I Need a Nap!

By Anita M. Schimizzi, Ph.D.

Have you had one of those days when there just wasn’t a good time to put your toddler down for the blessed afternoon nap?  Did his behavior and emotions look any different than they do after having a nap?  Take a moment to think about how you feel and react when you are sleep-deprived.  It gets harder to think clearly and to be in a good mood.  It’s pretty easy to feel irritable, though, right?  It’s probably not a surprise to you that toddlers would have a similar response to not getting enough sleep.  That’s exactly what the study below found, too.

While sleep studies typically focus on adults, a study in the Journal of Sleep Research by Berger and colleagues looked at 30-36 month olds.  They studied ten healthy children with no assessed sleep problems and looked at the impact of missing one nap.  Parents kept a strict sleep schedule for the toddlers for five days, at the end of which they either allowed or did not allow the daily nap.  They then repeated the same strict sleep schedule for five days and did the opposite nap arrangement (i.e., nap or no nap).

At the end of each five day period, the toddlers were observed in an emotion-related activity where they looked at pictures that typically elicited positive (e.g., baby), negative (e.g., shark), or neutral (e.g., dustpan) emotions.  They then participated in two problem-solving tasks (i.e., puzzles) with a familiar examiner, one of which was solvable and one of which was unsolvable.  These tasks took place about an hour after their typical post-nap wake-up time.

The researchers looked at displays of positive and negative emotions, as well as confusion.  Confusion, they stated, is a “knowledge emotion” that happens during times when there is low comprehension and high novelty and it can drive people to engage in a task and look for solutions. 

Just as they had guessed, the researchers found that skipping just one nap had a significant impact on the toddlers.  When they missed a nap they showed less confusion, or cognitive engagement, and more negative emotions when looking at neutral stimuli.  Missing a nap was also related to more negative displays of emotion in response to negative stimuli. 

And how about those puzzles?  After missing a nap, there was a significant decrease in positive emotions (less joy and pride) during the solvable puzzle and a significant increase in negative emotions (anxiety and worry) and decrease in confusion during the unsolvable puzzle in comparison to when they had a nap.   In other words, what may seem like not a big deal (i.e., missing one nap) looks like it led to less joyful, more anxious toddlers that couldn’t think straight enough to know when something was amiss.

The puzzle tasks are particularly interesting, as the researchers point out, for their similarity to tasks that children who attend preschool/school may encounter.  One of the first questions that I have for parents that have concerns about their child’s school performance, including the ability to stay focused, complete tasks, and regulate emotions, is how the child’s sleep is.  Not enough of it can certainly spell disaster for school performance. 

So the bottom line is pretty clear here.  Toddlers need their naps and a good night’s sleep.  And as they grow older, it is safe to say that your child will continue to need a good night’s sleep on a regular basis.  While this may sound simple, it is not always easy.  Good sleep is not a given, but doing certain things can increase the likelihood of it.  A good place to start for any child is with an established, positive bedtime routine.  For suggestions on getting started, please see Nestor’s previous post on the topic.  In the meantime, know that your child’s naptime and regular bedtime are just as important for parents as they are for the child.  We all need and deserve a break, some time to unwind, and to take care of ourselves.  Thanks for reading.  -Anita

Source:  Berger RH, Miller AL, Seifer R, Cares SR, & Lebourgeois MK (2011). Acute sleep restriction effects on emotion responses in 30- to 36-month-old children. Journal of sleep research PMID: 21988087

It Wasn’t Me: How to Handle Your Child’s Dishonesty

By Anita M. Schimizzi, Ph.D.

Awhile back, I posted about some research done on lying in children.  A very brief explanation of the study was that kids lied more often and more effectively when punishment was on the line.  Because so many children go through a lying phase, or more than a phase, I am writing this post to talk about ways to consider and deal with dishonesty.

Let’s first think about why lying gets under our skin so terribly.  Well, as parents we know that honesty is critical to healthy relationships, to having integrity, and to resolving problems.  Dishonesty can land you in a heap of interpersonal, academic, legal, and/or professional trouble both in the present and in the future and nobody wants that for their kids.

Now let’s look at our goals in confronting our child’s dishonesty.  First, we want to know the truth and we want for our kids to be able to readily share it.  Second, we want for our children to be able to make amends when their behavior affects somebody else, not skirt around the truth and try to get out of taking responsibility for it.  Third, we want for our children to be able to learn from their mistakes.  If they cannot be honest about those mistakes, then the learning is also lost.  You can probably add a lot of other goals to this list.  For this post, I’ll focus on the three above.

Okay, so how can we approach lying while keeping those three goals in mind?  Let’s start with the first goal: obtaining the truth.  This one simply takes a good dose of common sense.  If our kids fear us, fear being punished, fear the lecture, etc., then they will be less likely to come clean.  In Parenting with Love & Logic, the authors talk about the mistake parents make by stating that the child will be better off for telling the truth and then promptly punishing the child once the truth is told (p. 198-199).  Lesson learned: do not tell the truth.  Instead, parents can invite the child to tell the truth and rather than going bananas about whatever that truth is, they can instead thank the child for telling the truth, acknowledge that it was probably difficult to tell it, and then move on to the second goal: making amends.

Now I’ll get to amends in a moment, but I wanted to stay on goal one for a moment because there are likely going to be times that your child simply presses on with a lie.  Oftentimes, this happens because your child has been placed in a situation where he may feel compelled to lie, something Ginott referred to as “provoked lying” (p. 65-71).  Here are some things to consider: accusatory tones, statements, and/or questions will likely result in the lie being defended.  The why’s, how could you’s, and what were you thinking’s can pretty much assure us that our children would rather we didn’t know the truth.  

And one more thing to consider here: if you know the truth please don’t pretend that you don’t.  It is more productive for everyone if you simply state the truth and then move on to the second goal of making amends.  For example, your child comes to you with finger paint on her shirt and you say, “How did that finger paint get on your shirt?!”  Is she likely to respond in the same way as she would had you said matter-of-factly, “You got finger paint on your shirt.  What are you going to do about that?”  You get the idea.

