Archive for the ‘Parent-Child Relationship’ Category

SAD: More Than Just Winter Blues?

Friday, January 11th, 2013

Written by Dr. John Carosso

The change of season blues

How many of you can relate to the dismay of darkness settling-in as early as 5:00 pm? I know it gets me down in the dumps. For some, however, it’s more than just feeling somewhat ‘blue’ in mood; some struggle with severe bouts of depression during this time of year, known as ‘Seasonal Affective Disorder’ (SAD). This depression differs from it’s more typical counterpart in that the onset is rather predictable, usually around September or October, and corresponds with the shortening of daylight.

How Common?

As would be expected, depends on where you live. If you’re lucky enough to live in the cold Northern regions, rates go as high as 20%, but as low as 2% in brighter climates. Oh well, guess that’s bad news for all of us here in Pennsylvania.

Kids and Teens affected too?

This is not an adult-only malady. SAD usually begins in the teen years and strikes girls four times more than boys. Interestingly, teens born in the Spring or Summer are more likely to suffer from SAD than those born in the colder months. Not sure why, but may be because of how a child is light-programmed from early-on their life.

What to do?

Well, short of moving to Florida, treatment involves the systematic use of light. Guess this makes sense given the problem is based in lack of light. The ‘phototherapy’ involves sitting briefly in front of box that emits intense light, or the use of a Dawn Simulator; both are quite effective as well as traditional cognitive-behavioral talk therapy, and medication.

Hope that helps

If you’re feeling down, lacking in motivation, and blah in mood, or you notice your kids being exceptionally moody or agitated during the Fall and Winter months, then please do not hesitate to get help. You can reach me at or call 1-877-899-6500. You can find out more about SAD in an article on the e-Edition of the Exponent Telegram where I was interviewed about this form of depression. Check it out at

God bless.

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 ( or Comment here at the Blog and request some help or email me at 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.

Autism: When is it good to talk to yourself?

Tuesday, February 14th, 2012

Written by Dr. Carosso

Is it good to talk to yourself?

Sure it is. In fact, this is how we, as humans, problem-solve and work through our difficulties. We learn, beginning at a young age, how to ‘talk things through’ in our head, which helps us to process our feelings, experiment with potential problem-solving strategies, and rehearse resolutions.

Go on, let it out

How often have we heard young children ‘talking out loud’ in their play, or when working through some difficulty? In fact, as adults we not uncommonly do the same thing, but are more discreet about it (you know what I mean; talking out loud while driving home from work and hoping other drivers don’t think you’re strange). However, it’s not until about seven year old that children begin thinking more in words, quietly in their head, as opposed to out-loud and in pictures, the former of which tends to be more efficient and effective.

What’s this got to do with autism?

As we know, children with autism struggle with expressive language. Children who struggle with talking to others also struggle with talking to themselves. In fact, a recent study out of Durham University (Development and Psychopathology, January 26, 2012) found that 2/3 of children with autism experience significant difficulty with self-talk, even if they had some level of expressive language capacity.

Lets talk this out

So, what do we do about this skill deficit? Well, for starters we take every opportunity, in the presence of children with autism, to ‘talk out’ our thoughts as we plan our day and problem-solve, and we give children the words to problem-solve on their own. We do so as simply as possible, using as few words as possible depending on the age and language skill-level of the child.

Younger the better

To help young children and those with more severely compromised language, we use visual cues and schedules with actual pictures of the child or item. However, it’s important to transition, over time, to symbols, then symbols with written words, then only written words with speech, we then rely solely on speech; all of which builds the foundation toward inner speech.

20 Questions

This process is no game, but you’ll present it that way. We build foundations of self-talk by asking questions, during games and activities, which promote planning and ‘thinking things through’. Such as: “what can you do with that puzzle piece?” “What will you need next to finish the puzzle” “Where can you find that piece?” “What will happen after you’re done? Sometimes the questions can be posed to direclty promote self-talk, “I wonder what will happen next if you do that…?”

Turning action into words

The approach I find to be invaluable is ‘parallel talk’ that involves playing alongside a child and talking through what he or she is playing (putting actions into words, which is exactly what we want the child doing to plan and problem-solve). This is also helpful to enhance play skills.

Summing it all up

It is vital that children are able to utilize ‘self-talk’ to plan and problem-solve; it’s a skill that all children need to master but is usually quite deficient in children with autism. These strategies can help to increase your child’s ability to ‘talk to themselves’ and thereby more effectively plan and problem-solve.


Please comment, or Email me with any comments or questions at or Your feedback and individual experiences are welcomed and will be invaluable to share with others. Thanks again and God bless.

Autism Center of Pittsburgh!!

Monday, January 30th, 2012

Written by Dr. John Carosso

Proud to Announce:
I am very pleased to announce that I’ve taken-on the role of Director of the nonprofit Autism Center of Pittsburgh (ACP). Of course, I’ll be continuing at Community Psychiatric Centers, with Dr. Lowenstein, conducting evaluations, providing consultation, and overseeing clinical matters.

