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“Come on, Peter, let’s keep going. You can do it,” I said unconvincingly as we slowly trudged down the promenade. We came to Descanso Gardens to try to walk off a 230 calorie ice cream bar Peter had snatched from the grocery store freezer right before check-out.

 

I got him past several benches. Finally it was clear that the inertia was too much to overcome. Peter started squealing, and I knew that the chin-banging would soon follow. We spied a bench next to a duck pond at the end of the promenade.

 

Peter looked at me, hopeful. “Ok, just for a minute, Peter.” He made it to the bench and plopped down in relief. I sat next to him, a ball of frustration and worry. The doctor had told us that exercise was imperative, both to control Peter’s weight gain (due to his insatiable appetite) and to help temper his stimming, impulsivity, and emotional dysregulation (chin-banging). But how were we supposed to exercise when he has catatonia?

 

I didn’t know what to do. But the gardens were beautiful. There was a heavy, dark branch of a large oak draped over our heads like a canopy covered in tiny green leaves, sparkling in the late afternoon light.

 

I pulled out Peter’s iPad. “Under a green bower,” I typed, then offered the keyboard.

 

Peter started typing. The magic of the garden cast its spell of peace over the two of us, as Peter crafted his poem.

 

The quack of ducks. caw of crows,

flap of wings,

the rush of water,

the murmur of voices

happy sounds of a fall afternoon.

 

Under a green bower,

the water ripples, cool and quiet.

A school of goldfish swim by,

a streak of color.

Green heads, blue underwings,

a splash and flash of bright yellow,

The ducks preen,

hoping for a fish.

 

A boy sits and points,

disappointed at the dancing ducks.

I feel the same way.

How I long to hold you

Pretty, fluffy duck!

But you get away.

 

We sat a few minutes, the poem impressing the beauty of the scene into my spirit.

I said, “Peter, I loved your poem! The Lord gave you the gift of words, a gift of something lasting. Whenever I read this poem I can come right back here to this pond and experience it again.” Peter typed back his reply, “Thanks Mom, good poem. I enjoyed it. I wish we could do this every day forever.”

 

Just then, a man appeared behind us. He unlocked the gate to the Rose garden which was sealed off for a ticketed lighted carved pumpkin display to open later that evening. He drove through the gate in his tractor, leaving the gate open.

 

Peter stood up. He took my arm and led me away from the pond back to the path. “Peter, did you want to go this way or that way?” Peter pointed to the gate. As Peter pulled me along, I became intrigued. Before us were hundreds of Jack O Lanterns, some laying on the grass, some suspended in the air, wearing every variety of expression, many glowing softly with lights. Peter urged us on deeper into the Rose Garden, now transformed into a giant pumpkin patch. “Peter, I don’t think we’re supposed to be here. And the gardens are closing, it’s getting late.” Spooky music started wafting through speakers stationed overhead. That persuaded Peter. He turned me round and escorted me swiftly back through the gate, down the promenade, into the parking lot. “We made it, Peter! And no one saw us!”

 

As I related our adventure to Peter’s psychologist, Dr. Gwen, she pointed out how it had demonstrated the efficacy of floortime therapeutic principles. When a child shows signs of emotional dysregulation, consider the possible causes- a sensory or motor issue, primary emotional cause (such as panic attack or OCD), or behavioral (such as anger or frustration from not getting something preferred or trying to get out of something nonpreferred). In this case, Peter had a motor issue, inertia/mild catatonia, and we relieved the dysregulation by sitting down. That addressed Greenspan’s FEDL (functional emotional developmental level) one, getting a child into a calm, regulated state. When I offered the “stem sentence,” “Under a green bower…” Peter engaged with me. That was accomplishing FEDL two, joint attention and engagement. The poem allowed Peter to shift his attention completely away from the frustration of being made to walk when walking was hard and effortful to the beauty of the natural scene before us. Sharing and discussing the poem brought us into FEDL three, back and forth communication, and of course much beyond to a bit of self-reflection. Fully re-compensated, Peter was then ready to engage those frontal lobes to exercise the curiosity that overcame his inertia/catatonia completely and take the initiative (FEDL four) to explore the Jack o Lantern display, and power me swiftly back to the car. Intent, driven by the emotion, not conscious, voluntary, heavy handed willpower was what circumvented Peter’s motor disability, the faulty start signal in his basal ganglia that initiates motor actions.

