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

Attention Deficit Hyperactivity Disorder (ADHD): Accurate Diagnosis is the Key to Effective Interventions

At Mindworks, we frequently receive inquires from parents concerned about ADHD. In this article, I will try to present some general information to help parents become a bit more familiar with this relatively common disability. One of the first things we all associate with ADHD is hyperactivity—the kid you see running around like he’s wearing a jetpack with a frantic mother chasing him. While hyperactivity does occur in many children with ADHD, the fact that your child is very active does not necessarily warrant a diagnosis. The Diagnostic and Statistical Manual of the American Psychiatric Association contains three subtypes of ADHD, including Hyperactive, Inattentive, and Combined. ADHD is a constellation of symptoms and behaviors that cannot be explained by any other cause (such as anxiety, learning disability, or a thyroid disorder). Contrary to what many people assume, ADHD is not just having a short attention span. Many parents are confused by the fact that their child can happily spend two hours playing a video game, yet can not complete a short homework worksheet. ADHD is a neurological disorder that has a significant, pervasive impact on learning and behavior.

As Dr. Larry B. Silver has noted, ADHD is a ‘life disability.’ It is not just problems at school. Children with ADHD experience difficulties across settings, meaning that these children have problems with tasks that require sustained attention to detail wherever they go, from the Cub Scout meeting to the homework table. There are two major characteristics of children with ADHD that make life harder for them and the people who love them. One is a weakness with ‘Executive Functioning.’ Executive functioning is our ability to work efficiently, strategically, and to execute our plans mindfully. For example, writing and reading comprehension tend to be the downfall of many children with ADHD, because successful reading and writing depend on executive functioning. Another problematic symptom is difficulty with impulse control (also known as behavioral disinhibition). The child with ADHD has little ability to control his or her impulses, and may routinely violate rules, irritate other people, make careless mistakes, or complete tasks in a haphazard manner.

When talking to parents about testing for ADHD, I recommend investing in at least one very through, comprehensive psychological evaluation. One of the reasons for this is that I want to be able to recommend the most effective academic and behavioral interventions that will match the child’s particular pattern of strengths and weaknesses, but just as importantly, I do not want to be wrong in my diagnosis. ADHD is known as a ‘diagnosis of exclusion,’ meaning that you must make sure that nothing else could be causing the symptoms. Doing a quick parent interview or a couple of symptom checklists is not adequate. Additionally, it is currently estimated that as many as 50% of children with ADHD also have specific learning disabilities. Not only are these children at risk for school problems, they are far more likely than peers to have significant levels of anxiety, depression or behavioral problems. Researcher Dr. Russell Barkley has described children with ADHD as being several years less emotionally mature than typical peers. This means that both parents and child are likely to need additional support.

-Dr. Rebecca Resnik

Licensed Clinical Psychologist

“Too hard to say NO”

It is too hard to say “no” to your intensely protesting child even though in your heart of hearts you know it is the right answer? Given that a blog on this question is being posted, at least you know that you are not alone with this dilemma. First, children are very good at what they do. Indeed they are wired to be experts in survival. And while we are also wired to be caretakers, the challenge of parenting is much more complex and demanding than being the child. All that having been said, when children are fighting hard against their mother’s and father’s wishes and using every possible strategy they can find, from screaming in the middle of a crowded store to telling you adoringly how much they love you (with a kiss kiss here and a kiss kiss there) to get what they want, you needn’t be fooled. These brilliant young folks are likely testing your strength as the parent and the one in charge as much, if not more than trying to get their way.

It is hard to be a child and so dependent upon others for security. Not surprisingly, these smart little people need to test the limits of their security – when they learn their environment is safe, they can relax and engage more deeply in their environment – a good thing for healthy development. How do they test the limits of their security – by seeing how far they can push you – who is stronger, me or you,

Who is in charge here, how much distress can you tolerate and still prevail?

To test this theory, try refusing your child’s unreasonable requests with this in mind. Hopefully, this discussion will make saying “no” easier. After the initial “storm” do they seem calmer, more at ease, more solicitous of your affection? And how are you doing? Do you feel more “in charge” and self confident? Are you feeling more affectionate towards your child rather than resentful of their victory?

We hope this little experiment is helpful as setting limits effectively with you child not only greatly enhances the quality of your relationship with them, but it is an important component in healthy development, internalized security and respect for others. Another good reason to do this sooner rather than later is that it makes the adolescent years much more enjoyable for all.

Dr. Barbara Mazer

Clinical Psychology Resident and soon to be MindWorks clinician!

