Long-Term Benefits of Behavioral Therapy

Dear Friends of Quest,
 
Wishing you a HAPPY 4TH OF JULY from Quest!!!  

I hope that this monthly installment of our newsletter finds you happy, healthy, and ready for fireworks!  I can't believe it, but camp starts Monday!  
 
 Please checkout our website for
our detailed calendar and more information!  
LAST MINUTE SIGN UPS HAPPENING NOW!!!

Announcements:

We are asking you to partner with us to help scholarship children into the Quest program who otherwise wouldn't be able to afford it.  We now have two ways that you can help us in this endeavor.

1.  Contribute by donating money to our scholarship fund through the American Camp Association.
These donations are tax deductible and are held specifically by the ACA for our local Quest campers.  To donate please click here and type in "Quest Therapeutic Camps of Southern California" for the camp that you would like to donate to.

2.  Download the Communities for Cause app and some of your regular shopping helps fund kids into Quest.

 
This issue of our newsletter features a summary of a recent article regarding research on behavioral programs that I thought you might find interesting. At Quest, we are proud to provide an innovative treatment program through our therapeutic summer camp and school year rock climbing therapy groups that have been proven to reduce problem behaviors not only at camp, but in school, at home, and in everyday life.  We hope that our newsletter will be a source of support and applicable information to improve the lives of the amazing children and families in our community.
 
Sincerely,


Jodie Knott, Ph.D.
Director and Licensed Psychologist
Quest Therapeutic Camps of Southern California




Long-Term Benefits of Behavioral Therapy

In May of this year, the Scientific American published an article titled, "Not-so-quick fix: ADHD behavioral therapy may be more effective than drugs in long run."  I found this article interesting and wanted to share it in the newsletter since it focuses on how stimulant medications may help children focus and have better classroom behavior, but that programs focusing on making behavior changes may make more of a difference in the long-term.

The author of the article, SciCurious, states:
A new synthesis of behavioral, cognitive and pharmacological findings emerged at the recent Experimental Biology meeting, held last month in San Diego, where experts in ADHD research and treatment gathered to present their work.  Their findings suggest that behavioral and cognitive therapies focused on reducing impulsivity and reinforcing positive long-term habits may be able to replace current high doses of stimulant treatment in children and young adults.

The article goes on to cite research related to how behavioral change programs can have lasting effects regarding ADHD with different groups from children, college students, and parents of children with attention difficulties.  Regarding college students, the author cites research from Dr. Advokat at Louisiana State University that suggests that working to develop better study habits is what is most likely to translate into better grades and that medication and behavioral programs that target developing good study habits is crucial.  This research also suggests that less medication may be needed once good study habits are established.  Research conducted by Dr. Pelham of Florida International University suggests that for parents who utilize more skills to manage stress through behavioral interventions are shown to increase how well their children behave at home and in the classroom.  Dr. Schweitzer's research, out of the MIND Institute at UC Davis, is also cited as evidence regarding how cognitive interventions with children can help them improve control over their minds and may reduce the need for medication.

The article ends with a note that Advokat, Pelham, Schweitzer, and many other scientists agree that there should be a "renewed focus" on behavioral therapies since these programs create no drug tolerance, create no concerns regarding substance abuse, and may be the most effective for long-term treatment.  The author cites how it will be important to decipher which behavioral therapy programs are most effective.

Article by SciCurious, Not-so-quick fix: ADHD behavioral therapy may be more effective than drugs in long run. Scientific American, http://www.scientificamerican.com/article.cfm?id=adhd-behavioral-therapy-more-effective-drugs-long-term

The Keys to Successful Family Problem Solving

The Keys to Successful Family Problem Solving

Many factors can be involved in creating an environment ready for successful family problem solving.  Conversely, there are many approaches or tactics that can disrupt and ruin attempts for families to problem solve.  The good news is that by utilizing research based strategies and avoiding negative behaviors for family interactions families can have a wide range of successes in solving problems together and feeling more connected as a family unit.

