Asking for Help is Successful Parenting

I see lots of frustrated and stressed out parents. There are a number of phrases that I hear so often I'm considering making a poster for my wall so parents know they're not alone. These phrases are what it may sound like when parents are calling for help:

Top 10 Parent Sayings
(that may indicate a need for a new plan)

1. It worked for a little while.
2. I’ve tried everything. 
3. Time-out doesn’t work.
4. I’ve tried explaining things. 
5. He should do it because he’s expected to.
6. I feel like I have to ask 100 times. 
7. Everything is a battle.
8. It’s like pulling teeth. 
9. He doesn’t care about getting spanked.
10. I have to call him down all the time. 

If you are a frustrated, confused, and stressed out parent, don't feel like it reflects poorly on you in any way to go ask for help. Asking for help when needed is the most responsible thing you can do as a parent. You are concerned about your child's welfare, you want to have a good relationship with them, and you want them to be successful. Asking for help may simply be a part of achieving that. Refusing to seek help because of pride can further increase your stress and may cause you to do something you would regret. 

When working with parents, a psychologist does not judge them and certainly doesn't think less of them. I have seen amazing parents and wonderful people come in for help. They have incredible patience and love for their children, but they have simply run out of ideas. I have tremendous respect for these parents because they have realized that they need to get some outside input and are taking action. When we are frustrated, it is hardest to think about things logically and realize what we need to do (as opposed to what we feel like doing). As an outsider, the psychologist has the luxury of not being directly affected by the child's behavior, not being as frustrated, and not being so personally invested that they lose the ability to be objective. 

Parenting is a hard job, but it can be the most rewarding experience as well. However, parents must take care of themselves so they can take care of their child. When you reach your limit, take a step back and consider if you might need to get a little help. Know that if you decide you do, it's not a failure, but a success.

Sleep Routines

"Sleep problems" aren't really my main focus, but I've seen quite a few parents having problems with their child's sleep habits. The problems include the child not falling asleep in a reasonable amount of time, repeatedly getting out of bed, loudly complaining and refusing to go to bed, wanting to sleep in their parents' bed, or just being afraid of the dark. There are many things that can produce problems with sleep and there are many ways to deal with them. I always ask parents this same set of questions:

• What times does ____ usually go to bed (not necessarily asleep)?
• How long does it take for ____ to go to sleep?
• What time does ____ usually wake up in the morning?
• How easy is it for ____ to wake up?
• What is their mood when they wake up and do they seem tired the next day? 

I ask these questions for sleep problems and for a wide variety of behavior problems. Sleep is critical for a child (and for adults).  It is important for a child's physical and mental development, and it greatly affects their behavior and their ability to learn effectively in school. If a child hasn't gotten enough sleep, then the brain is less ready to learn and the child is less able to handle the frustration necessary for learning new things. We see more behavior problems because the child's tolerance for frustration is so low and their ability to control their behavior is simply not as good.

Though a child may try to insist otherwise, children really need sleep routines. They should be going to bed at basically the same time every night and waking up at about the same time every morning. By maintaining this, the child's body gets into the habit and they will naturally begin to feel more tired and ready for sleep at around the same time each day. This makes it much easier for them to go to sleep. As a quick note: I strongly discourage allowing children to fall asleep with the TV on. TV's are designed to be naturally stimulating and attention-grabbing.

It can also help to use a familiar routine of activities every night to prepare for bedtime. That might include taking a shower, putting on pajamas, brushing teeth, laying in bed, listening to a story, and getting tucked in. The routine activities help prepare the brain for going to sleep. It is sort of like when you see a bunch of familiar landmarks on the way home. You know where you're going because you see all of the same things and you know what to expect at the end of it. It's the same way with these activities, but naturally you want your child's bedtime routine to include activities that are less exciting and stimulating for them so they can "wind down."


The first major step in helping your child with their sleep problems is to establish a routine and stick to it. Be consistent and they'll get the hang of it (if we keep changing it, they'll just be confused). We cannot make a child sleep (which they'll point out to you if they're fighting it), but we can help them be more successful at it. We can use a routine, we can require them to stay in their room, and we can remove a lot of the distractions they may use to keep from sleeping (toys, TV, video games...). Beyond that, we need a large amount of patience as they begin to learn how to sleep well.

Psychological Sticker Shock

The cost of psychological services can be surprising to some parents, and usually not in a good way. On the one hand, the cost of services for one's child and the benefits of those services should be easily justifiable (for example, consider how much we might spend on maintenance for something as comparatively unimportant as a car). On the other hand, that doesn't necessarily mean it's easy to afford. Insurance coverage for psychological services varies a great deal, and even when insurance does offer to cover psychological services, some psychologists will not accept insurance.

Perhaps the most immediate comfort that can be offered is that psychologists have an ethical obligation (as required by the American Psychological Association) to not exploit patients, to seek to do good and aid the public, and to ensure that they do not harm others. Although the rates charged for service may vary, they should generally be fair. I've written up a guide in an effort to help increase parents' understanding about the cost of services and what those services might include. This guide is by no means perfect and it does not cover all services that might be provided, but it may help parents to make a little more sense out of what goes on in a clinic.

One rule that should always be remembered though: When not sure about something, feel free to ask. 

Cost of Services

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

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

"It worked for a little while..."

This story is really about two behavioral concepts that often surprise and frustrate parents: the "Extinction Burst" and "Spontaneous Recovery." First off, when a child is continually engaging in misbehavior, we know that we must change our response if we want the behavior to change. After all, why would behavior change if it seems to be working for the child? So we develop a plan (a "behavior modification plan" or a "behavior improvement plan"), start applying it, see a change in the child's behavior, pat ourselves on the back, and then become shocked and discouraged when the behavior comes back worse than ever before. These events are frustrating, but they are also typical and expected.

