Archive for the ‘Discipline’ Category

Autism: Squirt in the face for misbehavior?

Saturday, March 31st, 2012

Written by Dr. John Carosso

Water in the face, Tabasco sauce…
There have been some recent stories about parents and teachers using ‘aversive’ techniques to ‘punish’ autistic children for misbehavior. One boy was stuffed in a bag and another was squirted in the face with water. I’ve also heard stories of parents using Tabasco hot sauce on the tongue of a child. So, is this the way to go, or not so much?

The rationale?
Some time ago, aversive techniques, including mild electric shock, were thought to be quite useful and appropriate. In some respects, practitioners found that, for example, shocking a person for a particular behavior can, in fact, actually stop that behavior (no kidding); but at what cost? The child or individual becomes angry, fearful, and the behavior can resurface when the aversive stimuli is removed given there has been no training of a substitute behavior or coping strategy. In more recent times, we’ve become a bit more civilized (arguably) and ethics panels have justifiably frowned on such strategies.

Taking the easy way out…
Despite our newfound civility, the temptation to “shock” raises its ugly head every now and then; heck, it sure is easier to squirt a child in the face rather than take the time to think-through the function of the behavior, precipitating triggers, ways to effectively redirect the behavior, teach replacement (substitute) behaviors, experiment with different approaches for a period of time, collect data, analyze the results, and ultimately determine an effective game-plan.

No choice?
Now-a-days, practitioners sometimes use aversive techniques as a last-resort to avoid self-injurious behavior when there has been no response to other strategies. It would seem that stopping a child from permanently self-injuring would appear to be a compelling justification.

A reflection of mental laziness?
Except in the most extreme of circumstances, I would argue that the reliance on aversive techniques reflects a clinician’s lack of gumption to ‘think through’ the problem, be creative, think outside the box, and develop an effective treatment protocol relying primarily on the use of reinforcement. Moreover, to a lesser extent, I would suggest the same for ‘punishment’ including time-out and loss of privilege though both of these strategies can be quite effective and definitely have their place in any discipline approach. However, the reliance on “punishment” tends to be counterproductive; more often than not, no one wins. If the misbehavior is actually reduced, such is accomplished with the child’s accompanying ‘bad attitude’, negative feeling, and a potential fracture in the parent-child relationship, especially if the punishment is frequent.

Seek help:
If you’re stuck in a rut of relying heavily on using punishment (child is in time-out all day, frequently screaming and yelling at your child), and even considering anything aversive (Tabasco sauce on the tongue, soap in the mouth, spanking…), then drop me an email (jcarosso@cpcwecare.com) or Comment here at the Blog and request some help or email me at jcarosso@cpcwecare.com. Believe me, there is a better way. Parents often need some assistance to game-plan, but it’s time well-spent. Don’t be bashful, contact me for some guidance. God bless you and your kiddos.

Improve Your Child’s Community Behavior

Friday, January 20th, 2012

Written by Dr. Carosso

No Drama Outings:
As many of you are too well aware, taking your kids out to the store, or restaurant, can be as adventure-packed as any Indiana Jones movie. However, those are occasions you’d rather do without the drama.

Get some help:
If you want some help to improve your child’s behavior during outings, just go cpcwecare.com, click on Parent Resources, and you’ll find a downloadable packet that provides dozens of tips and suggestions to help improve your child’s public behavior. While you’re there, you’ll also see a bunch of other free and downloadable packets and e-pamphlets targeting childhood:
-Autism
-ADHD
-Mood problems
-Dietary considerations
-Toilet training
-Attachment Disorder and the Traumatized Child
-Encopresis (may not want to read that one before a meal)
-Helping the over-indulged child (I’ll need that for my kids)
-Dyslexia, and more.

Hope you find the packets and e-pamphlets to be helpful. Feel free to refer a friend. Please let me know of any other topics you want covered. God Bless.

ADHD: 5 Top Tips / new ADHD E-Pamphlet

Thursday, December 15th, 2011

Hair-loss prevention
The behavior of children with attention deficit and hyperactivity can cause parents to pull out their hair. So, before you become bald, which clearly would add insult to injury, you may want some pointers. Fortunately, I have an approach to treating hyperactive kids that might save what’s left of your hair.

