Making Changes Count and Last

Making Changes Count and Last

As the New Year starts and people are focusing energy on making resolutions it seems to be an appropriate time to write an article regarding how to be most successful with making healthy changes.  The process of how and why people change and what leads to lasting change has been a large emphasis of importance for the field of psychology.  The specific area of motivation to change has been an area of particular interest and study for myself personally in the field of mental health.

First, regarding motivation to change there is strong research in the field that has clearly defined stages that people commonly go through in their change process. Prochaska and DiClemente's Stages of Change Model describes a natural process in which people cycle through stages of readiness and action in the process of changing their behavior.  This cycle includes six stages:  precontemplation (person is not considering change), contemplation (person is considering change, but has not acted to make a change), preparation (person is getting ready to change and is surer that a change is needed), action (person implements changes), and maintenance (person is able to sustain change).  Relapse (stage 6) is also considered part of the process since most people re-cycle through the stages at least once on their way to stable change.  Relapse is generally an event that terminates the action or maintenance stages and leads the person to cycle back into the precontemplation or contemplation stages.

It can be important to keep a high level of motivation in order to stay in the action stage for change.  This can often be achieved by acknowledging both the pros and cons of a certain change since the pros of a change typically outweigh the cons.  For example: for someone deciding to eat healthier and exercise more the cons of this plan could be things such as it can be more expensive to eat healthy, takes more planning, can cause physical soreness, it is hard to give up some favorite unhealthy foods, etc.  This same person though when thinking of the pros or positives of healthier eating and exercise habits can focus on how he or she feels better when in better shape and eating healthy, the decreased risk for illness and chronic diseases, etc. Since these types of pros outweigh the cons that do exist the person can stay motivated and remain in the action phase of his or her change plan.  This type of strategy involving reviewing both the pros and cons also has been found to significantly help people maintain changes.

In addition, when people have made it through a motivation to change cycle and are in the action stage there are many things that assist people in being successful.  One key strategy is for people to set clear and realistic goals.  Setting both short-term and long-term goals can help people stay on track when creating new behaviors.  It also is critical for people to reward themselves with bonuses or incentives for reaching milestones along the way in achieving a goal.  Setting small, achievable goals and rewarding and celebrating successes is one of the best ways to stay encouraged and motivated to continue reaching a goal and moving into making a new behavior into a healthy habit.

Having significant support systems can also be crucial in successfully reaching goals.  In general, people who surround themselves with supportive others (often others with similar goals) are found to be successful.  For example, research has been presented that people who attend support groups for weight loss typically are more successful than others who try to reach their weight loss goals without a supportive system.

Sometimes people will try to change too many things at once, which for many people becomes too overwhelming.  This feeling of being overwhelmed often seems to lead to people becoming discouraged when they are not able to maintain all the changes they are trying at once.

The beginning of the New Year can offer a wonderful opportunity to reflect and reassess, creating the space to chart a course for change.  Hopefully some of this information regarding how the motivation to change process works, as well as strategies for how to set and achieve goals regarding creating new healthy habits will be helpful as people work to make changes this year.

**Prochaska, J. O. (1999). How do people change, and how can we change to help many more people?  In M. A. Hubble & B. L. Duncan (Eds.), The heart and soul of change: What works in therapy. (pp. 227-255). Washington, DC, USA: American Psychological Association.

Making the Most of the Holidays

Making the Most of the Holidays

For many families the holiday season can be both an exciting and stressful time of year.  This can be especially true for families with children with special needs who may struggle with some of the aspects of celebrating and participating in holiday events.  It can be particularly challenging for parents to make the most of the holidays in a way that doesn’t overwhelm them and their children.

The holiday season can be stressful for all children, especially children with special needs for many reasons.  Some of the challenges often presented this time of year include children being affected by a dramatic change in schedule, being overwhelmed by the amount of events that they are to attend, exposure to situations that can often aggravate sensitivities such as to touch, noise, and to various foods, struggling with being overexcited about events, and participating in family gatherings or traditions.  Attending family events can often be stressful for parents due to concerns regarding how their child might interact with other children and family members since often children with special needs struggle with emotion regulation and social skills.  This can be especially difficult when parents feel that other family members do not agree with their parenting in some situations since often parents of children with special needs have to provide interventions unique to their specific child.

The good news is that there are many strategies that can be helpful for families to truly make the most out of the holiday season for both parents and their children.  In general, it can be important to prepare children for what to expect and what will be expected from them as much as possible.  This could mean having many conversations about what is on the schedule for the day or week.  Often a visual reminder of what is coming can be helpful for children.  Parents can also benefit from being selective about what events they choose to have their children participate in and often limiting the number of events per day so that their child is less likely to be overwhelmed.  Allowing children to pick some of the activities that they will participate in and providing children with a lot of down time may also be important.  This may entail having large breaks in between events, but also may include bringing your child’s favorite toys or soothing things with them when you are out.  For example: having a stash of Legos that your child can play with in a quiet room at a holiday event for a specific period of time may be a lifesaver if your child is soothed by Legos.

For children with noise, touch, or food sensitivities it may make sense to try to avoid places that may be too stimulating for children.  For example: A parent may want to avoid holiday shopping with children at peak hours or during large mall events.  Parents can plan ahead and make sure to bring several of their child’s favorite snacks or foods to events as well.

Parents may also find that their children are more successful at family events if they provide a higher level of supervision and monitoring.  This higher level of monitoring can sometimes help children to navigate challenging social situations.  In many instances, parents may help stop a problem before it really starts.  For example: for children who struggle with playing board games with others, it may be helpful to pre-teach prior to the family event and provide incentives.  Pre-teaching could mean having a conversation prior to the day about how the child will likely be able to play a board game, and provide examples of how he or she can show good sportsmanship.  Incentives for good sportsmanship may also be helpful since children are often motivated by rewards.  Some parents will opt to bring a craft project or a noncompetitive game as a way to have their children participate in family events without having to compete if this would be too challenging at the current time for them.