Some Thoughts about Behavior Plans

Behavior plans are one of the most popular approaches for trying to systematically change a child’s behaviors. Decades of research has shown that even an earthworm can respond to a simple behavior plan. So why do so many frustrated parents come to us at Mindworks with the classic lament “We tried that, it didn’t work.”? As with most things in life, it’s because there is almost never a simple answer to a complex problem.

Helping our children develop self-control is one of the most challenging tasks we parents face. One reason behavior plans can fail to make lasting changes is that people understand them as ways of making a child to comply. Getting people to comply is pretty easy. I can get you to do anything I want if I threaten you with a nasty enough consequence. However, once I’m not around or I can’t make good on my threat, you’re going to go right back to doing what you want. While we all need our children to comply with our rules, the true goal of a behavior plan is to teach the child to do something new.

When we take a teaching approach to modifying behavior, we come at the problem differently. Now our goal is to help the child choose a better set of behaviors than whatever behaviors are causing problems. As the psychologist Reginald Lourie noted, we must not eliminate a behavior without giving the child an attractive option for how to handle a stressful situation. If we just focus on stamping out a particular behavior, the child will find another way of dealing with his anger, frustration, boredom or shame (e.g. the child goes from hitting to biting). Remember, the goal is not just short-term compliance, its long-term development of self-control. Behavior plans have many common pitfalls. A major problem is lack of consistency, or using the plan sporadically or for too short a time period. This inconsistency creates a situation like a person gambling at a slot machine. Your child is the gambler, hoping for a pay-off (i.e. you giving in!). Guess who is the slot machine? When the ‘gambler’ never knows when the machine will ‘pay-off’ he is very, very, motivated to keep pushing buttons until it does. Kids are always looking for how to ‘beat the system’ and many parents give up as soon as the child finds a weakness in the plan that he can exploit. Every plan has weaknesses your child will find. That’s a delicate phase in implementation.

A psychologist can help you get through it without having the whole plan go down in flames. It is vital to get help from an expert to make sure your plan is developmentally appropriate! Lots of great plans fail because they are better suited to older children or for those without disabilities. The child must have the maximum chance for success, because there’s nothing harder than trying to implement a second, third, or fourth plan after failed attempts. A psychologist can also help you avoid pitfalls like inappropriate consequences. Too many well meaning people enact consequences that make the situation worse for everybody. For example, some people take recess from a child who desperately needs to let off steam, cancel birthday parties, or put a withdrawn, avoidant child into time-out.

Keep in mind that changing troublesome behavior does not happen overnight, and can be incredibly discouraging. The good news is that when behavior plans are proactive, fair and a good match for the child, they can and do help children change!

-Dr. Rebecca Resnik

Of note, Dr. Resnik was just interviewed with the Voice of America to present a televised series of parenting tips in Urdu speaking Pakistan. It's a reminder that behavioral problems and parenting challenges are universal!

A feedback letter from a client

I received an e-mail from a family I worked with earlier this year. With her permission, she is allowing me to post it on this blog (alias used for her son's name)

Dear Dr. Varia,

I thought I'd write and update you on Michael's status since we met with you in August. I am SO grateful for your testing and advice. It gave us the information we needed to understand Michael's struggle with school, and to get him the help he clearly needs.

Michael was determined "Eligible" for help with his "Specific Learning Disability". An IEP was created on October 23. He had been placed in an 8th grade team of students that had special ed teachers already in the primary course classrooms on the second day of school, "just in case" he qualified for help. I am quite sure that just having those extra teachers available to help, for they help all of the kids, not just the ones assigned to them, helped him accomplish all A's and B's on his first quarter interims!

Michael has expressed relief in knowing that there is an explanation for his school difficulties, and that he is not alone moving forward. He's been very receptive to the help of his new teaching team, and continues to work hard at home.

I am so glad we were referred to you, and for the work you did with Michael. I just wish we'd caught it sooner. I know that if Michael had been identified sooner, it would have saved him, and me, much anguish. The silver lining is that it has been caught, and his future will be enhanced. I am so grateful for your work with Michael. Sure, we paid for the evaluation, but knowing it was done by a highly educated professional that specializes in this sort of assessment, and who prepared reports that were detailed and specific to him made it clearly worth the investment. His future was at stake, and has been brightened by your help.

When should my child be tested?

Parents often ask us when is the right time for a child to receive testing or therapy services. They may have heard people tell them to wait until third grade, or until a child is 7, or even “Don’t worry, he’ll grow out of it.” There is no magic age for testing and therapy, and if your instinct as a parent is telling you that something is not right, its time to act. Time is one of our most valuable assets in helping children. Most problems that took a while to develop take a while to improve, and when better to make changes than at a time in life when the brain is most adaptable? Early intervention is vital if you have concerns about a very young child (under 5) or if things have been getting steadily worse and worse for your child over time.