 Now on to making amends.  Here is an opportunity for children to take responsibility for their behavior and it can be done in a way that puts the onus on the child for making a situation right.  How many of us have said these words to our child, “Now say you’re sorry”?  And then what do we usually get?  The empty apology, the humiliated apology, the resentment-filled apology, or some other type of sorry that just does not help in the character-building realm.  Here is another way to approach the situation: “Okay, so you broke the picture frame when you were throwing the ball in the house.  You were probably pretty worried about what I would do when I found out.  Well, how can you make this situation better?”  Having the child come up with and execute a plan can oftentimes yield surprising results.  And if the child struggles to come up with a plan, then you can make a simple offer.  “Let me know if you would like some help coming up with ideas.”  This approach allows your child to remain in the driver’s seat (because we do ultimately want them to be the ones to take responsibility) while also having a wise resource to tap: you.

Putting together goal one and goal two, we have met goal three: learning (and learning the messages that we really want them to learn).  We have allowed our child the opportunity to learn that telling the truth is beneficial and that mistakes can be made and remedied.  True, our behaviors may have consequences that cannot be undone, but at least we will be putting our child on the path of doing everything that he can think of to make things better.

One last thing: when you have a moment to connect with your child after the lying dust has settled it can be a good idea to have a heart-to-heart.  This is a good time to again commend your child for telling the truth and for talking about why honesty is important as well as some of the reasons that people lie.  This talk can be a way to help your child understand himself a little more as well as not feel that something is inherently wrong with him.  As always, this talk does not mean lecture.  It means having a talk something like this:

“I want to tell you again how proud I am that you told me the truth about losing my watch.  I know that I can go pretty bonkers when you lose my things and I can definitely freak out when I find out that you have not been honest with me.  That took some serious courage! 

“As someone that loves you very much, I need to say something to you about telling the truth.  I know how important it is to be honest with people so they can trust you and help you when you need it.  I get why it’s hard sometimes to tell me what really happened.  There’s the bonkers factor, for one, and lots of kids have that same fear about their parents.  They also sometimes feel really embarrassed or upset and don’t think that they can make up for what they did so they don’t want anyone to find out.  I promise that I will do my best to not lose it when you tell me about something not so great that you did and I really hope that you’ll feel more okay about telling me about what’s going on.”

Thanks for reading!  -Anita

Sources:

Cline, F. & Fay, J. (2006). Parenting with love & logic: Teaching children responsibility (updated and expanded ed.). Colorado Springs, CO: Pinon Press.

Ginott, H.G. (2003). Between parent and child: The bestselling classic that revolutionized parent-child communication (revised and updated ed.). New York: Three Rivers Press.

Diagnosing ADHD: What every parent should know.

By Nestor Lopez-Duran PhD

A few weeks ago the American Academy of Pediatrics published the new practice guidelines for the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD). These guidelines are supposed to help pediatricians and other primary care physicians in the care of kids with ADHD. Although I agree with most aspects of the guidelines, I am not surprised that the guidelines created significant controversy among psychologists because many aspects of these guidelines are limited, and arguably may not improve the care of kids with this condition.

So, here are some thoughts that may help parent navigate the complex process of ADHD diagnosis.

Currently, the general consensus among psychiatrists and psychologists is that ADHD is diagnosed based on the criteria included in the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV Click here for the full diagnostic criteria for ADHD and a discussion of the proposed changes for the new DSM-5). Although I wont summarize the full criteria here, I want to talk about four important aspects of the diagnosis of ADHD, some of which are often disregarded by clinicians resulting in questionable diagnoses.

Aside for some additional details, ADHD is diagnosed when a child:

  1. Displays a minimum number of specific symptoms that are maladaptive and inconsistent with developmental level;
  2. The symptoms are observed in 2 or more settings;
  3. The symptoms dont occur exclusively (or arent due to) a number of other neurodevelopmental conditions; and
  4. There is clear evidence that the symptoms result in clinically significant impairment in the kids social, educational, or personal functioning.

On that note, the role of the recent guidelines by the American Academy of Pediatrics (AAP) is to provide clinicians with clear instructions about the procedures that they should follow to determine whether a child meets the criteria presented above.

In sum, the AAP states that:

A. The primary care clinician should initiate an evaluation for ADHD for any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity.

This first guideline is not too controversial since there is evidence that the proper identification and treatment of young kids can improve the kids outcomes (e.g., better academic performance, social functioning, etc).

B. To make a diagnosis of ADHD, the primary care clinician should determine that Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) criteria have been met (including documentation of impairment in more than 1 major setting), and information should be obtained primarily from reports from parents or guardians, teachers, and other school and mental health clinicians involved in the child’s care.

Here the guidelines become limited. The problem is that this specific guideline does not tell the pediatrician HOW to make sure that the kid meets DSM-IV criteria other than by obtaining information from parents and teachers, etc. What does obtaining information mean in terms of actual practice?

There are two key issues regarding this guideline that pediatricians and parents should keep in mind.

First, the behaviors (symptoms) reported by the parent or teacher must be inconsistent with developmental level.  This means that the problem behavior must be in excess of what is expected for the childs age. But in excess according to whom? That is, who decides what is appropriate for each age? The pediatrician? The parent? How much hyperactivity or inattention is expected in a child age 5? How about a child age 8? Does the sex of the child matter in terms of what is expected for a specific age? The questions are endless.

This is a problem that does not have an easy answer, but clinicians should at the minimum use well validated parental and teacher questionnaires that have been properly normed, which the guidelines do not mandate. These questionnaires allow the clinician to compare the parent and teacher reports to those of thousands of other parents, which helps the clinician determine whether the childs behaviors are in excess to what is usually seen in children of his/her age.

Although there are some limitations with these questionnaires, I would be extremely skeptical of a clinician that makes a diagnosis of ADHD based simply on a brief interview with the parent without having the parent and multiple teachers complete these questionnaires.