Utilizing some of these strategies plus taking the time to think about a child’s unique needs and what types of things such as level of structure and reward plans usually help him or her to be successful can really help to make it a wonderful holiday season.  Being positive with children, creating opportunities for fun family times, and using some of these strategies that apply will hopefully help parents to create some great holiday memories.

Finding your Inner Sherlock Holmes

Finding your Inner Sherlock Holmes: Key Strategies for Being a Good Parent Detective

One of the keys to assisting children to grow and develop healthy is by providing the supervision and monitoring necessary to help them navigate the minefield around them that is otherwise known as the teen years. Research in the field consistently signals the importance of monitoring and supervision as main ways to help children be successful in these potentially turbulent years. Monitoring and supervision often include things such as knowing who children are spending time with, what they do when they are out of the home, where they go, and what the supervision, monitoring, and value systems are of their friends' parents. While some children are open books, other children do not want to include their parents in their lives or choices. For these children who often want more privacy and independence, parents often have to work hard, channeling their inner Sherlock Holmes to be the type of parent detective that their children need.

It is a parent's duty to know what his or her child is up to and that he or she is safe. This can be especially challenging for parents of children who want to be left alone to make their own choices and decisions. The responsibility remains with parents to know that their child is safe, by knowing what behaviors he or she is engaging in and what situations they may find him or herself in. For situations in which children do not share with their parents or include them, parents need to do what is necessary to get the information that they need.

There are several signs that may signify to a parent that their child may be struggling. These signs might include:
1.            A child has become withdrawn or secretive.
2.            A child's grades have decreased dramatically.
3.            Teachers, a child's friend, family members or others have brought up concerns for a child.
4.            A child has changed who they spend time with (possibly associating with others who may not be making healthy choices).
5.            A parent questions whether their child might be using drugs.
6.            Something in a parent's gut just tells him or her that something is not right!
 
What I advise parents to do is to trust their gut response. If something is telling them that something isn't right, they need to investigate and get the information needed to know if their child needs help to be safe. Sometimes parents get overwhelmed or discount their gut reactions thinking that they are overreacting. Without further information a parent may not know, and if his or her gut is right that a child may need a lot of support, guidance, and clear guidelines in order to be safe.
 
Parents can ascertain information in lots of ways. This can be as simple as being sensitive to children and asking questions. Sometimes parents find that asking children at the right times is crucial to get the information they need. I know of parents who make a point to get a special treat with their child or ask questions while driving alone together in the car because they have noticed that these are situations in which their specific child is more open. Another key is to be involved. Being involved in a child's life may include:
1.            Talk to other parents.
2.            Pay attention when you are driving a carpool-you might just be amazed about what children talk about when they don't think you are listening.
3.            Show up where your children are supposed to be. Often you will not even talk to them, but I recommend that you sometimes attend a movie at the same time or go buy a coffee when you know your child is supposed to be hanging out at a coffee shop or bookstore with friends.
4.            Have many clear rules for phones, computers, and social media. These rules should include things like no deleting or closing down any screens when you are in the room, that you can ask to see their pages, emails, texts, etc. at any time, and that you control all passwords. I know many parents who also have their own Facebook account or something similar just as a means to have more information about what his or her child is doing.
5.            Get clear evidence if possible. For example: if you are concerned about drug experimentation conduct drug testing.
 
Another challenge for parents is that many teenagers are upset and angry when their parents set rules, supervise, monitor, and when they investigate their child's behavior. I recommend that you notify children that it is your responsibility to be a good "parent detective" and that you take this job very seriously. It is OK to inform your children that it is your duty to keep them safe and healthy and that this is a nonnegotiable thing. Some parents also need to be firm and let their child know that he or she needs to comply with the parent's conditions in order to earn privileges. For example: many families have a rule that in order for a child to visit a friend the parent needs to have met that friend previously and spoke to the other child's parent about this specific event. If a child is not willing to comply with these guidelines than the child is told that he or she does not have permission and the matter won't be further discussed until he or she does what is necessary to fulfill the guidelines.
 
The best way is to get the information needed is to foster positive, open communication with your child. This is more likely to occur in cases where you make times to just have fun and positive interactions with your child, where you praise and reward your child for telling you things you think are important for you to know, and when you are able to manage your own emotions regarding what your child is telling you. Children are much more likely to discuss more important topics in the future when you have stayed calm and had good conversations about what they are telling you. It is a difficult balance, but it is important to hear your child out and also tell them your values as well as your hopes and dreams for them in a way that doesn't feel too much like a lecture. The reality is that children need their parents in these turbulent years and parents need to rise to the challenge. Know there are supports out there, good sources for education, other parents who also are working hard to keep their children safe who can be important allies, and parents have a wealth of knowledge because they survived their own teen years and have lived to tell about it. With all of this support and knowledge, parents can make Mr. Holmes proud.

Determining Whether an Assessment is Needed for your Child

Determining Whether an Assessment is Needed for your Child

There are many occasions in which a parent may want to have his or her child's learning assessed. Often psychoeducational assessments are conducted to determine if a child has a specific learning disability, significant attention difficulty, or mood disregulation. Assessment can be a powerful tool to learn more about a child's strengths and weaknesses and learning style.  Assessments also often provide a solid foundation to advocate for a child to receive various treatments and accommodations to help at school, home, and in the community.

A parent may want to consider having an assessment conducted for his or her child for several reasons including when the parent is concerned about various difficulties learning, achieving academically, behaving, or coping emotionally. In addition, teachers often express concerns that a thorough assessment may help to address.