 

I was both stunned and grateful. Just as embryology recapitulates ontology, so we parents must recapitulate the levels of functional emotional development in the individual scenarios of daily life. When dealing with any dysregulated individual, keep in mind what you do with a fussy baby. You first take care of physical needs and adjust environmental stimuli and demands. (Get in a quiet room, rock the baby back and forth. Choose a beautiful natural place for Peter, let him sit down when motorically exhausted.) Invite, don’t pull the child into engagement. (Smile gently at the baby and coo. Offer Peter the keyboard with a stem sentence.) Constantly attune to your child’s feedback to create a fun back and forth. (Wait for the baby to smile back at you, and adjust the pace and amplitude of your coos and smiles according to the baby’s feedback. Scaffold the offering of encouragement and more stem sentences or phrases unobtrusively, and as needed as Peter crafts his poem). Recognize and encourage initiation. (If the baby starts laughing, widen your eyes and chuckle back. When Peter started pulling me through the gate, I went, though cautiously.)

 

We had a wonderful afternoon at Descanso. I may not have known what we were doing, but upon reflection, I learned a lot. You can’t rush. Those fundamental stages of emotional regulation and attunement are critical, and you must take whatever time it takes to address them thoroughly. I often feel myself pulling, doing 90% of the work to move Peter through an episode of dysregulation. That’s what happens when you’re trying to get through to an upper brain that may be mostly inaccessible at the time. Take down the emotional affective filter first, and then you can talk. The heart has reasons the head knows none of, and dealing with autism frequently requires the heart to lead the way.

We neurotypicals are so used to interpreting behavior and body language a certain way, that our dyspraxic children are commonly if not constantly misunderstood. Just the other day Peter was in the bathroom when his physical therapist arrived. Peter was within earshot when I casually told the physical therapist, “Oh, since Peter’s in the bathroom, perhaps you can talk with Teddy (Peter’s big brother) about physical therapy. He has some questions.” Half an hour later when Peter finally emerged, I said in exasperation, “Peter, let’s get going! Your lesson is half over, and we haven’t even started!” Later I thought I should have been more patient because he probably had been feeling catatonic, and may have been doing his best to move along. I asked Peter. He typed in reply, ” i did not get going. i stayyed in the bathhroom ffor a longg timre because you were all talkiing having an important conversation, good for teddy (about) physical terapy. i earnestly hope he makes it.” I realized I had misunderstood my child, not once but twice. First I assumed willfulness and then I assumed dyspraxia. What I failed to guess were his true, exceptionally thoughtful intentions.

The other day, Peter and I were engaging in one of our favorite hobbies, writing poetry. As a game I invited him to write a poem pretending to be any animal he feels either he shares characteristics with, or wishes he had characteristics of.

Mom: So the title is: “If I were a….”

Peter: Sea Otter

blue green sea splashes against my siddes.

i feel the cold waves lifting my body up and down, to and fro.

i feel the warm sun on my face.

the fine delight of fun before me

a dayfull quickly comes and goes

rolling on the waves

my body agile, responsive, quick

Juggling demands of the sea wwith my own hopes

hearing it roar as i clap another sea treasjure against ,my chest

and take a bite.