There are many problem solving don'ts that can negatively impact families. These don'ts include, but are not limited to:
Don't
1.  Blame the other person
2.  Defend yourself
3.  Talk about intentions
4.  Make broad generalizations
5.  Bring up the past (using terms like always and never)
6.  Change the subject
7.  Lecture or give long explanations
8.  Put the other person down
9.  Try to problem solve when angry or upset [1]

When problem solving it is crucial to stay focused on the topic at hand instead of making broad generalizations, bringing up the past, or changing the subject. When we forget that we are all on the same team it is likely that we will engage in blaming the other person, defending ourselves, or talking about intentions. It is impossible to read other people's minds and we often jump to unsound conclusions when we do this.  Instead of trying to read people's minds it is crucial to clarify things that we think we have heard to make sure we are interpreting the message correctly.  Often in my work with families we will discuss how the family will fall into these 9 pitfalls listed, especially in times when they are not remembering that they are all on the same team or when they engage in problem solving when they are too upset to think clearly.

It is paramount to give loved ones the benefit of the doubt, discuss troubling behaviors (versus character deficits) that are upsetting us, and engage in positive, open communication that is reciprical and supportive in nature.  Often coming from a strengths-based, solution focused approach can be helpful including asking questions like "How can we as a family rely on our past successes with problem solving to help us in this current dilemma? What are some of our greatest strengths as a family and how can we access them now?  What are we most thankful for currently in our relationships with each other and how can we keep that in mind while we problem solve?"

Avoiding problem solving when angry is one of the most important aspects to follow to engage in successful problem solving.  I will often have family members rate how angry or upset they are from 1 to 10.  As a general rule, I advise that anytime any of the family members is rating themselves above a 3 problem solving is abandoned until all family members are below a 3 since often when we go above this level of intensity we commonly fall into the problem solving don'ts listed above.  Questions that are often helpful to know when enough relaxation or coping strategies have been used to once again return to successful problem solving is to answer yes to these questions:
1.  Right now am I below a 3?
2.  Right now can I speak calming and respectfully?
3.  Right now I know that deep down we are all on the same team and I will be able to give my family member the benefit of the doubt?
4.  Right now can I think clearly and am willing to consider alternate perspectives and possible solutions?

If the answer to these 4 questions is yes for everyone it can be an appropriate time to return to problem solving.  While it is important to take breaks and call family timeouts when people rise above a 3 for intensity level, all family members must know that a timeout is a promise by everyone to return to working together to solve the problem when everyone is calm.  By avoiding this list of common pitfalls, while also monitoring current levels of stress and intensity, and returning to family discussions when everyone is ready to engage in positive, strengths-based problem solving great things can happen for families.

[1] Handout from child and family practicum program for the University of Oregon Counseling Ph.D. program (resource from Dishon and Stormshak)

Increasing Task Completion in School Aged Children

Increasing Task Completion in School Aged Children

Parents' concerns regarding their children's task completion are something I hear about all the time in my practice.  This concern is common for many parents, especially those who have children with attention and learning difficulties.  Difficulties with task completion are commonplace and children, parents, and teachers all benefit when plans are in place to support children to increase their task completion.

There are many things that can impact task completion including:
1)  Difficulties staying focused and a low arousal rate for children
2)  Distractions occurring in the classroom
3)  Difficulties for children understanding what is expected during certain times in class regarding task completion
4)  Frustrations for children having difficulty learning certain concepts
5)  Children becoming overwhelmed by the size of an assignment

It can be important to first assess what might be getting in the way of successful task completion since based on the type of struggle a child is having a different intervention strategy would likely be needed.  For example; children with difficulties related to attention difficulties typically benefit from systems that help them learn what is expected, assist them with managing organizational details, and stay on task, while children who might be having more difficulties due to low frustration tolerance or anxiety may benefit from different strategies.

Common strategies that can be helpful for children with attention difficulties include:
1. Provide as engaging assignments as possible that often are hands on and multi-sensory in nature.
2.  Provide many prompts to help children regain focus if their attention drifts.
3.  Limit distractions when possible in such areas as seating children with attention difficulties next to positive peers who are most likely to be on task and creating quiet study environments.
4.  Have auditory and visual cues that clearly define what is expected at times since children with attention difficulties often miss cues like seeing that their peers are working quietly and they should be too.
5.  Create incentive plans for kids so that they can be rewarded for completing work and demonstrating on-task behavior.  Please click here for a form that I often use for children that allows for teachers to target task completion and various behaviors such as talking at appropriate times, staying in one's seat, etc.  This type of form can be monitored by teachers and rewarded at home.  The attached form can also be altered to be specific for your child given their school schedule and targeted behaviors.  I know a lot of parents have concerns about providing rewards for children for doing behaviors that they "should just do anyway."  What I find is that the reason that these types of programs work is that they flood dopamine into the reward centers of the brain, thus increasing attention and task completion.  This is crucial since children with true attention difficulties regularly do not process dopamine in the frontal lobe of the brain as efficiently as children who do not struggle with attention difficulties.