I love you just the way you are!

Remind yourself to love your child the way he or she is. Accept that your child is more active and easily distracted than most, and subsequently needs more attention, guidance, support, and love. Nevertheless, there are some specific things you can do to help.

Softer and closer yet again
First, the ‘softer and closer’ approach is vital (see my earlier post by that name). Hyperactive kids need individual attention, close proximity with eye contact, speaking firmly but softly, and to be taken by the hand and walked-through through their responsibilities including chores. I’ll be describing some specific strategies to promote independence but, no matter, for the time being, don’t expect your child to go upstairs, brush his teeth, put on his pj’s, clean-up after himself, and come downstairs without you repeating step-by-step directions and providing ample oversight. Your individualized attention is invaluable and vital. Enjoy this time of bonding. Don’t become frustrated but, rather, enjoy the opportunities to spend extra time with your child, helping him to complete daily tasks and to make good decisions. Keep in mind that there will be a day when he’ll be out of the home and, believe it or not, you’ll miss this time. In the meantime, in trying to promote independence, here ya go:

Top-Tips:
1.) keep the daily schedule and expectations as routine and consistent as possible. Your child will carry-out tasks easier if the responsibilities are completed at the same time, done the same way, and in the same manner on a daily basis; no guesswork.
2.) Use schedules, both written and visual; such cues are invaluable as reminders of ‘what to do next’ and can include, for example, to ‘turn out the light’ either in writing or a picture of your child turning out the light.
3.) Get eye contact, give direction in short phrases, and ask child to repeat the direction before beginning.
4.) Allow opportunities for ‘blowing off steam’ (ample time to run outside…). Provide vigorous exercise prior to expecting prolonged seat-work such as homework.
5.) Keep the homework area quiet, distraction-free, well-organized, and allow breaks as needed (complete one page, take a break…). Ironically, some children perform homework better with some background music.
6.) One more tip (here’s a bonus tip); don’t forget behavior charts!! For example, child completes homework and gets a sticker that can be ‘cashed-in’ later that evening to watch his favorite show. Kids love it and it’s increased motivation to stay on task.

These strategies can be faded as your child uses more mature coping strategies and becomes increasingly independent. Follow these steps, see the difference, and keep the hair on your head. Now, go and get softer and closer with your kids.

For more information on understanding and managing ADHD, request our new E-Pamphlet: Facts and Fallacies about ADHD. Request in the ‘Comment’ section of this blog, or email me at jcarosso@cpcwecare.com and I’ll get you the pamphlet pronto. God bless and Merry Christmas.

Ten Tips for Managing Meltdowns

Friday, November 11th, 2011

Written by Dr. Carosso

It’s not uncommon that kids may become overly emotional, even tantrummatic at times. Parents typically ignore such behavior and send the child to their room to calm, which can be an effective and appropriate strategy.

To isolate or not to isolate?
For kids who show more severe emotion, banishing to the room may not be entirely effective. In some cases the child, in their room, may become destructive or self-injurious. Moreover, sometimes these kiddos refuse to go to their room, leaving parents in a quandary.  

What to do?
Here is a ten-tip prescription for success:

Remain Calm
Do not lose your cool, raise your voice, or become overly emotional, it only worsens the situation. Two out-of- control people certainly doesn’t help. Rely on the softer and closer approach espoused and explained by me in a prior post (see ‘the softer and closer approach’).  

Pick your Battles Carefully
Some battles simply aren’t worth it. You may have to decide whether your child picking-up their toys is worth a three hour battle that may ensue.

Accessing Antecedents
It’s often possible to predict emotionally volatile situations before they occur. If the problem can be predicted, it can often be avoided. For example, if your child tends to tantrum soon after returning home from school in response to contact with a sibling; you may keep the two apart for 30 minutes after the return from school, and provide a structured routine of after-school activities to slowly bring them back together on your terms, not theirs.

The Struggle for Power
Some kids are especially strong-willed and looking for a fight. If you butt heads, you may win the battle but find yourself losing the war if your home is turning into a battle-zone. Instead, avoid power-struggles by providing choices, using humor, starting the chore with your child, making a race of the chore (who can get done faster…), using hand-over-hand, utilizing the softer-and-closer approach, tag-teaming with your spouse (take a break and let your spouse intervene), reminding of good consequences for compliance, walking away and dealing with it later, giving a choice between a quick ten-minute time-out or losing TV for the rest of the night, and a host of other options. The larger your tool box is, the better-prepared you will be.

