We Thought He Would Grow Out Of It

bare feet boy child couch
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Sometimes parents wonder if “a little more time” may improve their child’s adjustment, simply through increasing “maturity.” The children with whom I primarily work, preschool and early elementary-age kids, are developing very quickly. So the reasoning is quite valid. With a few more months of time, some problems might evaporate. But this is not always how I see it. Sure — more “development” may make the problem better — or much worse.

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Development is like a river. It is moving, and moving quickly. But when a child is struggling, moving further downstream may or not help, depending on what else is poured into that child’s river —  that child’s stream of development. Like nurturing, supportive, repairing stuff … or inflammatory, destructive, or plain unhelpful life stuff.

For a struggling child in my care, behavior problems improved over a few months in Kindergarten. However, his parents and teachers added extra things to his “stream.”  Therapy offered him new coping strategies. His parents enrolled in my parent workshop. They dedicated energy and effort to learn about their child’s brain and development.  Both parents worked on changing their style of interaction with him.  His teacher welcomed and implemented new ideas, adopting a positive approach to his classroom behavior.

photo of boy laying on grass
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But for other children, there may be fewer helpful things “in the stream.” Their bodies get bigger and stronger as development progresses. Those changes can result in greater physical conflicts at home and on the playground. Gaps in social skills are more apparent and impactful as months go by, lowering a child’s self-esteem and heightening peer disputes. With progressing development, children become more able to reflect upon themselves and their worlds. And with increasing age, they often draw painful conclusions about their self-worth and abilities relative to others.

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As months pass in a struggling child’s development, family tensions may intensify. Unhealthy family dynamics may grow unhealthier still, without the benefit of parent education and support. In this scenario, time can be an enemy rather than an aid.

Yes, for some children, a few months time does make all the difference. But for so many children I meet, delaying helpful services while waiting for developmental maturity only makes problems worse.

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For the child who does not simply “grow out of it,”  problems may become deeper and harder to remedy. That’s why I work with younger children, when the clay is soft. The younger, the better.

Families arrive and say, “We thought about getting therapy a year ago …” or “I’ve had your card in my purse for two years.”  Don’t put it off … check out your concerns early in development. And find an early childhood specialist who understands that young children are not just smaller versions big kids. Don’t just wait for growth … help it along.

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Dr. Onufrak is the developer of ChildSightTools® parent programming.  Visit DrBethKids.com for more information and resources. Look for my Online Parent Courses coming soon. Get my free booklet Chill Your Child’s Anger on my homepage. My Weekly  2-Minute Tip videos can be found on my homepage and on YouTube.
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Activity of Choice: Your Presence

whirlwind2“We’re so busy with activities.”

Parents come to me with pressing child problems in busy family lives.  These problems occur alongside basketball, swimming or soccer practice, gymnastics, dance or piano lessons.  Or speech, occupational therapy, music therapy, pediatric specialists.  Life is busy!  And every activity is intended to enrich development,  release energy, or develop lagging skills.

But many parents grimace as their eyes dart across cell phones calendars … looking for even one free day to schedule the therapy they’re seeking from me.  Truly, I do understand, kids need certain appointments, even if they are piling up.  Seems they need so many things. But in all those appointments, what might they NOT be getting?

Kids are missing YOU.

Ironically, one of the most therapeutic activities is 1:1 parent-child time. Honestly, I prescribe it a lot.  Parents are surprised, expecting a fancier initial treatment. But quality parent-child time heals so much. It’s often the most productive and efficient starting point.  Recently, a devoted mother found herself in tears, realizing how hard it was to find 15 minutes a day for one of her kids. “Fifteen minutes,” she winced … “I felt like I spend lots of time with her each day … but not for any quality stretch of time.”

The old school truth, in these new school times, remains the same: Kids need your time, your attention more than anything else. Even if they don’t seem interested. Don’t let Minecraft or the latest phone game fool you.

Ten minutes a day can make a lifetime relationship change.

The most therapeutic thing I can recommend is 10-15 minutes per day talking and playing with your young child.  Not correcting her or reprimanding ~ not reviewing what “better choices” he could have made.  Save those discussions for another time. Just make time for hanging out;  noticing him, noticing her; joining your children in their worlds.

