When a parent brings their child in for evaluation, I naturally assume first that there is something out of the ordinary. At the very least, there is something out of the ordinary from the parent's perspective. The parent is worried about their child and wants to either make sure there is nothing wrong, or if there is, then it is identified so they can take whatever steps would likely be helpful. For this reason, it can be very frustrating for a parent when the child is evaluated and does not qualify for a diagnosis. It would seem strange that a parent would want their child to be diagnosed with a disability or disorder. Indeed, I do not think the parent wants their child to be diagnosed, but the parent wants some kind of answer or explanation for their child's behavior (and what to do about it). It may be that the parent merely wants reassurance that the behavior is actually "normal", or wants a strategy to use with the behavior of concern. In this post, I want to discuss "subclinical diagnosis", which is what happens when a child's behavior is unusual, but not unusual enough for a diagnosis.
To receive a clinical diagnosis, a child must meet certain conditions. These conditions are laid out in the Diagnostic and Statistical Manual of Mental Disorders (currently Fifth Edition), also called the DSM-5. However, a clinician does not rely exclusively on the DSM-5 for determining if a child has a disability. A skilled clinician has many resources used for understanding development and disorders (such as professional journal articles, books, and workshops), and ultimately the clinician must use "clinical judgment" when determining if a child presents with enough symptoms and enough severity to qualify for a diagnosis. The DSM-5 allows for "clinical judgment", and the clinician should meet with the child's parent to discuss the evaluation results and how to understand the results.
Discussing the results of an evaluation can take a lot of time, but the clinician has a responsibility to help the parent understand what the results mean and how the parent can use that information. If a child meets the conditions for a clinical diagnosis, then the clinician will explain this and what it means (along with recommendations of what to do about it). Alternatively, a child may not meet the conditions for a clinical diagnosis, in which case no diagnosis is given because the number or severity of symptoms is too low. In some cases, a child may not meet enough of the conditions for a clinical diagnosis, but does exhibit a number of significant symptoms, which require an explanation and may need accommodations. This may lead to a "subclinical diagnosis." A subclinical diagnosis may eventually lead to a clinical diagnosis if the symptoms continue or worsen in the future. Symptoms of a subclinical diagnosis may also be distressing for the parent, child, or teachers. The clinician should take time to discuss symptoms of a subclinical disorder with the parents and provide recommendations for how to address these, even though the child does not currently meet all of the requirements for a clinical diagnosis.
If a child does not meet the conditions for a clinical diagnosis, then it may be more difficult for a parent to get services for the child. Typically, a clinical diagnosis is one required part of getting school-based services (special education services) under IDEA (the Individuals with Disabilities Education Act). A child with a subclinical diagnosis may, at the school's discretion, receive additional assistance such as a Behavior Improvement Plan. Therefore, it is recommended for parents to discuss their concerns with the school and maintain a cooperative relationship with the school.
Lastly, if a parent is concerned that the evaluation may not be adequate or valid, then they should always be willing to seek a second opinion from another qualified professional. Evaluations provide a limited period of insight into a child and their behavior. The child may simply not show their usual symptoms during that time, which can lead to no diagnosis.
For more information on diagnosis and evaluations, see the following:
Showing posts with label parent frustration. Show all posts
Showing posts with label parent frustration. Show all posts
Tuesday, June 16, 2015
Thursday, December 4, 2014
"Why should I?" (Child Defiance)
Parents and teachers make many requests of children. These requests are assumed to be reasonable (by the adult), but children may refuse to comply. Children may have many reasons for refusing to comply with a request, and understanding the reasons is usually helpful in getting compliance.
Can't do or won't do?
The first question we should ask is if a child is refusing to do the task because they "can't do" or if they simply"won't do?" If a child is incapable or believes that she is incapable of doing the task, then it is a "can't do" problem. We usually address this by teaching and practicing with the child to make it easier. Teaching and practicing a task that the child is refusing to do, however, can be difficult. Having some kind of a reward as an incentive can encourage them to put forth the effort and "give it a try." Giving them feedback as they get better can help them become more motivated and more confident (which makes it easier to get compliance in the future).
