Sunday, June 29, 2008

The Dreaded Power Struggles!

The Dreaded Power Struggles!

I do not know of any parent who does not dread power struggles. This is one of the most popular things that brings families into therapy. There is nothing like a battle with your own child to cause intense frustration and self-doubt. Not to mention that our kids seem particularly adept at picking times when we are late for work or when your mother in-law is there to see the whole thing.

The only power struggles you truly win are those that you avoid. Once a child has engaged you in a negotiating, arguing, or tantruming battle, everybody loses. From the toddler who throws himself down and screams to the teen who becomes a prosecuting attorney, your best bet is to avoid ever being drawn into battling like an equal. It is very strange to think about it, but power struggles keep undesirable behavior going. Its not that they are pleasant for children, but during a 'battle' with you, your child is actually getting something he wants. When he can engage you, the child gets your full attention, ‘blows off steam’, and sometimes gets you to give in. Even if you are only loosing the occasional power struggle, that rare reinforcement of the unwanted behavior is enough to make it worse over time. Once your child learns that every now and then you will give in, it is just like he’s playing the slots in Vegas. He will keep going with more and more determination until the next big ‘pay off’ comes. Then the pattern becomes very difficult to break.

So the real answer is to keep power struggles from happening as much as humanly possible. First off, you can be proactive. Watch out for situations that make a power struggle more likely. The big triggers include: video games, low blood sugar, fatigue, an anxiety provoking situation, having to share, going to/staying in bed, not enough opportunity to burn off energy, and transitioning from a preferred activity (watching TV) to an unwelcome activity (going to school). We parents can anticipate most of these things coming and plan our strategy in advance by setting up expectations. Give lots of warnings and let the child know explicitly what to expect (“In 2 minutes, it will be time to turn off the TV and put on your coat”). If you are going to a trouble zone like a grocery store candy aisle, tell the child in advance what you will and will not be buying. Set a timer to tell your child when it is time to stop playing computer games. If you are going out, let the child know what behavior you expect to see, and what behaviors will lead to having to leave. Once you set an expectation, make sure to stick to it!

The other two big ways to avoid the power struggle is giving choices and just plain empathizing. I am borrowing here from a terrific book called How to Talk so Kids will Listen and Listen so Kids will Talk, which I can not recommend enough. Your kids will be less likely to battle with you if you give them two things everyone wants, including choices and the feeling that you understand their perspective. While the ‘forced choice’ does not work every time, it can stave off many battles. Give kids lots of little choices whenever you have wiggle room. Choices are great for their sense of independence and for helping them learn to take responsibility for their own decisions. You can offer choices related to when the child will do something (now or in 5 minutes), how it will be done, and what the child would like (which cereal, which shirt, which homework assignment first etc.)

If you can not give your child a choice, such as when its time to leave for school, let him know that you understand how he feels about it. We all feel so much better about unpleasant things when we feel that the important people in our lives care what we are thinking. This is NOT the same thing as giving in to our child’s demands! Empathizing is about helping your child tolerate the frustrations we all face in our day to day lives, not trying to make the frustration go away. We all have to do things like get shots and wait our turn, and kids need to learn to cope. However, we can help kids feel better with such simple statements like: “You wish you could play that game all day instead of going to Grandma’s”, “You’re really disappointed about not being able to have more cake” or “Having to leave your teddy bear feels sad, you miss him when you’re at school.” By empathizing with our children and giving voice to their feelings, we can help them feel that we are on their side, and that we care about their experiences. For an older child or teen, tell them to write you a letter/email describing their grievances. A little empathy goes a long way towards making them feel willing to go along with our directions.