Phones? Nope, not during this time.  We may believe that if parental body is in the same room, facing one’s child, a phone in hand doesn’t matter.  But your child knows you simply aren’t “there.” Hard to put it down? Yes.  But the payoff is priceless. There’s no single breaking news story, Pinterest pin, Snapchat update, click bait or Facebook Marketplace item that’s as important as connecting with your child today.

Some years from now, your grown child will lace fingers with a sweetheart … who will ask, “So, tell me about your Mom; what was your Dad like?” All your parenting years moments will fuse and condense into a 2-to-5-word perception.  He or she was “always on the phone” or “always working,” “kinda distant,” “usually complaining…”  “not really around” … What do you want your child’s 5 words to be? Make 10 minutes a day and shape them.


What Every Parent Wants

 

Parents want lots of things for their kids.

But when they call me, there is astounding similarity in what they want. Parents arrive, hope in hand. They sit on my couch and describe children of different ages, issues, gender, and problem settings. Yet every parent wants the same thing. Improbable, but true.  How can this be?

 

paris girls chalk

 

CONNECT

Parents yearn for their young children to connect better —  with them at home, and with others outside the home.  They pray for smoother interactions between their child and other kids, between their child and other adults.  They wish their child could …

Get through a play date without a knock down/drag out, friend-goes-home-early;

Feel brave enough to say hello on the playground;

Handle teacher correction without feeling she’s “mean;”

Be able to tell a teacher what one feels and needs;

Have as many loving moments at home as challenging ones;

Enjoy mutually satisfying parent-child interactions.

COPE

What else do they want? Without exception, every parent who comes to my office wants “coping skills for my child.” After many years, I noticed this word mentioned in EVERY intake — not just many or most. Parents yearn for their child to acquire skills that can be remembered, applied and activated in troubling times. For their children to learn to handle a situation without aggression, withdrawal, meltdown, a freak out, or “bad choices.”

THRIVE

My new patient paperwork concludes with this question:

“Say you run into someone six months from now, someone who knows your family well but hasn’t seen you in a while. Somehow, things have gotten better. What would you like to be able to say?”

In the hopeful answers to this question, the same word keeps cropping up: THRIVE. “He is just thriving” or “She’s thriving now in every way …” Parents want their child to feel success, joy, light, achievement and resilient self-esteem – to thrive on every level of development.

So, parents want their children to connect and cope better, so ultimately they can thrive.  Over my 20 years as a child psychologist, I see those aspirations as intertwined. But perhaps not as you’d expect.

 

With preschool & primary graders,

child coping is a joint venture between adult & child.

They learn and practice these skills with YOU

and apply them in the world.

 

Wait … don’t kids learn to cope in the therapy room?

They learn it in every room. Young children are developing their “coping systems” – a complex blend of neurological, physiological and emotional and social mechanisms for reacting and responding to challenge. Part temperament and genetics, part modeling, part impulse control, part emotional regulation. A tall order for the young ones I see.   Very hard to do alone.  We adults actually help or hinder children’s coping through our interactions with them.

Adult-child interactions literally build kids’ brains, fortifying the neural groundwork for either calm, confident problem solving or alarmist, defensive/offensive or escapist problem solving.  What’s the difference? Asking for help versus throwing a chair; greeting an unfamiliar child versus hiding behind your leg; expressing the thought “This is too hard” versus running out of the classroom.

 

To help children connect, cope & thrive,

I teach adults to facilitate their child’s coping

through brain-building interactions styles.

 

At some point in the process of child therapy  most parents mention to me, “It kind of seems like you’re training us …”   Down the road, many parents also share a common disclosure, admitting somewhat sheepishly but with deep pride: “I noticed he really started to change when I started to change. I had no idea ….”

Child therapy is composed of direct child intervention AND parent guidance.   Parent workshops go straight to parent guidance.   Workshops pump parents full of information that lower the temperature of child problems.

For instance, parents learn why yelling never works.  We think the louder we yell, the more kids will remember the lesson next time. Right? Wrong. Yelling activates the threat center in the limbic system in the brain, taking blood and oxygen away from the thinking cortex. Yelling literally incapacitates the child’s cortex from problem solving. Thinking goes off line. Good coping doesn’t get rolling like that.

