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At Think:Kids we are thinking about whether and how we might create some services in our clinic for siblings.  Parents often voice their concerns about the impact of challenging behavior on siblings, especially when maladaptive behaviors are directed towards a sibling.  Another commonly asked question involving siblings centers around parents’ concerns about having different expectations of siblings versus the child with challenging behavior.  Because we have siblings on the brain, several members of the Think:Kids team attended a training a few weeks ago by Don Meyer, the founder of Sibshops.

Sibshops was started 30 years ago by Meyer for the brothers and sisters of children with emotional and developmental needs. In recent years, there has been growing interest in also including brothers and sisters of children with mental health needs. The goal of Sibshops involves offering these brothers and sisters an opportunity to meet other siblings in a recreational setting.  Facilitators come up with group games and creative activities which they use as vehicles around which to offer psychoeducation, talk about the joys/concerns brothers and sisters face, and to talk about different ways of handling situations. Meyer is explicit that the focus of Sibshops is not therapeutic—instead the emphasis is on wellness and play.

Meyers’ big take-home point is that siblings’ experiences are often marginalized in family treatments, if considered at all. He makes the case for making space for siblings experiences because:

  1. Siblings experience many of the same issues as parents in families with special needs children
  2. Siblings are in the lives of children with special needs the longest and
  3. Siblings spend lots of time with the child so they have the opportunity to significantly impact the social development of that child.

Meyers says that any “family” intervention is not truly a systems intervention without actively incorporating siblings in some way.

We find this point by Meyers compelling.  What would it look like to carry this idea over to what we are doing at Think:Kids.  Would Sibshops as a model make sense in our clinic? Would more of a psycho-education group for siblings of children with challenging behavior be helpful to families? What about a group that brings siblings and the child with challenging behavior together and teaches them in real-time about problem solving with each other?  We think there is at least one fundamental difference between being the sibling of a child with challenging behavior and a child with a developmental or medical need—there doesn’t seem to be the same confusion about lack of motivation and will that children with challenging behavior so often face. I would expect this fundamental difference in our societal understanding of children with challenging behavior to impact the siblings of children with challenging behavior in a unique way.

We think there are some immediate ways we could work to incorporate siblings more into what we are already doing in the clinic. We could invite siblings to be part of the intake process as a matter of course, and listen to their perspectives. We do this sometimes, especially if the problems to be solved center around interactions with a sibling– but we don’t to this as a matter of course. We could also think more consistently about letting siblings know during intake that we’d be happy to share information about what we’re doing with their brother/sister and parents. This would invite siblings in from the periphery.

It is exciting to think about the opportunities to incorporate another perspective into our problem solving and to think about ways we can offer more and more children the opportunity to learn about CPS.

At Think:Kids we often wonder who our “clients” are. Are they the kids we serve? Or are they the adults who raise, teach and help them? Of course, the answer is yes!  This video from our colleagues on the Center on the Developing Child at Harvard could not make a stronger case for CPS and our work. Their theory of change is in fact the strategy we have been using to accomplish our mission. Think:Kids helps adults across settings learn a common philosophy and evidence-based process (that we call Collaborative Problem Solving) to build kids’ executive functioning, emotion regulation and problem solving skills. As Dr. Ablon has focused on in recent trainings with Dr. Bruce Perry of the Child Trauma Academy, the mindset and process of Collaborative Problem Solving also helps fosters co-regulation and builds hleping relationships between adults and kids which leads to exactly what the Center on the Developing Child advocates for: a better environment of relationships essential to improving outcomes in kids’ lifelong learning, health, and behavior.

We are wrapping up some of our parent groups at Think:Kids this week and several parents have wondered how to make a Plan B most likely to succeed. Besides following the ingredients and knowing the content of Plan B there is something often overlooked about the physical setup. There is research I read (but now can’t find the original study) that says sitting on a soft surface makes kids and adults more likely to collaborate – how cool is that? It makes intuitive sense, but we often overlook the significance. Think bean bag, think bed, think squishy sofa before you introduce a Plan B. Along these lines having something soft to touch or hold as you launch a Plan B is a good idea too. A pet dog or cat or a soft pillow to stroke can be very organizing and soothing for a child trying to problem solve. This is easy to implement and could make a big difference!

Inner ear dysfunction has been linked to hyperactivity. This finding is of course significant in its own right, but especially when you consider it was not long ago that poor parenting was thought to be the primary and even sole cause of behavioral difficulties. This research joins a long line of findings that remind us that its a lot more complicated than that. And throwing parents under the bus never helped anyone anyway!

“Hurry up!” is a phrase some parents may know all too well. We can easily imagine the scenario which triggers its initial launch. Yet, have you ever stopped to wonder, from the point-of-view of a small child, how is it being heard? What does it mean to a child? If immediate compliance were obtained as a parent might expect, what would we be asking the child to give up in place of the preference to rush?

