Mommy, my brain is hungry!

goldfish_crackers

Young kids tell you what they want. The iPad. Angry Birds. Skylanders and Lego Ninjago. American girl dolls and My Little Ponies.  A pop tart. A fruit rollup. Goldfish. Noodles with butter. Sound familiar?

If only they knew what their brains wanted to help regulate their physical and emotional states. Their pleas might then sound like this: “Mommy, my brain is hungry!  I gotta have some protein to focus. I need some avocado to think of something else before I hit my brother!”

 

The brain/nutrition link is elementary. The brain runs on neurotransmitters. Neurotransmitters are made from food, specifically protein. Neurotransmitters are carried on the superhighways between cells that are coated with fat. [Fat, you say? Good fats.] And sugars provide glucose for brain energy.  Complex carbohydrates supply sustained, long-lasting energy; simple, quick burning carbs only give rapid, short-lasting energy, leading to “zoom and crash.”

A parent might as well say,

“Blood sugar, go to your room!”

 

An after-school tantrum can reflect low blood sugar.  Classroom distraction can reflect inadequate intake of quality protein. Poor impulse control can reflect deficiencies and DHA and EPA.  I am no longer content to blame behavioral problems on “psychological” issues when the body may be the problem, or at least part of it. How silly that distinction even sounds… the distinction between mind and body is history.

Parents bring kids to psychologists to help change how their minds work … when it’s children’s bodies that often get them into trouble. The unspoken assumption is that the child mind can control his body, given the proper “tools.” But it’s more and more clear to me ~ we often have to help the body and brain first before I can do much with the mind.

Nothing is more proximal to your child ~ closer to his interior being ~ than what’s in his cells at any given moment.  

… closer than your hug, your touch, your loving words or threatened punishment … closer than therapy interventions. 

 

walnuts-health-benefits_1-1024x683

Knowing children’s brains are hungry, I now routinely recommend a nutritional consultation at the commencement of care.  Sometimes, I advise parents at the intake to return in 30 days after  implementing nutritional changes.  No longer can I accept parents’ money and take their time if I believe a child’s body needs help before her mind can respond. How would I know this?


Over the past 4 years of my practice, my referrals for child psychiatry consults have plummeted.
 Why? Because parents are trying nutrition first with profound results. Many kids accept new food routines and even request specific foods at key times. They quickly recognize how different ~ and better ~ they feel.  These children actually start to say, “Mom, I need some protein…” My colleague Jan Katzen, former Montessori teacher and Certified Nutritionist, often says, “I have yet to meet a brain that does not respond to better nutrition.”  Jan is one of my most valued referral sources. Learn more about her at http://www.NutritionforLearning.com.


Do I lose business with all my nutrition referrals?
 
 Sort of! Some kids improve by eating differently and no longer need my services.  But more often, kids come back after a nutritional boost. Then therapy is more efficient and effective. That’s because a child’s brain chemistry and blood sugar is working with me.


Findable, affordable foods could potentially transform your child’s brain and body from dysregulation to balance.
 
Changing the timing and composition of snacks and meals can make all the difference. Canned black beans, apples with almond butter, stone-ground tortillas, walnuts and cage free eggs can turn around brains and behavior. Not being a nutritionist, I’ll stop there and leave it to the experts.  Picky eater?  Nutritionists of often have sneaky ideas for helping gradually change your child’s palate.


Does changing your child’s diet take some time and money? Yes. So does therapy. Try one, and you may not need the other.

________________________________________________________
Child nutrition a module in Dr. Onufrak’s ChildSightTools® parent seminar series, delivered live in small-groups through out the year in her Phoenix, AZ office.

Girls’ Friendship Help to the Rescue!

What is it about girls and their friendships?  Feelings get caught up in the mix. Girls who yearn for good social connections find themselves wrapped up in painful drama.  Driven by their raw hurt feelings, girls often make retorts that worsen problems and intensify conflict.  Parents try to help but don’t always have the most useful suggestions. “Just ignore her” or “just stay away from her” doesn’t cut the cake. How do we teach girls healthy communication skills? How can we help them express feelings assertively as well as develop compassion for others?

The-Girls'-Q&A-Book-on-Friendship-092914-front-cover-800x1219
New book from Annie Fox

The best answers I have ever found reside in Annie Fox’s brand new book, The Girls’ Q&A Book on Friendship. Annie Fox, M.Ed., is an internationally respected parenting expert, family coach and trusted online adviser for teens.  But in this book she aims younger — to girls in third through sixth grades, ages 8-12. Annie Fox hopes to arm young girls with constructive, healthy friendship tools before the perilous middle school years.  The delightful illustrations are by the talented Erica De Chavez.  I love Annie’s vision of parents and girls cuddling up together with this book in their lap.

