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The campfire crackled, as we sat in a ring around it. It was twilight, and we could just make out each other’s faces as the sky darkened. Some faces were dappled by the deeper shadows of the overhanging oak trees.

 

It was our first time camping with USARC at Big Bear. Peter, his little brother Luke, and I had set up our tent and were waiting for the campfire introductory talk to begin. We had prepared Peter as best we could for the experience, showing him online photos of camping, describing the fun activities planned, and even setting up the tent the day before on the grass in our backyard. Peter had loved the tent, only reluctantly climbing out so we could take it down and pack it into our car. He had typed, “I think I’m ready for this adventure.”

 

But as the shadows lengthened, and he sat staring at the crackling fire, the monotone started to grow in pace and volume. “Papa, car ride home, bed, Papa, car ride home, bed, Papa, car ride home, bed…” Pressured speech, cold clammy hands, racing heart- I saw all the signs of a growing monster of anxiety. “Peter, I see you are getting anxious, but you will be okay. Remember how fun it was to sit in the tent? Look at all these other kids like you- they’ve all done this before, and they all came back they had so much fun. It’s new, but it will be fun.” Peter rocked back and forth in his camp chair, humming and chanting his “Papa, car ride home, bed” mantra over and over. But he did not get up to leave.

 

A lady with a kindly face came over and sat beside us. A USARC volunteer for many years, she quietly chatted about this and that camper and how many years he/she had been coming to camp. Then she turned to Peter, “Peter, do you want to go home?” she asked gently.

 

I handed Peter his iPad keyboard. As he continued to chant, “Papa, car ride, home, bed,” he typed, “Just fooling. I really appreciate being here.”

 

The lady looked stunned. I hastened to explain. “You know how we all have mixed feelings- you can feel excited and scared all at the same time? Well, in Peter’s case, the scared feelings tumble out automatically, and that’s what you see. But he really does want to try this adventure, and he really does appreciate everyone’s understanding.”

 

The lady was delighted and relieved, and continued her comforting chat with me and Peter. Peter made it through the entire campfire talk, and even enjoyed his first sticky s’more.

 

We still had our challenges that night- I had to kind of trick him to get him to use the bathroom by telling him that even if he wanted to go home, he would need to use the bathroom first, and at one point, he tried to repack the duffel bag into the car, but overall, he did well. He got into the tent and managed to fall asleep, with the help of a thick futon I brought along, a sleeping pill for the first night, and a great book he loved to hear me read aloud. We had an amazing adventure, sailing, fishing, and kayaking.

 

I’m sharing this experience because it is such an extraordinarily clear illustration of how careful we need to be when we interpret our children’s behavior. Our children are wired differently. Their upper brain, the frontal lobes, center of thinking and judgment may be underconnected to the basal ganglion that initiates movement and action. On the other hand, the lower brain’s amygdala, site of anxiety and the fight or flight response, is overactive and well connected. So whereas we handle our dichotomous feelings adroitly or less adroitly depending on the relative strength of our conflicting emotions, our children tend to automatically express the lower brain, sometimes even when the upper brain is trying its best to exert control.

 

So don’t be too fast to judge. Work hard to figure out the form of communication that works best for your child. Some children type much better than they can talk. For them it’s important to take the trouble to have a keyboard available for deeper conversations. And keep talking softly and reasonably to that upper brain that may be listening intently despite all the distracting noise of the lower brain expressing itself. “Understanding helps,” Peter often tells me. Not just a passive understanding, but realizing the person really is in there, and to address the person and support those higher intentions that may be hidden inside a locked-in upper brain. Your support may make all the difference in what your child is capable of experiencing, and how wide, joyful, and hopeful his world may become.

 

As Peter put it,

“i really love sailing.
i feel the wind on my face.
blue sky and lake,
the sound of the wind luffing the sails,
i feel fast and free among friends.”

free-vector-kids-sailing-clip-art_109651_Kids_Sailing_clip_art_hight

 

 

Does your child have a hard time hearing the word, “No”? Soften your child’s opposition, stretch his capacity to inhibit, engage his frontal lobes, and gain cooperation with these time tested alternatives (adapted from Norton, 2013).

 

1) Phrase it in the positive.

Instead of saying, “Don’t poke your sister,” say “Keep your hands to yourself.”

It’s hard for a kid to visualize what NOT to do, but if you phrase your instruction in the positive, he can visualize what he’s supposed to do.

 

2) Make it a rule for everybody.

Instead of saying, “Don’t touch Daddy’s computer!”, say, “Remember, no one in the family gets to touch Daddy’s computer. It’s hands off for everyone but Daddy.”

 

3) Offer alternative choices.

Instead of saying, “No, you can’t have that big doll,”, say, “We don’t have enough money for that one, but we do for this other doll, stuffed animal, or toy car. Which one should we get?”

 

4) Have your child come up with a solution.

Better yet, have your child put on his thinking cap and engage his frontal lobes. “We only have $10 left. What would be the best buy for that amount?” By turning it into a game, whenever possible, turn the challenge into an opportunity to learn or have fun.

 

5) Turn it into a reward.

“Wow, that doll is beautiful! Kind of expensive, but beautiful. What do you think it would take to earn that doll? Remember that big project we were dreading? It sure would be easier to clean up that garage together if we knew we could come back for that doll.”