While commands, requests, and even desperate parental pleas can roll quickly off the tongue without much thought, one Mom (and special education teacher), Rachel Macey Stafford, thought more carefully about the relative cost of these two small words.

Realizing the expense to her daughter (and to her own self), she found a way to put them aside. Life in the present afforded her the opportunity to escape the stress and frenzy associated with living for some other moment of the future.

Check out the full article posted by The Huffington Post to hear more of her story and come back to share with us your thoughts!

The Christmas holiday is just a few weeks away! This can be a particularly challenging time for our families. Being proactive and setting realistic expectations for you and your child are the keys to creating an enjoyable holiday.

Here are some specific suggestions that might be helpful:

1. Review your Thinking Skills Inventory noting the lagging skills and problems to be solved so that you will have a good understanding of what kinds of situations are likely to be difficult for your child and why (what skills these situations would call upon that your child is lacking).

2. If you anticipate that the holidays will be stressful for your child, think about reducing your overall expectations (more Plan C).

3. Be proactive and as collaborative as possible in thinking about the expected problems, by attempting Proactive Plan B conversations around anticipated holiday related problems.

4. Keep in mind “sensory” needs for self-regulation. Build in opportunities to meet those needs on a regular basis. In general heavy work, particularly involving the jaw or the hip are calming (carrying a backpack; wall-pushups; heavy blankets or heavy book placed in one’s lap; sucking a popsicle; drinking thick liquids through a straw; chewing gum or carrots).

5. Educate outside family members and friends about your child.

6. Try if at all possible to surround yourselves with adults that understand or are willing to learn about your child.

7. Prepare a daily schedule (whiteboard) for your child during vacation weeks/weekends. The unstructured time can be very difficult for many kids. This can also eliminate the unexpected/unpredictable situations which are the most troublesome for many of these children to cope with.

8. Try to stick to a regular sleeping schedule. Lack of sleep can increase everyone’s irritability affecting the child’s capacity for dealing with frustrations and your ability to help!

9. Determine before an activity which adult will serve as “surrogate frontal lobe”. Be sure to take turns so all adults have a chance to relax/participate in holiday festivities. Be mindful of signs that your child has had enough, and don’t attempt to push them beyond those limits.

10. Avoid at all costs comparing your child to others!!!! While he/she may have difficulty coping they likely have many wonderful qualities/strengths. Be sure to highlight these for your child, yourself, and others!

11. Take good care of yourself!!! Be sure to schedule in time for yourself and with spouse for activities that will renew your energy.

12. Make notes with your child of what worked and what didn’t for the next time. Learn with your child from mistakes (expect them to occur!).

This recent article in the New York Times highlights a positive change that we are seeing in schools across the nation.  Zero tolerance policies have not only been shown to be fairly ineffective, but they also disproportionally impact our students of color.  The vast majority of students who misbehave, particularly the ones that do so over and over, lack the skill, not the will to do better.  We know that punishment-based approaches not only do not teach children the crucial thinking skills which are lagging, but they rarely solve the problem in a durable manner.  The word discipline itself actually means “to teach.”  What should we teach?  Why, skills, of course.  And how can we teach these skills?  By engaging the child in a problem solving process in which we are as invested in hearing the child’s concerns as we are in sharing ours. Although not mentioned in this particular article, we are finding that many schools are beginning to incorporate Collaborative Problem Solving into their alternative disciplinary responses.  As a result, not only are they seeing reductions in disciplinary referrals, but reductions in problematic behaviors AND reductions in teacher stress.  When school staff and students collaborate to solve these problems, everybody wins.

 

 

Student background

Felix is a 10 year old 5th grade Native American male student. Felix has a physical disability that causes him to miss school for medical appointments. He is an empathic student. Sensitive about his own disability, he recognizes suffering in others more easily. Felix has few friends, but is close to them as well as his four or five cousins. Felix is quiet, but responds to questions after careful thought. Felix possesses excellent problem solving skills and came up with solutions after I gave him the invitation. Felix is a lover of animals and recognizes the reciprocal power of the human-animal bond. Felix is highly intelligent, articulate and could potentially be a “Gifted and Talented” student, but poor attendance has precluded this official identification. Felix relies on his mother to organize his things before school, to see him off to bed and to wake him up in the morning, but this year, family stressors have taken mom away from home significantly more, particularly on Sundays and Wednesdays.

Reflection

Attendance has been a concern for school officials since Felix’s Kindergarten year. The person who held my job before was not a social worker and practiced “Plan A” approaches like threatening social services and court involvement to no avail if a student’s attendance remained poor. Historically, school attendance and western time-keeping/promptness for Felix’s family have not been of great cultural value.

