“Why Doesn’t My Child Follow the Rules?” by Jennifer Andersen, PsyD

Families often seek help because they are concerned about their children’s behaviors.  As psychologists, we are frequently asked questions such as:

  • What should I do when my child is disruptive in his/her classroom?
  • Why does my child have trouble sharing?
  • How can I get my child to stop screaming at a restaurant?

In the above situations, these behaviors are often presumed to be “oppositional” or “defiant” in nature, and as a result, the children are described using these terms. In fact, many parents say that doctors or teachers have mentioned the possibility of Oppositional Defiant Disorder (ODD), and they ask if this diagnosis applies to their child’s behavior.  It is common for adults to feel frustrated when a child does not comply with their requests, or when efforts to change a child’s behavior seem unsuccessful: “I’ve tried yelling, taking away toys, using rewards, even crying… Why don’t they listen?!  Why don’t they follow the rules?!

These seemingly desperate questions are actually a large part of the solution. The moment we really begin to examine why the behavior might be happening, we become curious about a child’s experiences instead of acting punitive or blaming.

The most important thing to keep in mind is that uncooperative behavior is often an outward display of internal distress. In her blog, psychologist Mona Delahooke, Ph.D., urges us to pay attention to a child’s emotional and physiological experiences when they display defiant behaviors:

“We need to become investigators as to the range of individual differences that contribute to children’s emotional vulnerability, and help them construct new meanings from the sensations they experience leading to the challenging behaviors.”

This opens the door to so many possibilities to explore! So, let’s become investigators…the behavior is probably not happening because your child gets pleasure out of annoying you or because “they just don’t want to follow the rules.” There are probably several other whys if we look a little closer.

A common cause of internal distress is an overabundance of sensory input. Think about commuting home from work on a crowded train in the summer – you’re hot, tired, hungry, and likely have a low tolerance for people who are standing close to you (sounds, smells of others will make many folks feel annoyed or even outright angry at their fellow commuters). Most adults, thanks to their brain having fully developed its prefrontal cortex, are able to inhibit angry or aggressive impulses in this situation. But children, especially those with neurodevelopmental delays, are not as well equipped to handle these environmental stressors, as they are likely to be overly sensitive to such stimuli. Sharon Heller, Ph.D., writes eloquently about this sensory imbalance in her book, Too Loud, Too Bright, Too Fast, Too Tight.  While some children seem over-reactive to sensory input, there are also those for whom the opposite is true –those who need a higher amount of movement in order to stay regulated. These “under-reactive” children frequently get out of their chairs, run down hallways, or may look to “jump” from the second or third step at the bottom of a staircase. Whether a child shows more over- or under- reactivity, their unmet sensory needs can lead to dysregulation, which often in turn leads to “not following the rules.”

Behaviors of children with autism spectrum disorder (ASD) are often interpreted as being “oppositional” or “defiant” in nature rather than understood from the perspective of their developmental and individual differences.  For example, disruptions to normal routines can be triggering for children with ASD. When things don’t go as planned or expected in the environment, this can lead to increased anxiety, which often presents as irritability or as a full-on meltdown. Further, one of the hallmark symptoms of ASD is difficulty reading social cues. That means a child can’t always tell when their behavior is bothering someone else. Children with ASD typically need more help tuning into the social world around them, and they can miss the nuances that their peers pick up on. They are not annoying others just for their own entertainment or to receive attention, as is often presumed in the case of diagnoses of ODD.

Social communication difficulties play a large role in “defiant” behavior as well. A child with ASD or with a language delay may not have the expressive vocabulary needed to properly convey their feelings. Thus, hiding under a desk or trying to leave the room may be the best way a child knows how to say “I don’t understand what you’re asking me to do” or “I need to take a break.”  For example, I recently evaluated a child who repeatedly said, “No blocks!” when I presented him with a task.  On the surface, this phrase sounds oppositional, but given his very limited expressive language level (primarily consisted of requests and refusals), he was unable to explain what he needed (e.g., adults decreasing their level of language; a movement break) or what he was feeling (e.g., overwhelmed; distracted).