You can learn to help your child Connect, Cope & Thrive via child therapy or a parent workshop.  Or, you try to apply these few concepts and see if things improve:

Child coping starts at home in every interaction you share.

Your own calm coping is the best model for your child’s coping.

If your child’s “upset elevator” goes up, keep yours down.

 

Promote your child’s coping through calm connection that models the cool you want them to achieve. Remember, you are building his or her brain in these early years.  Parents are the most important part of child therapy.

 

Dr. Beth’s Parent Workshops & Saturday Seminars resume September 2014 including:  Savvy Solutions for Your Challenging Young Child; You & Your Anxious Child; and The Child-Sight Model: Change Your View and What You Think, Say and Do. Visit DrBethKids.com for details. 
 
Photo credit: by Beth Onufrak

Parents: Why a Workshop?


question marksSo, you’ve been concerned about your young child
for quite some time. You’re not sure if you need a child psychologist … maybe, maybe not. Starting therapy is not like signing him up for soccer! It’s a larger decision. Some friends say get help now; others say, “it’s just a phase.” You and your spouse may not even be on the same page about your child.

A few new good ideas would be soooo nice. So you read articles, blogs, posts, tweets … but none seem to address the specific issues in your life with your child. You’d love specific parenting advice, some face-time with an expert, and the support of other struggling parents like you. A safe place where you wouldn’t have to worry about judgment. And it would be great to “test drive” a therapist before signing up for care.

That’s when a workshop may be “just what the doctor ordered.”

people link

Workshops are one of my favorite clinical activities. For one, I can talk with grownups and don’t have to sit criss-cross applesauce on the carpet! More importantly, they serves my deep need to help more than one child per hour. Workshops serve my growing drive to get basic, customized, high-quality information to parents of young kids in a cost-effective format.

And these days, cost-effective things are more needed than ever! Workshops extend child psychology services in an affordable, comfortable, helpful way so people don’t have to forestall something this important. That being, helping your child connect, cope, and thrive.

For many years – 13 to be exact – I resisted the notion of holding parent workshops. How could I ever help children I’ve never met … especially when each child is so unique? Then it hit me. Week after week, along with the customized advice I dispense, a set of core principles and “prescriptions” kept coming in handy.

For any given child & family, about 50% of my interventions are singular and customized; the other 50% come from foundational elements of pediatric mental health & balanced parenting. These common elements are pervasively, predictably helpful across a wide range of diagnostic conditions, family circumstances and child problems. From these elements, the content of my Parent Workshops was born.

In the hot Phoenix summer of 2013, I launched my first workshops. Feedback from the initial sessions revealed what parents really need. In addition to facts, approaches & strategies, they craved something else as well. They needed the opportunity to …

    • step away from their busy lives
    • reflect deeply about their children
    • absorb new ideas while out of the house, and
    • receive laughs, tissues & high-fives from other parents.

Workshop attendees found encouragement through another week of tantrums. And cheers after sharing a breakthrough. Some of the best moments occurred as I listened in the circle. And whadya know … I actually helped children I had never even met. Several, in fact, in a few hours time. As Mr. Rogers used to sing, “It’s such a good feeling …”

Workshops resume next month.
Dr-copy.Beth-Kite-Story-3-PRINTSavvy Solutions for Your Challenging Young Child will run Wed. nites, March 5th thru April 2nd and Thurs. mornings, March 6th thru April 3rd.

Workshops in development include: My Child & Me and ADHD and You & Your Anxious Child.

For details and registration, visit the Workshops tab on my website at DrBethKids.com. If you’re a Phoenix local in the Valley of the Sun, take a look or tell a friend. If you live elsewhere, look into parent workshops near you – for facts and friendship, solutions and support.


The Brain Bridge: From Play to Clean-Up

 

Imagine your sleeping child … rosy cheeks, languid limbs, lost in dreamland. And you have to wake her up. You know it will a challenging transition to the waking world. Instinctively, you know — the journey from sleep to wakefulness is a colossal transition between brain states. So you offer a gentle nudge, a tender stroke, a soft whisper. You know gentle brain transitions keep everyone happy.