Thrilled to be part of the ACP team:
I could not pass up this opportunity to be a part of such a dynamic and altruistic Center. ACP has been around for ten years, founded by Cindy Waeltermann, who fortunately is staying on-board and we’ll be working together to continue providing support to children with autism and their families. ACP also has Becca and Kris answering the always-ringing telephones and responding to parent’s questions as well as managing the on-line store full of practical and enticing items. Initial and re-evaluations continue to take place for autism assessments, and ACP also touts a 900 member on-line chat room where parents provide support to one another. ACP has proudly provided service dogs, sponsored conferences, Holiday parties, and provided respite opportunities for parents, and there’s more to come.

Check it out:
Come visit ACP at and the latter of which is a national database for autism services. Join the listserv at AutismLink and receive autism-related updates and pertinent news. Don’t forget to check-out the ACP store as well.

Join ACP’s support network:
I hope you’ll consider supporting ACP; we accept on-line donations and would appreciate your generousity; I trust you’ll join us in upcoming fundraisers. We’ll keep you informed. Also, all proceeds from the store support children with autism.

Keep us in your thoughts and prayers:
We appreciate any ideas you may have to improve autism services, and welcome input about unmet needs for your child. Please let us know if there is something missing in your child’s treatment regimen, maybe we can help or develop a service program to close the gap. Feel free to email me directly at Finally, and most importantly, please keep ACP in your prayers; we feel privileged to do God’s work through this nonprofit effort, and need a daily boost of wisdom and discernment. Thanks again and God bless.

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, 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:
-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:

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 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

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 In the meantime, God bless.

Smart vs. Wise: Which is Better?

Friday, October 14th, 2011

The benefits of brilliance
Okay, I know you want your kiddo to be smart, get good grades, and achieve lots of academic success. It’s wonderful to see that ‘A’ on the report card, and it makes you feel proud and encouraged for your child’s future.  

Smart = Wise?
We want our kids to be smart, but does that mean they’ll be wise too? If a child gets good grades, will they also make good decisions in their life?  That’s a tough one.  Research has shown that smart people tend to be happier and more successful. However, is it always a sure bet that they’re wiser?  I think we know that there are lots of smart people in jail. As a psychologist, I also know that there are lots of smart people who are not especially happy. I also know that there a lot of less-than-brilliant people who are very happy, and not in jail. Smart doesn’t equal wise.

The Wisdom Factor?
So what the different between being smart and being wise. Smart people may have a high IQ, but wise people make good decisions. They know when to say no. That begs the question: what are “good decisions?” It could be said that ‘good decisions’ are those choices that keep us out of trouble, help and bring us closer to others, and benefit our lives and the lives of others. The more we do such things, the happier and more content we’ll be.

Where does wisdom come from?
We can read from the book of Proverbs, the “manual for living”,  that God cherishes wisdom much more than smarts and such has since helped to “keep us from making wrong turns or following the bad direction.”  Am I saying that wisdom comes from our relationship with God; well, yea, I am. How else do we learn right from wrong and stay strong to do what’s right?

Where does that leave our kids?
Okay, back to where we started; you want your child to be smart and earn good grades. However, you also want your child to be make good decisions, have good and healthy interpersonal boundaries and relationships, not make  a wreck of their lives, help others, and be as joyful as possible despite inevitable trials and tribulations.  To put it more simply (albeit less clinically), we want our children to avoid sin and do what is pleasing in God’s eyes.  I think that’s why we, as parents, go to such great lengths to get our kids to church, Sunday school, CCD, Synagogue, or wherever you go to get closer to, and learn about God. We inherently know that the closer our child is to knowing and understanding God, the more likely he or she is to make better choices. We also remember that ‘what you do speaks so loudly I can’t hear what you say’, so we work extra hard to model, for our children, a virtuous life.

Smarts vs wisdom
I’ll be happy if both my kids earn straight A’s, are valedictorians, go to medical school, and find a cure for cancer. However, I’ll be positively thrilled if they, quite simply, are wise. How about you?

Feel free to comment, or email me directly at God Bless.

Separation Anxiety: A Kindergartner’s Struggle

Wednesday, September 21st, 2011

Written by Dr. John Carosso

Off to school blues
Have you had smooth experiences getting your kids off to school? I hope and trust that your kids have navigated this transition without undue difficulty. However, my kiddo has not been so fortunate. Much to his chagrin, Nico is starting Kindergarten, and the separation process has not been easy. Our mornings have been replete with his crying, clinging to his mother’s leg, making a run for it, and exclaiming his desire to “skip” Kindergarten.

Heal thyself
Of course, as a child psychologist, I have dealt with this problem countless times. I know what to do; but it sure can be tough to do it. How hard is it to see your child suffer? It’s our first impulse to ‘do something’ to remedy the problem and see our child smile again, as quickly as possible.