 

6) Delay tactics. Putting it in a logical place.

“You really want that extra bag of chips. Let’s save it to go with your sandwich for lunch tomorrow.”

 

7) Penalty incentive.

“I have to think about it. If you insist on an answer, it will have to be ‘No,’ because I can’t say yes right now.”

choices

End of Sidebar

What is descriptive praise? Noel Janis-Norton in her excellent international bestseller “Calmer, Easier, Happier Parenting” (2013) defines it as “noticing and then specifically describing what your child has done that please you.” It’s looking for opportunities to catch your child being good, and then using concrete, specific words to acknowledge the positive behavior.

“I saw the way you gave the baby a piece of your cookie. I love the way you shared.” “I heard you using words instead of hitting. Nice self control!” “Thanks for coming to help me carry in the groceries. How helpful and thoughtful of you!” Even if he might have shared the cookie with the baby because he wanted to prevent a painfully loud scream if he didn’t, or even if he just happened to be standing there by the trunk of the car rather than purposefully coming to help, go ahead and pretend or assume the best, so the child learns to want to behave that way. Point out the positive practical consequences. “You shared with him, and see? Now he’s sharing with you.” “Good thing you helped me bring in the groceries. Those popsicles would have melted. Would you like one?”

Reinforce the praise later during conversation. Let your child overhear you as you tell Papa how he shared with the baby. If you have a habit of conversing as you put your child to bed or a tradition of bedtime prayers, try to bring up at least one good thing your child did that day. He’ll learn to tune in to listen during that special time of recollection together, and come to look forward to it.

Making descriptive praise a habit creates a positive, nurturing family atmosphere. Descriptive praise is the most powerful tool to gain cooperation from your child and to motivate and shape attitude and behavior. But it is even much more than that. Consider the following scenario. You are trying to lug a heavy box from one room to another. You could make a behavioral contract with the child, and say, “If you help me move this box, you earn 10 more minutes of computer time.” Better yet, you could say, “Wow, if you help move the box, I’ll finish my work sooner and have a few minutes to play with you.”

But now picture this. You groan and moan as you tug at the box. “It’s so very heavy! Oh my, I just can’t seem to move this by myself.” Your child looks up. “Maybe there’s hope! I see you’ve noticed Mom’s desperate situation. You’re even getting up although I bet you’d rather keep playing with your toys. Oh joy, can I dare to hope? Hurrah! Help to the rescue!” After the job is done, you might conclude with, ” Just what I needed- a strong, fine young fellow to save the day!”

Both methods might get your child to help you move the box. But with the behavioral contract, the motivation is external, and it’s you taking the initiative and basically telling your child what to do. With descriptive praise, the support is from behind as you acknowledge every little step in the right direction he takes on his own initiative. But that is the way he internalizes motivation and learns to initiate. He’s helping you because you’re fun to help. So he’s learning that helping others is rewarding. He’s also bonding more with you. Your relationship, which was the initial motivator, in turn gets strengthened even more as that connection between pleasure and interaction gets reinforced one more time.

The acknowledgement you give your child for looking up encourages him to get up from the floor. When you acknowledge his getting up and sacrificing his fun with his toys you motivate him to help push the box. By descriptively praising each little step, he gains the momentum to do what seemed impossible at first. When you call him a strong, fine fellow, you build your child’s self-esteem, self-concept, and help him internalize the value of hard work and helpfulness.

So make descriptive praise a habit. In the beginning, you may need to pair it with an external reward, but eventually you will be able to fade the contracts, as your child builds that internal standard. Instead of laboriously pulling from ahead, you’ll be able to gently push from behind. As soon as your child can do without the contracts, make it a goal to cut the tow ropes, and try to just remain the wind that fills his sails.

commons wikimedia.org

“No! No!” With a mad gleam in his eye, Thomas dashed forward for the glass. He snatched it out of his mother’s hand, and made it to the sink in three mighty strides, dumping the contents with a look of relief and triumph on his face. Then he quickly refilled the glass with juice and exactly five ice cubes.

 

Harry wailed as he screamed at the top of his lungs, “You just want to give me more work! This is using up my free time!” as Mom corrected his math homework.

 

Do you sometimes feel like you live in a nuthouse? That as soon as your child with autism and OCD (defined below under footnote [1]) gets over one compulsion, a new one (or two or three) springs up to take its place? That the “neurotypical” younger sibling with the low frustration threshhold explodes whenever you do homework together?

 

I put these cases together because they actually occurred in tandem one afternoon to a family I work closely with. It was a mess of a day, struggling with these disparate situations involving children having completely individual profiles and challenges, but afterwards upon reflection, Mom realized that she had used the same method called CBT, cognitive behavioral therapy, on both.

 

So what is CBT (see definition below under footnote [2] )? Is it something parents have to spend a lot of money to get from mental health professionals for their crazed children? Or can you try it yourself right at home in the trenches? The answer is definitely yes for latter, and possibly yes for the former. Parents can definitely learn to use CBT effectively on their own in the home. Professionals can add critical support in tougher cases, but the more a parent practices CBT on their own, the fewer consultations will be required, and the more fruitful those sessions will be.

 

The following steps were adapted from Dr. Anne Marie Albano’s excellent book, “You and Your Anxious Child,” (2013), Penguin Books. She’s the director of the Columbia University Clinic for Anxiety and Related Disorders.