The second, and much more complicated issue is that, according to the DSM-IV, the symptoms must result in clinically significant impairment in the kids social, educational, or personal functioning. What does this mean? Specifically, what does clinically significant impairment means and how is it determined? That is, who decides that the child is experiencing impairment due to his/her symptoms? Is a parents concern about the kids academic functioning enough evidence of impairment? How about a teachers frequent complains about the child? Is that enough evidence of impairment? The guidelines call for documentation of impairment in more than 1 setting, which is a good start, but it is not clear what this actually means in terms of actual practice by the clinician.


The problem is that there is no definition as to what clinically significant impairment is, and how it should be measured or documented, and relying only on the reports of a parent or a teacher has some limitations. For example, a child may be labeled a problem child by one teacher while other teachers may have no issues whatsoever with the childs behavior. Similarly, a parent may complain extensively about his/her sons behavior while the other parent may think that nothing is really wrong. Who is right and who is wrong?

This highlights the issue that determining whether the symptoms are causing impairment is not easy, and requires significant effort on the part of the clinician. Thus, I would be skeptical of any clinician that makes a diagnosis after talking only to one parent or one teacher (although in some unique cases this may be appropriate or necessary). Instead, clinicians should obtain information about level of impairment from as many people as possible, including both parents or guardians and multiple teachers. I would also be skeptical of clinicians that make a diagnosis after only asking whether specific symptoms are present or not, without using specific questionnaires to assess impairment or at least paying attention to how much the symptoms are affecting the childs functioning. For example, clinicians should ask to see the kids report cards, talk to multiple teachers, and document specifically how the behaviors affect the child at home.

Finally, the AAP states that:

C. Clinicians should include assessment for other conditions that might coexist with ADHD, including emotional or behavioral (eg, anxiety, depressive, oppositional defiant, and conduct disorders), developmental (eg, learning and language disorders or other neurodevelopmental disorders), and physical (eg, tics, sleep apnea) conditions (quality of evidence B/strong recommendation). 

The problem here is that the AAP guidelines did not indicate who or how such assessment should be made. Although Pediatricians can screen for these conditions, Pediatricians in general are not trained (nor have the time, sadly) to conduct the type of comprehensive evaluations needed to properly diagnose most of these conditions. Therefore, my interpretation of this guideline is that pediatricians should refer the child to other professionals in order to obtain the necessary evaluation that would rule out the possible presence of these conditions.

Therefore, I would be skeptical of a clinician that makes a diagnosis without at least asking questions that suggest that the clinician is screening for the possibility that the child may have another condition, such as conduct or learning problems, depression, anxiety, and other neurodevelopment disorders (e.g., autism).

I sum, when considering whether your pediatrician or other healthcare provider has properly diagnosed your child, you should ask yourself the following questions:

  1. Did the evaluation include long questionnaires completed by me, other adults living at home, and multiple teachers, coaches, etc?
  2. Did the clinician pay attention to how and if these symptoms are affecting my child, such as by asking for my kids report cards and talking to teachers and family members?
  3. Did the clinician rule out other conditions. For example, did clinician recommend that my child should get an evaluation for learning disabilities, or did he/she suggest that I see a child psychologist/neuropsychologist to rule out the presence of a mood/behavior or other developmental problem?

If you answered no to any of these questions, I would recommend getting a second opinion about your childs diagnosis.

The reference:
Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management (2011). ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents PEDIATRICS, 128 (5), 1007-1022 DOI: 10.1542/peds.2011-2654

Put Aside the To-do List: How to Bring Mindfulness to Parenting

By Anita M. Schimizzi, Ph.D.

Mindfulness.  It’s practically a buzz word these days.  Even Oprah is talking about it.  So what is mindfulness, exactly, and why all the buzz? 

In brief, mindfulness is the bringing of one’s attention to what is right here, right now.  It is inviting oneself to let the ruminating about the past go and the obsessing about the future go as well.  And just as important, it is treating yourself with compassion while suspending judgment.  Studies have given much support for the usefulness of mindfulness in treating a variety of mental health and medical conditions, such as depression, anxiety, and chronic pain and stress (Baer, 2006).  By simply being where you are and gently and compassionately bringing yourself back to the moment when you find yourself wandering elsewhere, you can calm your nervous system and allow a peace that we could all use.

Hectic doesn’t begin to describe the busyness that we can experience in tending to child-rearing, work, errands, running a home, and the variety of other things that we do that fill our days.  I know that for me, I have spent many moments with my son where I was not truly with him.  My mind was wandering to a million places at once:  dinner planning, work, laundry, the errand that I forgot to run yesterday, and what I wish I had said during a prior conversation.  What I realize now is that in my quest to square away the past and the future, I missed a lot of what was right in front of me. 

The good news is that we have choices.  And we can choose to join with our kids and relish what is right before us.  Here are a couple of ways you can try.

1.  Be in the moment with your child.  In the beginning, this can seem pretty challenging when you really try to do it.  That’s okay.  Practice will make it easier in time.  If you tend to move quickly and busily through your day, I recommend finding a time when you can be unhurried.  Manufacture an opportunity to be mindful, so to speak.  Set aside your agenda and let things unfold between you, your child, and that which surrounds you. 

For example, let’s say that you usually take your child out in the jogging stroller, have your run, and promptly return home.  Instead, you can go out and have your run, but rather than return home right away you can stop somewhere while you’re still out and let your child out of the stroller.  Go explore together.  When you find your mind wandering back to what you really, really need to get done, recognize that you are worrying about what you really, really need to get done and kindly nudge yourself to come on back to the present moment.  Besides, let’s face it, the worrying does not bring us much benefit.  Oftentimes, it is just chatter that keeps our brains hyped up more than they need to be.  Your to-do list will be waiting for you when you’re done watching the birds, smelling the fresh air, and listening to your child giggle with delight after throwing a rock in the pond.  

2.  Do a sensory activity with your child to practice being in the moment.  Using as many senses as you can, experience the moment with your child.  A fun time to do this is snack time.  Rather than gobbling a snack only to get to the next thing on the agenda for the day, mindfully eat it. Study the look, texture, taste, smell, and sound the food makes as you bend, break, and chew it.  Or take a mindful walk together.  Again, using all of your senses, discover what surrounds you in that very moment.  It’s kind of hard to be elsewhere when you are that connected to the here and now. 