Moving from play to clean-up is a brain transition, tooA shift from flexible fantasy to order and organization. The enormity of this shift and effort it requires often elude us. “OK, playtime is over, time to clean-up”  we rattle off, expecting an immediate shift. The resulting push-back tells us an earthquake has just erupted, the young child’s resistance like the rumble of tectonic plates! It’s a very strenuous brain shift for young kids, especially those age 7 and under.

Stern voice, expressions of displeasure and threatened consequences are simply not effective ways to inspire clean-up.  Young kids need a bridge, a navigable, appealing bridge from the tragically sad end of play to the brutally unappealing work of cleanup. We grown-ups can build that bridge in thin air.

bridge with frame

What is a Brain Bridge? It’s a development-wise, brain-smart style of engagement that helps young children shift (body, mind, & soul) from one activity to another. Such as, from play to your next agenda item! The Play-CleanUp Bridge links the right hemisphere and the frontal lobes. This notion vastly over-simplifies brain function, but the general concept is instructive. So, what do those brain areas have to do with play and clean-up?

Play lights up the right hemisphere. Not this brain area exclusively, but significantly. The right hemisphere, which delights in symbols, fantasy, imagery, creativity and spontaneity lends a lot of support to imaginative play.

Clean-up requires the frontal lobes and their activities called Executive Functions. From only a few of their names, you’ll detect their relevance to clean up: Response Inhibition (stopping one’s play), Task Initiation (starting to clean up), Working Memory (remembering 2+ step directions), Sustained Attention (resisting getting sidetracked). These behaviors take SKILL power, not just will power. Brain specialists say the frontal lobes require 18 to 20 YEARS to fully develop!  And we want clean up done (with cooperation, no less) in ten minutes?

So let’s build a Brain Bridge. The work of cleanup is simplified by incorporating the spirit of play. Your young child has been reveling in her right hemisphere. Join her there for best results.

1)  Celebrate first.  Wrap things up with joyful concluding remarks! Comment on your child’s play and how fun it has been. And get down on eye level instead of towering overhead.

2)  Give a countdown with fingers. Time is a total abstraction to the young child, let alone its passage. Make it visual. Say you have 5 minutes left and show fingers. Not just 5 fingers but 4, 3, 2, 1 and zero fingers as you sit nearby. Add the encouragement, “You can have a lot of fun in 5 minutes!” 

3)  Talk to the toys. This highly effective back-door brain route sneaks messages to the frontal lobes and bypasses the volatile limbic system. Address the toys:  “Guys, I’ve got some kinda sad news – it’s almost clean-up time. I know you’ve had fun with Brandon, but you can play with him again tomorrow.”

 Advise the toy to obey your child.  “T-Rex, in a minute Brandon is going to put you in the bucket … I know you’re sad to get picked up.  But it’s important you listen to him, because he knows it’s clean-up time. You can do it, T-Rex.”  If the child says, “T-Rex can’t understand you!”  just reply, “I know, I’m pretending.”  And co-pretending will resume.

4)  Make piles. To kids, picking up a toy-strewn floor is akin to cleaning up the planet. Help this job look do-able. Cluster like-items into separate piles for your child. Describe what you’re doing. Teach these skills by being your young child’s frontal lobes, modeling skills to come.

5) Thank the toys for the fun we’ve had.  Farewell play-talk borrows lightness from the imagination, facilitates emotional coping and supports cooperation. (Dr. Dan Siegel would say it integrates the left & right hemispheres too, which helps kids self-regulate.)

6)  Describe each item & action: Bye yellow chopper, curly ribbon.  Is your child using one hand or two?  Do toys drive or dance into their buckets? Cleaning up can take 150 separate behaviors. Describing them gives your child credit and celebrates objects as they get put away.

7)  Meet them halfway. A.k.a., give it to them on a silver platter. Hand your child the toy.  Point to where it goes. And hand him the next thing. Soon you’ll hear “I can do it myself!”

8)  Add pretend media.  Narrate like a fascinated radio host or a Monster Truck announcer. Tell America how fast Megan is cleaning up.  Want to grow your child’s executive function skills? Then keep this task appealing with joy and fun in your voice.