 

Step One: Help your child learn the identify the negative feeling while it’s happening, with the goal of doing so early, before the emotion grows too intense to cope with.

 

Thomas’s case: Too late! Thomas went from 0 to 60 in seconds without warning- ice cubes triggered the OCD, and he was unbearably anxious immediately, acting on it (dumping the ice cubes) before there was any chance to engage those frontal lobes. But that’s ok. Mom was quite sure there would be a next time. So she talked about how wow! he must have felt pretty anxious when he saw there were too many ice cubes. She drew an emotional thermometer scaled 0 to 5, and he pointed to the 4.

Harry’s case: Also too late! At first Mom was puzzled- Harry got upset so suddenly, without warning, and in her opinion without any provocation- by fourth grade, surely he should expect having to correct his homework. But upon reflection, she realized that it was not her demeanor nor demand that had anything to do with the problem, but the situation combined with Harry’s temperament. He was proud of having done his homework on his own, and was looking forward to relaxing. He has a low frustration threshhold, so the thought of possibly having to start all over again when he was already tired was too much. Mom realized the importance of the two of them having a discussion about expectations (expecting his homework to be corrected), setting aside time for it, and limiting extracurriculars so that enough homework time could be set aside and scheduled early enough before he tired out. Especially for our kids with short fuses (so no warning time), setting up for success is critical. This kind of forethought and preparation may not only be your best but only option to avoid an explosion.

 

However in general, for the next time, how does one teach a child to recognize a negative emotion early, before it grows to overwhelming proportions? According to the book, during a calm time, you’re supposed to take the time to teach your child how to identify the physical feelings of anxiety, so he’ll be able to spot it in himself early. For example, you can draw a body map of your child on a big piece of butcher paper, and draw arrows to the chest labeling a tight, explosive feeling or racing heart, lungs for rapid breathing, wrist for rapid pulse, forehead for perspiration, hands for cold and clammy, abdomen for gurgling or tummy ache, etc.

 

For Harry, Mom also wrote on the pink side of an index card: “Homework Explosion Signs! Turning away. Raised voice volume and pitch. Fidgeting and throwing erasers. Blaming. Changing the subject.” Although I wouldn’t try this with every kid as it might make him madder, she also videotaped :Harry once during an explosion, so he could see what it looked like. Both of those “self-awareness” measures have reduced the explosions, even though Harry has never once viewed the videoclip, and Mom usually has only to mention and not even pull out the card.

 

Step Two: Address the Emotion

In a way, it was easier to address Thomas’s emotion because his anxiety resolved immediately upon performing his compulsion (easy only in the short run, BAD in the long run because the more times he performs a compulsion and feels relief, the stronger that connection between the compulsion=relief becomes in his mind, and the stronger the compulsion becomes).

 

But for Harry, dealing with the emotion was the hard part. All Mom could do is be silent and present until he stopped screaming and yelling, since he couldn’t hear her anyway even if she tried to talk. After a period of ranting about the “extra work,” he started ranting about why Mom was just sitting there instead of moving forward, “wasting more time.” Sigh! When she tried to quietly tell him he needed to calm down so he could hear her, and then she’d talk, he just yelled louder. When she suggested deep breaths and tried to demonstrate them, he just got madder. So finally she decided “being present” was actually providing an audience that wasn’t helping. Mom told Harry he could come get her when he was ready to work, and left. Lucky for her, Harry really did want to finish his homework, and did eventually calm down (barely) enough to finish going over the corrections. That was an accomplishment. In earlier days, she had had to send him to his room with a timer to make sure he didn’t just go and play and get out of his work. Several such time-outs were necessary for him to get the point that cooperation (fixing his homework mistakes) was required and inevitable.

 

If it were possible to catch these emotional “dysregulations” at an earlier, more manageable stage, perhaps they could have done deep breathing or PMR (progressive muscle relaxation) to put a halt to the growing anxiety. Deep breathing is “balloon breaths” where the child puts his hands on his abdomen and feels his fingers expand out (“blow up the balloon”) as he takes a deep breath on the count of 5, and slowly exhales (“blow out the birthday candles”) on a count of 5. You’re supposed to teach deep breathing exercises and “progressive muscle relaxation” (in which you teach your child to sequentially contract/tense up the various muscles groups and then relax them from head to toe) as exercises a couple times a day, as a fun family routine activity, so they’re automatic when you need to use them to cope with anxiety.

 

Often humor works the best. For Harry, if Mom thinks some homework item is going to be hard, she’ll say, “Now don’t panic, Harry, this’ll be okay!” before tackling the problem, and get a smile out of him. She used to say, “Oh dear- here comes the lion! I think he’s ready to roar!” when he was younger, and the imagery was fun and helpful. “I think I’ve got an angry cat!” still works to clear the air sometimes.

 

Step Three: Help the child identify the untrue, negative thought, in other words, the distorted thinking that does not match up with reality. Then come up with the true, positive replacement thought together. It is NOT advisable to try this until the child has calmed down!

In fact, usually this step can’t even happen at the first incident. You usually get through the incident as best you can- for example, Thomas had already performed his compulsion. Harry and I had already gone over his homework corrections. Once the child is relieved from the stress/demand, and has thoroughly calmed down, you can sit down and go over this step for the next time.