A parent may want to consider an assessment if his or her child is having trouble learning including:
1)    Consistent difficulty in a specific subject area
2)    Not performing up to his or her ability across subjects
3)    Failing grades
4)    When there is danger of the child being retained
5)    Persistent difficulty despite additional academic support

An assessment may also be warranted if a child struggles in areas such as:
1)    Trouble paying attention/maintaining focus
2)    A parent questions a child's level of motivation due to trouble with homework struggles including homework time being a consistent source of conflict, a high number of missing assignments, incomplete work, or a child forgets to turn in work that was completed.
3)    A child has trouble sitting still for any significant length of time when it is not a favorite activity
4)    Trouble with organization
5)    Difficulties at school (with teachers or peers) due to impulsive behaviors such as talking at inappropriate times or saying or doing things without first thinking of the consequences of a behavior.
6)    Difficulties regulating emotions

An assessment may also be helpful for families in which there is a family history of learning or attention difficulties.

While the assessment process can take some time, conducting a comprehensive assessment can be one of the most important ways to support a child's growth.   Assessments make it possible to determine if a learning disability, attention difficulty, or mood disorder is impacting a child's learning, as well as provides information regarding a child's specific needs and often the most helpful ways to intervene.

Strategies to Help Children Overcome Social Challenges

Strategies to Help Children Overcome Social Challenges

Many children struggle socially.  This is especially true for children with attention, learning, and behavioral difficulties.  Certain behaviors common to ADHD can often negatively impact children socially.  These behaviors often include: acting impulsively, being insensitive to subtle interpersonal cues, having difficulty controlling what affects attention span, struggles learning from both positive and negative experiences, and trouble predicting audience response.[1]  Unfortunately, even when children with ADHD have friends, the friendships tend to be less supportive and more conflict-filled than those of children who do not struggle with attention difficulties.[2]

Parents play a vital role in assisting children with building their social competencies.  Several strategies that can be helpful include:
talking to your child about the importance of social skills
setting specific and realistic social goals
set up supervised, time-limited play dates for your child
review social goals prior to outings
choose simple and enticing play activities, involve teachers and other professionals in teaching your child social skills
prompt your child to think about the feelings and reactions of others.[3]

A great way to practice understanding the feelings and reactions of others is to stop movies or television shows and have your child guess what characters might be feeling, what social cues or body language they may be displaying, and to guess what might happen next.

Adding exciting bonuses for children practicing specific social skills can also be helpful.  For example: a child may receive a bonus at home for asking a peer a question during lunchtime at school.  Some children know exactly what to say to others and just need some prompting while other children desperately want friends but do not know what to say.  For children who struggle to know what to say to others an adult can practice conversations together.  Ping Pong Conversations is one of my favorite social skills games we play at camp in which children try to see how many times they can volley a conversation back and forth by asking questions and responding appropriately.  At Quest, we use this game as a way to have children practice skills including eye contact, turn taking, focusing on the other person’s perspective, practicing switching topics, etc.

Some tips for when you provide your child with friendship feedback are to keep it brief, be specific, stay focused on the present, and stay positive.[4]  I often think about the Charlie Brown cartoons in which any adult talking always sounds like “wha wha wha.”  Children with attention difficulties are typically more prone to hearing adults this way.  A large challenge for a parent or teacher can be to try and be concise and to the point by trying to give a child information in 10 words or less.  It can also be helpful to teach your child what to say in situations such as “If you lose you can say ‘good game’ to the winner”.[5]  It can also be helpful to praise and reinforce a child for what he or she did well versus focusing on what he or she did incorrectly in a social interchange.

Deep down social skill development takes time and children often benefit from getting to practice skills across a variety of settings and situations.  The good news is that positive adults can utilize a variety of strategies to assist children in building important skills in this area.



[1] Cohen, C. Raise your child’s social IQ. Attention, April 2010.
[2] Mikami, A. Y. How you can be a friendship coach for your child with ADHD. Attention, April 2010.
[3] Cohen, C. Raise your child’s social IQ. Attention, April 2010.
[4] Mikami, A. Y. How you can be a friendship coach for your child with ADHD. Attention, April 2010.
[5] Mikami, A. Y. How you can be a friendship coach for your child with ADHD. Attention, April 2010.

Taking the Emotion out of Parenting

Taking the Emotion out of Parenting

Parenting can easily be one of the most challenging aspects of a person's life.  While parenting can be an incredibly rewarding experience, there is no question that having to parent when a child is testing limits can be one of the most stressful and upsetting things for a parent to handle.  This can be especially true for parents of children with special needs since at times their children are more prone to high levels of emotional outbursts and challenging behaviors.  Luckily there are many strategies that can assist parents in staying calm no matter what situation arises with their child.

There are many strategies that can assist parents in staying calm despite their child's emotional or behavioral level.  These strategies can include:

1.  Pay close attention to your own emotion level by monitoring your mood and behaviors.  For example: If you can still talk calmly and feel positively about your child then you are probably still able to problem solve or provide appropriate discipline for your child.  If instead you are struggling to not raise your voice, threaten your child, provide unrealistic consequences, or are having trouble thinking clearly it is best to step away from your child to calm down.

2.  It is critical to notice what messages you are interpreting from your child to make sure that you are hearing them correctly.  Often when we are angry or upset we infer what others are thinking or feeling incorrectly.  This can often arise in parenting in cases when parents misinterpret their child saying "no" to them to instead mean, "You are a bad parent.  I don't care what you say.  I don't love you."  Parents often are able to manage their emotions better when they can frame their child saying "no" as "Right now my child is telling me that he or she needs a lot more guidance to make a correct choice."  It also can be really important to alter your child's message to what they really mean.  For example: It is crucial to re-frame when a child says something hurtful like, "I hate you." or "You are the meanest mom ever." to instead be, "I am so mad right now that I can't stand it."

3.  Walk away from the situation and calm down prior to trying to solve a situation with your child.  It is better to say, "I love you and I will work to solve this problem with you, but first I need to calm down" than to resort to a less effective and overly punitive approach.  It is also often helpful to tell your child, "You have earned a consequence for your behavior, but I am too mad to give it right now," as a way to acknowledge your child's behavior, but to also allow yourself room to avoid the pitfall of providing harsh consequences when angry.  