These are just a couple of ways that you can practice dropping into right now.  I would love to hear back from readers on any other ideas they have, as well as their experiences with practicing mindfulness in parenting.  In the meantime, enjoy giving your brain a break from all the noise and being truly present with your child.  This week is a perfect time to do this.  The kids are out of school for a couple of days and we have the choice to slow down and really connect.   I wish you and your families a safe and lovely Thanksgiving.   -Anita 

Source: Baer, R. (2006). Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review Clinical Psychology: Science and Practice, 10 (2), 125-143 DOI: 10.1093/clipsy/bpg015

Liar, liar, pants on fire: How punishment can affect children’s honesty

By Anita M. Schimizzi, Ph.D.

Raise your hand if you’ve been there.  Your young child has just gotten into something that she knew was off-limits.  When met with an angry, red-faced you and the threat of punishment, she denies having done anything.  Now replay this scenario where she commits the forbidden act, but you approach her matter-of-factly and she knows that there is no threat of harsh punishment.  Does she still lie?

Many, if not most, parents out there wish for their children to be honest.  We know that honesty lies at the heart of healthy relationships, for it helps people to build and maintain trust in one another. Are there discipline styles, things that we are doing as parents, that hinder or promote honesty?  Talwar and Lee (2011) lend evidence to the affirmative. 

The researchers recently published a study in the journal Child Development where they conducted an experiment with 3- and 4-year-old preschool children in two West African schools serving children from comparable backgrounds.  One school was deemed to be punitive (e.g., allowed beating with a stick, slapping of the head, and pinching) and one was labeled non-punitive (i.e., utilized time-out, scolding, and, for more serious offenses, trips to the principal’s office).

Each of the 42 children per school underwent what the authors call a “temptation resistance paradigm” study wherein the adult examiner played an object guessing game with the child and then excused herself from the room, having “forgotten” something.  The child was recorded during the one-minute departure after being told not to peek at the object left behind by the examiner. 

Upon the return of the examiner, the child was asked if he/she peeked at the object.  Regardless of the response, the child was then asked what the object was.  In other words, the lying child either confirmed the lie by stating exactly what the object was or covered up the lie by saying it was something different or responding with something like, “I don’t know.” 

As you may guess, most of the children peeked regardless of which school they attended.  Who could resist?  The difference came in how they responded to the examiner’s questions.  While just over half (56%) of the children from the non-punitive school lied about peeking, almost all of the children (94%) from the punitive school lied regardless of age. 

Further, 70% of the children from the non-punitive school told what the object was (revealing their lie) and 31% of the children from the non-punitive school told the truth about the object.  In other words, the children from the punitive school were over five times more likely than the children from the non-punitive school to cover up their lie by telling another lie.

The authors concluded that the threat of severe punishment may not only encourage lying, but the lying may be more advanced as children learn ways of continuing the cover-up to avoid punishment.  Conversely, it may be argued that environments that are “non-punitive” may also allow children the safety that they need to be honest about their transgressions. 

The argument makes good sense.  You would probably be hard-pressed to find a child that comes clean with the knowledge that harsh punishment is sure to be delivered just as you would be more hard-pressed to find a child that is unwilling to tell the truth when he feels that it is safe to do so.  In the end, would you rather have your child do the right thing because he fears punishment or because it is the right thing to do?

Thanks for reading.  -Anita

Source: Talwar V, & Lee K (2011). A Punitive Environment Fosters Childrens Dishonesty: A Natural Experiment. Child development PMID: 22023095

A Little Control Goes a Long Way: Why and How to Use Forced Choice With Your Child

By Anita M. Schimizzi, Ph.D.

In a previous post on time-out, I mentioned the technique of forced choice.  Reader feedback tells me that this topic is a good one to cover on its own.  So without further ado, here you go.

Why Use Forced Choice

First, let’s talk first about why it is important to give children choices.  Perhaps it’s easiest to start with someone you know very well: You.  Think about how it feels to have your power stripped from you, to feel that you have no say in a matter that’s important to you.  For children, most matters do feel pretty important.  And, let’s face it, kids get told many, many times a day what to do, when to do it, and how to do it.  While having a parent as a guide can feel quite comforting, having a parent with all of the control can feel pretty terrible and sometimes downright infuriating.

Kids need an opportunity to gain a sense of control by having a say, to make mistakes, and to learn from their decisions in a supportive context.  (Refer back to the natural consequences post for more on this.)  Giving choices allows for all three to occur.  It’s simply more empowering to be a decision-maker rather than a passive participant in your life.  Looking back at Diana Baumrind’s seminal 1960’s research on parenting styles, she and several others (e.g., Maccoby & Martin) since that time found that those that use an authoritative style had some pretty positive outcomes with their children.  In a nutshell, this style provides structure within a democracy.  That is, parents set the stage with rules, expectations, and guidance while allowing their children healthy decision-making opportunities.  And when their kids mess up, they are typically met with a supportive style rather than a punitive one so their kids can worry more about learning from mistakes than hiding them from their parents.  They can then apply this knowledge moving forward as they are presented with more opportunities for decision-making.

Contrast that with an authoritarian style where mom and dad are more like drill sergeants that dictate so much of their child’s existence that the child has difficulty building the capacity to make his own good choices.  And then there is the permissive parenting style where kids have so much freedom that they can easily tend toward being the kids that grown-ups refer to as out-of-control.  Finally, we have the neglecting/uninvolved parenting style that is as its name suggests and these kids typically struggle with a host of problems such as depression, aggression, and poor self-control.  And this brings me back to the authoritative parenting style and, more specifically, the technique of forced choice that falls under the umbrella of authoritative parenting.

So we talked about some of the benefits of forced choice already, such as helping kids feel empowered and safe to make and learn from mistakes.  An added bonus is that it can get parent and child unstuck during power struggles.  A tense situation can be easily defused when a parent can think of some good solutions to the problem at hand and then offer the child a choice of these solutions.  For example, let’s say that the morning is rushed and you’re afraid that you’ll be late for work and your child late for school.  You toss some clothes on your child’s bed and tell her to get dressed.  She yells that she doesn’t like that outfit.  You have the option of pressing on by telling the child to put on the clothes anyway OR you can take the opportunity to quickly say something like this: “Sometimes there are clothes that I don’t feel like wearing on some days, too.  Would you like to wear your flower dress or your frog outfit today?”  The five seconds that you spend giving your child a choice can easily save you five minutes of power struggling with her.