 

Thomas’s case:

Mom drew a sad face (actually two eyes with upgoing eyebrows and a horizontal zigzag for the mouth) with a blank balloon thought bubble that they filled in with Thomas’s answer.

Mom: “So Thomas, what were you thinking when you saw the ice cubes before you dumped them?” Thomas: “I need five ice cubes or I won’t be okay.”

Then she drew a happy face with a blank balloon speech bubble that they filled in with Thomas’s next answer.

Mom: “So what’s the actual truth? What can you tell yourself and say back to the OCD?”

Thomas: “I’ll be okay with any number of ice cubes.”

 

Harry’s case:

Mom: (First we worked on getting down the negative thought on the pink side of an index card.) “So Harry, is this what you were thinking?”→Then they worked together on the true, positive thought which they wrote down on the back (white) side of each card.

1) “Mom is making more work for me.”→

“She is checking my understanding or giving me more needed practice.”

2) “This is too difficult and takes way too long. I’ll lose all my free time.”→

“Breaking it down like this will help me get it faster and save time in the long run.

Mom will set the timer and make sure we only work this long, so I’ll have plenty of free time.”

 

(Here are some other common ones, but I wouldn’t recommend presenting them all at once:)

3) “Making mistakes means I’m bad or stupid.”→

“Making mistakes is a normal part of learning. The faster I recognize a mistake and learn how to fix it, the faster I’ll learn.”

4) “Mom is correcting me because she thinks I’m stupid or don’t get it.”→

“Mom is correcting me because she knows I can understand and do this even better.”

5) “Mom is trying to punish or delay me by giving me a time out.”→

“I can’t learn when I’m too upset. I’ll learn better and faster if I give myself a little time to calm down.”

 

Step Four: Brainstorm management (“dealing with it”) strategies.

Thomas’s case:

Mom: “So Thomas, next time you see a glass with something other than five ice cubes in it, how are you going to deal with the OCD?”

Thomas: “I can squish it by delaying it.”

Mom: “Great idea! Shall we set the timer for 5 minutes or 10 minutes?”

Thomas: “Five minutes.”

Mom: “While the timer is going, what can we do to help you with the anxiety? Balloon breaths?”

Thomas: :”Squeezes.” (He likes hand squeezes.)

Mom: “And what do you tell yourself?”

Thomas: “Any number of ice cubes is okay.”

Mom: “And remember the doctor told us we should also plan a way to get busy while the timer’s going. Should we do math facts? Lunch?”

Thomas: “Lunch.”

 

Harry’s case:

Mom: “So Harry, next time you start panicking about homework, how can I help you?”

Harry: “I don’t know.”

Mom: “Do you feel it coming on or do you just suddenly explode?”

Harry: “What do you mean, ‘explode’?”

Mom: (Starting to show him the pink side of the card from step one) “You know, the homework explosion.”

Harry: (laughing) “Oh. I don’t know. I just get mad.”

Mom: “Maybe it just broadsides you. How about if I see signs of it coming (you know, the clenched fists and high voice), we try the deep breaths?”

Harry: “No! I don’t like doing those!”

Mom: “How about push-ups or jumping jacks?”

Harry: “No! I won’t do them!”

Mom: “Well, ok, but if I hear you make those negative thinking statements, I’m going to hand you a pink card.”

Harry: “What do I do with it?”

Mom: “Turn it over and try on the other way of thinking.”

Harry: “Ok, I’ll try it.”

 

Step Five: Set up contingent, controlled rewards, meaning positive consequences the child chooses and can look forward to. The reward should be simple, controlled: meaning not generally accessible (if the child has ready access to it anyway, it won’t mean anything), dependent on replacing the maladaptive with the adaptive behavior, and given as immediately as possible after the positive behavior.

Thomas’s case:

Mom: “Thomas, I can see you working hard on this ice cube OCD. Ready to tackle it head-on?”

Thomas: “What do you mean?”

Mom: “The doctor says that you can stop OCD’s faster when you exercise your “stop muscle” in the brain.”

Thomas: “That’s her answer for everything. Practice.”

Mom: “True. So she suggests doing ‘exposure-response’ homework. Twice a day, we give you a glass of water or juice with some other number of ice cubes than five. You stop yourself from dumping the ice cubes for five minutes on the timer.”

Thomas: “Then what?”

Mom: “You do what you like with the drink. I’m hoping you just drink it, and find you don’t have to dump it after all. OCD is like a wave. If you wait it out, it passes over, and you won’t feel the need to dump anymore. We can gradually increase the timer to wait for longer lengths of time, till you get to that point.”

Thomas: “Ok.”

Mom: “Once you’re not dumping drinks anymore, we’ll celebrate, and go out and buy some of your favorites!”

 

Harry’s case:

Mom: “So Harry, next time we have a lot of homework to correct, how do you want to handle it?”

Harry: “Just let me do it, and don’t check it.”

Mom: “That sounds like a great goal. I’d love to do that once you’re ready.”
Harry: “What do you mean by ‘ready’?”

Mom: “When you’re checking your homework yourself, and correcting your own mistakes.”

Harry: “Mom! That’s too hard!”

Mom: “So we’ll get there step by step. The first step is checking the first three problems of your math homework yourself today. If you do, and they are correct when I look them over, you get three pennies in the homework jar. We can talk about what you want to use the pennies for- you can turn them in for a playdate or computer time.