4.  Talk deep breaths, use imagery to think of a relaxing place, think positive thoughts, exercise, talk to a friend or spouse, read, or engage in other activities that will assist you in calming down and being ready to engage in healthy problem solving.  It is recommended that people engage in a minimum of 20 minutes per day of self-care as a way to manage stress and anxiety.

By removing some of the emotion related to parenting, parents often feel more in control and positive about their interactions with their child.  Give your child the benefit of the doubt in your communications with them and it is possible to feel happier and more effective as a parent.

Last Child in the Woods

Last Child in the Woods: Saving our Children from Nature-Deficit Disorder
 Spotlight on a Landmark Publication

Richard Louv's national bestseller, Last Child in the Woods: Saving our Children from Nature-Deficit Disorder, is a must-read for nature enthusiasts and anyone concerned about our children's health or the environment.  Mr. Louv states, "A growing body of research links our mental, physical, and spiritual health directly to our association with nature--in positive ways.  Several of these studies suggest that thoughtful exposure of youngsters to nature can even be a powerful form of therapy for attention-deficit disorders and other maladies.  As one scientist puts it, we can now assume that just as children need good nutrition and adequate sleep, they may very well need contact with nature."  He cites research that has shown that exposure to nature may reduce symptoms of ADHD, improve children's cognitive abilities, creativity, and productivity, while also increasing resistance to negative stresses and depression.

Mr. Louv has coined his own phrase, Nature-Deficit Disorder, to not act as a formal medical diagnosis, but instead to reflect the "human costs of alienation from nature, among them: diminished use of the senses, attention difficulties, and higher rates of physical and emotional illnesses.  The disorder can be detected in individuals, families, and communities.  Nature deficit can even change human behavior in cities, which could ultimately affect their design, since long-standing studies show a relationship between the absence, or inaccessibility, of parks and open space with high crime rates, depression, and other urban maladies."

Several chapters in the Last Child in the Woods account for how this decreased connection with nature has occurred over time, citing many areas including children and adults' increased dependence on electronics, less accessibility to natural areas due to less space and more restrictions placed by government and private agencies to use space, fears related to safety concerns regarding allowing children outside to explore independently, and the busy over-scheduled lives of families.  Mr. Louv describes how visits to national parks have decreased dramatically despite the long history of parks being safe for families.  He notes how these changes are leading are younger generations to not be as connected to nature and less concerned with protecting our environment.

In the expanded version of Last Child in the Woods, Mr. Louv also provides a list of many steps that children, families, community members, and government officials can take to preserve nature and positively impact the lives of children and adults.  He cites the No Child Left Inside Act as a positive step being taken on a national level to address the negative impact of losing our connection with nature.  Mr. Louv also provides a clear list of several actions we can take to celebrate nature including: viewing nature as an antidote to stress, encouraging kids to camp in the backyard, engage in cloud watching, have a "green hour" as a family tradition as a time for unstructured play and interaction with the natural world, institute a "sunny day rule" where children's inside time is highly limited when the weather is nice, hike, plant a garden, send your child to camp, spend family vacations in state or national parks, read outside, work to transform communities to be places with lots of green space, and to be an advocate for the environment.  Mr. Louv's message is clear--nature matters and we need to do our part to protect it for ourselves and future generations.

The Wild West of Parenting

The Wild West of Parenting 

Changing Negative Behaviors through Strong Parenting
There is no question that parenting can be like the wild west at times.  This is especially true when a child's negative behaviors have taken over a whole family system.  The image that this draws is one of an old western town in which there is chaos and instability due to the wild rule breaking ways of a small group.  There is fear among the townspeople that one wrong move can bring havoc and disrupt the tentative peace.  Often in families where this has occurred the natural tendency is for parents to submit to their children’s wishes to try to keep unstable situations from escalating.  Ultimately, though, what saves the western town and restores peace and order is the same thing that can rescue families and reestablish serenity in the home.  Just as in westerns where the sheriff must ride into town and take control through a true show of legitimate authority, parents must also assert themselves and restore order.

The first step to repair the true family order and stop negative behaviors is for parents to realize that they are the sheriffs and that their rightful place is in an authority position.  Parents should be in charge.  Then the best way to move forward is to set clear expectations for behavior with a large selection of rewards for positive behaviors and appropriate consequences for negative choices.  Parent sheriffs must be ready to put down rebellions when they arise.  This is analogous with the famed western gun battle.  Children engaging in negative behaviors do not want order to be restored so they will typically raise the stakes when a new limit is set to try and bully parents into giving into their demands.  Parents, who know that their limits are right and that they (not their child) are the appropriate ones to be setting the rules and expectations, do best.

There are many keys to a successful transition in the family system.  The following list can be used as a guideline:
Be prepared for the showdown emotionally, knowing that most likely you will see an initial increase in negative behaviors when you set clear expectations for your child.
Have a large amount of possible rewards to provide for your child for making good choices.  Rewards are always needed for any program to be successful.  These should be rewards and incentives, not bribes (meaning that the child must first engage in a positive behavior prior to receiving a reward and not the other way around).  Rewards do not have to be of monetary value.  Sometimes spending alone time with your child doing his or her favorite activity can be a great reward. Another possible reward could be letting your child choose what meal he or she wants for dinner.
Have appropriate limits and clear consequences for when a child continues to act out.  It is important a create a large list of appropriate consequences ahead of time so that a parent doesn't fall into the trap of selecting too harsh of a consequences resulting from aggravated emotions in the moment.
Seek support from others who are able to assist you when the showdown is occurring.
Take time for your own self-care.  This can include leaving the situation for a brief period to calm down and manage your own emotions.  Taking deep breaths, exercising, utilizing imagery, taking time out for fun activities, and accessing a support network can all be important components of self-care.
Parents need to know that the showdown is time-limited.
Ultimately, order will be restored.  Only this type of order can bring about true happiness and safety for a family.