In my early childhood private practice, I see many girls in 3rd grade in addition to those who return at an older stage of development.  For a long time, I’ve been yearning for such a book as this. And here it is! For my first guest blog, Annie Fox agreed to answer some questions of mine to introduce this book to my readers … for help today, or for tomorrow!

Dr. Beth’s Interview with Annie Fox

Q: Dr. Beth – Why do you think girls become “mean?

A: Annie  –  If there can be a short answer to that HUGE question, it may be that “meanness” is a cover for hurt, jealousy, frustration, feelings of rejection, etc. And of course, girls aren’t the only ones who experience those emotions! Without getting too philosophical, I believe we live in a culture of cruelty where it is more acceptable to express aggression than it is to express vulnerable emotions. Maybe that’s why many girls and boys, men and women find it “easier” to respond to hurt, etc. with meanness. It’s ironic, when you really think about it, because when we feel vulnerable (and insecure in a relationship or in our social standing within a group) what we really want and need is reassurance. We want to bring people closer to us. Being mean isn’t likely to get us what we really want, and yet, that’s the behavior many choose.

Q: Dr. Beth – What led you to create the Q&A Guide in this format?

A: Annie – I’ve been answering email from tweens and teens since 1997. They send me questions about everything you can imagine (and lots of things you probably can’t imagine! LOL). And I often ask them questions too. So the question and answer format has become a very natural way for me to teach kids about empathy, compassion, social courage, and the difference between real friends and the other kind. Like any good teacher, my goal is to get kids to think for themselves … hopefully to help them learn how to calm down and ask themselves some questions before they respond to sticky situations. Questions like: “What am a going after in this situation?” and “Can I really change someone else’s behavior?” “And if I can’t get someone to change, how can I change my own response to what’s going on?”

Q: Dr Beth –  What are the main messages you hope to promote in the Q&A Girls Friendship Guide?

A: Annie – My main messages are:

1. You have the right to choose your friends, but you never have the right to be rude or disrespectful to anyone.

2. When we’re upset we don’t think clearly and we’re more likely to do or say things we will later regret. Calming down is the best first step to resolve any friendship challenge.

3. Sometimes we need to “take a vacation” from the drama! When you take that break you give yourself time to regroup and figure out what you really want and need in a friendship. You may discover that what you want and need can be found with a new friend.

Q: Dr. Beth – Parents often don’t see girl troubles coming until it hits their daughter. Why might this be?

A: Annie – Some girls (and boys) assume that when they get to a certain age they should not be sharing their emotional upsets with their parents. They figure “I’m old enough to take care of this myself.” And sometimes they can! But other times, kids start to feel overwhelmed by what’s going on in a friendship or some other peer relationship. The emotions are so intense they may not know how to talk about them to parents or anyone! (That’s when they write to me.)

In some cases, a girl is having trouble with a long-time friend (and her parents are long-time friends with the other girl’s parents). In those scenarios, the girls find it really hard to accept that there is a problem. (“How can there be a problem when we’ve been bff’s since pre-school!?”) And when they do talk to parents, the advice they get isn’t so helpful. (“Oh, she was probably just having a bad day. Forget about it.”) Parents need to know just how important their daughter’s friendships can be. By paying attention to the signs that a girl is feeling upset, a parent can help a girl express her feelings and brainstorm some options for her next best move. I’m hoping that parents/grandparents, teachers and counselors will read the book and use it to help girls.

Q: Dr. Beth – Your book is for 3rd to 6th graders. But what are your thoughts on 1st & 2nd grade girls?  What early messages should they receive to build a foundation for healthy friendships as they grow?”

A: Annie:  I know that girls’ friendship challenges can begin as early as preschool. My book could be used very effectively with K-2nd graders as girls that age are likely to recognize the situations in the book’s Q&A. This book is designed to give girls (and the adults who care about them) tools for managing emotions, communicating more effectively, and recognizing that when it comes to friends, it’s important to have some clear standards about what makes a real friend. And it’s very important that girls of all ages recognize that a friendship is a 2-way street. Yes, we want a friend to be kind, fun to be with, generous, a good listener, etc. And we also need to be aware of the kind of friend we are to others as well!