So, while we often may find ourselves asking, “Why isn’t this child following directions?” it is best to consider what the child’s needs are in that moment.  A child’s behavior is an attempt to communicate something, and we as the adults have the responsibility to uncover what our children are trying to say. The times when parents ask, “Why isn’t my child listening?” are crucial opportunities for attunement and co-regulation. Children feel just as frustrated as adults if their needs are unmet or if demands are too high. They may be asking the very same thing, “Why aren’t (the adults) listening to me?” Understanding a child’s behavior from this perspective, and learning how to meet them where they are at developmentally, can help caregivers and providers to respond in an appropriate, strength-based manner that promotes a child’s development.

Let’s all continue to be investigators and strive to understand children’s internal experiences and developmental differences to promote their development!

Parenting Practices: Back to School: How to Support Our Kids

By Dr. Jaime Marrus

I thought it would only be appropriate for this month’s installment of the Parenting Practices series to highlight strategies to support our kids as they transition to a new school year.  The end of summer brings about many feelings in all of us.   Especially during the last few weeks of August, I personally start to feel a push-pull sense of ambivalence… The measured excitement of waiting for some new things (e.g., schedule) to begin, combined with the longing for continued summer vacation and relaxing vibes.

It is natural for children to feel similarly, with the potential added stress (depending on how your child responds to transitions) of thinking about new teachers, new routines, new classmates, new classrooms, and maybe even a new school.  They may worry about having friends in their class, getting a lot of homework, higher expectations of a new grade, and whether or not their teacher will feel like a good fit for them. 

Below is a list of ways to support children through the August to September (and October…) transition, with ideas for both informal and formal supports.

1. Establish a healthy routine prior to the first day/week of school.

This may seem tough because we all want to squeeze the last bit of summer out of August by staying out all day in the nice weather, seeing family and friends more often than you might be able to during the school year, and naturally, letting our children stay up later and wake up whenever they want.  It is important to begin reestablishing routines at least one week before the start of school.  This includes regular bedtimes and wake-ups (that are as close to a “school year” routines as possible), healthy meals, and likely more limited screen time than is the case during the summer.

2. Attune to and validate your child’s emotions.

As discussed above, emotions may run high in anticipation of the transition from summer to school.  Let your child know that however he/she feels is “okay.”  Some validating statements include:  “I understand you are a little nervous about meeting your new teacher.”  “I remember feeling worried about the beginning of the year, too.” “I know you’re wondering which of your friends will be in your class again this year.”

3. Prepare for and review the logistics.

Some children may feel stressed about the transition because it is difficult for them to picture or get a sense of what the changes may be like.  If your child is going to a new school, it is often helpful (if possible) to take your child on a tour before the first day.  Sometimes teachers may even be open to saying a quick “hello” if they are available- reach out to them!  If getting inside the school is not possible, even driving by and walking around the outside can go a long way in easing your child’s nerves.  Show him/her where he will arrive (and how- by bus? Will you be dropping off?) and where he/she can expect to go at the end of the day.  You can also check out the school’s website for pictures and information.  For some children, creating a social story (to be read on their own, and/or with you) including short sentences and visuals about the new routine is very helpful.   It’s fun to include pictures of the child outside the school building or with his/her backpack and school supplies.  You can also include a “countdown calendar” to the first day, and cross of each day that goes by. 

4. Do your best to ensure carryover from one provider or therapist to the next (if applicable).

If your child will be transitioning between therapists, think about reaching out to your child’s previous provider (e.g., speech therapist, occupational therapist, etc.) to ask if they can think of two or three “tips” to pass on to the next therapist about working with your child.  (This is also an idea to keep in your back pocket and ask for prior to the end of the school year next June).

5. Reach out to teachers and providers regarding your child’s IEP.

For children receiving supports at school via their IEP, it is a good idea to call and/or send an e-mail to the teachers and support staff to ensure your child’s services will be provided as mandated.  Do not hesitate to follow-up on this throughout the first few weeks of school.  It is very helpful to let your child’s team know that you are interested in connecting and collaborating with them.

Best wishes to you and your children for a smooth and successful start to the new school year!

