Incoming Resources

I had planned to write up a short explanation about the costs associated with psychological services to help parents understand the costs and not suffer as much sticker shock, but I found that this is a larger project than I expected. I am still working on this and will post it when I am done, but there is a lot of information that goes into explaining evaluation, consultation, and intervention services (and that is just within my particular approach: behavioral and academic).

I ask for some patience while I prepare these resources!

Happy Biting

"We were playing and having fun, why did he bite me?!"

When children are biting it's not fun for anyone. Their ability to bite is often surprisingly strong, and sometimes their desire to do so is equally strong! It's common for children to go through phases where they bite, but it can become a real problem as they get older. I've worked with quite a few parents who reported a biting problem of some sort. It's often a problem that the child bites when angry, and we can kind of understand why the child is biting at those times. We tend to think of biting as an aggressive action (after all, it hurts!), but children may bite for a variety of reasons, and not always because of anger or aggression. In this case, we're talking about "happy biting."

To best help a child who bites, we need to understand a bit about why the child is biting and then how we should respond to it. Naturally a child may bite out of anger, but it often surprises parents that a child may also bite out of happiness. This seems strange, right? We need to understand that emotional reasoning takes time to develop and if a child is "worked up", then certain behaviors (like biting) are more likely. Being "worked up" can include being mad, being scared, or being very excited and happy. In all cases, the child is "in a state of high arousal."

High arousal has a bunch of behaviors associated with it, including things like laughing, jumping, clapping, screaming, spinning, biting, hitting/kicking, grabbing, and hugging. Most of those sound fine, and maybe even fun. But some of those we tend to associate with being angry. For a child who is 2 to 4 years old, they've not had a lot of time to understand the differences between these different types of "high arousal" states and may produce any of those behaviors during any of those emotions (such as biting or hitting when happy). As they get older, they'll learn to tell the difference and their behavior will become more specific (hugging is not part of being mad, hitting is not part of being happy, and so forth). They learn to tell the difference, however, based on the reactions of others and by observing your behaviors (they'll imitate you). It takes time, but patiently helping the child learn what is "ok" and what is not, and giving other cues to show how they maybe should be feeling will help them learn to tell these emotions apart.

Information on how to respond to and stop biting can be found here: Biting

Psychobabble and Jargon (quick reference)

There is a lot of lingo and jargon in psychology and education. Sometimes I relax into my jargon when talking with parents and eventually notice the look of confusion on their faces. It can take effort to be aware of what we're saying and make sure we use terms that make sense. Unfortunately, when parents go to a meeting at the school they often hear lots of jargon and get confused. School personnel may not realize that they're using a bunch of jargon (after all, they use it everyday when talking to each other) or that the terms are unfamiliar to parents. I saw a very helpful post on another blog recently, where the author collected a bunch of terms used in schools and special education and provided nice explanations for them. I'm posting a link to that here and highly recommend reading through it to learn a bit about terms used in schools and special education.

Education Lingo Every Parent Should Know

What's the Big Deal with a Diagnostic Label?

Diagnostic labels can bring relief, sadness, confusion, or anger. Often they produce all of these emotions at the same time. When I meet with parents to talk about the results of an evaluation, I wish I had an hour to go over the main results, a couple of hours for them to leave and think about it, and then another hour to talk about their questions and what to do next. I usually end up spending an hour or two with them talking about the results and coming up with some kind of immediate plan. Then we make another appointment after they've had time to think about everything and come up with new questions.

Labels can be scary because we don't want our kid to have "that label", for other people to say things or judge them, and sometimes because we don't want to accept that label. A lot of work goes into reducing the "stigma" (the negative thoughts associated with a label), but that work is never-ending because a label means "something unusual" has happened. We may also think that if there is a label, then it will never get better. While it may be true that there are some challenges that will always be there, it is wrong to think things will never get better.

On the other hand, labels can be useful. One of the main purposes of a label is so that we can work toward making things better. With a label a child may get access to services he previously couldn't. We may understand a bit more about why the child does the things he does, or maybe why he doesn't do some things he should. As a result, we might become more patient with our child once we know "what's going on." We can also start using lots of research to find better ways of helping the child.

Labels often seem to create more questions than they answer, but we can start asking better questions. We're no longer trying to find our way through a large, open field. We have clearly marked paths, and can start exploring them. Finding the approach that is best for your child may begin with an evaluation and a label, but it continues with problem-solving and working together.


I have two documents that discuss evaluations and labels in more detail:

Diagnosis - more information about the process of making a diagnosis

Understanding Diagnostic Results - written with one of my colleagues, this one is about questions that often come up after the diagnosis

"Remorseless Children"

Parents and teachers want children to "do the right thing" because of a moral compass. Really, this compass is almost a magical device. We kind of expect it to happen without really thinking about what it takes to develop moral reasoning. There's a lot of research out there about moral reasoning, and a couple of my favorite points are that two things are very important for its development: 1) the ability to think about and understand things, and 2) experiences that challenge the child's current moral beliefs. I like those ideas. They're neat, they make sense (intuitively), and they're very appealing (maybe because they don't put all of the responsibility on parents). The problem is they don't give us any comfort when a child is engaging in aggressive behavior and doesn't appear to feel guilty.