Common strategies that can be helpful for children with anxiety and low frustration tolerance include:
1. Teaching strategies for better emotion regulation including learning how to take deep breaths, use imagery, count to ten, think a happy thought, etc. to calm down.
2.  Provide positive counter thoughts for children if they tend to say or think negative or self-doubting statements.  Creating new positive thoughts such as, "I am bright and I work hard.  I will be able to figure this out.  I just need to go one problem at a time.  I can ask for help if I need it." can be incredibly helpful for children who struggle with negative thinking.  I often write these types of statements down for the children I work with on notecards when appropriate and it is common for their teachers to help them by reminding them to read their notecards when they appear anxious or frustrated.
3.  Cover up several of the work problems with another piece of paper so that children are less likely to get overwhelmed and can just focus on one problem at a time.
4.  Provide rewards for utilizing coping skills and completing steps along the way.

The great news is there are many ways in which children, parents, teachers, and other service providers can work together to support children who have difficulties with task completion.  Establishing high levels of communication between school and home and teamwork can greatly improve children's work completion, but also their self-esteem regarding themselves as good students.

Being Clear About the Nonnegotiable

Being Clear About the Nonnegotiable: How to Use Specific Language to Assist Children with Following Directions

I find that one of the most challenging areas for parents is how to assist their children with following directions quickly.  While almost all children will struggle on some days more than others to demonstrate good listening, this is often a significant issue for children with difficulties with attention, learning, or mood regulation.  Utilizing clear language can help children to better understand what is being communicated to them, which ultimately can improve the frequency of their following of directions quickly.

There are several challenges that can impact following directions quickly including:
1)  Difficulties staying focused and a low arousal rate for children, making it difficult for them to process directions when given.
2)  A tendency for children with some special needs to get "hyperfocused" on what they are doing and have difficulty tearing themselves away to respond to a new direction or expectation.
3)  Difficulties for children with cognitive flexibility causing them at times to get "stuck" in a certain way of thinking often with less ability in the moment to consider options.
4)  Difficulties with emotion regulation
5)  Children having difficulty with reading social cues, often not realizing that a direction that has been given is not a topic that is up for debate.

It can be important to first assess what might be getting in the way of successful listening and the following of directions since based on the type of struggle a child is having a different intervention strategy would likely be needed.  Last month's article provided some suggestions for how to increase attention and improve emotion regulation with tips to help children calm down and better manage their emotions if you would like more information in these areas.  

I consider hyperfocusing to be one form of getting "stuck" when it becomes incredibly challenging for a child to tear themselves away from some activity that he or she finds really engaging such as a video game.  Children also seem to struggle with cognitive flexibility frequently in various situations including when they expect things such as their schedule to go a certain way and plans change, when they believe that they are in charge of making a decision instead of their parents, and when something doesn't feel fair to them.  Clear language can be an important tool for parents to assist children to more accurately understand what is expected of them in a given situation.  I believe that not only do children benefit from clear directions and communication, but that often by using the same terminology over and over again, children begin to be more consistent in following directions quickly.