Parenting Practices: Validating Feelings

By: Dr. Jaime Marrus

Welcome back to the Parenting Practices blog series on Supporting Children’s Emotional Development! We hope you found last month’s tips helpful (https://drtobingpuente.com/2019/04/15/supporting-childrens-emotional-development-starts-with-accepting-their-feelings/) and have gotten a chance to take notice and practice “accepting” your child’s feelings.

This month’s focus is on validation.

All people seek validation from others in a number of ways.  We may wear an outfit that we know our partner loves in hopes of a compliment or a loving gaze. At work, we often want to ensure that the boss knows of our particular contributions to a project and enjoy receiving accolades. Children may seek validation through obtaining “good grades” and being praised for them, or telling their friends about a really cool new toy they have.  What is often missed by parents, however, is the idea of validating our children’s feelings (rather than “good” behaviors or concrete results).

For some perspective, think about a time you may have felt upset or scared and shared those feelings with someone close to you (a friend, partner, colleague, etc.), and may have received one of the following possible responses:

  • You: I’ve been having this same argument with my husband for a week… I am so upset, I don’t know what to do!
  • Response 1: Maybe you can try a different approach with him?
  • Response 2: That is frustrating. I would be upset too.
  • You: I am just so nervous about this deadline at work.
  • Response 1: Oh, don’t worry about it! I’m sure it will be fine!
  • Response 2: Yeah, deadlines are nerve-racking, that’s tough.

While there may not necessarily be anything “wrong” with Response 1 in both examples, you may have noticed that Response 2, although not providing you with any solution or reassurance, just feels better; it feels like you were being heard.  That feeling is a feeling of validation.  It’s that person communicating: “You have a right to feel that way. If it happened to me, I probably would feel the same way.”  For some of you, you may have felt like Response 1 felt INvalidating.

We want to do this same thing with our children. We want to accept their feelings and then send the message conveying, “Hey that’s ok to feel that way, I get it!”  This is important for overall emotional development and mental health.  Acknowledgement of children’s feelings is an important step in supporting them to move through the feeling in order to work towards a solution to whatever may be causing it.  Children will feel worthy and dignified in their experiences, which leads to positive outcomes such as healthy self-esteem and self-efficacy skills.

As I continued to comb through my bookshelf this month, I came across this example from Dr. Daniel Siegel’s and Mary Hartzell’s Parenting from the Inside Out:

A child comes in from playing outside and excitedly shows his mother some beetles he has collected in an open jar.  He says, “Look, Mommy, look what I found, aren’t they pretty?” All the mother sees is the possibility of bugs getting loose in the house and responds, “Get those out of here right now…”  Although at first consideration, this example does not even have to do with emotions and feelings, it is important to see how the child’s emotional experience was missed by the mother.  He likely felt quite excited and “good” about his discovery, and clearly wanted to share it with his mother.  Instead, the mother communicated a message more likely to be associated with “wrongdoing,” thus missing the meaningful emotional connection that could have given value to this experience.

So, we want to validate our children’s experiences, as well as their emotions.  In this way, we send a message of acknowledgement, acceptance, and understanding.  Validation can take many forms, including reflection, normalization, empathic responses (i.e., “I’ve had that happen to me too.”).  Below are examples of some validating parent responses:

  • Child: This homework is so hard! I hate my teacher for giving this to us.
  • Parent: Hmm, yes, it is tough to get through it tonight.
  • Child: My friend was so mean at recess today.
  • Parent: It sounds like you’re still upset about it, I’m sorry that happened.

Try to start thinking about the language you use to respond to your child when he/she is expressing an experience or a feeling.

Stay tuned for the next post in the Parenting Practices series!

Reference:

Siegel, D. J. & Hartzell, M. (2003) Parenting From the Inside Out. New York, NY: Penguin Group (USA) Inc:


Supporting Children’s Emotional Development… Starts With Accepting Their Feelings

By Dr. Jaime Marrus

Recently, many parents that I work with (either independently or in conjunction with working with their children), have asked me for “parenting strategies.” My first instinct is to reassure them: “You are wonderful parents!” (as this undoubtedly applies to the families with whom I currently work). First and foremost, my goal is to empower them to feel confident in their own techniques and relationships with their children. They often smile and look a bit embarrassed, and say something like, “Well, thank you, but… maybe there are strategies to help me be better.” I am so touched to be in a position in which parents turn to me (not yet a parent myself) in these moments to glean information and suggestions to promote more effective interactions in their own homes.