In the meantime, what do you think a reasonable amount of time to spend on homework might be?”

Harry: “I don’t know.”

Mom: “Well, your teacher says 45 minutes a day is expected for 4th graders”.

Harry: “Ok.”

Mom: “So let’s set a timer. Do your homework, and we’ll check it together. After 45 minutes you’re done, even if we’ve only corrected part of it. But if you start fussing and complaining, I turn off the timer during the fussing. It only counts, and the timer only restarts when you’re working.”

Harry: “Ok. Let’s try it.”

(Discussion with the teacher ahead of time to give her a heads up on this plan is advisable, so she isn’t caught off guard when some of the homework is turned in uncorrected or even incomplete.)

 

Step Six: Create a hierarchy of specific recurring problematic situations, and tackle them from easiest to hardest. Don’t get stuck- keep moving up the staircase, while you gradually hand over the responsibility of self-regulation to the child by getting him to query/say to himself what you have been saying to him.

 

Thomas’s Case:

Mom and Thomas might sit down and come up with four or five common OCD’s Thomas displays, rank them according to how anxious/how hard it would be to stop doing each one, and work on them one by one, easiest to hardest, with a celebration/reward after each success. For example, Mom could create a staircase with dumping ice cubes on the lowest step, then sitting on every bench they pass by on the next step, then pulling off sticks from our neighbor’s bush on the next, and finally on the top step cutting up yard-long pieces of tape into tiny pieces before doing each page of homework, as these are all problematic OCD’s for Thomas.

For strategies on dealing with OCD’s see my previous blog entitled, “A Contemplative Walk… Working with OCD,” from 2013. The basic exposure/response prevention “homework” is for the individual to intentionally and regularly expose himself to the OCD or anxiety trigger by gradually increasing degrees (for example, if one is afraid of dogs, one would not immediately expose oneself to a huge German shepherd, but start out with a small, very tame dog or possibly even a picture or movie about a dog), and make himself stop (not perform the compulsion or fight/flight response) for increasing amounts of time. Each time he successfully prevents himself from performing the compulsion, the “stop muscle” in his brain (in the basal ganglia) gets stronger, and the OCD gets weaker.

 

Harry’s Case:

Mom: “Harry, how would you rank the things you have to do for school but make you feel anxious or overwhelmed, from 0 to 10?”

Harry: “Like what?”

Mom: “Like correcting your homework, reading a chapter from a chapter book daily, writing a report, or cleaning out your backpack?”

Harry: “Homework 6, chapter book reading 5, report 10!, backpack 4.”

Mom:” Ok, I put the four school tasks on four index cards in rank order of difficulty. I’ll give you all the support you need to get through them all, but we’ll work towards independence on the backpack first. Each time you master a card, we’ll do something really fun.”

Harry: “Can we go to Target for baseball cards?”

Mom: “That sounds good to me! And when you make it through all the cards, I’ll even get Dad to take you to a Angel’s game. So tell me what you know about keeping your backpack in order… “

 

So there you are, CBT in a nutshell, or at least a flavor of it. CBT is a powerful, multipurpose tool, used successfully in a wide range of psychological disorders, including depression, anxiety, OCD, eating disorders, substance abuse, insomnia, posttraumatic stress disorder, personality disorders, trichotillomania (hair-pulling), tic disorders, and other repetitive behavior disorders. In Thomas’s case, we used CBT to work on OCD. In Harry’s case, we used it to develop a higher frustration threshhold. As parents, frontline and in the trenches, we need this tool.

 

A lot of CBT is commonsense. Teach your child to become more attuned to the body, recognize the physical symptoms of intense emotion and use deep breathing and muscle relaxation to ameliorate it. Address emotional dysregulation in its early stages while there’s still some frontal lobe control (ie ability to use his thinking brain). Teach him to become more self aware, both in monitoring his emotional state and identifying false, negative thinking. Help him learn how to replace it with true, positive thinking, and use a Socratic approach to develop the child’s multicausal thinking, giving him the freedom and support to brainstorm a variety of possible solutions and then to exercise judgment to decide upon a course of action. Show him how to harness motivation and reward to help execute those plans. Work systematically and persistently, from easier to harder, with the goal of transferring more and more control and responsibility to the child for his own emotional regulation. Set reasonable goals and expectations and make the steps as little as needs be for your child to experience success regularly with a reasonable, not heroic amount of effort.

 

CBT has got to be more effective than not knowing what to do, getting upset in reaction to our children’s crazed behavior, and acting out of frustration or trying to take over. So don’t be afraid to try it. Consider reading Dr. John March’s (2007) book “Talking Back to OCD,” or Dr. Anne Marie Albano’s book, referenced earlier. If you need more help, ask your pediatrician for a referral to a licenses psychologist or mental health provider experienced in CBT (you can ask if the therapist has any certification from the American Board of Professional Psychology or from the Academy of Cognitive Therapy). Things can only get better as you start moving your child in the right direction.