How to Use Forced Choice

While there are times when choices simply cannot be offered, as in circumstances where safety is truly at risk, there are many times during the day where an opportunity to make a choice can be easy to give.  Here are some guidelines for offering a forced choice:

1.)    For very young children (e.g., preschoolers and beginning elementary kids), it is typically easiest to offer two choices.  For older children and adolescents, more choices can be offered if you sense that your child can handle them.

2.)    Any choice offered needs to be one that you genuinely support.  For example, giving your child a choice to do homework now or in the morning when you know that doing it in the morning will likely cause a lot of stress on your child as well as you may not be a good idea.  Offering the choice of doing homework now or right after dinner may work better for all involved.

3.)    If a child is given the list of choices and refuses to make a decision, you can offer something like the following statement: “I have given you your choices, but you are not telling me which one you want.  I will give you one more minute to think about it and tell me.  If you don’t, then I’ll make the decision.”  Most frequently, this results in the child seizing control of the situation by making a choice.  If he doesn’t, then it’s important to follow through with what you said and make the decision for him.  True, you may get a tantrum out of the deal, but that’s better than your child learning that your word will not be kept.

4.)    Sometimes kids have great ideas for choices and deserve to be heard.  For example, you may give the option of wearing a coat to the store or putting it on the seat in the car.  The child may make the suggestion of putting the coat in his bag and putting it in the car.  Times like these warrant comments like this: “Wow!  I didn’t think of that one.  That sounds perfectly reasonable to me.  Let’s head out.”

5.)    As I mentioned in the time-out post, forced choice is perfectly acceptable to use during times of misbehavior.  For example, a tantrum at the grocery store can be met with the following: “You can continue to yell and we’ll go home now or you can use a calm voice while we’re in the store and we’ll keep shopping.”  Of course, you have to be willing to leave the store immediately if the tantrum continues.

6.)    When the child has made a decision from the choices available and things don’t work out very well, an opportunity for talking about the outcome has presented itself and should be taken.  For example, let’s say that you gave your child the option of taking a peanut butter and jelly sandwich in his school lunch or taking yogurt.  He chose the yogurt but ended up hungry much earlier than usual.  A situation like this could be met with something along the lines of, “Oh, I’m sorry to hear that you got so hungry at school.  I’m wondering if there is something else that you could choose for your lunch that would fill you up for longer.”  This statement is a whole lot different from “You were the one that chose the yogurt so those are the breaks.”  Remember, we want our kids to feel safe to come to us with their concerns as well as empowered to make good decisions for themselves.

As always, thanks for reading.  -Anita

This post is sponsored by The Chicago School of Professional Psychology. Get your degree in psychology.

Sources:

Baumrind, D. (1966). Effects of Authoritative Parental Control on Child Behavior, Child Development, 37(4), 887-907.

Baumrind, D. (1967). Child Care Practices Anteceding Three Patterns of Preschool Behavior. Genetic Psychology Monographs, 75(1), 43-88.

Maccoby, E. E., & Martin, J. A. (1983). Socialization in the Context of the Family: Parent–child Interaction. In P. H. Mussen (Ed.) & E. M. Hetherington (Vol. Ed.), Handbook of Child Psychology: Vol. 4. Socialization, Personality, and Social Development (4th ed., pp. 1-101). New York: Wiley.

The Universe is a Great Teacher: How to Use Natural Consequences to Help Your Child Learn

By Anita M. Schimizzi, Ph.D.

The scene: Jamie, a fourth-grader, knows that he is responsible for remembering to put his lunch in his backpack for school.  He has forgotten it today for the umpteenth time, which his mom does not notice until the school bus is pulling away.  She sighs and puts the lunch in her car, again.  On her way to work, she stops at school and drops it off for Jamie, especially because she knows that he does not like the school menu for the day.

We’ve all been there.  Your child wants to do something or has forgotten to do something that you fear will result in unwanted consequences.  Your impulse is to assert your opinion, change the behavior, or otherwise involve yourself so your child does not have to suffer those undesirable outcomes.  It may be helping with last minute homework that the child knew needed to be done, bringing the winter clothes to the car that your child refused to take on a cold day, or contacting a teacher because you did not agree with a grade.  When this need to intervene becomes extreme, we call this parenting style helicopter parenting due to the image that it conjures of a parent hovering around the child ready to act the moment anything looks like it may go wrong.  Guess what?  We may be doing our child a disservice by stepping in.

In a 2010 study of 300 college freshmen conducted by Neil Montgomery and colleagues, they explored traits held by students who reported having helicopter parents (those that exhibit parenting behaviors that are viewed as overly involved or meddling) versus students who did not.  Yes, the study’s findings are preliminary and more research needs to be conducted in this area, but the results thus far are rather interesting.  While it is likely that helicopter parents mean to convey love and support of their children, their style of parenting may lead to unintended and costly effects.  For example, the study participants with helicopter parents were found to be more anxious, dependent, self-conscious, impulsive, and vulnerable than their peers without helicopter parents.  You may wonder where the balance is.  In other words, how do we develop self-sufficient, confident children without allowing them to fall too far into harm’s way?

Natural consequences are what happen when we allow our children to act and then see how the world responds.  For example, if a child does not wear matching clothes he may be made fun of at school.  If a child does not eat dinner she will be hungry when it’s time for bed.  I have always enjoyed using natural consequences as a teaching tool with my clients.  Sometimes, they were simply more willing to go and find out something for themselves than they were to listen to me offer my words of wisdom.  “Wow!  You decided it was worthwhile to throw a chair at the wall, causing property damage and now you have to pay for it with what little money you have left in your account?  Interesting decision.  Any take aways from that?”