The safety zone
It’s sometimes necessary to turn the child’s bedroom in a safe and secure place for your child to calm. Otherwise, parents may find themselves restraining their child for extended periods of time, which often leads to someone getting hurt. If you find yourself in this situation, contact this psychologist, for guidance, at jcarosso@cpcwecare.com.

The Beauty of Behavior Charts
Yes, sticker charts can be a pain, but they sure can provide children with extra motivation to control themselves. When they don’t work it’s often because they’re being used incorrectly. It can be more complicated than people think to figure-out how often, how much, and for what should stickers and rewards be given. For example, it’s all for naught if you give a 4 year-old stickers once per day, and extra rewards once per week (a four year-old often needs reinforcement far more frequently). I’ve found it best that parents seek professional guidance to devise a chart but, in the meantime, see my earlier post explaining behavior charts.

The Medication Malady
Parents are usually hesitant to consider medication. However, many children who struggle with more extreme emotion respond very favorably to various medications. In more severe situations, it may be wise to consider seeing a psychiatrist and such can be arranged with Dr. Lowenstein here at CPC.

What About Autism?
Many of these strategies also pertain to children with autism. However, we would also want to target sensory issues, language difficulties, and socialization deficits that can quickly lead to heightened emotion. It’s vital that we avoid sensory overload, find ways for children with autism to communicate their needs and wants, and avoid social situations that we know will likely contribute to frustration. I’ll write a separate post on managing meltdowns for children who have autism.

The Spiritual Connection
Get your child involved in activities that enhance spiritual development (church services, Sunday School, Children’s Ministries, Youth Group, Retreats, listening to KLOVE (98.3FM), playing with Spiritually-Minded friends…). It is comforting to be reminded that God loves, cares, is a protector, comforter, helper during times of frustration, and that He’s only a prayer away (see my prior post, “the argument squelcher“).

Praise without Ceasing
Always be on the look-out for good behavior, self-control, and cooperation. Praise whatever you want to see more of. Don’t miss an opportunity to praise your child for handling a situation without excess emotion, or for calming-down quicker than usual. Big hugs, high-fives, a big smile, and words of praise go a long way to increase your child’s motivation for next time.

I hope you find this post to be helpful in your effort to calm and comfort your child. If you want some more guidance in dealing with your kiddo’s emotional issues, don’t hesitate to email me at jcarosso@cpcwcare.com. In the meantime, God bless.

Relationship: The Foundation of Discipline

Wednesday, June 22nd, 2011

Written by Dr. Carosso

The discipline trap
How beneficial is time-out, taking away the TV, or ‘grounding’ a child from going outside? Of course, as most parents have come to find, all of these discipline strategies can be effective. However, what happens if you rely too heavily on these strategies? Well, first, your household can become like a gulag; not too pleasant. Second, you and your  child will be miserable. Third, the discipline strategies become less effective.

 Relationship: Beyond Softer and Closer
That’s why I recommend relying on the ‘softer and closer approach (see the blog, “softer and closer approach”). However, no matter what discipline you attempt, it will all go to waste, and you’ll feel like banging your head against the wall, if you don’t have a healthy, positive, and pleasant relationship with your child.

 Quality and Quantity
The key to parenting and discipline is you and your child doing things together, laughing and enjoying each other’s company, and spending time (quality and quantity time) in fun activities. Actually, even ‘not so fun’ activities can be quite bonding and reinforcing (e.g. helping with homework or school project, assisting in getting your child ready for bedtime…). In any case, absent a healthy relationship, there is no glue to connect a parental directive to the subsequent (hopefully) compliant behavior. Kids comply because, ultimately, they love their parents, want their parents to be happy, want to get-along and have a good relationship, and realize that ‘we’re all in this together’ so I might as well do my part.

The fear factor
If your child is complying predominately due to a fear of punishment, then you’re in trouble. In that case, your child’s ‘compliance’ is based in manipulation and fear, and tasks are often completed superficially and marginally. 