An extinction burst is what happens when a behavior the child used to do reduces in severity for a while, but then comes back worse than it was before. There are a lot of ways to think about how and why this happens, but one of my favorites is to consider what people do at elevators or crosswalks. If there is a button that can be pushed to activate the elevator or the "walk" sign, then we often see someone push it once. If the machine doesn't respond in the time we expect, we might push it again. If we're frustrated, we are likely to push it again many times and maybe even harder. This is similar to what is happening with the child. A good example of when this happens is with tantrums.

Initially the tantrums will often reduce as the child has noticed that the way you're responding has changed. We think, "Oh wow, it's gotten better already, that's great!" However, the child is responding to the change because it is new. Once the child has figured out that the change is long-term and gets used to it, the "new" has worn off. Now the child wants things to work the way they did before. She wants something, you say "no", she gets mad and is going to punish you for your behavior. The tantrum starts up and you don't respond. Knowing that tantrums worked before, she's going to go past what she has done before and make a more severe tantrum. The idea, essentially, is that if this worked before, then she just needs to push the button even harder to make it work again. What is critical is that you maintain the same response and plan as you have been doing. That is incredibly hard to do at times because a really severe tantrum is hard to ignore.

Spontaneous recovery is kind of like an extinction burst, except it occurs much later. In spontaneous recovery, we've managed to get a behavior to reduce and it has stayed that way for a long time. We feel pretty good, like we're out of the woods and the behavior is simply "better" now. Suddenly the behavior comes back without warning and we're surprised. It isn't necessarily as severe as an extinction burst, but it surprises us because it has been so long. What we have to remember is that a behavior is never truly completely gone. There is always a chance that it may occur, even if we've managed to reduce it to a very small chance. Just like with the extinction burst, we need to maintain our same response plan, exactly as we did before, and things will continue. It's hard to remember these things, especially if a child is going into a full tantrum and we're stressed out, embarrassed, or frustrated. If we can remember our plan and stick to it, though, we'll help the child learn the appropriate behavior and get things going in the direction we want.

(This is an excellent picture showing the typical pattern of Extinction Burst. It is from another blog, which also has good information about behavior! http://www.iloveaba.com/2011/12/extinction-procedures.html)

Planned "Together Time"

One of my favorite stories from my work is about a child who frequently had severe tantrums and disruptive behaviors at home. The problems weren't quite as bad at daycare, but when he was home after daycare, he would often seemed to suddenly engage in disruptive behavior (like screaming, slamming the door, hitting/kicking the wall or couch...) with little apparent reason. The mother and I brainstormed for a while trying to figure out what was setting him off. It's not rare for triggers to be things we don't notice, so we have to take time to really sit and think of all possibilities and rule them out.

In this case, the child was being raised by a single, working mother. She dropped him off at daycare in the morning and picked him up at about 5pm. Then she made dinner and let him play. After talking for a while, we noticed that whenever he would engage in these tantrums and disruptive behaviors, his mother would go over and talk to him to try to calm him down and find out what was bothering him. He would usually calm down after a bit, but then might start up again later. We thought that maybe it was in fact the mother's response (direct attention) that was maintaining the behavior. Essentially, he was acting up to get her attention.

We came up with a plan for this child that involved a planned period of "together time with mom" every day after daycare. They would simply sit down and enjoy an activity together. The activity isn't terribly important, and if it is TV, then that's fine (we'd rather it be something interactive, but TV is better than nothing!). The mother also taught the child a different way to ask for attention: he could come sit by her, tap her, or hug her. Any of those would start some "together time with mom." (Using words to ask for attention is fine too, but if the child doesn't have good language yet, then these alternatives are easy for them to do.)

Later, if his mother noticed the child getting upset, then instead of scolding him, she would happily call his name and ask him to come sit with her. This is preempting the behavior (catching it before it escalates) so that behavior doesn't get rewarded. To preempt a behavior we have to be especially observant to notice before it occurs. That can be hard to do, but if we can prevent the behavior from even occurring, then it is not rewarded, which is good!

The theory behind this solution:
When a child is engaging in a "bad behavior" to get something (tantrums in this case), it's often helpful to see if we can find an alternative behavior they can do to get the same thing. We want that behavior to be as easy or easier than the original target behavior. That's not always possible, and if it isn't, then we want to make the reward (the payoff) even better to compensate. Ideally, the child also won't have to do the new behavior for as long or with as much energy as the original (basically like just saying one word to get the reward as opposed to a whole conversation).

This story shows an example of addressing the "antecedent" (things that occur before the behavior and maybe cause the behavior to occur) and identifying the reinforcement (the reward that maintains the behavior). Additionally, there is a lot of value in promoting a close relationship with a child: the child listens better, pays more attention to the parent, values the parent's opinion, and the parent feels less stressed and more patient with the child.

Toilet-Training

The pattern in raising young children seems to be that we strive to help them learn new skills that inevitably make things more challenging for us as parents (crawling, walking, talking... eventually pushing the rules, questioning authority, and making their own decisions). It's all an effort to promote independence, which is good in the long-term, but a challenge in the short-term. Fortunately, toilet-training is one of those times when we're helping them develop a skill to make things easier on us.... eventually.

The process of toilet-training can be tiring and frustrating for the parent and the child. I've worked with a number of parents and children in developing toilet-training skills, including problems such as awareness training (so the child knows when he needs to go), following all of the steps, and overcoming the fear or reluctance to sit on the toilet. Fortunately these problems can usually be resolved with a combination of behavior planning and patience. I've written a general guide to help with toilet-training. The information is from a variety of excellent sources I've read as well as my own experiences in helping parents overcome the challenge of the porcelain throne.

Toilet Training