So, I have taken some time to reflect on more concrete “strategies” and conceptualizations to impart upon parents, and began combing through my dusty bookshelf that I should remember to consult with more regularly.

While there are a seemingly infinite number of wonderful resources that I could “assign” parents to read, I view it as my job to scour these resources myself in order to share the “take home (literally) points” with clients– “THP’s,” as an old professor of mine called them.

In the rest of this post and those that follow in the coming months in this Parenting Practices series, I will provide you with some bullet-point strategies to consider and practice in your own home. You can find resources at the end for further reading.

This month’s strategy: Accept your children’s feelings!

Ideally, everyone (including and especially children) wants their feelings to be recognized and heard.  However, as a parent you may find yourself, now that you think about it, “denying” your child’s feelings from time to time.  The renowned book, How To Talk So Kids Will Listen & Listen So Kids Will Talk, include some great examples.  The authors, Faber and Mazlish discuss how natural it is for us to respond to something as straightforward as “Mom, I’m hot, I want to take off my sweater.” with “It’s cold in here, keep it on.” The same tendency is often true for emotional expressions.  For example, “I hate the new baby!” is likely (and even understandably) met with “No, you don’t! Don’t say such a thing, that’s not nice, you don’t mean it.”  But, let’s think about what we are really communicating here with such responses. The broader message that is likely unintentionally communicated may be a denial of the possibility that children just may have different feelings from us, the adults. So, the first step to accepting our children’s feelings is to accept them as they are- and that they may be (or are even likely to be) different from our own.


To practice this technique, take some time to consider how you can respond to your child in an accepting way in the following scenarios (as you may encounter them in the not-so-distant future). I included examples of some accepting parent responses:

1.         Child: I hate school!  I am terrible at math.

           Parent: Wow, you are feeling terribly about math and school right now.  I wonder why.

2.         Child: My big sister is the meanest in the whole world!

            Parent: Wow, she is so mean?  What happened?

3.         Child: (crying, tantruming) I don’t want to leave the playground!

            Parent: Yes, I know how hard it is to leave the (slide, swings, friends, etc).

Take some time to recognize opportunities to accept your child’s feelings, rather than (likely accidentally) deny them. This is a great first step in attuning to your child and setting yourself up for additional techniques to build emotional connections and understanding in your child.

Stay tuned for next month’s post in the Parenting Practices series on validation

References:

Faber, A. & Mazlish, E. (2012) How To Talk So Kids Will Listen & Listen So Kids Will Talk. New York, NY: Scribner


Free Parent Workshop: Transitioning to Kindergarten 4/10/2019

We are pleased to announce that Dr. Lauren and Dr. Jaime will be presenting their annual FREE parent workshop on Ensuring a Successful Transition to Kindergarten on April 10, 2019. Please forward to any parents of children of children with special needs who are navigating the “Turning Five” process and preparing for kindergarten starting September 2019. RSVP to: jmarrus@drtobingpuente.com

Signs of Love: A closer look

I recently came upon a posting from a joyous new mother citing an article on “signs your babies love you.”  I soon found that many websites that cater to new parents have articles listing the ways parents can determine that their babies love them.  I was appalled.

First, the title of such articles is not accurate.  The “signs” that these articles list are not indications of “love,” but actually signs of appropriate social-emotional development (in Western culture).  Of course, “signs of love” is a much catchier title than “developmental milestones,” but the distinction is a very important one to make.  The following are some examples of behaviors included in these articles:

  • Eye contact
  • Smiling at you
  • Noticing when you enter a room; showing an eagerness for your attention
  • Coos at you
  • Reaches his/her arms at you to signal that he/she wants to be picked up
  • Showing distress when you leave

These behaviors should most certainly be celebrated; not as signs of “love,” but rather as signs that the baby is developing fundamental developmental capacities, such as the capacity to share attention and relate and engage with their caregivers.  These foundation skills are essential in developing self-regulation, socialization, emotional processing, play skills, and many, many other developmental milestones.