Success at Home Starts with Home(work)

Success at Home Starts with Home(work)

Homework is often one of the most challenging times of the day for both parents and their children with attention and learning difficulties.  Homework is also one of the most crucial elements to a child's ultimate success at school.  The good news is that there are several things which can be done to make this time less stressful and more productive for both children and their parents.

Prior to setting up a homework routine, there are a number of issues that need to be worked out to ensure success.  First, there needs to be a high level of communication between the parents and the school.  This should occur on a daily basis for elementary school children and at least once a week for middle and high school students with attention and learning difficulties.

For elementary school aged children:

Your child's teacher should check and sign that your child has written down all homework in a designated place (such as a homework journal, special folder, or agenda).
Also, it can be helpful to have the teacher check your child's binder to make sure that he or she is bringing home all necessary items (such as books or handouts) to be able to complete the homework.  This step can be especially important for children who have difficulty tracking their belongings.
Children at this age should not be spending more than one hour of focused time on homework.  If their homework is taking longer than this, it can be helpful to have assignments shortened/modified as needed.

For middle and high school aged children:

It is crucial to receive a weekly update from the school concerning your child's school performance including tests, quizzes, missing assignments, behavior, and projects.
A list of all homework to be assigned for the week is also helpful in supporting your child's success.
Often parents wonder if the above accommodations are realistic, typically citing the teacher's limited time and high number of students in class.  However, if your child has a diagnosis of ADHD or a learning disability, your child's school has a legal obligation to make these types of accommodations if a 504 accommodation plan or an Individualized Education Plan (IEP) is in place for your child. Communication between parents, children, and teachers is critical in order to set your child up for success.

A successful homework routine starts with structure and clear expectations.  It is best to have children come home from school and start homework after a snack, prior to engaging in any desired activities such as outdoor play, TV, computer, or videogames.  Children with ADHD struggle to delay gratification and respond best when they know there are clear rewards (such as earning these desired activities) after first completing a task.

 For your child to earn time to play/engage in desired activities:

Set the expectation that your child needs to show you all work before it is considered finished.
It is your child's responsibility to complete all assignments, which includes making all corrections noted by the parent.
There should also be a clear expectation that your child demonstrate respect through their words and actions during this process.
It is the role and responsibility of the parent to:

Set clear expectations for homework time and immediate rewards for finishing (such as earning 30 minutes of playtime).
Praise and reward your child often for improvement.
Be consistent about enforcing the structured time to start homework while also providing the rewards that have been established.
Provide weekly rewards for improvement regarding your child's daily/weekly tracker.  For example: you might reward your child for bringing all needed assignments home for the week, decreasing the number of missing assignments, having a well-organized binder, or for taking more initiative to show you their completed work while demonstrating a positive attitude.
Missing assignments is often where children with attention difficulties have a major problem.  It is common for children with ADHD to struggle with completing assignments and then find it challenging to remember to turn in completed work.  There is often dramatic improvement in both completing and turning in assignments by tracking for improvement and providing rewards, as well as setting consequences such as limiting some weekend privileges and designating that time to complete the missing assignments until your child is caught up.

The good news is that by making these changes to the expectations, structure, rewards, and consequences for homework, it is possible to see dramatic changes in your child's performance.  In addition to helping children feel more successful and competent in their environment, these changes can often relieve stress and conflict between parents and their children.

The Power of Exercise

The Power of Exercise
 Spotlight on a Landmark Publication

New research provides great support for the use of exercise as a treatment option for ADHD, anxiety, depression, and as a means to improve learning.  One ground-breaking book in this area is Spark: The Revolutionary New Science of Exercise and the Brain, written in 2008 by Dr. John J. Ratey, clinical associate professor of psychiatry at Harvard Medical School.  In Spark, Dr. Ratey clearly summarizes the growing research to support the power of exercise to positively impact the lives of children and adults.

Dr. Ratey describes growing concerns regarding the high level of obesity in children, the alarming amount of time that children spend in front of a screen (TV or computer) per day, and the unfortunate trend in which only 6% of high schools offer physical education daily.  To further his assertion, Dr. Ratey provides statistics including the fact that 30% of U.S. school children qualify as being obese, with another 30% being at great risk for obesity and citing that children average 5.5 hours per day sitting engaged with electronics.

Researchers consistently find that exercise is able to positively affect our thoughts and emotions by increasing levels of serotonin, norepinephrine, and dopamine.  Exercise encourages nerve cells to bind to one another from stem cells in the hippocampus.  This has been found to improve learning by increasing attention, alertness, and motivation.  Indeed, Dr. Ratey cites clear research that demonstrates the power of exercise to improve learning and memory while decreasing anxiety and depression.  He provides research related to how exercise can be as effective as therapeutic treatment in some cases.

Spark summarizes work from 2004, in which a panel of thirteen noted researchers in fields ranging from kinesiology to pediatrics, conducted a review of more than 850 studies regarding the effects of physical activity for school-aged children. The studies examined issues including obesity, cardiovascular fitness, blood pressure, depression, anxiety, self-concept, bone density and academic performance.  Based on their findings this group recommended that school children should participate in one hour (or more) of moderate to vigorous physical activity a day.  In addition, rock climbing is specifically recognized as a sport that provides opportunities to engage in technical movements found to alter chemicals and specific areas of the brain related to attention. Dr. Ratey states that:

 According to the broad science, exercise tempers ADHD by increasing the neurotransmitters dopamine and norepinephrine-both of which play leading roles in regulating the attention system.  With regular physical activity, we can raise the baseline levels of dopamine and norepinephrine by spurring the growth of new receptors in certain brain areas.[1]

 Any of the martial arts, ballet, ice skating, gymnastics, rock climbing, mountain biking, whitewater paddling, and-sorry to tell you, Mom-skateboarding are especially good for adults and children with ADHD.[2]

[1] Ratey, J.J. (2008). The exercise solution: A renowned ADD expert explains how physical activity changes our brain for the better. (book excerpt). Additude, 8(4), 37.