The fun factor
Instead, build the relationship and you’ll have a disciple (a willing follower) and be less reliant on discipline. Don’t get me wrong; both are vital, but the former is a lot more fun:)

 God Bless. If this was helpful, forward to a friend, and then go have some fun with your kid.    

The Softer and Closer Approach

Written by Dr. Carosso

How it all began
Many years ago, starting out as a Psychologist, I came across a Principal who established a ritual with his teachers. At the conclusion of every morning meeting, he would huddle the teachers together and lead a chant “softer and closer” repeated four to five times, before sending the teachers off to their students. 

Repeat after me…
I am hard pressed to contemplate a more significant or relevant mantra for teachers or parents.  I have espoused the “softer and closer” approach since that time, and can think of no better way to connect with a child. Getting on the child’s level, moving-in close, and speaking in a soft tone, if not a whisper, is remarkably powerful, comforting, and bonding for a child in any situation, but especially when the child is experiencing a difficulty and needs supportive guidance. 

Go get softer and closer
Try it with your own child; rather than standing across the room and yelling, get close, soft, and comforting in tone, and see the difference. 

Time-In?
I’ve also espoused time-in rather than time-out. Of course, the latter is necessary at times, but far too often we neglect trying the former.
 
Try it, the softer and closer approach, and see the difference.
 
Let me know your thoughts. God bless.
 

Getting kids to listen: Do rather than say

Sunday, February 27th, 2011

Written by Dr. Carosso:
As parents, we expect kids to follow directions when told to do so, and that our child will do so immediately.  Oh, that it would be so.  To our despair, it’s not, and likely shall never be.

That’s the important point; kids are not automatons (or at least mine aren’t) – oh that it would be so:). 

I tell parents that we don’t expect a table or chair to move immediately on our command; so why do we expect our kids, who have their own agendas, wants, and distractions, to immediately follow our direction with a sense of urgency?

In fact, we might have better luck with that wooden table. 

So, should we simply give-up?   Okay.  Well, maybe not.   Instead, how about changing our expectations and, in doing so, lower our blood pressure.

Recognize that kids often need that ‘softer and closer’ approach (see former blog on that subject) and a physical prompt (gently guiding them in the right direction) and getting them started on the task. Helping them begin the chore also helps.

It helps to back-up our direction with firm consequences, and soft-spoken reminders of rewards that can be earned, and privileges that will be lost.

However, to our avail, we as parents tend to rely on pestering with an ever-increasing volume. This approach is the least favorable, and results in the most frustration and bad-feelings for all involved.

Remember, as parents, emotion and words are your enemy, while a softer and closer approach, and clearly explained expectations and consequences, is your friend.

Rely on consequences and action, not pestering.   After you’ve explained expectations and consequences (i.e. rewards and punishments), one time, then you’ve said enough; time to be quiet and follow-through.

Try it, you’ll like it. Now, go get softer and closer with your kids.

If you liked this, forward to a friend:)

So, whose behavior are we “managing”?

Friday, February 11th, 2011

Written by Dr. Carosso

When we think of behavior management, we tend to think of time-honored strategies such as time-out, loss of privilege, or “grounding” a child. We tend to think of “behavior management” as how a child’s behavior will be managed.

Instead, we may be better-off to think of behavior management of how the parent or caregiver is going to “manage” their own behavior that will hopefully have a positive impact on their child. It could be said that a child’s behavior, whether good or problematic, is a response to the parent’s behavior and actions. Therefore, we may be more effective if we focus on our own behavior.

That means focusing on what we say, how we say it, how consistent we are, the relationship we have with our child, how often we praise, and how we model effective problem-solving, all of which has a profound effect on the child’s behavior.

Consequently, as a parent, it may be helpful to think of “behavior management” in terms of how you are going to manage your own behavior, and adjust your responses to your child’s behavior, to promote harmony within the family home.

Remember, you may have more success focusing on how you’ll change your own behavior, which will then have a positive impact on your child.

I’ll be writing more in the days to come about how parents can “manage” their behavior to produce a positive outcome in their child’s behavior. Stay tuned. If you found this to be helpful, forward to a friend and subscribe. God bless.