Finally, the important thing in managing power struggles is to diffuse them if you can not prevent them. Keep in mind, it is always better to be proactive in managing behavior than reactive. When you have to be reactive, start by labeling the feeling (“You look frustrated” “I can see you are getting annoyed about this” or “This makes you very grumpy.”), and then state your expectation firmly (“And now we are going to have to leave for school” or “But I expect you touch the dog gently” or “Use words, not fists!”). If the child starts to calm down, you can offer a forced choice at this point (“Now, do you want to wear your coat or your jacket to school?”). If the child escalates with negotiating or a tantrum, it is time to get very firm and direct about what you are going to do (“If you do not choose, I will choose” or “We can discuss it later, right now it is time for school”, “If you need to calm down, I expect you to sit on the steps for two minutes.”). You’re your statements short. Then once you have told the child what you expect, it is time to ignore him until he complies. Some children will become very provocative trying to re-engage you, but ignore all behavior except something that puts your child or someone else in danger. Once the child complies or gets close enough towards acceptable behavior, praise and give attention again.

Across the board, your goal is to give lots of attention, descriptive praise, and affection for desirable behavior, and as little as possible for unwanted behavior. In most families, we tend to pay little attention to the kids when they are doing what we want, and give then our undivided attention when they are being inappropriate. A power struggle is our children’s way of trying to get control over us, so keep in mind that once we are engaged in battling like equals, they have already won. Lastly, it is important to remember that our children do NOT really want to win power struggles. A child who wins power struggles is not a happy child, instead he becomes anxious, angry, and contemptuous (Remember Veruca Salt from Charlie and the Chocolate Factory?). What truly makes a child feel happy and calm is when he knows that his parents are in-control, protecting him even from his own worst impulses.

Dr. Rebecca Resnik

Licensed Clinical Psychologist

Mindworks Clinical Psychology

Friday, June 20, 2008

The Dreaded Power Struggles!

I do not know of any parent who does not dread power struggles. This is one of the most popular things that brings families into therapy. There is nothing like a battle with your own child to cause intense frustration and self-doubt. Not to mention that our kids seem particularly adept at picking times when we are late for work or when your mother in-law is there to see the whole thing.

The only power struggles you truly win are those that you avoid. Once a child has engaged you in a negotiating, arguing, or tantruming battle, everybody loses. From the toddler who throws himself down and screams to the teen who becomes a prosecuting attorney, your best bet is to avoid ever being drawn into battling like an equal. It is very strange to think about it, but power struggles keep undesirable behavior going. Its not that they are pleasant for children, but during a 'battle' with you, your child is actually getting something he wants. When he can engage you, the child gets your full attention, ‘blows off steam’, and sometimes gets you to give in. Even if you are only loosing the occasional power struggle, that rare reinforcement of the unwanted behavior is enough to make it worse over time. Once your child learns that every now and then you will give in, it is just like he’s playing the slots in Vegas. He will keep going with more and more determination until the next big ‘pay off’ comes. Then the pattern becomes very difficult to break.

So the real answer is to keep power struggles from happening as much as humanly possible. First off, you can be proactive. Watch out for situations that make a power struggle more likely. The big triggers include: video games, low blood sugar, fatigue, an anxiety provoking situation, having to share, going to/staying in bed, not enough opportunity to burn off energy, and transitioning from a preferred activity (watching TV) to an unwelcome activity (going to school). We parents can anticipate most of these things coming and plan our strategy in advance by setting up expectations. Give lots of warnings and let the child know explicitly what to expect (“In 2 minutes, it will be time to turn off the TV and put on your coat”). If you are going to a trouble zone like a grocery store candy aisle, tell the child in advance what you will and will not be buying. Set a timer to tell your child when it is time to stop playing computer games. If you are going out, let the child know what behavior you expect to see, and what behaviors will lead to having to leave. Once you set an expectation, make sure to stick to it!