A "won't do" problem means that the child is able to do the task, but it is unpleasant for them or they would rather do something else. It's very common for children to want to do something else (for example, playing or watching TV), and a task like "clean your room" is naturally not appealing. One approach for getting compliance in this case is to allow the child to do what they want to do after they finish what you've asked them to do. When needed, you can also offer bigger rewards (for bigger tasks). This is essentially like paying your child for doing the task, which is not necessarily a bad thing (they will learn about that in the future anyway). Many parents are afraid that their child will come to expect a reward for "every little thing", but this rarely appears to happen and we can always reduce how often they get the rewards in the future. It is important to not think of it as "bribing" the child, though, because bribes are given for unethical or inappropriate activities, whereas rewards are given for appropriate activities.
Avoiding direct conflict (aka "opposition")
There are many things we cannot make a child do, and children will eventually discover this during direct conflicts with a parent. It does not help to get into a "power struggle" with a child because we 1) give them something they can oppose, and 2) they will sometimes win. By setting up choices for a child, we reduce the opportunity for them to directly oppose a parent, and essentially leave it up to them. If they want to play a favorite game, then they need to first complete their chore. If they refuse to complete their chore, then they simply do not get to play their favorite game. This is less about fighting with the parent (though expect the child to whine and nag; see Tantrums) and allows the child to make the decision for herself.
Providing multiple choices can be helpful at times as well. We may tell a child that she can choose which chore she wants to do and give her two or three options. It is usually not recommended to give too many options (which can be overwhelming). When a child selects one of the options, then she may be more willing because it was "her choice" (even though you set the options).
Why should I?
Always keep in mind that it is a fair question for the child to ask, "why should I?" when you ask them to do something. Just because it's a "fair question" doesn't necessarily mean that you have to engage them in some kind of debate or negotiation. However, acknowledging to yourself or anticipating this question can make it easier to understand the child's resistance and how to best overcome that resistance. There is further discussion about working with resistance and defiance in this post about "making concessions."
The last point I would like to make is: try to remain calm and patient. Defiance can be extremely frustrating, but becoming angry is not a good long-term solution even if it gets an immediate response. Your child watches and learns from how you handle these situations.
Can't do or won't do?
The first question we should ask is if a child is refusing to do the task because they "can't do" or if they simply"won't do?" If a child is incapable or believes that she is incapable of doing the task, then it is a "can't do" problem. We usually address this by teaching and practicing with the child to make it easier. Teaching and practicing a task that the child is refusing to do, however, can be difficult. Having some kind of a reward as an incentive can encourage them to put forth the effort and "give it a try." Giving them feedback as they get better can help them become more motivated and more confident (which makes it easier to get compliance in the future).
A "won't do" problem means that the child is able to do the task, but it is unpleasant for them or they would rather do something else. It's very common for children to want to do something else (for example, playing or watching TV), and a task like "clean your room" is naturally not appealing. One approach for getting compliance in this case is to allow the child to do what they want to do after they finish what you've asked them to do. When needed, you can also offer bigger rewards (for bigger tasks). This is essentially like paying your child for doing the task, which is not necessarily a bad thing (they will learn about that in the future anyway). Many parents are afraid that their child will come to expect a reward for "every little thing", but this rarely appears to happen and we can always reduce how often they get the rewards in the future. It is important to not think of it as "bribing" the child, though, because bribes are given for unethical or inappropriate activities, whereas rewards are given for appropriate activities.
Avoiding direct conflict (aka "opposition")
There are many things we cannot make a child do, and children will eventually discover this during direct conflicts with a parent. It does not help to get into a "power struggle" with a child because we 1) give them something they can oppose, and 2) they will sometimes win. By setting up choices for a child, we reduce the opportunity for them to directly oppose a parent, and essentially leave it up to them. If they want to play a favorite game, then they need to first complete their chore. If they refuse to complete their chore, then they simply do not get to play their favorite game. This is less about fighting with the parent (though expect the child to whine and nag; see Tantrums) and allows the child to make the decision for herself.
Providing multiple choices can be helpful at times as well. We may tell a child that she can choose which chore she wants to do and give her two or three options. It is usually not recommended to give too many options (which can be overwhelming). When a child selects one of the options, then she may be more willing because it was "her choice" (even though you set the options).