 

Disclaimer: CBT is only one tool in a parent’s toolbox. It is most appropriate to use on “crazed” behavior that may be primarily due to biologically-based.(meaning due to neurological wiring or temperament) negative emotion. But a lot goes into a parent’s decision that the emotion is irrational. Lots of times children get upset for very good, legitimate reasons, and those feelings need to be affirmed and their causes rectified, not extinguished with behavioral methods. Also some seemingly baseless negative emotions have deep roots in traumatic memories. You might need other tools to help you uncover and address the pain of these kinds of past experiences, such as psychodynamic or play therapy. Above all, there is no substitute for first and foremost listening to your child, and letting him know you care about all his feelings, rational or not.

Charles Schultz peanuts

 

[1] OCD stands for obsessive compulsive disorder. It is due to a brain glitch in which the individual has a recurrent false thought (like “there are always dangerous germs on doorknobs”) that compels him to perform a compulsion (like “I must wash my hands every time I touch a doorknob”).

[2] CBT stands for cognitive behavioral therapy. It is based on the assumption that thoughts lead to actions, and so if you repair the maladaptive cognitions or thinking, you can improve the behavior.

 

Last inning, bases were loaded, 2 outs. Our team was on the outfield, the score 7 to 6. When we heard the crack of the bat and the ball soar far into center field, the parents of our team all thought the game was over. But then a little outfielder leaned way back, mitt over the fence, and caught the ball, tumbling backwards. The third out! The game was over, we had won, the crowd went wild, and the whole team piled over that center fielder with joy!

 

When the coach announced the MVP for the All Star La Canada Little League and held up the big red trophy, he said, “This player played consistently well over all his positions (pitched a good inning, hit several players in, did a great steal of a base, and got an out on first). But Luke Tran will be known forevermore in this town as the kid who made THE catch!”

 

It was a great day for Luke!

 

I love childhood. I love the innocence, the hope, the belief that all things are possible. In the previous championship game, Luke had pitched one good inning, but the second was tough. He got tired, the bases were loaded, and the inning ended with the mercy rule, which ends an inning after 5 runs. But Luke was indefatigably hopeful. When Papa was reluctant to let him play in All Stars because of the fear of blisteringly hot weather, Luke begged him, “But Dad, I want a chance to win the MVP trophy!”

 

So Papa let him. And little Luke, the same guy who as a first grader could barely sleep the night before and went bright eyed and hopeful to his first Jogathon rally, despite my trying to let him down easy by letting him know none of his brothers or sister had ever won anything at a school Jogathon raffle, and actually won the great cash grab prize, also won the MVP trophy. The same little guy who just flunked his social studies test and got a C on his worldly wise test. The guy who I’m always pulling my hair out to get him to behave respectfully, but whose disinterested saunter and nothing-phases-me toss of the head actually looks pretty cool out on the baseball field. Thanks be to God who mercifully makes a place for each one of his creations, and lovingly bestows upon them gifts like this day which he will always remember.

 

And Peter was there. Laughing and smiling, he later typed, “The game was great. (If Luke hadn’t caught the ball) the other side would have made 3+1=4 runs. I’m proud of Luke!” It was also joyful for me just to sit close next to Peter and Papa right there in the front row of the bleachers in the midst of the community, who all know, understand, and welcome Peter. Thanks be to God for that as well, for this great game, and the families and dedicated coaches who love it, providing this venue for our boys to learn teamwork, practice, perseverance, and hope of dreams that may actually come true.

from dothesnoppydance.blogsot.com

from dothesnoppydance.blogspot.com

Something quite miraculous occurred in the life of my son.

We had a birthday party.

Not just any party.

A real, bona fide, joyful, fun, everyone-into-it birthday party, with Peter’s teen friends, no less.

I honestly did not know if such a thing was possible. Because all of the kids at the party have autism, and two are nearly nonverbal, with  pretty severe dyspraxia as well. This is how it happened.

It was a warm, sunny day at the park. The kids (I’ll call them “V”, “T”, and “S”) drifted in at different times to our picnic table. A fried chicken and chicken tenders/fries lunch was laid out and the kids and their mothers chatted as they ate. The difference was we used AC (typing) to chat. Peter’s friend V brought him a book for a present so they talked about reading- so cute, when asked who his favorite author is, Peter typed, “I like Beverly Cleary.”

When all four were done with lunch, we gathered around another picnic table upon which we had taped a big long piece of white butcher paper. I had the kids sit in two pairs opposite each other and handed round little squares of different colored sticky note paper. The game rules were simple. Start from your end and lay down different colors of paper (no two in a row alike) toward your partner, but you have to match your partner (so you have to pay attention to your teammate, and incidentally the design turns out symmetrical). First team pair to meet in the middle wins. Then we did it with matching stickers, then with colored design tape cut no longer than an inch (the dyspraxic kids got to use a tape dispenser as an accommodation, but the others had to use scissors). The results were amazing! I couldn’t believe how fast even the dyspraxic kids got going, and the butcher paper was really colorful and pretty at the end. As Peter put it, “It was a fine and energetic game.” We made such a happy hulabaloo that other moms in the park started coming over to see what was going on. Then the kids decorated their initials with opalescent sticker dots between the decorative strips they had created. We cut the paper so each child had a “poster” to home (that could alternatively be used as a book cover or piece of wrapping paper).