Now that I am a parent, I can really attest that this stuff works.  For example, the other day my son decided to wear his favorite shoes on a muddy, wet playground.  He, of course, returned home with muddy, wet shoes.  They were so wet, in fact, that he was unable to wear them for the next three days.  When he inquired about them each morning, we took a look and saw that they weren’t dry enough yet, which he found to be very irritating.  The lesson: if you want to wear your favorite shoes every day, then it’s probably not a good idea to get them all wet and muddy.  Wear old shoes that you don’t care about instead when it comes to wet, muddy playgrounds.

I have several parameters for determining when it is a good idea to use natural consequences:

  1. It is never appropriate to allow your child to be put in true danger (e.g., seatbelts are non-negotiable).
  2. It is best to use natural consequences when you are not in a hurry.  It can take extra time to allow your child to manage a situation on his/her own and a time crunch can add extra stress to the situation.
  3. If something is extremely important to you, then it is not the time for natural consequences (e.g., going to a formal wedding in dirty overalls probably isn’t the way to learn about socially-appropriate attire).
  4. If you can afford to be flexible and you sense a good learning opportunity on the horizon (e.g., cutting an outing short when a child has refused to bring along mittens and the playground is cold), then that is the time to use natural consequences.

The primary goal of natural consequences is to allow our children to learn first-hand how to wisely navigate the world rather than feel the way the college freshmen in Montgomery’s study did.  The use of this method requires a lot of flexibility on the part of parents and the ability to let go of the need for our kids to be perfect or to never experience hurt.  Dr. Wendy Mogel has written a wonderful book on parenting based on her many years as a psychologist and educator.  It is called The Blessing of a Skinned Knee and while it is based on Jewish teachings, one need not be Jewish in order to find some very valuable information.

The Blessing of a Skinned Knee

In it, she includes a chapter on natural consequences.  She states, “Real protection means teaching children to manage risks on their own, not shielding them from every hazard.”  She goes on to say, “If parents rush in to rescue them from distress, children don’t get an opportunity to learn that they can suffer and recover on their own.”  As much as we don’t want our children to have emotional and/or physical pain, it is part of life and they must learn how to manage it.

In using natural consequences, the sooner the better.  We want our children to start thinking ahead about potential consequences from a young age so they don’t find themselves in a truly terrible situation.  It takes a lot of practice to develop this type of thinking.  Parents can anticipate many bumps in the road along the way.  It is preferable to have these bumps be less costly and they usually are when kids are younger.  For example, it is less costly to learn the lesson of thinking ahead when rain boots are forgotten than it is to drive 90 miles an hour on a curvy road at night.  In other words, the potential for true danger generally increases with age as there is access to more and more of the world.

Let’s conclude with one last example by revisiting our opening scene.  Jamie forgets his lunch and his mom notices it as the school bus pulls away.  This time, she decides that it’s more important for Jamie to learn something from continually forgetting his lunch.  After all, how will he learn if she keeps delivering his lunch to him?  So she decides to leave it right where she found it and leaves for work.  It would be nice to not have to rush her commute in order to stop at the school.  Jamie calls her cell and tells her that he forgot his lunch.  His mother empathizes with him since she knows that he doesn’t like what is on the menu.  He asks her to bring his lunch to school.  She tells him that she must get to work instead and wishes him well for the day.  Infuriated, Jamie hangs up the phone.  Later that day, he gets an IOU from the cafeteria to purchase the school lunch and eats what little he likes.  He feels hungry and grumpy.  The next day, he remembers to take his lunch.

References:

Mogel, W. (2001).  The blessing of a skinned knee: Using Jewish teachings to raise self-reliant children. New York: Penguin Books.

Montgomery, N (2010, October 11). Parents Protecting Their Investments. The New York Times. Retrieved June 29, 2011 from http://www.nytimes.com/roomfordebate/2010/10/11/have-college-freshmen-changed/parents-protecting-their-investments

How to Effectively Implement Time-out

By Anita M. Schimizzi, Ph.D.

And the argument continues…time-out versus corporal punishment.  I could do a lengthy review of the research on both, but my bottom line will still be this: if you can utilize time-out and get desired (and better) results why hit your kids?  (See Nestors 9/27/10 post for a discussion on spanking.)

That being said, here are some steps and key points to keep in mind regarding time-out.  The technique is especially recommended for young children (2-4 years but as young as 18 months) and can also be used with elementary-age children.  Bear in mind that there will be variation among professionals regarding how to specifically do time-out.  I am including what has been effective in my work with families, including my own, across the years.  You know your child and your home better than anyone and the point is to make this work for you and your family.

The Purpose of Time-out

Time-out is not a punishment, per se.  Time-out is designed to stop unwanted behavior and to give your child some time and space from the situation that involved the behavior.  Think of it as taking a break, just as you would if you were trying to solve a problem and got stuck.  Sometimes having space from the problem can decrease frustration and other negative feelings as well as provide renewed energy and greater perspective.  We want our children to eventually learn how to stop themselves from negative behaviors and find a better route.  In addition, we want our children to learn responsibility and empathy, two skills that can help them throughout life in their relationships with others.

Preparing Your Child for Time-out

A child should always be told about how to complete a time-out before the technique is used rather than waiting until the heat of the moment to go over this information.  It is also important to make sure that your child knows and understands the family rules.  During a calm time, such as family meeting time, discuss the process of time-out with your child.  You can include examples of behaviors that would warrant a time-out and then go over the steps of time-out.

You can say something like this, “We noticed that sometimes it’s hard for you to follow the rules of our family, like when you yell at your brother.  We are going to do something called time-out when this happens because we want to help you talk nicer to your brother.  When you are told to go to time-out, you will sit on the chair by the dining room for five minutes.  During that time, we expect you to be quiet and safe.  You are not to shout, hurt or play with anything, or come down off of the chair.  If you can do that, then one of us will come and talk to you a bit about what happened and how you can make it better.  You can then go on with your day.  If you are noisy, disrespectful, or unsafe in any way, then you will be in time-out for longer until you can show us that you can calm down and be ready to talk.  We are doing this because we know that you can have good behavior and we really want to help you with that.  Do you have any questions?”

Of course, this conversation would be modified for very young children.  In this case, you could say, “When you do things that are dangerous or mean you will sit by yourself on this chair for a minute.  When you calm down, then I’ll let you get down.”