[2] Ratey, J.J. (2008). The exercise solution: A renowned ADD expert explains how physical activity changes our brain for the better. (book excerpt). Additude, 8(4), 39.

The Importance of Social and Emotional Intelligence

The Importance of Social and Emotional Intelligence

 Information Provided by Robert Field, Ph.D.,
Founder/Director of Quest Therapeutic Camps,
 the original Quest Camp in the San Francisco area since 1990.

There has been much excitement about emotional and social intelligence in recent years.  This is in large part due to research that has shown that emotional and social intelligence are more predictive of later success than IQ and academic achievement. Emotional strength and social abilities, which includes logic, emotional stability and morality, have been highlighted as key areas for success in life.[1]

Emotional intelligence has been defined as:
The ability to take risks that are logically sound but may fail.
The ability to handle failure without loss of self-esteem.
The ability to learn from mistakes and develop further actions.
The ability to accept that life is not fair and too bad!
Resiliency-the ability to come back and try again.
Social Intelligence includes:
Social cues- the ability to read others' actions, words and nonverbal cues.
Social interaction- the ability to interact successfully with others, understand communications and articulate well.
Social understanding- the ability to observe, relate and understand the results of these interactions.
Daniel Goleman is considered to be one of the main experts regarding emotional intelligence.  He has postulated that social neuroscience details how multiple lanes of knowing and doing spring into action as we engage with others.  Goleman focuses on abilities like social cognition, as well as synchrony and attunement, social intuition and empathic concern, and the ability to demonstrate compassion. He describes these abilities as non-verbal and intuitive, noting that they occur in the span of micro-seconds, and have the power to shape the very platform for a smooth social life.[2]



[1] Cherniss, C. (2000). Emotional Intelligence: what it is and why it matters. Paper at the Annual Meeting of the Society for Industrial and Organizational Psychology, New Orleans, LA, April 15, 2000
[2]Goleman, D. (1998). Working with emotional intelligence. New York: Bantam.

Treatment Options for ADHD

Treatment Options for ADHD: Putting the Pieces Together 

It is considered "best practice" for children with attention difficulties to have multiple interventions simultaneously to provide the best emotional and behavioral outcomes.  Successful interventions include educational support, medication management as needed, parent training, and behavioral interventions at school and home.[1]  The treatment for ADHD is similar to a puzzle with many pieces that fit together.  Medication and therapy are often two large pieces of the puzzle, along with several other important pieces including assessing children to further explore their academic needs, establishing school accommodations, increasing communication between school and home, utilizing behavioral plans in the home, providing group interventions, incorporating nutritional plans, exercising, and using biofeedback.

 A therapist who specializes in working with children with ADHD creates a treatment plan with the family to provide the most comprehensive assistance for a child given their specific needs (in a sense, helping to put these various pieces together for the most complete picture).  In addition, therapy is utilized to provide support for parents in establishing behavior plans that work in conjunction with school officials and set accommodations to best support the child's growth, academic success, and appropriate behaviors in his or her multiple environments.  Therapy is also a place to discuss various emotions that usually arise for children who commonly experience poor academic performance or difficulties socializing with peers.

Group therapy interventions can be incredibly helpful in treating ADHD since children with attention difficulties often struggle greatly in their social interactions with others. Seventy-five percent of children with learning disabilities have been found to show some difficulties in social skills which interferes with their ability to learn.[2]  Research on social skill instruction demonstrates that quality interventions:

1.     focus on social and emotional learning strategies that encourage reflection and self-awareness
2.     create opportunities to practice effective social skills both individually and in groups
3.     adjust instruction strategies to address social skills deficits
4.     tailor social skills interventions to individual needs.[3]

Medication is often considered an extremely effective and viable treatment option for ADHD.[4]  Many parents often have concerns about medications including possible side-effects and other parents worry about what medicating their child really means.  I find that children who tend to have the best response to medication are often those connected with physicians who are responsive to parents' questions and concerns regarding medication.  Often when a family feels comfortable with their physician, informative and helpful discussions regarding topics such as the pros and cons of medication as well as the best approaches to mitigate side effects, can take place.  Parents who work closely with a professional to examine a child's response to medication can dramatically help to minimize side effects and support a positive outcome with medication.  I also strongly recommend that parents do not alter medication dosage or stop medications without first discussing this with their physicians.  This behavior occurs frequently and greatly decreases the benefits that medication can have as a viable treatment option.


There are several alternative approaches outlined below that have been found to be effective in treating attention difficulties.[5]  Parents who are more interested in alternative approaches can find consulting with a naturopathic physician or a nutritionist specializing in ADHD to be helpful.  Nutritional interventions can include basic changes such as making sure a child:

1.     eats breakfast every morning
2.     has an adequate level of protein at each meal
3.     limits high-sugar juices and sodas
4.     decreases caffeine and energizing carbohydrate intake in the evenings

In addition, having children tested for heavy metals and their absorption of various essential minerals can be beneficial as children with attention difficulties often have irregularities in these areas.  Biofeedback is another alternative treatment option that has been demonstrated to be effective for some children with ADHD to normalize brainwave patterns that impact concentration and learning.  There is also clear research demonstrating the powerful impact that exercise can have improving attention and learning.