Common strategies that can be helpful for parents to be more clear in their language include:
1. Phrasing questions and commands clearly.  Often parents struggle when they use phrases like "Can you" or "Will you" with their children when they are really not asking a question, but giving a command.  In cases in which a parent is wanting to give a direction, avoid asking a question and using vague language and instead be clear.  For example: "Susy, right now I expect you to pick up your dish and place it in the sink." gives a specific direction about what is expected including when the parent is expecting the behavior to occur.
2.  Providing many prompts as well as auditory and visual cues can be helpful with situations involving hyperfocusing.  For example: If a child struggles with turning off a video game or putting away a game when it is time to do so, the child will often be more successful if the child is given several prompts about what to expect such as, "You have five more minutes to play before cleanup.  I am setting your timer next to the TV with five minutes on it so you will know when to stop."  Being consistent with clear rewards for stopping as directed and clear consequences such as losing game time the next day for struggling to stop as directed can also be beneficial in this area.
3.  Labeling children's feelings and the challenges for them that come when something feels unfair or unexpected can also be helpful.  Making statements such as, "I am guessing that you are disappointed or frustrated right now since it is time to cleanup and you would rather keep playing.  It is OK to feel frustrated.  I still need you to pick up your toy and put it in the toy box right now."  It also can be helpful to directly address the unfairness of life.  I often tell children that life isn't fair and that it isn't going to be and that the sooner that they can learn this the happier they will be.
4.  The use of the term "nonnegotiable" to me is one of the best ways to use clear language with children to help them know what is expected.  I encourage parents to define the term "nonnegotiable" for their children and to use this phase with their children in cases in which they have made a firm decision and the topic isn't up for debate.
5.  As always, incentive plans for kid can also improve the speed at which they have success with following directions quickly and being more flexible.  For example: "I know that this doesn't feel fair to you and you would like to keep playing, but this is a nonnegotiable.  Right now I need you to put the game in the box and place it on the shelf.  If you can do that quickly and deal well with your disappointment you can earn a bonus this evening."  

Families often get into the bad habit of arguing about or debating what should happen next.  The more that parents can use consistent and descriptive language the better that children will do with following directions quickly without as much debate.  Combining clear language, with labeling emotions children are likely experiencing, acknowledging times when children are getting "stuck", and providing cues and reminders about the bonuses that can be earned by being flexible and complying quickly good results are possible.  With consistency and time spent focused on having specific language dramatic behavioral changes are possible.  

Increasing Task Completion in School Aged Children

Increasing Task Completion in School Aged Children

Parents' concerns regarding their children's task completion are something I hear about all the time in my practice.  This concern is common for many parents, especially those who have children with attention and learning difficulties.  Difficulties with task completion are commonplace and children, parents, and teachers all benefit when plans are in place to support children to increase their task completion.

There are many things that can impact task completion including:
1)  Difficulties staying focused and a low arousal rate for children
2)  Distractions occurring in the classroom
3)  Difficulties for children understanding what is expected during certain times in class regarding task completion
4)  Frustrations for children having difficulty learning certain concepts
5)  Children becoming overwhelmed by the size of an assignment

It can be important to first assess what might be getting in the way of successful task completion since based on the type of struggle a child is having a different intervention strategy would likely be needed.  For example; children with difficulties related to attention difficulties typically benefit from systems that help them learn what is expected, assist them with managing organizational details, and stay on task, while children who might be having more difficulties due to low frustration tolerance or anxiety may benefit from different strategies.

Common strategies that can be helpful for children with attention difficulties include:
1. Provide as engaging assignments as possible that often are hands on and multi-sensory in nature.
2.  Provide many prompts to help children regain focus if their attention drifts.
3.  Limit distractions when possible in such areas as seating children with attention difficulties next to positive peers who are most likely to be on task and creating quiet study environments.
4.  Have auditory and visual cues that clearly define what is expected at times since children with attention difficulties often miss cues like seeing that their peers are working quietly and they should be too.
5.  Create incentive plans for kids so that they can be rewarded for completing work and demonstrating on-task behavior.  Please click here for a form that I often use for children that allows for teachers to target task completion and various behaviors such as talking at appropriate times, staying in one's seat, etc.  This type of form can be monitored by teachers and rewarded at home.  The attached form can also be altered to be specific for your child given their school schedule and targeted behaviors.  I know a lot of parents have concerns about providing rewards for children for doing behaviors that they "should just do anyway."  What I find is that the reason that these types of programs work is that they flood dopamine into the reward centers of the brain, thus increasing attention and task completion.  This is crucial since children with true attention difficulties regularly do not process dopamine in the frontal lobe of the brain as efficiently as children who do not struggle with attention difficulties.