Steps for Time-out

1.  Designate a time-out location.  It is recommended that this location be easily viewed by the parent, away from stimulation such as TV and toys, and in a place where the child is not likely to cause any damage to surrounding objects.

2.  When your child misbehaves instruct him/her to go to that location for time-out and state the number of minutes it will last.  Very young children may need to be escorted, whereas older children should be able to go there on their own.  Many children benefit from having a visual of the time so using a timer can be helpful.  The rule of thumb is that time-out lasts one minute per year of age.  For example, a four year-old can do a four-minute time-out.  This time can be adjusted for children that need more time to cool down, need less time due to difficulty with focusing and sitting still, etc.

3.  If the child follows expectations for time-out, then approach the child when the time is up and go through a few questions.  Modify these based on the individual child’s abilities, such as language development.  Keep in mind that this is not a time for lecturing.  You are merely helping your child think through what happened and how it can be changed to be more positive.

Here are some standard questions you can ask.  1.  Why did you have to go into time-out?  2.  What would have been a better choice in that situation?  3.  Is there anything that you can do right now to make it better?  (This question is designed to encourage rather than force your child to make amends with somebody that he/she has acted poorly toward in some way.  It is always better to have a child-initiated apology/restitution that is genuine rather than a parent-forced one that isn’t.)

Again, for very young children that don’t yet have the language to answer these questions variations are necessary.  For example, you can say, “You had to go in time-out for throwing your food.  We do not throw food in this family.  When you are done eating you can say, “All done.””  Here you are labeling the misbehavior, restating the rule, and then stating the appropriate behavior.

4.  If your child does not follow the time-out rules (e.g., yells, comes down off of the chair), then it is necessary to inform the child that he/she will remain in time-out until the rules are followed for the number of designated minutes.  Restart the timer.  For some children, restarting the timer may not be necessary because they need only to be reminded that time-out will not end until the rules are followed and you can see that he/she is ready to talk.  Use your judgment on what you think will work best for your child.  Whatever you choose, do it the same way each time so the process is predictable.

I also like to use something called forced choice in the situation of non-compliance to put control back with your child.  You can say something like this.  “You can either keep calling out and remain in time-out for longer or you can sit quietly and we can have a quick talk so you can get on with your playing.  It’s your choice.”  Once your child is compliant for the amount of time that you chose, complete step 3.

Spanking in the USA: A sad state of affairs and why spanking is never ok.

By Nestor Lopez-Duran PhD

The results were not surprising:

1. 65% of 3 year-old children were spanked at least once by their parents during the previous month.

2. The odds of using physical punishment doubled in households where parents used aggression against each other. This is not surprising since physical punishment is a form of interpersonal aggression.

3. Maternal stress significantly increased the odds of using physical punishment. This is also not surprising since physical punishment is more likely to be used by parents who are angry.

4. Maternal depression significantly increased the odds of using physical punishment.

5. The odds of using physical punishment were not associated with maternal education, but when the father had a college degree both the father and the mother were significantly less likely to use physical punishment. I am curious to hear my readers thoughts on this interesting finding.

The authors concluded (CP = Corporal Punishment; IPAV = Intimate Partner Violence):

Despite American Academy of Pediatrics’ recommendations against the use of CP, CP use remains common in the United States. CP prevention efforts should carefully consider assumptions made about patterns of co-occurring aggression in families, given that adult victims of IPAV, including even minor, non physical aggression between parents, have increased odds of using CP with their children.

Yes, the American Academy of Pediatrics unequivocally recommends against the use of aggression as a discipline method. Why? Because the research on physical punishment is clear: it is unnecessary and is associated with a long list of NEGATIVE consequences. For example, although proponents of spanking argue that if you dont spank, the child will not learn to behave properly, the research actually suggests the opposite. Children who are spanked, when compared to their non-spanked peers, are, among many others:

1. more likely to use aggression against their peers
2. less likely to internalize rules
3. more likely to engage in criminal activity during adolescence
4. more likely to engage in domestic abuse as adults
5. more likely to suffer from depression
and on and on and on.

For those who want to read more about the science behind the negative effects of corporal punishment, visit the research library of Project No Spank; http://nospank.net/resrch.htm

I unequivocally oppose the use of violence towards children as a discipline method for two reasons. The first is explained above. The scientific research shows that physical punishment does not work in the long run, is associated with an increased risk for many behavioral and psychological problems, and is simply unnecessary given that we have non-violent discipline techniques that are very effective. But I also oppose violence towards children on philosophical grounds. Although I never talk about philosophy -and especially my views- on this site, this time I want to share them with you. I am a secular humanist, and as a humanist I oppose interpersonal violence except in cases of self defense. I view spanking as a culturally accepted violent act towards a child. We use the words spanking or corporal punishment as euphemisms so that we dont confront the reality of the act: when a parent spanks a child the parent is physically assaulting the child. Why do we accept such aggression when we oppose other forms of interpersonal violence? For example, in western societies we oppose marital violence. We believe that there is no excuse that could justify a husband for hitting a wife. A husband cant argue that he hit his wife because the wife was misbehaving, or that it was just one hit, or that he used an open hand, or that the hit didnt leave any marks, etc. Under all circumstances, we oppose the assault of a wife by her husband. We do not accept the premise that it is the husbands right to hit his wife. Yet, our culture accepts the premise that it is a parents right to hit his/her child. We allow the use of violence against young children under the excuse that such aggression is culturally accepted or even necessary to teach the child a lesson. But I ask, what lesson? That we can use violence to achieve our goals? That it is acceptable to hit people when they dont do what we want? That hitting those who cant defend themselves is ok as long as you are teaching them a lesson? Children are not possessions. Children are, albeit small in size, real human beings who have the right to live in an environment where they are safe from being physically assaulted. Being free of physical harm is the most basic human right, and children should not be exempt from it.

From a scientific and humanistic perspective, there is no valid argument that justifies the use of violence towards children in the name of discipline. It is unnecessary, ineffective, and leads to many negative consequences. My explicit recommendation to all parents is: Never use violence to correct a misbehavior or to teach your child a lesson.

