrasing, and “difficulty understanding what is not explicitly stated.”

This diagnosis would cover those kiddos who may have autism-like verbal and social deficits and kiddo’s who ‘don’t quite get it’ socially, but who do not have any restricted or repetitive patterns of behavior or interests.

Which DSM-IV diagnosis will be most affected by the SCD diagnosis?

At least a portion of the kiddo’s who would have been diagnosed with Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) will now be diagnosed with Social Communication Disorder (SCD). Research published in January 2014 in the American Academy of Child and Adolescent Psychiatry found that about 8% of kids diagnosed within the autism spectrum under DSM-IV have subsequently been changed to SCD, which is a far-cry from the 20% predicted earlier by the Center for Disease Control (CDC). Most of the children whose diagnosis was changed had been diagnosed with PDDNOS, and were changed to SCD, which is understandable given that PDDNOS has such vague criteria. Those who had been diagnosed with Autistic Disorder or Asperger’s Disorder under DSM-IV were largely unaffected.

Nonverbal Learning Disability

Another “diagnosis” that may be impacted is “nonverbal learning disability” which essentially is the same as SCD. However, given that there has never been a formal DSM-IV “nonverbal learning disability” diagnosis, now these NVLD kiddo’s too have a better diagnostic fit with SCD.

Consequence of the DSM-V?

It’s likely this change in diagnosis to SCD, for the very few children who will be affected, will generally be positive. In that regard, having seen these kiddo’s first-hand, they clearly struggle with verbal and social skills, but are not “autistic”. Up to now, the diagnostic options have been few besides PDDNOS. These children can still obtain services consisting of individual and group speech/language, and outpatient social skill training, while avoiding the autism diagnosis that does not quite fit anyway.

Hope that helps to clarify the effect of DSM-V regarding the “Autism Spectrum Disorder” vs. PDDNOS, Autistic Disorder, Asperger’s, and Social Communication Disorder.

Feel free to follow-up with me, with any questions at jcarosso@cpcwcare.com.

Would You Rescue Your Spouse Before Your Kids?

June 20th, 2014

Here’s a story for you

A Dad and his son were fishing in a boat. The son looked toward his Dad and inquired, “Dad, if Mom and I fell out of the boat and were drowning, who would you save first?” His Dad, without hesitating, responded “son, I’d have your Mother in the boat, and dried off, before I’d even think about coming after you.” The son, astonished, looked with eyes wide and was about to exclaim his disapproval but stopped, appeared contemplative, then grinned and said, “yea, that’s the way it should be.”

The kid’s pretty wise

The son came to understand that the strength of the home, the foundation of the family, is Mom and Dad, together in harmony, close in their relationship, working for the family, strong in their bond, and on the same page with the kids. It’s true, there is no stronger glue to hold the family together than when Mom and Dad are secure in their relationship, which helps the kids to also be secure with themselves. Secure kids are far more likely to be calmer, more compliant, and easier in disposition. Of course, we don’t want to interpret the story literally, any number of factors may contribute to the Dad rescuing his son first (his wife is a better swimmer…) but, of course, that’s not the point of the story.

Single parent?

If you’re a single parent, for whatever reason, then you’re undoubtedly doing the best you can, and God bless you in your efforts. The sentiment of this post in no way diminishes your diligence and love for your children, or suggests that your child is not healthy and happy. The basis of this story is simply to express the importance of parents remaining strongly committed, and clearly there are advantages of having two loving, committed, and harmonious parents working together with the kids. In a single-parent situation, of course, when possible, it’s optimal that both parents, despite separated, remain highly involved with the children, civil with one another, and work toward having consistent expectations between the homes.

Bottom line?

Simple; do whatever you can to maintain the sanctity, security, commitment, closeness, and bond in your marriage. Place your spouse first in your life (well, technically, second to God, but He too understands the importance of two becoming “one”… see Genesis 2:24). Live like it’s you two against the world, and you’ll always be ready for that overboard plunge. God bless.

Dr. John Carosso