The past power struggles between school officials and Felix’s mom have left her reluctant to deal with the school. Mom missed two appointments we had set up and would not respond to messages I left on her phone. With patience and persistence, and nearly a month after starting to reach out to her, I was able to meet with her. I found a neutral territory to meet as the principal’s office seemed to put mom off.

We met for nearly two hours. Instead of threatening mom or starting off the conversation with the school’s concerns, I listened to what was going on in her and her family’s life. Recent deaths and health problems had put a lot of stress on the family.

Mom told me that since this last summer she needed to be away from Felix a few days out of the week and late into the night, whereas before she was with him most of the day outside of school and was always at home at night to put Felix to bed. This separation was taking some getting used to. Felix has had to take up more responsibility and has been struggling to go to bed at night. Mom would get home sometimes around midnight on Sundays and Wednesdays and find Felix still up and not having any of his stuff ready for school the next day. Mom would manage to get Felix to bed, but often would be too tired to help him get his stuff prepared for school and would not fight him the next morning when Felix kept hitting snooze or sleeping through his alarm.

I easily empathized with mom because I myself have been adjusting to getting my own son ready for Head Start, as his mom is starting a new job; change is draining, and as it turns out, neither mom, nor Felix or I are rise and shine types. We would rather stay in bed on these chilly fall mornings.

Felix’s mom had found herself in “Plan A” attendance conversations before, and was quite familiar with the school’s attendance policies and consequences for missing. I think this was why she had dodged me for so long. Fortunately, in the time I was waiting to meet her, I had gathered enough information about Felix so that my stated concerns were less about legal consequences and more about some specific academic and social impacts of Felix’s poor attendance. His teachers are impressed with how Felix manages to keep up his grades despite his absences; they think he is very bright and probably a student who would test as “gifted and talented” if he didn’t miss so much.

I also told mom that I saw Felix coming into class one morning looking very tired and was unresponsive to his teacher’s questions about math facts that she was sure he knew. His teacher said this was becoming more common and that they noticed Felix looked embarrassed when she or others, including students, asked about how his mornings were going. Felix simply shrugged his shoulders when I had asked him how his morning was going when I observed him in class that day. I told mom what I had observed and relayed the teacher’s concerns, including how Felix’s tardiness was becoming a distraction to her and others in the classroom.

Mom appreciated the concerns I mentioned. No one had told her before that Felix could possibly get the official designation of being “gifted and talented,” but this was not shocking either; she knows how bright he is. His mom expressed how she would like Felix to get ahead in school and not play catch up. She also apologized for the distractions Felix’s tardiness may be causing.

When I asked mom if she had any ideas on how we could solve this problem, she thought for a while and said maybe it would be a good idea if Felix stayed with his cousins and Auntie on Sundays and Wednesdays. Felix’s Auntie is sterner and has her own kids in bed by 8 and to school on time the next day. I checked on the cousin’s attendance and they had only missed a couple of days and were never late. Mom’s idea seemed pretty solid and I told her I would still like to meet with Felix and hear some of his concerns and ideas too. Mom said she didn’t have time to meet with Felix and me, but would love it if I would talk to him alone. I said the next day would be great and asked if she would give him a heads up and summarize for him what she and I had discussed. She happily agreed and we parted ways.

The next day I met with Felix and it was probably the easiest Plan B I had with a student so far this year. He had talked to his mom the night before and was thrilled at the prospect of staying with his cousins regularly. I asked him what was up with his attendance and he told me how hard it had been with his mom being away so much more these days. Felix plays Xbox late into the night, instead of getting homework done and preparing himself for school the next day. Felix likes to hit the snooze button many times and sometimes his alarm stops. Mom tries waking him up every morning, but does not fight him when he tells her to come back later and let him sleep. When Felix does wake up, he likes to spend some time with his cat before leaving his house and does not like eating breakfast until he has been awake for a couple of hours.

I told Felix I too have a hard time getting up in the morning, but that it helps me get out of bed when I think of how embarrassed I would feel if I showed up late. I mentioned the morning I had observed him coming in late and asked him if he felt embarrassed that day and if he thought that might be distracting to other students and his teacher. Felix said it was pretty upsetting to come to school late, but that it was still too hard to get up in the morning on his own. He said his Auntie would make sure he gets to school. I said that was a great idea and asked him if he had thought of any other ideas, since he wasn’t going to be staying with his Auntie on Mondays, Tuesdays or Thursdays. We agreed that his attendance was a problem on any given day of the week.