Why should I?
Always keep in mind that it is a fair question for the child to ask, "why should I?" when you ask them to do something. Just because it's a "fair question" doesn't necessarily mean that you have to engage them in some kind of debate or negotiation. However, acknowledging to yourself or anticipating this question can make it easier to understand the child's resistance and how to best overcome that resistance. There is further discussion about working with resistance and defiance in this post about "making concessions."
The last point I would like to make is: try to remain calm and patient. Defiance can be extremely frustrating, but becoming angry is not a good long-term solution even if it gets an immediate response. Your child watches and learns from how you handle these situations.
Monday, October 27, 2014
Importance of Silver Linings
"Bad behavior" is frustrating, common, and can quickly drive a parent to the end of their patience. Whatever we expect to see is what we are more likely to notice, regardless of how often it is really happening. We are quick to notice when a child is engaging in bad behavior and before long it can become all we notice. In the same way, a child who has a tendency to get in trouble a lot quickly begins to expect to get in trouble. The process can become an unpleasant cycle and can put a strain on a parent's relationship with their child.
In a similar way, there is an effect referred to as "behavioral momentum." It is called "momentum" because the tendency is for an individual to continue behaving in the same manner when they start behaving in a certain way. This is commonly used by effective sales-people to convince customers to agree to things they probably would not have if simply asked upfront. In the case of a child, we can begin to prime a child's behavior to get more good behavior simply by getting the child to change their direction and praising them for it.
These two concepts (the first paragraph and the second paragraph) can be important for parents. When a child begins misbehaving, parents are quick to point it out, which begins to frustrate the child after it has happened a few times. The child quickly gets into a pattern of misbehavior, and the parent quickly gets into a pattern of scolding the child. More scolding is not likely to improve things; indeed, if the parent is having to scold many times, it has already been shown to not work at that time. It can take a tremendous effort, but if the parent deliberately changes direction and begins praising the child for doing relatively simple things correctly, then the child may begin to get into a more positive direction with their behavior too.
This may mean trying to identify the things the child has done right, creating easy requests for the child to make an opportunity to do something right, and trying to focus on the many things the child does right while not focusing on the little things that are done wrong. This process is not simple, but it can make a world of difference for a frustrated parent and child.
Another strategy (the Penny in a Pocket technique) for changing a child's behavior and our own behavior as parents is provided here.
In a similar way, there is an effect referred to as "behavioral momentum." It is called "momentum" because the tendency is for an individual to continue behaving in the same manner when they start behaving in a certain way. This is commonly used by effective sales-people to convince customers to agree to things they probably would not have if simply asked upfront. In the case of a child, we can begin to prime a child's behavior to get more good behavior simply by getting the child to change their direction and praising them for it.
These two concepts (the first paragraph and the second paragraph) can be important for parents. When a child begins misbehaving, parents are quick to point it out, which begins to frustrate the child after it has happened a few times. The child quickly gets into a pattern of misbehavior, and the parent quickly gets into a pattern of scolding the child. More scolding is not likely to improve things; indeed, if the parent is having to scold many times, it has already been shown to not work at that time. It can take a tremendous effort, but if the parent deliberately changes direction and begins praising the child for doing relatively simple things correctly, then the child may begin to get into a more positive direction with their behavior too.
This may mean trying to identify the things the child has done right, creating easy requests for the child to make an opportunity to do something right, and trying to focus on the many things the child does right while not focusing on the little things that are done wrong. This process is not simple, but it can make a world of difference for a frustrated parent and child.
Another strategy (the Penny in a Pocket technique) for changing a child's behavior and our own behavior as parents is provided here.
Saturday, September 20, 2014
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)
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.
Top 10 Parent Sayings
(that may indicate a need for a new plan)
- It worked for a little while.
- I’ve tried everything.
- Time-out doesn’t work.
- I’ve tried explaining things.
- He should do it because he’s expected to.
- I feel like I have to ask 100 times.
- Everything is a battle.
- It’s like pulling teeth.
- He doesn’t care about getting spanked.
- I have to call him down all the time.
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.
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