Second, and more disconcerting to me is the impact of such articles on parents of babies who may not be showing these signs. There are many parents whose children with special needs do not display these signs, but under no circumstance does that mean these children do not love their parents, or that this should be questioned by the parents themselves or anyone else. It is important for parents of children with neurodevelopmental differences in relating and communicating to know that just because their children do not look at them or engage with them as expected, they still do love them. These parents and children may need the support of professionals who are specifically trained in helping parents and children attune to one another.  Stanley Greenspan, MD’s DIR (Developmental Individual Differences Relationship-based) model and related Floortime approach1 specifically addresses this. Such support may include identifying and developing expressions of love in unique and wonderful ways.

Third, and probably most alarming to me is the impact of such articles on the babies themselves.  Imagine a child who is born with developmental differences.  Maybe he has difficulties coordinating his eye gaze because his visual system is not well-integrated with other sensory systems, which impacts his ability to make eye contact.  Maybe her sensory system is overloaded and cannot process a combination of stimuli in loud and busy environments.  Maybe he doesn’t register that his parent entered the room because his auditory system has trouble quieting and ignoring the extraneous buzz and brightness of the fluorescent lights.  Maybe she needs so much swaddling and rocking to feel regulated that she has not yet mastered (or have time to master) attending to her mother’s face.  How sad for such babies that their developmental differences may be misinterpreted as a lack of love or affection for their parents.

The last thing children who are born with developmental challenges need are caregivers who think that they do not love them.  From my experience working with autistic self-advocates, they are glad to express and explain their unwavering love for their parents, even though they may never had made eye contact with them when they were babies or displayed other signs listed in the aforementioned articles.

Thinking again about the parents, giving them the false idea that their babies do not love them is far more likely to dishearten, sadden, worry, and possibly depress parents, rather than spur them to reach out for support, ask questions of their pediatrician, or initiate a developmental screening.  Thinking or feeling that your baby does not love you is likely to be embarrassing, which may even be an impediment to seeking help.  Further, I shudder while wondering if such parents may subconsciously change their behavior toward their babies if they do not think their babies love them, rather than understanding that they may need support in developing these social-emotional behaviors.

I am thrilled with the anecdotes often shared by parents of children with autism spectrum disorders (ASD) and other neurodevelopmental challenges who have learned to attune to their children and develop more robust relationships with them.  I have heard numerous accounts of how those parents recognize the, often unconventional, signs that their children love them:

  • “He (five year old) never used to look at me, but when I swing him around fast the way he likes me to, he looks right at me.”
  • “She (three year old) presses her chin into my knees, which prompts me to squeeze her tightly.  That’s when I know she is with me.”
  • “The more I join in with his (10 year old’s) interests, the closer he stays to me, and the more he wants to be around me.”

These expressions of love are reflections of the beauty of parent-child relationships among those with a range of developmental differences, and are worthy of celebration.  Lets remind ourselves that the signs most commonly listed in the general media should be celebrated as signs of social-emotional milestones in Western culture.  Suggesting that they are signs of love can be dangerous to those with developmental differences or special needs and their families.

 

1 For information on DIR/Floortime, see:  Greenspan, S. & Wieder, S. (1997). The Child with Special Needs. Perseus Books, and http://www.icdl.com.

“I have Autism”: Self-advocacy and Learning from the individuals we serve

By Dr. Jaime Marrus

As a psychologist working with individuals with a range of communication abilities, I often find myself wondering about what my clients are thinking, specifically with regard to the effectiveness of a particular intervention or treatment approach. Thus, I recently came across a report commissioned by the Office of Developmental Primary Care (of the UCSF Department of Family and Community Medicine), prepared by the Autistic Self Advocacy Network of Greater Boston. In reading the document, titled “First-Hand Perspectives on Behavioral Interventions for Autistic People and People with other Developmental Disabilities,” I was reminded of an experience I had just over a year ago.