For children with ADHD and learning disabilities (as many as half of all children with ADHD also have learning disabilities), testing is critical as soon as problems are noted at school and home. Children with average intelligence can usually cope with the demands of the first grade curriculum, at least for the first part of the year. First grade is a time when the basic skills are introduced. Each task is short, involving only a few steps to complete. First grade work is highly structured, and most things the child reads will have helpful pictures. Homework can usually be completed in a half-hour. If your child is having learning problems in kindergarten or first grade, this can mean that the problems are particularly important to address. If the first year of school is unsuccessful, children may become convinced that they will never be able to do well. Feelings of frustration can lead to school avoidance or disruptive behaviors. As a former teacher, I have observed that some children quickly get a reputation among teachers for being 'trouble.' Once it sticks, the label is one that follows the child from year to year. It is much harder to develop a working partnership with school staff when everyone in the school has decided that your child is a 'problem.'

Many of the children I see come during the third grade. The reason for this is simple if you are aware of the scope and sequence of the elementary school curriculum. Third grade is when academic tasks require sustained attention to detail. Almost everything takes more time to complete and involves more steps. Instead of taking five seconds to complete a math problem, it can now take a few minutes to complete each problem (e.g. borrowing and carrying operations). Instead of writing a single word or sentence, the child must do a book report. Children with reading comprehension problems have an exceedingly difficult time understanding chapter books and text books. The helpful pictures they depended on are gone. Projects can take a week or more of planning, which is the downfall of a child with executive functioning impairment. These changes in the curriculum can cause child's academic progress to stall. Children who can not sustain attention or understand most of what they read fall behind their classmates very quickly. This can be a disheartening event for the child. Some develop anxious fears that they are not smart enough to learn. Many cope by convincing themselves that they don't care anyway, that school is stupid or that all teachers are against them. This state of affairs should be a thing of the past now that we have so many treatments and educational interventions, yet I still see children who have gone for years without receiving the help they need.

When deciding whether or not to test, it is important to understand that troubling symptoms can happen for a lot of different reasons. Symptoms like irritability can indicate conditions such as ADHD, depression, anxiety, obsessive compulsive disorder, sensory integration disorder, or even a medical problem like a sleep or elimination disorder. Children are complex beings who, unfortunately, do not often know how to tell us what is wrong. When we ask a child questions like "Why aren't you doing your work?" or "Why can't you sit still?" we get answers like "I don't know." Testing can give us the answers the children can not. I have yet to meet a child who is unsuccessful because he chooses to be. I believe that all children want very badly to make their parents and teachers proud. Research has shown that when children can not meet adult expectations at school and home, they are at-risk for secondary mental health problems like depression or anxiety. Children with undiagnosed disabilities often feel terrible. When kids feel terrible they may become disruptive, avoidant, or even aggressive. It makes sense if you think about it from the child's perspective, who can be happy spending six hours a day feeling like a failure or getting punished? As adults, we would quit a job like that, but kids don't have that option. Children are stuck with school, whether it goes well or not. Children who feel chronically frustrated, irritated, stupid or disliked need help before they become so discouraged that they give up school, or worse, on themselves.

Rebecca Resnik, PsyD, Licensed Clinical Psychologist and Former Special Education Teacher

Our Mission Statement and Philosophy

MindWorks Philosophy and Mission Statement
What Makes MindWorks Work.

MindWorks, Clinical Psychology is committed to providing the highest-quality therapy, consultation, and assessment services by having specific standards for its:

1. Clinical Services
2. Staff
3. Environment

1) Clinical Services. MindWorks believes in a family systems model of therapy where children are not treated in isolation, but parents are made active participants in creating change. Assessments are based on creating a roadmap for clinical concerns and are individualized and thorough. MindWorks believes in communication with other parties and a collaborative model of care.

2) Staff. MindWorks believes that high quality services can be provided to clients by having excellent clinical staff. Staff is carefully selected to have a combination of professional acumen, personal warmth, sincerity, and approachability. MindWorks offers contractors a flexible schedule, steady stream of clients, and the ability to focus on clinical work instead of administrative and insurance tasks. MindWorks’ contractors are encouraged to create niche clinical services for professional and business satisfaction and growth. In addition, MindWorks is dedicated to a family friendly work environment where personal needs are prioritized (time off, child-care, pregnancy, professional development).

3) Environment. MindWorks provides a client-friendly office atmosphere where both adults and children feel comfortable. MindWorks strives to create an environment where clients are not anxious about receiving services and rather experience the clinic as a secure place. This Environment is created through clinician warmth, speedy communication and coordination, and a décor that is inviting and colorful.