Common strategies that can be helpful for children with anxiety and low frustration tolerance include:
1. Teaching strategies for better emotion regulation including learning how to take deep breaths, use imagery, count to ten, think a happy thought, etc. to calm down.
2.  Provide positive counter thoughts for children if they tend to say or think negative or self-doubting statements.  Creating new positive thoughts such as, "I am bright and I work hard.  I will be able to figure this out.  I just need to go one problem at a time.  I can ask for help if I need it." can be incredibly helpful for children who struggle with negative thinking.  I often write these types of statements down for the children I work with on notecards when appropriate and it is common for their teachers to help them by reminding them to read their notecards when they appear anxious or frustrated.
3.  Cover up several of the work problems with another piece of paper so that children are less likely to get overwhelmed and can just focus on one problem at a time.
4.  Provide rewards for utilizing coping skills and completing steps along the way.

The great news is there are many ways in which children, parents, teachers, and other service providers can work together to support children who have difficulties with task completion.  Establishing high levels of communication between school and home and teamwork can greatly improve children's work completion, but also their self-esteem regarding themselves as good students.

Increasing Happiness and Goal Attainment in the New Year

Increasing Happiness and Goal Attainment in the New Year--A Review of The Happiness Project by Gretchen Rubin

As many of you prepare to ring in the new year it seems like a good time to write about increasing happiness and goal attainment.  I thought that this would be a good topic for the month as many people are mentally preparing this week to set resolutions for the upcoming year.  I have chosen to provide a review of The Happiness Project (Or, Why I Spent a Year Trying to Sing in the Morning, Clean My Closets, Fight Right, Read Aristotle, and Generally Have More Fun) by Gretchen Rubin.  Reviewing this book felt like a good start since this book is a true life tale of Rubin's own quest to fulfill her New Year's resolution to increase happiness in her life through a yearlong systematic approach.

Rubin starts her book by deciding to focus her resolution for the next year on happiness since she reflects on how, while, overall she has a pretty good life and is generally happy, she really should appreciate her life and experience more happiness than she currently is.  From this decision, she sets out on a course of goal attainment for the next 12 months with several goals set in a single area of her life per month with additional goals to keep up with changes she had already put in place in other areas the previous months.  For example: Rubin sets several parenting goals for herself in April related to "lightening up" in her relationships with her children including: 1) sing in the morning; 2) acknowledge the reality of people's feelings; 3) be a treasure house of happy memories; and 4) take time for projects.  These goals are then added to her previously set goals for January, February, and March related to boosting her energy, having more acts of love in her marriage, and "aiming higher" in her work.

One of my favorite parts of The Happiness Project is how Rubin provides a wealth of research supporting the importance of happiness in life and how to increase happiness in a variety of areas.  Many of her chosen areas for change have been carefully picked based on her thorough examination of current scientific research.  She provides a funny, firsthand account of the trials, tribulations, and successes on her journey to bring further happiness to herself and those close to her.  Many of the studies she cites are often used in therapeutic settings since a lot of this research can increase happiness, but also are key areas often targeted to either decrease or prevent anxiety and depression.

I also really appreciate Rubin's systematic approach to how she works to achieve her goals.  While I know this approach will not work for everyone, I find her organized and methodical approach helpful.  Rubin also provides a nice personal example of how a person can set many small goals in one area over a period of time and have a large amount of success at making both small and large changes that improve the quality of her life.  She is thoughtful on her journey, setting up a lot of ways to reflect on her progress as a means to both evaluate and celebrate her successes along the way.  Rubin's approach is a nice illustration of several key characteristics associated with success in goal attainment.  As a psychologist who often journeys with others on their road to change, there are a lot of great pieces of Rubin's book that will ring true for others.

Rubin also provides great lists of tips in her book including her 9 tips for keeping resolutions:
1)  Write it down
2)  Review your resolution constantly
3)  Hold yourself accountable
4)  Think big
5)  Think small
6)  Break your main resolution into manageable tasks
7)  Keep your resolution everyday
8)  Don't let the perfect be the enemy of the good
9)  Consider dropping a resolution if you keep breaking it

Beyond the advice dispensed in The Happiness Project, Rubin also provides further support through her website with a happiness project starter kit for others inspired to start their own quest.  For those of you wanting more support in the area of making changes please Click Here for last year's newsletter article "Making Changes Count and Last" to learn more about how motivation can affect goal attainment and lasting change, as well as some strategies that people can use to make changes successfully.  Whether the new year finds you looking to increase happiness or make changes in other areas of your life, I wish you success and happiness in the upcoming year.  Just as Gretchen Rubin discovers that there is much to celebrate and be happy about I wish you the same in the year ahead.
 