[1]CHAAD: Children and Adults with Attention Deficit/Hyperactivity Disorder. Understanding AD/HD: How is ADHD treated?  Retrieved July 23, 2007 from Chadd.org Web site: http://www.chadd.org/Content/CHADD/Understanding/Treatment/default.htm
[2]Kavale & Forness (1995); as cited in Steedly, K. M., Schwartz, A., Levin, M., & Luke, S. D., (2008). Social skills and academic achievement. Evidence for Education, vol 3, issue 2.
[3]Steedly, K. M., Schwartz, A., Levin, M., & Luke, S. D., (2008). Social skills and academic achievement. Evidence for Education, vol 3, issue 2.
[4] Monastra, V. (2005). Parenting Children With Adhd: 10 Lessons That Medicine Cannot Teach
[5] Monastra, V. (2005). Parenting Children With Adhd: 10 Lessons That Medicine Cannot Teach

Sensory Integration and Sensory Processing Disorders

Sensory Integration and Sensory Processing Disorders
 Information Provided by Jamie Pence, OTR,
Head of Occupational Therapy Services,
Quest Therapeutic Camps of Southern California

Sensory integration is a normal, neurological, developmental process which begins in the womb and continues throughout one's life. Sensory processing is the process by which our brain takes in sensory input and interprets that information for functional use.

When talking about typical sensory processing, a productive, normal and "adaptive response" happens as our neurological system takes in sensory information. The brain then organizes the information and allows the body to use it within the environment in order to achieve goal-directed actions.

We receive and perceive sensory input through various sensory stimuli including sights, sounds, touch, tastes, smells and movement. Difficulty taking in or interpreting sensory information can lead to impaired daily functioning, strain within social and family relationships, behavioral challenges, difficulty regulating emotions, low self-esteem and challenges in learning. When children’s central nervous systems are ineffective in processing sensory information, they have a hard time functioning in daily life. They may look typical and have superior intelligence, but may be awkward and clumsy, fearful and withdrawn, or hostile and aggressive. Sensory processing difficulties can affect how children learn and move as well as how they behave, play and make friends, and feel about themselves.

Stanley Greenspan, author of "The Challenging Child" (1995) provides a useful illustration in helping us understand what it feels like to have a sensory processing disorder. He explains, "Imagine driving a car that isn't working well. When you step on the gas the car sometimes lurches forward and sometimes doesn't respond. When you blow the horn it sounds blaring. The brakes sometimes slow the car, but not always. The blinkers work occasionally, the steering is erratic, and the speedometer is inaccurate. You are engaged in a constant struggle to keep the car on the road, and it is difficult to concentrate on anything else."  This metaphor can help people without sensory processing difficulties understand the daily challenges of those who do.

Children with sensory processing difficulties may be oversensitive or undersensitive to touch, movement, sights, smells and sounds. Also, they may have difficulty with body awareness and knowing where their body is in space. They often appear clumsy or awkward and may struggle coordinating motor tasks as well as regulating and organizing their behavior.

We all have sensory preferences and it only becomes a disorder when it significantly impacts one or more areas of a child's daily life. The great news is that sensory integration activities are unbelievably fun!  They are a necessary part of development for any child, whether they have a sensory processing disorder or not. Treatment activities include messy play (painting, floam, slime), heavy muscle work (jumping, hanging, crashing, tug-of-war) and movement activities (swinging, spinning games, scooterboards). Nearly all play addresses one or more areas of sensory processing and the possibilities are endless.
Sensory diets are just one of the many sensory processing treatment approaches. Just as our bodies need food evenly spaced throughout the day, so too do our bodies need a variety of activities to keep them operating at an optimal level of arousal. Sensory diets are usually developed for individuals who need a large amount of sensory input throughout the day; however, they can be helpful for anyone who needs to be "woken" up during the day.

The therapeutic camp environment provides a natural setting for sensory integration to occur. The camp experience is designed to provide games and activities that incorporate a variety of sensations and that encourage children with sensory processing difficulties to confront their challenges in a supportive and fun atmosphere.

Information in this article compiled from the sensory processing disorder website (www.sensory-processing-disorder.com)

Navigating Dangerous Waters: The Use of Electronic Devices by Children

Navigating Dangerous Waters: The Use of Electronic Devices by Children

There is no question that it is becoming increasingly difficult to monitor and negotiate children's use of electronic devices, internet usage, and complex social media.  While these are difficult areas for all families to navigate, this is especially true for families who have children with special needs.  Often a systematic plan is needed to protect your child from the dangers that these devices can create.

Protecting your child from inappropriate information that is available online and through communications with others is of critical importance.   A study in 2007 found that 42 percent of all Internet users ages 10 to 17 are exposed to online pornography of various kinds.  Fourteen percent of all Internet users ages 10 to 17 actively seek out online pornography on a regular basis.[1]  "Sexting" is another troubling behavior for children in which sexual messages or pictures are texted by cell phone.  The Pew Internet and American Life Project found in 2010, that 75% of children ages 12 to 17 owned their own cell phone.  Of this group, 31% report having received a "sext" message, while only 19% admit to having sent one.[2]

In addition, it is very important for parents to be aware how social networks like Facebook have altered the ways in which children communicate.  These networks can be challenging to navigate as children often respond quickly and post information that can be spread rapidly.  This danger can be especially true for children who may be more impulsive and not be able to understand the social implications of saying something online.  These messages can have lasting consequences because once some information is posted, sometimes it cannot be deleted and moreover, other children reading their messages are not likely to forget. These sites can also create an atmosphere in which children can be targeted and bullied.

Another important issue related to electronic devices is the increasing evidence that suggests that these devices are dangerous to children.  In a recent edition (March, 2011) of Time magazine, an article stated that "Manufacturers maintain that mobile phones meet government standards for safe radio-frequency radiation emission, but enough studies are beginning to document a possible increase in rare brain tumors, migraines and behavioral disorders in children to cause concern."[3]  Experts from the World Health Organization have concluded that children demonstrate greater susceptibility to some toxins and physical agents and that precautionary measures should be taken to limit children's exposure to electromagnetic fields.[4] A recent study also found that radiation from mobile phones delays and reduces sleep and causes headaches and confusion.  "The research, sponsored by the mobile phone companies themselves, shows that using the handsets before bed causes people to take longer to reach the deeper stages of sleep and to spend less time in them, interfering with the body's ability to repair damage suffered during the day.  The findings are especially alarming for children and teenagers, most of whom-surveys suggest-use their phones late at night and who especially need sleep.  Their failure to get enough can lead to mood and personality changes, ADHD-like symptoms, depression, lack of concentration and poor academic performance."[5]  A study published in July of 2008 in Epidemiology, found that pregnant women who used handset cell phones, which generate low levels of non-ionizing radiation, were more likely to have children with behavior issues after birth.[6]  The researchers also found that children who were more frequent cell phone users were 80% more likely to have behavioral issues.  Many countries outside the US including Germany, the United Kingdom, France, and the Scandinavian countries have already taken steps to decrease cell phone use among pregnant women and young children.  These countries are taking a precautionary approach and allow children to use cell phones only in emergencies.[7]