I've heard from parents, teachers, and daycare providers that some children are "remorseless" or even take pleasure in the suffering of their peers. That seems scary and is likely to make us think of criminals, murderers, and so forth. Maybe there is a biological risk of a child having a natural tendency to become a criminal, but it does not do any good to assume a child is "bad" or destined to become the next Jack the Ripper (or Hamburgler). If we assumed that it was the child's fate, then at the worst we abandon all efforts to change the child, and at best we begin thinking from the perspective that this child is "bad." It's better to think of the child's behavior and what we want them to do instead of their current behavior.

"But he smiles and laughs after hitting his classmate/taking something from his classmate!"

We're thinking from our own perspective in that situation. We don't actually know why he is smiling or laughing, though, and we're making a pretty big assumption: that the child is thinking like an adult or feeling emotions like an adult. It's also not a well-supported assumption. Children have only had a limited amount of time to learn how the world works, and that includes their "internal world" (emotions, thoughts, and body sensations). Consider the following questions:

- When an infant smiles or laughs, what kind of reaction does that get from other people?
- If a child is feeling nervous, worried, or confused, what kind of reaction do you expect from them?
- What do you think the child is expecting after hitting his classmate?
- What does "remorse" look like? How do you really know it's happened?

I'm oversimplifying here, but when young children feel worried, sad, upset, frustrated, irritated, angry, anxious, confused, or nervous, what they're really feeling is "Upset." It's one category for them and all of those emotions fit in there. They aren't that good at telling the difference yet, nor are they very good at controlling their behavior when they suddenly get a strong feeling. It takes a lot of time to understand the difference between frustrated and irritated, or worried and nervous. If you ask a child what those emotions feel like, they'll probably tell you that they feel "bad" and that's about it (note: I've asked many children and gotten the same responses). It also takes a lot of time and practice to get good at not immediately responding to how one feels. Indeed, many adults still can't stop themselves from acting immediately in response to a strong emotion. It's just how humans are wired; it helps a lot in certain situations, but the classroom is not one of those situations.

So we should consider that this child is not "remorseless" (which really isn't even a "thing" for young children yet), but that he/she doesn't know how to respond to the worry they're feeling about getting in trouble (which they know is coming). We shouldn't pay as much attention to what we see on their face at that time. We need to focus on what we want them to do differently, give them every incentive and advantage in being able to do that, and then letting them know when they've done the right thing instead of the wrong thing. Try to take ourselves out of the situation and instead focus on the behavior and the child. It's hard to do because we don't naturally think that way, but it is more helpful than assuming the child is seeing things the same way we do.

"Poop Candy" (overcoming toilet fear)

Here's another of my favorite stories about using behavior modification to solve a common problem in early childhood: toilet training.

I had a parent come into my office because of a number of different behavior problems that a child was experiencing, but one of them had a pretty fast solution (we were kind of lucky it was this easy). The child refused to sit on the toilet. In fact, the child was so afraid, that he would not tell his mother when he needed to go to the toilet. As a result, there was a lot of soiling of clothing ("pooping the pants"). We needed a way to get the child to be willing to even sit on the toilet first. Then we needed to get him to sit on it for longer periods of time (so he could actually do his business).

Our solution turned out to be pretty simple. We identified his absolute favorite candy, and he would get a piece of it every time he sat on the toilet. We started calling it "poop candy" in our meetings, though I'm not sure what the mother told the child it was called. Here's the important key to this though: it didn't matter if he needed to use the toilet, it didn't matter if he actually did anything, and at first it didn't matter if he took his pants off. If he put his bottom on the toilet, he got the candy. Basically, we were giving him a button to push to get candy whenever he wanted it. Naturally, he took advantage of the situation some, but that's fine, he's still sitting on the toilet. After a little while, the problems stopped entirely. He was willing to sit on the toilet, he actually used it, and the fights were over (and fewer dirty clothes). As time passed, his mother could reduce how often he got the candy: not every time he sits on it, but sometimes; not for just sitting on it, but taking pants off, and so on...

Like I said, this turned out to be a pretty simple problem and solution. We were lucky that it was just a fear of sitting on the toilet (the same approach can be used with a child who is afraid of entering the bathroom). If the child didn't have language to indicate when he needed to use the toilet, that would have to be addressed, such as teaching some way for the child to communicate it. If the child wasn't aware of when he needed to go, that would also have to be addressed, which can be challenging (there are good techniques for that too though).

There are many problems that come up in toilet training. Naturally, there are many different solutions as a result. However, a common problem I've heard is a child developing a fear of the toilet. This can take many forms, including refusing to sit on the toilet, running from the toilet when it is flushed, and refusing to enter the bathroom at all. The way we handled the anxiety in the story above is "counter-conditioning." In counter-conditioning we provide something desirable and enjoyable (a "reinforcer") to counter the fear. This can be done with many different fears or even things the child simply doesn't like (for example, school). We have to match the reinforcer to the aversion (fear or dislike). If the child is extremely afraid of something, then the reinforcer must be extremely desirable to the child. We want to start off by making the reinforcer available every time the child encounters the aversion. Eventually we don't have to make it available every time; we can start to reduce it and make it inconsistent (maybe available once, but not until two or three times later). This is called "fading" and it is a common technique so the child does not become dependent on the reinforcer.

There are some other recommendations for toilet training here: Toilet Training