You can visit Annie at AnnieFox.com.  Look for The Girls’ Q&A Book on Friendship at Amazon.com, where you will also find my review.  I know this book will be of help to many girls in my care – for now, and in the years to come.


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

What’s Wrong with “Wh” Questions? 5 Things and The 5-Word Fix

 

Your child is falling apart. Another volcanic meltdown, drowning in a tsunami of tears, siren-like screams. If you knew what specifically was wrong, you’d know what specifically could help. So you resort to the strategy that helps you the most in adult life:  specific questions.

what-why-how2What are you upset about?
What happened?
When did this happen?
Where were you?
Why are you so upset?
How did this happen?

Who? What? When? Where? Why? How?
Wh-wh-wh …

It truly is unfair that the style of inquiry that helps us function in the adult world incapacitates us when trying to help a young child.  Specific questions can even prolong and impede the process, while emotions spiral further out of control like a tornado on the plains.   Why? (oops!)

In 20 years of being a child psychologist, and the years of training before, I learned the cardinal lesson: “Wh” questions shut a child up faster then you can say ice cream sandwich.

 “Wh” questions can be unhelpful, even anti-helpful, because they:
    1. Shut down a child’s own narration and conception of the problem
    2. Block a child’s sharing of the salient details to him
    3. Pigeonhole a child’s thinking into your categories of thought
    4. Build a child’s frustration with us adults
    5. Make a child more upset from the communication gap

May I suggest an alternative ~ my 5-word Fix: “Tell me all about it.” It may sound similar to asking …  but this approach to inquiry is completely different. How so?

Consider the last time your computer displayed a cryptic, terrifying error message before going blank, toying with your life. In consultation with the  IT person, it may be very hard for you to explain the problem.  The IT person might ask you specific “wh” questions, such as: What did the error message say?  What were you doing right before this happened? What gobbledygook thingy is your thingamajig?

But you’re upset and you don’t have computer language. It may be doggone difficult to answer those “wh” questions. You might even grow more frustrated in this process. You might wish the IT person would simply say, “Tell me all about it.”  At that point, you could begin with the language you have to describe the problem at the level you are capable of.

When a child hears “Tell me all about it,”  it feels like “Just give it to me, however it’s going through your head right now, with whatever words you got … and I will just listen.”

“Tell me all about it” also opens up your child to tell you a detail you’d NEVER have asked for.  Because you couldn’t have thought of that.  Because you’re weren’t there … and you’re an adult.

haystack
Relying on “wh” questions in a meltdown is like trying to find a specific needle in your child’s haystack.  It’s like asking, repeatedly:   Is this the needle? Is this the needle?  Is THIS the needle? You would get infinitely farther, infinitely faster by just saying “Tell me about this haystack you got here.”

Naturally, you have to ask “wh” questions at some point. Probably several, to get the clarity you need. But starting out with nine “wh” questions will create more problems than progress.  “Tell me all about it” may be the most productive start.

You can add “I’m so sorry you’re so upset.”  When you’re lost, interject, “Help me understand; tell me some more about this, honey.” (Hint:  forget about solving this problem right now; her brain needs empathy too cool the limbic system down.) 

“Wh” questions are like putting your hand on a specific door knob and asking, “Is it this door?” Saying, “Tell me all about it” opens doors you didn’t even know were there.  Try it and you will see.

“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


To Do or Not To Do

I have a child in mind who is running through the house, tracking mud along the journey, jumping on the couch, scrambling up on a countertop, dropping clothes in the hallway, making tsunamis in the tub.

And into his little ears comes a reprimand (or two or three) passed down through The Ages: “Cut that out, now you behave yourself.”  “Stop it.”  “Don’t do that!”

These phrases are ingrained in the sub-conscious minds of most adults. They fly out of our mouths like pre-recorded messages.  Actually, we do have “recordings” in our minds, for better or worse, from parental words spoken to us.  These are often the first words we spout forth, even without thinking – they are part of us.

But STOP & DON’T are the least effective words to change children’s behavior. My job is to look through a child’s eyes, listen through a child’s ears.  A child may hear:

“Anthony, stop that right now or there’ll be no XBox when we get home.”

I usually hear the following translation:

“Anthony, cease this action right now, even though you are physically activated and completely engrossed in it. Calm yourself down, generate a list of other things you could do, select an alternative acceptable behavior, and re-route your mental and physical energy into that. Otherwise, you will lose a privilege several hours from now, long after this moment has passed.”