The other two big ways to avoid the power struggle is giving choices and just plain empathizing. I am borrowing here from a terrific book called How to Talk so Kids will Listen and Listen so Kids will Talk, which I can not recommend enough. Your kids will be less likely to battle with you if you give them two things everyone wants, including choices and the feeling that you understand their perspective. While the ‘forced choice’ does not work every time, it can stave off many battles. Give kids lots of little choices whenever you have wiggle room. Choices are great for their sense of independence and for helping them learn to take responsibility for their own decisions. You can offer choices related to when the child will do something (now or in 5 minutes), how it will be done, and what the child would like (which cereal, which shirt, which homework assignment first etc.)

If you can not give your child a choice, such as when its time to leave for school, let him know that you understand how he feels about it. We all feel so much better about unpleasant things when we feel that the important people in our lives care what we are thinking. This is NOT the same thing as giving in to our child’s demands! Empathizing is about helping your child tolerate the frustrations we all face in our day to day lives, not trying to make the frustration go away. We all have to do things like get shots and wait our turn, and kids need to learn to cope. However, we can help kids feel better with such simple statements like: “You wish you could play that game all day instead of going to Grandma’s”, “You’re really disappointed about not being able to have more cake” or “Having to leave your teddy bear feels sad, you miss him when you’re at school.” By empathizing with our children and giving voice to their feelings, we can help them feel that we are on their side, and that we care about their experiences. For an older child or teen, tell them to write you a letter/email describing their grievances. A little empathy goes a long way towards making them feel willing to go along with our directions.

Finally, the important thing in managing power struggles is to diffuse them if you can not prevent them. Keep in mind, it is always better to be proactive in managing behavior than reactive. When you have to be reactive, start by labeling the feeling (“You look frustrated” “I can see you are getting annoyed about this” or “This makes you very grumpy.”), and then state your expectation firmly (“And now we are going to have to leave for school” or “But I expect you touch the dog gently” or “Use words, not fists!”). If the child starts to calm down, you can offer a forced choice at this point (“Now, do you want to wear your coat or your jacket to school?”). If the child escalates with negotiating or a tantrum, it is time to get very firm and direct about what you are going to do (“If you do not choose, I will choose” or “We can discuss it later, right now it is time for school”, “If you need to calm down, I expect you to sit on the steps for two minutes.”). You’re your statements short. Then once you have told the child what you expect, it is time to ignore him until he complies. Some children will become very provocative trying to re-engage you, but ignore all behavior except something that puts your child or someone else in danger. Once the child complies or gets close enough towards acceptable behavior, praise and give attention again.

Across the board, your goal is to give lots of attention, descriptive praise, and affection for desirable behavior, and as little as possible for unwanted behavior. In most families, we tend to pay little attention to the kids when they are doing what we want, and give then our undivided attention when they are being inappropriate. A power struggle is our children’s way of trying to get control over us, so keep in mind that once we are engaged in battling like equals, they have already won. Lastly, it is important to remember that our children do NOT really want to win power struggles. A child who wins power struggles is not a happy child, instead he becomes anxious, angry, and contemptuous (Remember Veruca Salt from Charlie and the Chocolate Factory?). What truly makes a child feel happy and calm is when he knows that his parents are in-control, protecting him even from his own worst impulses.

Dr. Rebecca Resnik
Licensed Clinical Psychologist
Mindworks Clinical Psychology

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Tuesday, April 8, 2008

Developmental Assessments: Testing for children Five and Under

A psychologist conducts a developmental assessment to evaluate your child’s progress in meeting important milestones of early childhood. Important ‘milestones’ occur in the areas of language, visual motor integration, self-regulation, motor skills, and emotional development. While every child is unique, and develops on his or her own timeline, sometimes there is cause for concern. The American Academy of Pediatrics recently recommended that pediatricians conduct more formal screenings of early childhood development. This is easier said than done. Most pediatricians have to compress their exploration of your little one’s progress into a 15 minute appointment, while also conducting a physical and giving shots, all while the child is crying or running around the room. Its more difficult for pediatricians in a practice where the child sees a different physician every time. Pediatricians refer patients to other professionals such as psychologists, developmental pediatricians, and speech-language pathologists when they suspect that something about the child’s development is either delayed or atypical.

