Finding outlets to your child’s endless energy

I recently heard about a karate studio that began a new program that is being offered for children with autistic spectrum disorders. The idea for offering a specific program for a broad spectrum of Autistic children came from one of the parents that trains with the owner and Sensei (instructor). 

"One day my student dropped by my school with her son and she walked around the studio with him," commented the instructor, "he was very excited and interested in the mirrors and the pictures. We asked him to do a couple of basic kicks and he did really well. The next time she brought him to the studio, she had him put on a karate uniform, and he was laughing and couldn't wait to get into the car and come to the studio. This is when the idea hit us; why couldn't we tailor a program of martial art's for kids with Autism?"

After a few visits, the boy's ABA Board Certified therapist started coming to the studio, rather than the boy’s house, to help develop a curriculum and structure for him.

"The goal of this program," commented the Sensei, "is to help these children find an outlet for their pent up energy. I know some parents are going to be concerned about their child learning how to kick or punch, therefore think they will be more aggressive, but we believe giving the child an opportunity to exercise, will actually help them to relax. Just like any normal child, these kids have a lot of energy and they don't have a way to use it. In addition, the martial art's is all about learning self-discipline, focus and concentration. Lastly, we hope that these classes will provide a social setting for these children to meet and have fun with other children."

"The goal of this new program is to tailor the curriculum to each child and target the areas they need the most help with," stated the instructor, "I also understand that I will need to be flexible with each child and work with the parents to make this a successful program!"

Initially, one of the requirements will be each child will need a "shadow" with them during their class. This can be a parent, an adult sibling or therapist.

What a great idea. And it can be any sport activity. I recommend group sports so there is social interaction. Many kids spend their long after school hours inside their homes, sometimes with little or no space for physical outlets and no social interaction, which is a recipe for disaster. They accumulate energy and if we do not direct them to appropriate activities, they find their own activities with known results. Change the dynamic of your household by enrolling your kids in sport classes. And when you are there, try it yourself. Trust me, it is worth it.

Daniel Adatto, BCBA

Obesity II

In my previous blog “Overweight Children” I shared the case of one of my students and presented my opinion that parents ought to take action on this issue.

My blog was so timely that a few days later, the L.A. Times published the article “It's time to serve up some big incentives to curb obesity” (To read the full article go to http://www.latimes.com/business/la-fi-lazarus-20120515,0,1949780.column)

Here are some quotations from the article:

“To combat the alarming obesity rate, the Institute of Medicine says the U.S. needs to overhaul everything from farm policies to zoning laws. Clearly, doing nothing isn't an option. Americans eat too damn much. And we all pay a rising cost for this gluttony in the form of higher insurance premiums and lost productivity. A study last year by the Society of Actuaries calculated the total economic cost of an overweight and obese population in the United States and Canada at about $300 billion a year (with 90% of that figure attributable to America's dietary issues).”

“We need to acknowledge that much of what we put in our mouths is very bad for us and accept new rules intended to foster healthful behavior and discourage the endless noshing that's turning us into a herd of porkers.”

David Lazarus, the author of the article, proposes some ideas. For example:

“First, we should limit the marketing of fast food and junk food to kids. Young people are just not in a position to make wise choices when it comes to sweets and treats. It's foolish to believe otherwise. Just as parents were outraged by the idea of a Joe Camel trying to make cigarettes look cool to youngsters, they should be equally upset with all manner of colorful characters hawking everything from sugary breakfast cereals to corn-syrup-sweetened sodas.”

He goes further and proposes a cigarette-style tax on such foods and beverages, with the proceeds going toward obesity research and wellness programs. And higher insurance rates for overweight people.

I think these are fantastic ideas.

Here is my crazy idea: a parenting license. After all, for almost everything else you need a license or a certification, from driving a car to being a nurse, from getting married to being a contractor. Even baristas at Starbucks and “hamburgeristas” at McDonalds need to go through a specific training.  

Why is it that the most difficult job on earth requires no training, zero, none, nada?

Part of the license process can be training on healthy nutrition. For those “non-licensed” parents, higher taxes to pay for all the mistakes they will make and all the fixing that will have to be done, with tax-payers money, of course.

So, get a license, or get a pet.

What do you think?

Daniel Adatto, Licensed Parent # 00-0000-01

Overweight Children

Mary (not real name for confidentiality purposes) is overweight. She is one of my students and I’m concerned about it. I noticed that the snacks and lunch she brings from home are croissants/salami sandwiches, several desserts every day (cookies, brownies, candies, etc.), pizza, pasta, etc. In short, not very healthy choices. I felt it was concerning enough that it warranted a conversation with the child’s mother. The conversation went something like this:

Me: “I noticed that Mary is a little overweight”.

Mother: “Yes, I know, but what can I do?”

Me: “Well, I noticed that the food she brings from home is not very healthy”.

Mother: “I know, but she wouldn’t eat anything else”.

So, I discussed the issue with the BII (one-on-one behaviorist that works with her from our company) and she agreed to be sure Mary eats the food if mother sends her healthier choices.