Of all the animals he could have chosen, Peter chose the one with “a body agile, responsive, quick.” It must be painfully hard for our children to live with dyspraxia. After fifteen years of experience, Peter has proven to me time and time again that he tries his very best. Yet the deep longing in his heart is to be better than his best. That’s one assumption I firmly believe I can make.

bog.nwf.org

bog.nwf.org

Peter would not get out of the car. It was a hot summer day, I was standing outside the car with door open, and my skin was starting to prickle in the hot sun.

Mom: “But Peter, you love gymnastics! You seemed so eager to go.”

Peter: no reply, no movement

Mom: “Are you having trouble getting your body to move? How about doing it together step by step. Remember? First you unbuckle your safety belt.”

Peter: no reply, no movement

Mom: Maybe that isn’t it. How about we just get into the nice air-conditioned gym. We can sit at the tables and just talk about this. Don’t worry, I won’t try to make you start exercising. We might as well sit in a nice, cool room than sit here in the hot sun.”

To my relief, Peter got out of the car slowly but determinedly, and we made it to the table and chairs in the cool lobby.

 

I set up Peter’s iPad and keyboard, and asked, “So what’s going on, Pete?”

Peter: “on, a scale of 0 to 5 i’m at a 5.  overstressed.”
Mom: “How come?”
Peter: “i have hot gas in my xesophagus.”

Mom: “Oh my gosh! You have reflux again. Want a TUMS?” I fished one out of my purse, and Peter took it eagerly.

A few minutes later, we continued our discussion.
Peter: “i ythi nk it’as gettinfg better.”
Mom: “Now we know another item that causes reflux in you. Remember how you had a bit of reflux after lunch, but felt better after the Pepcid? But then you grabbed something to eat on the way out that made you worse.”
Peter: “Doritos chili ppowder”
Mom: “You got it! And I’m so proud of you that you used your emotional state of regulation scale to communicate with me.
Because you identified your level of dysregulation, what happened?”
Peter: “i was able to get medicine and rrest. i get to get information on the chili powder.”
Mom “help for now and in the
Peter:  future.”
Mom: “So what do you think of using an emotional thermometer?”
Peter: “it’s good”
Mom: “I am so proud of you because although you didn’t like the idea of the emotional thermometer at first, you still tried, and got pretty fluent at it fast- only 2 days of practice! Helps to be smart!”
Peter: “yes.”

 

This was a milestone for us. It’s the first time Peter has identified and communicated his state of emotional regulation to avert a meltdown. In the past, we caretakers were always the ones to notice the body language that clued us into how he was feeling, and we were always the ones to initiate the steps to help him calm down.

I’m telling you this story for two reasons

.

One is to share a practical tool. How many of us experience our kids going from zero to 60 miles a hour in a moment, in terms of emotional dysregulation? That was Peter. He would be trying to hold it together so hard until the moment he would explode. We tried to introduce the emotional thermometer years ago, but he told us it wasn’t useful because he had no warning. He was either at a 0 (no stress) or 5 (meltdown), and was not aware of the levels in between.

So I realized that Peter’s problem was not so much in communicating his emotions, but in becoming aware of them. A key piece in emotional regulation is to monitor one’s emotions. So for example, a person with reasonably developed emotional regulation might feel her blood start to boil during a confrontation with a colleague. She automatically senses she’s getting upset, and takes measures to regulate herself, like asking herself, “This isn’t like me. Why am I getting so upset?” She finds a way to end the conversation like saying, “I need a moment to think about this some more. Can we get back to this later?” She might leave to take some deep breaths, take a walk, talk herself down, vent with a friend, or otherwise regulate herself before thinking through the situation and coming up with the best way to deal with it.

 

But our kids don’t even realize how upset they are getting until they act out. So we talked to Peter about creating a way to practice this first step in emotional regulation, which is emotional self-awareness. We re-created the emotional thermometer, but anchored the stress levels to specific experiences he could relate to (idea from Dr. Gwen Palafox, meaningfulgrowth.com). So instead of 0 being no stress and 5 meltdown, we let Peter make the definitions based upon his own memories.