When I use the words ‘delayed’ and ‘atypical’ to describe early childhood development, I mean that some children develop skills more slowly than others (a developmental delay), while other children’s development does not follow the expected course. Atypical development (also misleadingly referred to as a ‘developmental delay’) may mean that a child has an autistic spectrum disorder, suffers the effects of living in an orphanage, or has a genetic difference. For example, children with autistic spectrum disorders may acquire and then ‘lose’ some ability to communicate, while a child with a speech-language delay reaches the typical language milestones (one word, two words, phrases, sentences), just later than his peers.

Parents often want to know what I do during an early childhood evaluation. My job is to study several areas of development, including: social relatedness, intellectual functioning, receptive and expressive language, attention, memory, information processing, adaptive functioning, visual motor integration, behavior (especially play), and sometimes I look at how well they are mastering pre-academic goals like learning their numbers and letters. The trick is to do all of this with the most reliable, child friendly assessment tools I have in the brief time window when I can access the child’s best performance. I have to be ready to be anything from Mr. Rogers to a circus clown to help the child feel comfortable. After data collection, I want to consult with as many of the child’s teachers, doctors and related service providers as I can to get the full picture and to help me interpret what I have observed.

Sometimes when a pediatrician refers a child, the nervous parent will ask me if all this is really necessary, if perhaps their child will just ‘grow out of it’. I am a parent too, and I understand that fear that something is wrong with your child, and how much you hope it will just go away. When a parent calls, here are the ‘red flags’ I am listening for: the child’s expressive or receptive language are well behind schedule, the child is having trouble relating to other people, the child is having temper tantrums that are causing problems at home/school/daycare, the child is having trouble learning at school, the child is exhibiting behaviors that are unusual or severe as compared to same aged peers. Testing gives us answers that we need to address our concerns effectively and with compassion. Testing helps answer what I call the “can’t versus ‘won’t” question. The test data help us make a plan to develop what the child can’t do and guide him toward what he won’t do. The last thing you ever want to do is punish a child for something that is beyond his control.

Sometimes people ask me if I do in-home testing. I strongly prefer to see a child in my office. Generally, home is a very accommodating environment. The child knows all the routines, where everything is, and what every object is called. However, life is not about staying home and functioning in that soft nest of familiarity, it is about transitioning to school, the playground and developing relationships with people outside of your family. I need to see how your child copes with being in a room with a new person, strange toys and unfamiliar tasks. I also need to be more objective than a parent or grandparent, and that includes following standardized testing procedures. Since becoming a parent, I know how hard it is to be objective about your own child, especially when you’re afraid something could be wrong. Using standardized tests and making careful observations allows me to systematically measure your child’s strengths and weaknesses as compared to same aged peers.

Finally, parents come to Mindworks wanting a diagnosis. As psychologists, we do diagnose. This is different from the school system, where the goal is to determine eligibility for special education services (typically under the catch-all early childhood label ‘Developmental Delay’). I believe obtaining a diagnosis is valuable beyond that it helps you access special education services (speech-language therapy, occupational therapy, self-contained pre-school, physical therapy, applied behavior analysis etc.). A diagnosis helps you to empathize with your child, advocate for him, meet his needs, and most importantly to plan for the future.

Unless a child was born with a congenital condition, there is often very little time in between when a delay is identified and when that child will go to school। Early intervention therapies take time. The earlier they begin the more effective they are likely to be. Each family only has so much time, money and energy, and you want to devote those resources to interventions that will matter most. Early childhood services are critical in helping ensure that the transition to elementary school goes a smoothly as possible for a child with a delay or disability. At the end of the day, the reason to do testing is to answer those nagging questions, and to let each family go forth with confidence that they are making the best choices for their child.

-Rebecca Resnik, PsyD
Licensed Clinical Psychologist

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