Three final points. Please dont confuse a position against spanking with being permissive. You can be very strict without the use of violence. You can provide structure, rules, limits and consequences, without being violent towards your child. See below for alternatives to spanking.


Second, be wary of the my grandma smoked till she was 100 excuse. That is, some people justify spanking, or even refuse to believe the science, because I was spanked as a kid and Im ok. That would be the same as believing that there is no association between smoking and cancer because my grandma smoked till she was 100 and didnt die from it. Smoking increases the probability that you will get cancer, even though some people who smoke will be ok. Likewise, spanking increases the probability of a laundry list of negative outcomes, even though some people who are hit as children will be ok.

Finally, some have argued that spanking is OK in certain cultures as long as you provide nurturance and love. It is true that some studies have shown that high levels of maternal support can reduce the negative consequences of physical punishment. But, from a humanistic perspective, I find the argument that it is ok to hit my child if I provide love as invalid as a husband saying it is ok to hit my wife if I show her that I love her.

For information about alternatives to spanking visit:

http://www.awareparenting.com/twenty.htm
http://www.naturalchild.org/jan_hunt/22_alternatives.html
http://www.loveourchildrenusa.org/parent_positiveparent.php
More information about spanking visit Project No Spank: http://nospank.net/
Update:
Please support NY Rep Carolyn McCathy on her efforts to ban physical punishment in US schools. http://www.thehittingstopshere.com/

The reference:
Taylor, C., Lee, S., Guterman, N., & Rice, J. (2010). Use of Spanking for 3-Year-Old Children and Associated Intimate Partner Aggression or Violence PEDIATRICS, 126 (3), 415-424 DOI: 10.1542/peds.2010-0314

Bedtime Routines: More evidence and step-by-step guide

By Nestor Lopez-Duran PhD

FRIDAY BRIEFS:

Routines are good. Routines are effective. Routines are adaptive. As a rule of thumb, most parents should use structured routines with their children.

I could end this post right here. The research about routines is so strong  that I feel comfortable breaking this blogs policy of not providing clinical advice when saying that unless you have specific clinical reasons, most parents of infants and toddlers should use bedtime, mealtime, and other daily routines. But in the science-based spirit of this blog, let me talk briefly about one more study showing the benefits and effectiveness of bedtime routines, and then I will explain how to implement a bedtime routine.

This study was conducted by Dr. Jodi Mindell and her colleagues at Childrens Hospital in Philadelphia. The study included 405 mothers with 207 infants and 199 toddlers. The mothers were randomly assigned to a bedtime routine or a control group. After only 3 weeks, the children experiencing the bedtime routines had:

  1. Faster sleep onset
  2. Less night wakening episodes
  3. improved maternal mood!!

Bedtime routines are safe, effective, and usually the standard treatment intervention for toddlers and infants with sleep problems. Routines are so effective, that bedtime sleep problems are one of the most treatable behavioral disorders in early childhood. And as an additional bonus, bedtime routines are associated with positive outcomes in the parents too, including improved marital satisfaction (see for example Pediatrics Vol. 84 No. 5 ).

Often parents say there is no way my kid will follow a routine, or fighting his bed time is a losing battle, he always wins, or I have tried routines and they dont work. This sense that routines wont work is often stronger among parents who dont have a bedtime for their kids and feel that it is now too late to implement a bedtime or a routine.  It is true that routines will not work for every single case. But for the majority of kids, routines will significantly improve sleep problems. The key issue here is knowing how to properly implement a routine.  Thus, let me briefly describe one method that has been found effective, specially with difficult children with no bedtimes (or very late bed times).

For kids with no bedtimes, it is very difficult to implement a bedtime routine with a new sleep time if this is done abruptly. For example, if your toddler is used to running around the house until 10 or 11pm, it is very unlikely that you will be able to get him to sleep at 8pm the day, or even week, you decide to implement a bedtime routine. In this case, one approach is to use a gradual positive bedtime routine procedure. The procedure works like this:

  1. First, identify the time your child usually falls asleep on her own. 9? 10? 11?
  2. Now, build a bedtime routine of 4 to 5 activities that last no more than 30 minutes with the last 15-20 minutes  in bed. For example you can start the routine 30 minutes before the desire sleep time by having the kid brush her teeth, wash her face, put on pajamas, followed by a bedtime story, etc. Make sure that a) this routine is the same every night (same order), b) avoid activities that make your child excited (playing active games, watching TV, etc), c) dont extend the routine or make exceptions ( just 5 more minutes pleeease).
  3. Start the routine 30 minutes before the kids current sleep time. At the end of the routine, simply tell the child its time to sleep. (see below for what to do if the child refuses)
  4. Use this routine at exactly the same time for at least a week. Then start the routine 10 minutes earlier and maintain that time for at least another week. You can continue to change the time every 1-2 weeks until you get the child to sleep at the time you consider best for your kid.

A few additional considerations:

  • If the child refuses to sleep at the end of the routine and tries to get out of bed etc, you would need to use an extinction method. Put the child gently back in bed, give her a kiss, and firmly but softly tell her its time to sleep (avoid saying anything else). Dont fall in the trap of starting negotiations with your kid at this time. It is time to sleep, nothing else. If you have to use the extinction method, please know that initially it will take many many tries until your child finally falls as sleep. It may be a very tough battle, but you will eventually prevail, and remember that you are doing all of this for the benefit of your child.
  • Give your kid a heads up that the routine is about to start 30 minutes before the start of the routine (thats 1 full hour before sleep time).  Then give her a 20, 10, and 5 minute notices. This will give her time to self regulate and prepare for the change. It is easier for the child to transition into the routine after being provided with such notices, than if abruptly interrupted in the middle of an activity.

Routines are relatively easy to implement and research supports that such routines are effective in reducing sleep problems.  Tell us about your experiences implementing bedtime routines.

The reference: Jodi A. Mindell, Lorena S. Telofski, Benjamin Wiegand, & Ellen S. Kurtz (2009). A Nightly Bedtime Routine: Impact on Sleep in Young Children and Maternal Mood Sleep, 32 (5), 599-606