 

Peter made carrides and plane rides a 0 because they were not just no stress, but positively fun.

1 became no stress, like talking to his teacher at school, whom he likes very much.

2 became mild stress, like walking into his doctor’s newly remodeled office- it was different, he preferred the old one, but could handle it fine.

3 was stress, the kind, as Peter put it, “you could handle for now, but not forever.” He matched that to when his little brother Luke was fussing during a long car trip.

4 was very stressed, like when he went to Mass in a different city and the priest tried to give him Communion on the tongue instead of in the hand; it was “when you could hold it together barely, and needed help right away.”

5 was overstressed, as Peter put it, “out of control,” like when the car battery died right when he wanted to get a well-earned car ride. He felt so frustrated that he banged his head.

 

Then we spent an hour a day setting a timer and having Peter practice identifying his emotional state using the levels he defined on his stress thermometer every 10 minutes. And after just a couple of sessions, he was able to use the thermometer in a real life situation, and got to experience the benefits of emotional self-awareness, identification, and communication.

 

Now that’s a milestone, a success worth celebrating!

 

So that’s the first reason I’m telling you this story. To share a new way to use an old practical tool, to fill in the missing piece that made the emotional thermometer useful for Peter.

 

But there’s another level to this story. I have a dear friend who has almost exclusively used behavioral methods with her child who has moderately severe autism and big behavioral challenges. She asked me the other day what else was there out there to help her son.

 

The answer is there’s a whole world of intervention out there besides behavioral, and it’s big and deep. That whole world is the inner world of the child, his thoughts, feelings, desires, dreams, his personhood. His right to make his own decisions, and express his personality, to be loved and appreciated and listened to.

 

Your goal from the beginning has got to be to discover that inner person, develop it, and give it a means of expression.

 

Don’t get me wrong, I use and depend upon behavioral methods every day. I even teach Peter to use them on himself. This morning when he wanted an extra piece of toast, I told him, “Peter, I’d be happy to give you that toast. But my question is when do you want me to give it to you. I could give it to you right now, which is fine with me, because it will satisfy your appetite. But you could kill two birds with one stone. You look like you’re having trouble moving your body this morning, and I bet it’s hard for you to get up out of that chair and make it to the car. Do you want me to give you the toast in the car?”

Peter replied, “Use the toast to help me get in the car.”

So I made the toast, and held it in my hand. We walked to the car slowly, and Peter happily received his toast.

 

How different would this picture have looked if I had replied thusly to his request, “You can have that piece of toast if you get in the car.”

 

That’s the difference between a behavioral contract, and a floortime, person-oriented approach. Both can use behavioral methods, but in one case the emphasis is on what I want and the other on what you want. Internal vs external control, self-determination vs a degree of perceived intrusiveness.

 

So I’m so grateful for my floortime training as well as all the great tools I’ve learned from behaviorists. Because I could have used a straight behavioral formula at that moment when Peter would not come out of the car. “I’m boiling hot standing out here waiting for you. You were the one who kept asking for gymnastics today. Either come out now, or we’re quitting gymnastics.” “I see it’s taking extra effort to move your body today. If you make the extra effort to come out now, you earn an extra token for TV time later.” Positive or negative reinforcement would have been of no avail. “You’re not coming out, but that’s your choice. I’m going to sit in the shade and wait for you.” Natural or logical consequences (getting overheated in the car) would have been of no avail. Any of these courses of action would have resulted in a meltdown, as the reflux,heat, and frustration would have exacted their toll.

 

But thank heaven there is another way. The way we all need to be treated as human persons with a soul and will and dignity. To be understood, to be given reasonable options and accommodations. To be given a chance to communicate.

 

Because that’s where you’ll get your real answers and solutions. From the person himself. The only one who can give you the answers you need to help him.

 

breakingthroughwithyou.co.uk

breakingthroughwithyou.co.uk

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.

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