What happened next was surprising for a couple of reasons. Firstly, when I have offered the invitation to most students, they do a lot of shoulder shrugs. Like Lost at School suggests, students are more used to having adults assert their will and not consider the student’s unresolved problems, concerns or possible solutions. Because power struggles are more common, many of us do not have ample opportunities to develop some of our cognitive abilities.

Felix, however, has some pretty solid skills, and he demonstrated these when he said, “Maybe my cat can help.” We had talked earlier about our mutual love for animals and Felix had recalled that discussion and was now suggesting that his mom’s struggles to get him out of bed in the morning would be made easier if she just sent the cat into the room early in the morning to claw at Felix’s chest. The cat would jump on Felix sleeping sometimes, and her purring and clawing would always get him out of bed. Felix had not shared this with his mom before. I instantly fell in love with the idea and I hope I didn’t scare Felix with my excitement. This Plan B stuff had become rather fun.

The second reason what happened surprised me is that it actually appears to be working! I guess dealing with attendance for the last year has left me apathetic.  It’s been over a month now and Felix has only been absent two days due to a documented medical reason. And he hasn’t been late at all!

The relationship piece I believe has been crucial to Plan B’s success. Normally, I like to give positive phone calls to parents when I see any kind of improvement, but with Felix’s mom, I have been on the receiving end of the calls. She called me the day after we met to say how awesome her and Felix’s plan was working. I was excited too, but knew it was only the first day. But then, she sent me a text that read, “Yeah! We made it a whole week!” This was followed by similar messages in the coming weeks, and the last one read, “Yeah! A whole month!”

Of course, I told Felix personally how happy and pleased I was with his efforts, and I implored him, “Please thank your cat, too!

At the Children’s Mental Health Network conference in Tampa last week we met a woman involved in the making of a film on the stigma of mental illness. In our Department of Psychiatry here at Massachusetts General Hospital we often say that “no family goes untouched.” Our experience is that whenever someone is brave enough to talk openly of mental illness, whomever they are sharing the experience with invariably has a story themselves – from their own life or someone they love. And yet, the stigma around mental illness continues to be a major barrier to treatment.
We are hoping the power of film can help break down some barriers especially when it comes to children’s mental health. Check out Illness, a critically acclaimed film by Jonathan Bucari.

Also, check out: https://www.facebook.com/illnessthemovie and https://www.indiegogo.com/projects/illness

 

Last week, Think:Kids hosted Bruce Perry, MD, of the Child Trauma Academy  for a joint training on how brain development is affected by trauma, and how the Collaborative Problem Solving approach addresses these neurobiological deficits. Dr. Perry and Dr. Ablon spoke for two days about the Neurosequential Model of Therapeutics (NMT) and Collaborative Problem Solving (CPS), and attendees walked away with a better understanding of tools that can be used to assess and address challenging behavior in children affected by trauma.

One phrase that has stuck with me from this training, and that can be a helpful anchor for all of us when we are working with challenging children, is “Regulate, Relate, Reason.” The order here is critical! Until a child is regulated (i.e., feeling physically and emotionally settled), he is unlikely to be able to relate to you (i.e., feel connected and comfortable). And until a child is related, he is unlikely to have the mental capacity to fully engage with you in the higher level cognitive processes that are critical for problem-solving, like perspective taking, predicting the future, and considering multiple solutions. This is not just true for traumatized children, but for all children (and all adults too)! So in honor of Dr. Perry, let’s pay special attention this week to our CPS regulating tools (reflecting and reassurance) during all three ingredients of our Plan B conversations. If you take the time to make sure your child is regulated, you’ll have a better chance of relating, and then ultimately, a better chance of reasoning!

Looking for a New Year’s Resolution that you can keep and that will bring peace to your whole family in 2015?  Why not resolve to problem solve?  When your child asks for something, instead of automatically saying “no”, say “What’s up?.”  When you are dreading asking your child to do something, instead of threatening removal of a privilege, ask “What’s up?.”  Remember, a problem simply results when adults and children have unreconciled concerns.  Get both sets of concerns on the table and you are well on your way to a mutually satisfactory solution.  And a happy, healthy new year!

Matt and Mandy began attending a monthly CPS Support Group in Feb 2014 in NJ for challenging behaviors that Matt’s 6 year son, Ryan, was exhibiting. They were skeptical at first, but came with an open mind and a true desire to help Ryan and for a more peaceful household. They had a lot of success with the model, but didn’t realize just how much and how well Ryan was absorbing the skills taught by the model until . . . Mandy’s 4 year old nephew, Sean, was visiting in Dec 2014 and having trouble listening. Ryan (who was 7 years old by then) said to Sean, “Sean something’s bothering you, what’s goin’ on? Tell me what’s up!!!!” It made Matt and Mandy smile that their hard work was not only paying off for Ryan, but that Ryan was learning important life-long skills that would benefit him as well as others.