It has been very tempting to simply send Nico back to his small, private school with only a handful of classmates. I’ve talked to parents who have been equally tempted to home or cyber-school. I appreciate, now more than ever, their inclination to do so. It’s tortuous to see our kids struggle.

What to do?
The answer is to compel Nico to face his fears. Despite the impulse to do otherwise and simply wait (hope) for maturity, there is no guarantee that time will solve this problem. I’ve reminded myself of having worked with High School students who continue to struggle with school refusal due to anxiety.  So, rather than capitulate, we have remained firm but have accommodated. Nico has been given ongoing encouragement, calming strategies, he’s been driven to school, the Guidance Counselor has met him to walk to class, and he has been given some extra attention from the classroom teacher. We’ll fade these strategies over time, but so far we’re seeing progress. He’s still not too happy about Kindergarten, but the fuss is reducing.

One size fits all?
The motto for anxiety disorders is ‘face your fears’; and it’s the most effective avenue for overcoming such problems. However, the key question is how, when, and how much fear we face at any given time. Sometimes we need to face the fear all at once; but sometimes gradually. It all depends on the severity of the fear, and the child’s response to ‘facing’ the fear. Nevertheless, either way, the goal is always a progressive and unrelenting pursuit of facing the fear.

Future Anxiety?
Children who struggle with separation anxiety tend, by their very nature, to be more sensitive, anxious, and uptight about other things, and such often carries-on throughout life. However, while excessive anxiety may surface now and then, the key is to teach Nico, and your kiddo, to learn now how to manage the fear so that they control it, rather than it controlling them. He will be able to use what he learns now for the rest of his life.

I’ll keep you abreast of Nico’s progress; in the meantime, feel free to email me about any anxiety problems with your kids as well (comment below, or email me at God bless and happy separating.        

Good Morning America, and Sleeping with Our Kids

Monday, August 29th, 2011

Written by Dr. Carosso

What happened?
You may have noticed that, despite announcement otherwise, I did not appear on GMA last Wed. It was disappointing given that the interview was taped and the segment was ready to go but, as I was informed later by the Producer, at the last minute the segment had to be shortened due to time constraints. Guess that’s life in show business.

What would have happened?
If I had been interviewed on GMA, the topic was pros and cons of parents sleeping with their kids; I was supposed to be the “expert” speaking on the potential “cons.” Not that I am totally against kids sleeping with their parents. God knows my kids have far too frequently snuck-in and we’ve been too tired to fuss about it (with no harm done and, in fact, it can be a nice bonding experience). Moreover, as you know, kiddos who’ve had a bad dream, or aren’t feeling well, may wind-up sleeping with their parents, and I doubt any “expert” would describe that as remarkable or damaging.

So what’s the problem?
Seems I’m treading on thin ice here, because some parents get really sensitive about any negative comments regarding regularly sharing the bed with kids. I was recently quoted in the Huffington Post in that regard and subsequently called, by one of my admirers, as myopic and ethno-centric. Well, I’ve been called worse (and expect more of the same after today post), so here it goes.

The Parent Trap(s)
-Child has bad dream or isn’t feeling well
-Parents indulge child in parent’s bed
-Child later finds other reasons to sneak-in
-Pattern of behavior is quickly established
-Parent can’t get child out of bed This is an all-too-common scenario. Not to mention an infant who presents with colic and can only be put-to-sleep in Mom’s arms, in the parent’s bed. Next thing y’know, the child is three years old and still in Mom and Dad’s bed. I know about this one first-hand. Believe me, it was no easy task to get my daughter back into her bed.  

Another scenario: Single parent wants some company, so indulges child to share sleeping quarters. Parent later gets married; you guess the rest.

What parents really want
After discussing this issue with parents for over 20 years, I’ve come to the conclusion that the vast majority of parents do not want their kids in bed with them.  Need I mention the intimacy-thing; and that it’s hard to sleep with kids (they’re squirmy and kick…)?  However, parents don’t know how to get them out without subsequent emotion, tantrums, and upheaval.  I should post next time about how to do that.

What’s best for the kids
Okay, feel free to call me myopic, but children can learn a lot by sleeping on their own. These posts are supposed to be brief, so I’ll cut to the chase: the act of falling asleep, and falling back to sleep, requires the ability to self-soothe, which is a skill that comes in handy even during the day. I’ve seen countless kids who appear more self-confident, secure, and calmer after finally learning how to remain in their own bed and sleep through the night. I’ve seen parents who appear happier too, which is another plus for the kids. 

Don’t want to forget to mention: research suggests that SIDS rates are significantly higher for children sleeping with their parents. One would think that there is at least some danger of rolling-over on an infant or toddler.

Good Morning America revisited?
Maybe someday I’ll get on that show but, in the meantime, I covet and appreciate this wonderful audience of remarkable parents and individuals who put their heart and soul into caring for kids, and who actually take time out of their busy schedule to read these posts.  I take this writing seriously, and hope you find them worthwhile. God bless.