Although there are many dangers regarding electronic devices several strategies are available to manage these devices safely.  The following tips can help to keep your children safe regarding managing electronic devices:

1.     Make decisions regarding what you feel your child is ready to handle.  Many families will decide that their child isn't emotionally ready to have things like a cell phone, an email address, or a Facebook account.
2.     Have clear expectations and guidelines for the use of electronics.  Typical rules include that children can only use devices in common areas of the house, a parent can look at the device at any time, and have random checking of email, Facebook, or internet usage to monitor your child's behavior and posts, etc.
3.     Some families will let their children email or make Facebook posts, but will require that a parent reads all submissions before they are sent to protect children from sending inappropriate or damaging posts that could hurt them socially.
4.     Limit your child's exposure to these devices since children should spend time in other enrichment activities daily.
5.     Use parental controls on all electronic devices to regulate content that children can access.  Along with these controls, some applications are available to assist parents in limiting their children's ability to seek out information as well as to utilize their phones during inappropriate times.  I know one savvy parent who has also developed her own app to regulate her child's cell phone usage.
6.     Discuss internet and electronic safety with your children on a regular basis.
7.     Explore ways to limit your child's exposure to electromagnetic frequencies when utilizing these devices.  I personally use several products from Gia Wellness as a way to limit my exposure to electromagnetic frequencies.

Helping children to navigate the safety concerns and complexities of engaging in social media is one of the most important ways that you can help your child. Please stay vigilant and remember this crucial role you can play for your child.

Experiencing Enrichment through Camp

Experiencing Enrichment through Camp: How to Find the Right Camp for your Child

In the 150 years that camps have existed in the United States, there have been opportunities for enrichment for children.  Selecting the right camp for your child can be a challenge given the vast number of camps that exist.  Selecting the right camp for your child can be even more challenging when you have a child with special needs.  There are a variety of camps including general, adventure programs, specialty such as a sports camp, academic, and therapeutic camps offering intensive summer programming.  For children with special needs, some families choose mainstream camps, while other families select therapeutic camps.  Children with ADHD make up 20 percent of enrollment at some mainstream camps.[1]  It is recommended that you may consider a mainstream camp for a child with special needs if your child makes friends easily and does well with unstructured times.

Tips for selecting a camp include investigating for a camp that has the presence of: a highly trained staff, individual attention, social skills instruction, enhanced medical services, academic support, and peer interactions.[2]  Other recommendations from camp directors include: making sure that the camp has experienced staff, camp staff discuss camp activities opportunities with your child, that you meet camp staff prior to attending camp, they have a low instructor-to-child ratio, and for parents to examine safety credentials including that instructors have first aid and CPR training.[3]  Preparing and registering early for discounts was also cited as helpful, as well as getting word-of-mouth recommendations.  Considering various options such as assistance with afternoon childcare or transportation services may also make some additional camps a possibility since these types of services can provide childcare or transportation to or from camp if needed.[4]  In addition, when specifically looking for a therapeutic camp it is often beneficial to discuss your specific child with camp staff prior to signing up to make sure that this camp is the right fit for your child and that you feel confident in the therapeutic model utilized by the camp.

At Quest, we hope that you will consider these tips helpful in selecting an enriching environment for your child over the summer.  "Unlike 150 years ago, today we have evidence-informed data that illustrates, articulates, and demonstrates the legitimacy of the camp experience as it relates to learning and development."[5]  There is also clear evidence to support the positive benefits of play.  The American Academy of Pediatrics has cited unstructured playtime as healthy for children and essential for their development.[6]  "It is absolutely essential that children be afforded the opportunity to play to enhance their physical, intellectual, and psychosocial development.  Perhaps no entity addresses this opportunity more effectively than the camp community...It is often said that camps are in the 'child development' business.  Perhaps, a more apt description would be that camps are in the 'whole child development' business.  Play may serve as the underlying foundation of that business."[7]  Marla Coleman, past national present of the American Camp Association, has specifically cited the power of day camps since "children learn life skills and behaviors that become habits of the heart."[8]


[1] Hanlon, P. Get with the programs: social skills prep, outdoor adventure, sharper academic skills-Choose the best kind of summer camp for your child. Additude, Spring 2011, 54-58.
[2] Hanlon, P. Get with the programs: social skills prep, outdoor adventure, sharper academic skills-Choose the best kind of summer camp for your child. Additude, Spring 2011, 54-58.
[3] Eifler, E. Camp champ: 10 tips to set your child up for summertime success. OC Family, March, 2010, 82-84
[4] Eifler, E. Camp champ: 10 tips to set your child up for summertime success. OC Family, March, 2010, 82-84
[5] Smith, P., Navigating complexity to greater relevance, Camping Magazine, Jan/Feb 2011. Volume 84, 1. P. 22,
[6] Ginsburg, 2007; as cited in Bryant, C., A platform for growth, Camping Magazine, Jan/Feb 2011. Volume 84, 1.
[7] Bryant, C., A platform for growth, Camping Magazine, Jan/Feb 2011. Volume 84, 1, pg. 28-31.
[8] Coutellier, C. Years of adventures and challenges: The history of day camp, Camping Magazine, Jan/Feb 2011. Volume 84, 1, pg. 44.