Instead of the traditional birthday cake, we set up a “cupcake bar.” Each child got to pick his favorite topping to be the server of (so he could eat up the leftovers). The toppings were healthy- different kinds of cut up fruits, mango, strawberry, and kiwi- and nuts. Each child got a plate with a chocolate cupcake and dollop of whipped cream, and had to select his own toppings by asking the server to put a little, a lot, more, etc. on top. At the end, the group had created a little panoply of colorful custom-made cupcakes together, and sang happy birthday. Peter really got into it and gustily “blew out” a pretend flame on the candle on his cupcake (forgot the matches, and too windy to light a real flame anyway).

By then, it was 2 1/4 hours later, and Peter was saying, “Car-ride, home,” over and over. I thought he had probably had enough, but I knew previously he had hoped we’d do his favorite game, creating a group story together. He had even picked out a topic, “The Perfect Day,” ahead of time. So I quietly asked him, “Peter, have you had enough? We can end now and go home, and do the story another day.” To my surprise, Peter typed back, “No, I want story.”

So here’s how it went. (Each writer’s name is on the left with a colon after it.)

“Peter’s Perfect Day”
Mom: Once upon a time there lived a boy named Peter. He was

V:friendly,

T: smiling,

Luke (Peter’s little brother): smart,

S: (verbally) I like him, I like him! (likable), and

Peter: impressive.
Mom: One day his friend V called up. “Hey Peter I’ve got an idea for something we could do for your birthday. Let’s

V: “lets go sailing in a yacht.”
Mom: But then, T called. “Just a minute, V, I’ve got another call coming in. Hold on while I put you on call-waiting a sec” said Peter.
T said, “Hey Peter I heard it’s your birthday. Let’s

T: “lets go to the beacch”
Mom: Just a minute,” said Peter. I’ve got another call coming in. It was S.
“Hey Peter, let’s

S: (typing) go to the beach. (verbally) July! July!”

Mom: “I wish it was July,” he said, “so the water would be warmer, but at least today…,”
Peter interrupted, “We can all

Peter: “go on V’s yacht!”
Mom: So the four friends did just that,
Peter: and had a great time!

Peter was totally satisfied. All the children wore huge grins. Looking at their faces as they typed, leaning forward, anxious to see what the next would write, with huge smiles and huge reactions- it was truly beautiful. In their imaginations they could do anything, and they were there, sailing on a yacht on a warm, sunny day, together.

I’ve been working pretty hard this year taking a terrific online course on floortime through a fabulous organization called “Profectum” (I highly recommend it, and they have courses for both professionals and parents- the webinars are superb with remarkable, talented teachers showing videos of their work with children to make the process tangible and clear). During the course, I worked with each one of these children individually, so I knew their challenges and capabilities. To me the party was a clear illustration of the magic of floortime, when children receive the support (such as AC, tape dispenser, structure of the games and story template, but also high affect, gestures, and other scaffolding) of their individual differences that they need to express themselves and reveal their beautiful personalities.

Like most magical moments, I didn’t expect it. I took the Profectum class for Peter’s sake, so I’d be better at helping him along in his development. I feel like I got much more than I paid for. True, I spent hours and hours of time in class, listening to lectures, working with children, and viewing hundreds of floortime videoclips. All of this resulted in what I’d hoped for- to get floortime more “in my bones.” But what I received was beyond my expectations- a beautiful gift, to see my child enjoy real friendship with all its richness of joy, laughter, creativity, and shared experience, a blessing from above, a bit of heaven.

 

Play therapy is just floortime with a specific purpose to work on an emotional issue. In the following example (published here with permission from both the parent and the child), the child is on the withdrawn, compliant side, so it was fortunate that the parent was attuned enough to the child to realize there might have been an issue that needed discussing that had occurred the night before.

This child communicates via typing on his ipad, so the interaction was captured in its entirety.

Sam and his mom had this conversation/play therapy this morning. The previous evening, they didn’t get to Sam’s ILS therapy (listening to altered classical music through headphones to help desensitize a child with sound hypersensitivity; motor exercises are done concurrently to work on sensory integration) until later in the evening. He took a bathroom break, and when they returned to the family room, Dad had turned on the TV. Mom tried to woo Sam into continuing the ILS, but that was not realistic, so she finally said, “I’m not going to waste my time, I’m going to take a shower.” She then set up a bath for Sam, and settled to watch TV. When he finished and came back into the family room, Mom invited him to come watch Frozen with the family, but he said, “Bed!,” pointed to his room, and put himself to bed.

Mom: How come you didn’t watch the new movie with us last night? Frozen was good.
Sam: i was in(side) sad
Mom: Why were you sad?
Sam: because you got mad
Mom: I’m sorry, Sam. I was just frustrated because I didn’t want to fall behind on your ILS schedule, but you got tired and didn’t want to finish the exercises. But I do understand. A person can’t work all the time. So I was hoping you would enjoy the movie with us.
Sam: ok. i hoope you kind(er) next time.
Mom: I deserve that admonishment. I should have gone after you when you went to bed to give you a chance to talk about your point of view about the ILS exercises, and to explain that I really wanted you to enjoy the movie with us.
Sam: ok.
Mom: Were your feelings hurt when I said I didn’t want to waste my time?
Sam: yes.
Mom: I’m very sorry. I could see that you really didn’t want to finish those exercises, and knew it was no use to keep trying to persuade you. That’s what I meant about wasting time. I never feel it’s a waste of time to be with you.
Sam: yes i understnd it was a miscommunication, so youdidn’t mean you very mad
Mom: Let’s do a re-do, ok? I’ll be the wolf, and you be Pooh, Ok?
Sam: ok