Since two weeks ago, her lunch and snacks consist of carrots, broccoli, celery with a small portion of peanut butter, whole wheat pita bread sandwiches, apples, etc. She still has a hard time with chicken, tuna or turkey, for example. She prefers foods that are crunchy. So for now we honor her preferences and proteins are a work in progress, but we’ll get there.

I went to school this week and I swear I noticed that Mary had lost some weight. I thought it was my perception, you know, my eyes seeing what I want to see. But the BII said that not only she, but the PE teacher noticed it too.

The next step is talking to her mother again. I’m planning to praise her for sending healthy food and encourage her to feed Mary the same food at home. I know she will say she can’t do it, so I’m going to invite her to school at lunch time so she can see with her own eyes what the BII does, and how Mary eats her food willingly.

I share this story because I want to make one point very clear: it is about your behavior, mom, not your child’s. You change the child’s behaviors by changing the behaviors of the adults that take care of that child. Plain and simple. No kid starves if there is food available. So it is about what is available. If cheeseburgers and fries, donuts, pizza, pasta and candies are available, they will eat that. Who can blame them, right? We are all tempted by these delicious but unhealthy foods on a daily basis.

Obesity is an epidemic. The effects of it on our health and wellbeing are endless and very well documented. We all should be concerned. Feeding your child only with cheeseburgers, donuts, pizza, pasta and candies is poisoning him. Would you let your child smoke cigarettes, drink beer, or eat paper for that matter? I know your answer is “NO”. Unhealthy “junk” food when your child is already overweight is the same. I know it can be hard because your child will fight for junk food. But this is definitely a fight we have to fight. And win.*

When my wife was pregnant with our daughter she was vomiting all the time and wanted some medication. My wife called the doctor and the doctor said “No medication. It’s not good for your baby. This will be the first of many sacrifices you make for your child”.

And no more monkeys jumping on the bed.

Daniel Adatto, BCBA

*Important: Always consult with a doctor when implementing a weight management plan.

Applied Behavior Analysis in every day parenting

Many kids are picky eaters. Picky eating is one of those parenting challenges almost every parent faces. And while picky eating is not unique to autism, it can be exacerbated by it because of the heightened sensitivity to texture and taste that many children with special needs experience.

 In previous blogs I talked about some of the applications of Applied Behavior Analysis (ABA) and its use with autism. But I also tried to emphasize that ABA is not synonymous with treatment for autism. In fact, ABA can be applied in any situation where a behavior change is desired. And of course, the principles and strategies can be applied in every day parenting. Picky eating is a great example of this.  The same systematic techniques combined with positive reinforcement used to teach any skill can be used to address picky eating. If your child has a severe aversion to a food, start with baby steps, breaking down each task into very small reachable goals. For example, you can start by just having the undesired food on the table. Get the child used to having it there next to his other food and seeing other people eat it. Once he accepts the food on the table, you can move on to having him smell it, bringing it closer to his mouth. Remember that every successful step needs to be rewarded with, for example, a bite of a food that the child likes. Possible next steps can be to have the child lick the food, getting him used to the taste. After that, move on to taking a bite. He may not even chew or swallow the food, just take a bite and spit it out. Remember, we are breaking this down into tiny achievable steps. After the child agrees to take a bite, you can move on to swallowing and so on and so forth until the child agrees to eat the new food.

 The same principles and strategies can be implemented with problems such as brushing teeth, sleep in own bed, toilet training, etc.  

 These baby steps may not be necessary with a typically developing child. Most of the smaller steps can be bypassed and the idea is simply to convey to the child that he at least needs to try the food before saying he doesn’t like it. If the child tries and does not like it, he can have a reward of something else to eat, then slowly move up towards eating more than one bite of the food the child refuses to eat. Eventually, you will be able to say to your child “you can’t have your dessert until you eat dinner” and the child will get the point.  Most children will usually give in to eating something over going hungry.

Always keep in mind that some food aversions can be related to allergies and should be checked with a doctor. Also, even adults have food preferences so if your child really does not like a certain vegetable there is no reason to ever force a food on a child. Be realistic with your expectations and relax.

 Good parenting almost always involves offering choices and a loving approach that focuses on “the good” rather than “the bad”. Love is the most powerful tool of discipline.    

Daniel Adatto, BCBA

Can a child be “a little” autistic?

Parents often ask us if their child can be “a little” autistic. The truth is there really is not a clear answer. There are many terms used for children who do not have a full-blown diagnosis of autism. Some examples of these are autistic-like, on the autism spectrum, displaying autistic-like symptoms. These often refer to children who may exhibit some of the symptoms on the autism checklist but not all. Displaying one or two autism symptoms is not always cause for concern but does raise a red flag and should be checked by a professional.
One can infer that for every kid who receives an actual autism diagnosis, there is another who has autistic traits - including repetitive behaviors and communication problems – but is not found to have autism spectrum disorder. For a diagnosis to be made, a child must exhibit a certain number and severity-level of these characteristics. In other words, not every child with social impairment can be characterized as autistic. But on the flip side, many children can suffer from autistic traits on a level that is in fact impairing even though they may not meet the full criteria. The good news is that Applied Behavior Analysis treatment, which is proven to be the most effective intervention for children with autism spectrum disorder, can also be used to effectively treat any behavior disorder as well as to teach critical skills that a child may be lacking.