I was at a friend’s destination wedding, and during the rehearsal dinner, the “emcee” of the evening (the groom’s brother), introduced the next speaker who was to share her well wishes for the couple— one of the bride’s sisters. As the rest of the guests sat in dresses and sleeveless tops (Northerners enjoying the Floridian weather), the bride’s sister walked up to the podium wearing a purple puffy winter coat and sweatpants. She introduced herself as the bride’s sister, and then simply stated, “I have autism. So I don’t like talking in front of crowds.” She then went on to deliver a speech riddled with humor, insight, and incredibly practical and heartfelt advice for the newlyweds-to-be. Needless to say, I experienced a surge of emotions as she wrapped up her speech: joy, pride, awe, compassion.  Tears sprang to my eyes and I looked down to see my hands clapping wildly.  I looked around at my fellow guests to see them all dabbing at their eyes with napkins, and some even rising from their seats to applaud.

As I reflect on that evening, I remember wondering about what the other guests were thinking. Surely, I thought, they were responding to many different things in the moment: that the young woman “made it through” her speech, that she even had the courage to make the speech at all, and, not the least of which, that her words themselves were brilliant and funny and kind.  And of course, I appreciated all of those things as well, in spades. But I was most focused on her opening statement, declared using the same conviction with which she doled out marriage advice: “I have autism.” This simple statement and its effect on me resounded so much with Dr. Tobing-Puente’s message in her previous blog, “21 Years of Autism,” specifically the theme of self-awareness and self-advocacy.  As a psychologist who specializes in working with individuals with autism spectrum disorder and their families, I was truly touched by the heartfelt reactions of the guests around me. However, I continue to be even more touched by the speechmaker’s own frankness, her openness in speaking her truth.

I am grateful to be at this point in my career during a time in which self-awareness and advocacy is growing stronger.  I recently completed the LEND fellowship program (Leadership Education in Neurodevelopmental Disabilities), in which professionals from a variety of disciplines (e.g., psychology, social work, occupational therapy, speech/language therapy, etc.) were trained to assume leadership roles in their fields.  For me, a noteworthy component of this program was the participation of a “self-advocate” as a LEND fellow himself, participating in the same curriculum to apply to his own career in policy and self-advocacy.  As emphasized by the self-advocacy network that prepared the aforementioned report, I believe it is so important to learn from the very people we are serving, and I plan to continue to seek such opportunities throughout my career.  I am always eager to read works published by self-advocates and/or their families (e.g., The Reason I Jump by Naoki Higashida, Thinking in Pictures by Temple Grandin, Look Me In the Eye, by John Elder Robison), and hope to engage in enlightening dialogue with my clients and their families about lessons learned from them. As noted in  “21 Years of Autism,” in which Dr. Tobing-Puente discusses “how the world has changed with respect to autism” during her decades of work, and in relation to the NAA-NY Metro panel, I also feel fortunate to be in a position to use the training and knowledge that I have (based on the DIR/Floortime model) about individual differences, including sensory processing profiles, to help families understand why their children may behave in certain ways… or why it is perfectly okay to wear a puffy winter jacket to a rehearsal dinner in Florida.

P.S. I encourage self-advocates, caregivers, and professionals to read the report written by the Autistic Self Advocacy Network of Greater Boston. However, for those who would like a quick glimpse, here are some brief excerpts from the report that stood out to me:

“The Autistic Self Advocacy Network of Greater Boston prepared this report to provide personal perspectives on behavioral interventions for people with developmental disabilities. These interventions include Applied Behavioral Analysis (ABA), Floortime, and cognitive-behavioral therapy (CBT). We believe strongly that people with lived experience can provide well-needed perspective on what works and doesn’t work for them, and that service providers working with people with disabilities can benefit from first-hand accounts.”

“In the interviews and questionnaire responses, participants identified values they considered important in behavioral treatment: promoting positive outcomes, preventing harm to people with disabilities, protecting people’s autonomy, advocating for inclusion, being sensitive to people’s past trauma, and supporting cultural competency.”

“Participants preferred treatments to focus on skills that would help them understand their own disabilities and coping with sensory overload, as opposed to therapies that made people look less autistic on the surface. Therapies that participants considered helpful included occupational therapy to help with sensory integration, play therapy, social skills groups for children, job coaching, mentoring, and mindfulness to help with anxiety. All the therapies suggested were aimed at encouraging self-determination and self-care, rather than indistinguishability from their peers.”

“Autistic people and other people with developmental disabilities are not a monolithic community. They can come from all racial, ethnic, socioeconomic, and cultural background…”