Behavior Charts: How to Make Them Work

Friday, December 31st, 2010

Written by Dr. Carosso
Sticker charts can be an invaluable resource. Kids love to get stickers, which are inexpensive, highly motivating, and can be used numerous times throughout the day or week. From my professional and personal experience, I have seen first-hand how kid’s eyes light-up when they earn stickers, and the opportunity to cash-in for some later reward.  

However, sticker charts have their draw-backs; they can be cumbersome (parents rarely stick with them beyond a few weeks), it can be tough to figure-out how many stickers to give before a reward is provided, and how often should stickers be earned and allocated in the first place? All good questions. So, lets get them answered:

  1. Prior to setting-up a sticker chart, count how many times the problematic behavior is occurring per day (hitting brother). Child would then earn a sticker, for example, once every three hours if he has not hit his brother.
  2. Stickers are ‘cashed-in’ for a reward.
  3. Establish an ‘economy’ whereby child has to earn at least 70% of all possible stickers to earn the ‘top prize’. However, they may earn lesser-valued items for some success. 
  4. Keep charts simple; no more than two or three targeted behaviors.
  5. One targeted behavior should be very easy for which to earn a sticker
  6. Children younger than five years need stickers allocated at least two or three times per day, sometimes every hour in the beginning. At that age, stickers need to be cashed-in at least once per day for a reward. Thereafter, rewards can be cashed-in twice a week, moving toward once per week over time.

Children older than 12 tend to prefer ‘point charts’ (child earns points, rather than stickers) that are added to determine if reward is earned). Variations abound and include marbles being placed in a jar when chores are complete; if child earns all seven jars in a week, then a weekly reward is given. Or, a marble in the jar determines if favorite show can be viewed that evening.

Point charts are a highly effective and motivating. Give them a try. Don’t worry if you only stick with it for a few weeks; in fact, you can tell your child that this “contract” (i.e. the sticker chart) is for only a few weeks, until a desired reward is earned; then feel free to take a break for a week or two and regroup. Also, don’t forget to get softer and closer with your child (see prior post). Go buy them there stickers. God bless you and your little ones this New Year. Please provide feedback on your experience with sticker charts.

Spanking: Might makes Right?

Thursday, December 2nd, 2010

Written by Dr. Carosso
Okay, as a professional you know that I am 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. Of course, many of us have our own experience with being spanked, and recognize first-hand the potential effectiveness of a hand on the back-side. 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 spank him? 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? 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 unto 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’ verse. However, God’s “rod” also provides comfort (23rd Psalm “your rod and your staff, they comfort me”); rods were used in Biblical days to guide sheep, not beat them. 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 humer, will serve you well in raising your kids. Now, go get softer and closer with your kids. I’d love to read your comments. Also, subscribe to regularly receive posts, and forward to a friend:)  God bless.

Relationship: The Foundation of Discipline

Thursday, October 28th, 2010

Written by: Dr. John Carosso
How beneficial is time-out, taking away the TV, or ‘grounding’ a child from going outside? Of course, all of these can be effective, as most parents have come towjW find, but if you rely too heavily on these strategies, what happens? Well, first, your household can become like a gulag; not too pleasant. Second, you and your  child will be miserable. That’s why I recommend relying on the ‘softer and closer approach (see the post, “softer and closer approach”). However, no matter what discipline you attempt, it will all go to waste, and be like banging your head against the wall, if you don’t have a healthy, positive, and pleasant RELATIONSHIP with your child.

The key to parenting and discipline is you and your child doing things together, laughing and enjoying each other’s company, and spending time (quality and quantity time) in fun activities. Absent a healthy relationship, there is no glue to connect a parental direction to the subsequent (hopefully) compliant act. Kids comply because, ultimately, they love their parents, want their parents to be happy, want to get-along and have a good relationship, and realize that ‘we’re all in this together’ so I might as well do my part.

If your child is complying predominately due to a fear of punishment, then you’re in trouble. Your child’s ‘compliance’ is then based in manipulation, avoidance, and tasks are completed superficially and marginally.  Instead, but your relationship with your child and you’ll notice what it’s like to have a ‘disciple’ (a willing follower), and it’s a lot more fun.

God Bless.  By the way, I welcome any comments or questions.