9)  Invite “Searching Eyes.”  When items go unnoticed, say “Use your searching eyes to see if anything is hiding from you.”  (Note: This is the opposite of “You missed that one.”  Why demean and deflate when your child is working so hard?)  Exclaim, “You found it! That puzzle piece couldn’t hide from you!”  Searching and finding fills a child’s heart with achievement and pride.

10)  Give a Praise Re-cap. Crouch down, arm around your child, and gaze upon the cleaned-up landscape. Recall each thing put away. “Amazing! You put away all the books, markers, frogs, snakes & lizards. What an excellent cleaner-upper today. You really know how to do it.”

When you build a Brain Bridge, you respect your child’s mind and, in the process, your child’s spirit. And that benefit extends long after the last lizard is put away.

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References: The Whole Brain Child by Dan Siegel & Tina Payne Bryson; Smart But Scattered by Peg Dawson & Richard Guare; The Family Coach Method by Lynne Kenney.


“You’re Taking Your Child to a Shrink?”

You’ve wondered and waited ~ with your worries and wishes.  You’ve hoped this was “just a phase” in your young child’s life. Time after time, you’ve reassured yourself, “He’ll outgrow this; he’s young” or “she has so much time.”  In talks with your partner, you’ve raised your concerns … and talked yourself out of them as the weeks and months (or years) passed. There have been periods when he blossomed and was doing just fine. Times when those problems seemed far behind her.

Then the difficult days return … An event occurs, a moment arrives when it’s all too clear – you cannot manage this yourself. You are out of ideas. You begin to ask around, look online, make some calls. Make an appointment with dread and hope, shaky nerves and eager heart. Nearly every parent who seeks child treatment describes these phases. Now that you’ve made that call, you wonder what (or whether) to tell family & friends. The reactions of others can be a gnawing concern:

what

“I’m not even mentioning this to my mother, she’d have a cow.”

“I can just hear my dad now … ‘MY grandson is not crazy!’ ”  

“We’re not telling our friends, they wouldn’t get it – she’s an angel at other people’s houses.”  

You are not alone if this story sounds like yours. In fact, you are entirely typical. You may feel wary of following your plan while anticipating disapproval from others. It is hard to seek outside help. So hard that many families put it off a little longer. A good number of parents arrive moist-eyed and shake my hand confessing, “We should have been here two years ago. We knew things were getting bad, but we just weren’t ready.”  

How do you know when it’s time?  The following benchmarks may tell you: When you have tried countless strategies, but the problem keeps worsening; when you’re starting to worry about the safety of your child and those she plays with;  when the problem is hampering friendships, school, and family life; when your child doesn’t seem to enjoy “being a child;” when there are more “bad” days than good and his or her self-esteem appears to be suffering.

How do you select a child mental health provider? At local community mental health centers, staff assign a therapist to match your needs.  If you select a health insurance provider or elect to private pay, your choice will be more personalized.

checklist

    • Ask trusted people.  You’d be surprised how many parents have struggled behind the scenes just like you. Many have a favorite provider they count upon.
    • Look online.  More and more providers have websites and social media presence.  How do they describe their practices? Check out their Facebook business page posts. What do they Tweet?  How do you like  their material?
    • Call for an initial inquiry.  Do you feel comfortable interacting with the office staff?
    • Understand medication vs. therapy.  Medication is prescribed by psychiatrists, physicians & nurse practitioners. Therapy is provided by psychologists, counselors, & social workers
    • Ask if a parent-only intake is possible.  Not all providers can offer this. However, such an intake allows coverage of sensitive topics you don’t wish to discuss in front of your child.

O.K., so you’ve made an appointment. Or you’ve begun the process and feel ready to tell people.What do you say?  I offer these suggestions:

We’ve found a provider who specializes in young children.

We need “new ideas” to address a big problem that just isn’t going away.  

We want to help our child now before the problem grows so we can have “better days” together. 

After meeting your therapist, assess how you feel. Provider-family “fit” is very important! But a degree of unease is natural until you all settle in. Be open to sharing information. Providers cannot truly help your child or family without the “full picture.” Know that any personal information you share is entirely in service of your child. Also, be ready to change yourself! Providers help young children by giving their grown-ups “new ideas.”