In psycho-babble, we are asking him to deploy his emotional and physical self-regulation skills and use executive functions.  OK, let’s switch to plain old English!  Only telling him STOP/DON’T asks him to take control of his body and emotions, suppress a strong impulse, and make a measured decision about what to do instead.   All of which require his frontal lobes … which are still growing.

Grown-ups can act as a child’s frontal lobes. Tell him what TO DO instead of what NOT to do.*   It’s an extra thinking step —  in an already busy day — but it yields the best results in the now and promotes learning for next time.  It’s teaching.  And it’s loving. It keeps YOU calm. Best of all, it’s effective.

Your effort to convert STOP/ DON’T responses into DOs will pay off.  The trick: imagine what your child would be doing if she were not doing this behavior.

    • If his shoes were not on the couch, his sneaker feet would be on the floor.
    • If she were not running through the house, she’d be using her quiet walking feet.
    • If he weren’t squeezing the family cat, he’d be using soft hands.
    • If she weren’t hitting brother in the car, her hands would be on her own side touching her own things.
    • If he weren’t scribbling, he’d be drawing slowly and carefully.

Sometimes the STOP/DON’T moment is urgent – like hurting or breaking. The first reasonable DO conversion might be “please come here by me.” There you can explain what needs to stop and what else your child can do.

“DO commands” do the initial work for you child’s frontal lobe – they tell her what to do instead. In my experience, children are more likely to comply with constructively phrased, friendly but firm DO commands.   Begin with “You may” to add an element of courtesy and authority, a respectful and effective combination.  Follow with praise for any amount of effort, however small, and generously describe any response going in the right direction.  DO commands are teaching moments.

    • “You may make small waves under the water; thank you for trying little waves.  Ooh, that’s a little one!”
    • Walk slowly and carefully with that cup of juice, please.  Excellent trying! You are really watching that cup.”
    • Hug me with gentle arms, please – oh, that feels so good, thank you for being gentle! “
    • “You may move over here [point] away from sissy to make your building.  Good job starting to move your stuff.”

DO commands readily lead into detailed praise.  When you notice spontaneous displays of DO behaviors you’ve been teaching, give a specific praise! Add lots of description. I call this “Positive Noticing,” detecting and commenting upon cooperative DOs that occur even without your prompting. Quite simply, “catch ’em being good.”

Try some DO commands.  They have changed the lives of many families in my care!  Make a list on your fridge converting your most frequent STOP/DON’T commands to DOs.  The extra thought will pay off as your child advances in self-control and emotional regulation.

* These ideas are drawn from the Parent-Child Interaction Therapy (PCIT) treatment model developed by Sheila Eyberg Ph.D., University of Florida, with whom Dr. Onufrak trained in her doctoral studies.


Developmental Skylines

The child I have in mind today is growing so quickly, on every dimension of development … but each area progresses at it’s own pace.

In the preschool years, abilities unfold with staggering speed!  Children move from mouthing their toes to balancing upon them, reaching for heights.  Babbled syllables of every language on earth grow into clear speech in the language(s) of home.   Reasoning extends past peekaboo games to twenty-piece puzzles.

The rapid rise in child abilities leaves us gasping at every turn.  But advance in one area feeds expectation for comparable advance in another.   Growth spurts in another child can generate comparisons with one’s own.

Development, however, is like a city skyline.  Buildings of varied heights mirror multiple abilities in different stages of progress.  Look at a cityscape with a mathematical eye and you can visualize a vertical bar graph.  To a child psychologist, those bars are analogous to normative, uneven growth across developmental domains. These areas are Cognitive (reasoning), Emotional, Social, Speech & Language, Toileting, Fine motor, Gross motor,  etc.  In no child do those developmental areas grow evenly.  Just like the varied heights of downtown.   And what a boring skyline it would be if the structures were uniform in shape!

Expect variation between developmental domains in your child.   Support your young ones where they are.   Lags in certain areas might foretell the need for specialized help, but not necessarily so.  If you have concerns, track your observations with detailed notes and refer to them every few months.  Public school districts offer free developmental screenings. Child psychologists conduct developmental evals.  You may consult your child’s teacher or pediatrician, who follow hundreds and thousands of children, if you are worried.   But all those professionals will say a uniform “skyline” is not the developmental norm.   And the window of typical development is very wide.

Observe your child’s individual skyline. And know that your attentive  support encourages growth in each developmental area.