Rubin, G. 2009. The Happiness Project.  HarperCollins Publishers. New York.
www.happiness-project.com

Helping Prepare Teens with Attention and Learning Difficulties for College

Helping Prepare Teens with Attention and Learning Difficulties for College

As many teens and their parents are feverishly completing their final applications to attend college in the fall it seemed like an appropriate time to write about some of the strategies that can help parents to best prepare their children with attention and learning difficulties for college.  The college years can be a unique time in a person's life filled with both a large opportunity for growth and positive experiences, as well as presenting a variety of challenges.  Luckily there are many things that parents can do to support their children both prior to attending college and while enrolled in college to best support their learning and positive development.

For families not yet at the point of applying for college it can be very helpful to allow children to practice necessary skills while still in high school with varying levels of support based on each student's unique needs.  Some of the strategies that parents can utilize to help their children to be more successful academically include:

1.  Talk regularly with children about the importance of education and how advanced training whether in college, junior college, trade school, etc., may work to set them up for a positive future.  While this can be challenging to do without nagging or sounding like a broken record these conversations can be helpful for children.  The more that parents can take their own emotions (such as their fears) out of these conversations and allow their children time to express a variety of interests and ideas the better.  Conversations focused on hopes for your children's future and what you think they are capable of, given their unique abilities, will often be more successful than lectures about the pitfalls of not furthering their education.  For children with attention difficulties making short, brief points (25 words or less) will often be more effective.  For example: "My hope is that you will go to college and major in something that interests you." or "You have so many great abilities like your enthusiasm and creativity. I hope you use these qualities in the future in a job you love."

2.  Have systematic programs in school (often through Individualized Education Plans or 504 Accommodation plans) to support children academically and help them build their skills and provide a safety net for times when their attention or learning difficulties could potentially get in their way.

3.  Provide high levels of support to help ensure that needed skills are developed such as ways to improve task completion, develop study skills, be more organized, and to think critically about the world around them.

4.  Explore various options for further development for your children such as helping them set up internships or jobs in areas of interest.  Often children with attention and learning difficulties are great hands-on learners and these type of experiences can build skills and confidence.

5.  Consider what type of higher learning options your child may be ready for.  Some teens are really ready to attend a four-year university, while others may struggle to live away from home and might originally be more successful in a junior college program initially.  There are also some colleges and trade school programs that specialize in working with young adults with various academic and emotional challenges.

For families in which their children are either preparing to begin or who have already started higher learning opportunities many things may help their children who are now young adults to succeed.  Some strategies include:

1) Access a large variety of services through the disability services center on campus.  These programs are available at all levels of higher education from the junior college to graduate program level and can be instrumental in a student's success.  Often in order to qualify for services in these programs you need to be able to show documented proof of either a learning disorder, attention disorder, or other mental or physical condition.  Depending on the program and type of unique difficulty of the student differing levels of documentation are needed from a letter from a physician or psychologist up to a comprehensive psychoeducational assessment.  Often programs require that young adults be reevaluated after turning 18 to qualify for services.

Typical services and accommodations at the college level include:
a) Having extra time for tests and assignments
b) Testing in a quite room
c) Note-taking support (I strongly encourage accessing this support since often college can be so lecture intensive)
d) Extra tutoring services
e) Priority registration
f) Options to be considered a full-time student even if taking less coursework
g) Academic and/or mental health counseling

I often find that for many students these accommodations make the difference regarding their success in college.

2) Having a high level of communication with your children about how to balance their school work and college life may also be important if your young adult children are open to the idea.  Otherwise, having young adults work with tutors, coaches, or therapists may provide these same type of supports without involving parents in the mix to help increase independence and decrease conflict between parents and their adult children.

While the transition to college or other adult learning options can be stressful and challenging at first, there are many ways to help students to access services and build skills that will help them to be successful.