Seeking help for your young child is a step of courage.  And it can make a world of difference! Intervention with young children sweeps stones off the path of development before they become boulders. Begin early so the only thing weighing upon his young shoulders is sunshine. happy20sun


“You can tell me anything, I’m a puppet!” Why Play Therapy Works

Criss-cross applesauce, a spunky boy sits on the whimsical playroom carpet, eyes wide, mouth agape. He’s listening to my impulsive puppet Freddy exclaim, “I get so mad, I want to kick him in the leg!”  Freddy elaborates: “Why won’t he just play my game, my way, every time?”  It’s no longer any surprise. Nine times out of ten the amazed child replies, with visible relief, “THAT’S JUST HOW I FEEL!”


The child I have in mind speaks to the puppet, and he’s not alone.  Freed by genuine understanding and clear acceptance, the child opens his heart. He pours out his own troubles to the boy, girl, dragon, wolf, octopus, skunk, or chipmunk on my hand.  “I know, last night I kicked my brother,”  he offers, commiserating with the puppet.  “I hate time out.”  Another child reveals, “I did that in school and got sent to the principal. It was the worst day EVER.”

Now, I have a nice degree on the wall, with all the rights and privileges thereunto appertaining.  But puppets are my co-therapists and their credentials seem to surpass mine.  Children tell the puppets far more than they tell me alone.  Why is this?

The answer is simple: Puppets give safe distance.   No child wants to see a therapist who fixates on her problems, nor feel there’s something wrong with herself. In my playroom, it’s the puppet who has the problem. And to a much greater extent than the child.  That’s the secret.  If a child is here for anxiety, Puppet Miranda has hilarious, unreasonable terrors.  The boy here for anger meets puppet Pedro, who mentions unmentionable aggressive thoughts … the very thoughts children harbor and sometimes enact.  The boy can hardly believe Pedro feels the same way.  And before he knows it, we are talking.  Other puppets join us, supportive “voices of reason.”  Four-way conversations ensue between the troubled puppet, the helper puppet, the child … and oh yeah, me.

Puppets help bring the child’s problem comfortably into the room. They often speak for the child, making her feel not so alone and not so BAD.  Puppets are but one of many play therapy tools. But for me and many child providers, they open the door.  Puppets are exceptional delivery vehicles for Cognitive Behavioral Play Therapy, described above.  CBPT helps children try on new thoughts and rehearse new behaviors.  And guess who models those — yes, the puppets.

There are many models of play therapy, including directive (didactic in style), non-directive (following in style), and familial (incorporating parents).  One expressive mode is Sand Tray therapy, using miniature toys children select and arrange in sand.  Sand Tray helps children heal from trauma, abuse, and emotional damage too painful to speak aloud.  Regardless of the mode, play therapy provides stand-in symbols (toys, materials) to represent feelings and people, events and things, wishes and fears.  The child’s imagination creates a buffer and a flexible “space” to explore tough stuff.  Therapeutic play allows the freedom to approach and retreat from uncomfortable ideas, memories, and feelings.  Children open up about burdens such as obsessions and compulsions, low self esteem, wishes that one was “never born,” despair, rage and shame.  Play gets inner feelings “out on the table” so we can deal with them together.

So puppets are one tool of the play therapist.  The puppet-child connection is unsurpassed in early childhood psychotherapy. Children often bond with their puppets friends, proudly believing they themselves are the helpers. One child brought a nugget of puppy chow to nurture a chronically anxious puppet. “Worry Wolf,”  she entreated, “you have GOT to get hold of yourself!”  She then rattled off an expert list of self-calming tips for emotional regulation.  Well-remembered and expertly modeled.  Parents bring their children for follow-up visits, amazed with progress. In a hush, they whisper, “He’s been talking about Freddy nonstop for two weeks.”

Good.  Freddy sends a tangible and memorable message out the door – long outlasting the single hour with me.  I ought to put him on the payroll.

#parenting  #playtherapy  #puppets  #self-regulation  #angermanagement #child psychology