(Mom handed Sam a Winnie-the-Pooh stuffed bear, and she put on a wolf puppet.)
Wolf: Pooh, let’s finish your exercises. Let’s roll the ball 20 times.
Pooh: no i’m tired.
Wolf: What about our ILS today?
Pooh: i had enough. stop hurting me.
Wolf: What hurts?
Pooh: i don’t want to listen anymore. it hurts my ears.
Wolf: I’m so sorry. Is it too loud? or is it this particular piece of music? or are you just tired and would rather do it tomorrow?
Pooh: tired.
Wolf: So what do you want to do?
Pooh: let’s stop for now.
Wolf: It must be hard to have to practice listening to uncomfortable sound, even music.
Pooh: yes. it’s not too much trouble if i feel happy,but i’m too tired nnow.
Wolf: I’m so glad you told me. Please keep letting me know, so we can make this work out for you, ok?
Pooh: ok
Wolf: Do I push too hard a lot?
Pooh: i don’t think so.
Wolf: That’s a relief. I wouldn’t want to do that. I want you to learn, but at the pace that feels best for you. Will you tell me when I need to slow down or you need a break?
Pooh: yes i will by tyyyping
Wolf: Would you like to watch Frozen with us?
Pooh: yes
Wolf: That’s great! We really missed you last time. How about tonight?
Pooh: i feel like sausage now
Wolf: Ok, coming right up!

The conversation that preceded the play had already cleared the air in theory, but the symbolic play cleared it in practice. Being able to speak through his stuffed animal freed this gentle and sensitive child to be assertive and actually have the satisfaction of telling “Mom” outright to “stop hurting me,” without having to worry about hurting her feelings. The child got to be in charge of what to do next (“Let’s stop for now”) instead of Mom.

Children often offer more when they feel they are the ones taking the initiative. Sam offered more information about the music “hurting his ears” that Mom had not unearthed in direct conversation. Therefore she was able to express sympathy and understanding about how hard and uncomfortable the ILS was for her son, and probe deeper into the more general issue of how hard she was pushing her son overall. Sam even came up with the seminal plan for how to solve the ILS problem for good by offering the information that it’s only a problem for him when he’s tired, but “it’s not too much trouble if… happy.” Initiative begets more initiative, and Sam ends the conversation by telling Mrs. Wolf that he’s really more interested in breakfast right now than watching a movie with the family.

The mother told me that events later that day confirmed the value of the play therapy. When Sam’s big brother asked him why he didn’t watch the movie with them the previous night, Sam, already emboldened by the earlier encouragement to express his true feelings even negative feelings, went a step further. He replied, “Because I was mad.” (Note now he admits he was mad, as opposed to just sad, and as opposed to Mom being mad.) When asked why, he revealed another as yet undisclosed piece of information, “because I didn’t want ILS and mom said no carride.” He actually said this in front of Mom as she was helping him with his typing. That gave Mom the opportunity to say, “I’m sorry, that was unfair. I should have given you a chance to type before handing down a demand, and you could have told me the ILS was hurting your ears because you were tired.” Shortly afterwards at dinner grace when all the children were giving thanks, Sam’s prayer was to thank God that “I and mom made up.” Later that evening, even though he was getting tired, Sam finished up the last 20 minutes of his ILS session, not in a spirit of anger, but cooperation and perseverance because he also wanted his noise sensitivity to get better.

Don’t feel that play therapy needs to be as direct a re-do as this illustration. Most of the time, therapists set up play scenarios that are much less specific. They observe the child for his favorite toys and stories, and then set up a play scenario using them to introduce a theme of nurturing, aggression, control, or whatever is immediately emotionally relevant to the child. The key element is freedom- to give the child an opportunity to freely express his emotions and act on them in a completely safe environment in which he is encouraged to do so and in which he is handed the control of the action in the play scenario. This gives the child an opportunity to retell his own emotional story obliquely and in as much part as he wishes. Dr. Dan Siegel, author of the outstanding book “The Whole Brain Child,” would probably say that helps the child process his right brain emotional memories with his logical left brain, and bring implicit memories into consciousness so that they don’t have to be acted out later in real life as inexplicably explosive reactions to triggering events that are similar in emotional content.

The recent Profectum conference in Pasadena highlighted the enormous value of symbolic play in both effectively addressing emotional issues and moving development forward. In this illustration, Sam learned how to express his negative feelings in words, came up with the beginnings of a logical solution, and learned how to negotiate and effectively resolve conflict. What a better way to handle anger than allow it to get bottled up inside. As parents of kids with autism, we’ve all seen the self-injury and aggression that can result from anger. We have to give our kids another channel. Make symbolic play a regular part of your interactions with your child, and it will bring you closer, give you a more peaceful home, and most importantly empower your child to not only deal with negative emotions and learn to express it a regulated, organized way, but push his cognitive and emotional development forward.

from fit.webmd.com "Old MacDonald Had a Farm"

from fit.webmd.com “Old MacDonald Had a Farm”

I wish to thank two outstanding child psychologists, Dr. Mona Delahooke and Dr. Connie Lillas, for their inspiring presentations on play therapy at the Profectum conference. Both of them practice locally in the Pasadena and Los Angeles areas.

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