A parent’s gut feeling is often the best indication. Parents should follow their instincts and talk to a professional if they have trouble in any of the following symptoms:

·        Impaired social interaction or difficulty forming relationships

·        Trouble responding to social cues

·        Inability to understand give and take activities like sharing

·        Shows extreme distress over minor changes in routine

·        Problems with verbal and non-verbal communication

·        Failure to respond to name

·        Avoidance of eye contact with other people

·        Repetitive movements such as rocking, hands flapping or twirling

·        Self-abusive behavior such as biting or head-banging

 Applied Behavior Analysis is a scientific system of principles and techniques aimed at understanding and changing behavior. Any behavior: eating disorders, addictions, outbursts, domestic violence, relationship problems, crime, stress, etc., etc.

Also, and probably more important, is a system to teach skills. Any skill: learning skills, social interactions, stress management, anger management, productivity and motivation in the work place, etc., etc.

Challenging behaviors are means of communication: your son is telling you something when he throws a tantrum. By understanding what he needs, we teach functional skills (replacement behaviors) that are socially appropriate, thus eliminating the need for crying and screaming.

If you mom or dad are concerned about your child’s behaviors, we can help. We know how. There is a light at the end of the tunnel, even though you may not be able to see it now.

Daniel Adatto, BCBA

Fun can change behavior for the better

This little experiment was too good not to share. We’ve said it before and we’ll say it again, motivation is a crucial element in behavior modification. In applied behavior analysis we say that a behavior followed by a reinforcing stimulus results in an increased probability of that behavior occurring in the future. A new initiative set out to prove that something as simple as fun is the easiest way to change people’s behavior for the better. In this video, participants chose the healthier stairs over the escalator because the stairs are more fun. You can see it in action here:

http://www.youtube.com/watch?v=2lXh2n0aPyw

It is such a simple idea and very easy to implement with children.  Parents can use fun to motivate children to do things they don’t want to do.  For example, if a child is resisting brushing teeth, going into the bathroom together and singing a funny song may be motivation enough. If getting dressed is a struggle, initiate a game of tickle, act silly and turn getting dressed into something fun.  Instead of demanding that a child clean up the toys, turn on some music, dance around and turn it into a game.  To bring out the best in a child, don’t demand good behavior, motivate it with fun.

Daniel Adatto, MA, BCBA

MANAGING TANTRUMS IN PUBLIC

A public tantrum is one of parent’s most dreaded moments. A mother who called me for advice recently told me that every time she takes her child to the store he has a tantrum. The answer seemed obvious. Don’t take your child to the store.  I know this wasn’t the response she was looking for; but the point to be taken away from my two cent answer was: if you can learn the ways to prevent the tantrum from occurring in the first place, you won’t have to deal with the tantrum. Preventive discipline is one of the most powerful tools in a parent repertoire. Instead of waiting for the storm and react, usually out of frustration, prevent the problem to happen all together.

However, leaving the kids at home for shopping and errands isn’t always an option. Therefore, make sure you and they are prepared for the situation. Here are some tips:

·        Make sure you go with clear and realistic expectations. Explain to your child what you are going to be doing and where you are going. Tell him when you will eat, or when he will be able to play so they know what to expect.  Be specific about what behavior is expected. Telling them to be a good boy is too vague. For example, “we are going to a place where we will have to walk and stay close to mommy and we will have to use an inside voice”. Always tell them what TO do instead of what NOT to do. Providing them with the tools to behave makes life easier. 

·        Always feed your kids before going out and be prepared with snacks. A hungry child is a recipe for disaster.  Also, be sure your kids are not tired. Taking them out after a nap is always easier.

·        Plan short outings rather than long ones. 15-20 minutes of a successful experience are much better than 1-2 hours of a disaster.

·        Allow some extra time. If you are running against the clock, it will be very difficult to avoid and prevent problems. If your child has difficulty in public, each outing should be a training experience. It is not about the groceries, it is about teaching your child appropriate behaviors in public. Do groceries “for real” when your child is at school or somebody can take care of him.

·        Whenever possible, get some help. Being alone with your 3 kids is a recipe for failure. The ideal adults-kids ratio is 1:1.    

·        Big stores like Target and shopping malls can be overwhelming. Some children get over-stimulated from all the people, lights, colors and smells.  Children don’t like, and sometimes they can’t, standing in line, being quiet or still. Allow them some time to run around between stores. Do not plan on going to the mall or store at rush hours and avoid overcrowded places as much as possible.

·        Motivate your child to behave by providing an incentive when the shopping is done, such as a trip to the park or an ice cream. When a desired activity follows an undesired activity, a child’s motivation to behave is increased.

·        Even with the best preparation, something still might set your child off and a public meltdown may be unavoidable.  Watch for the signs that your child may be unraveling, and be sure you have a “Plan B” just in case. Perhaps you have to leave the cart full of groceries or walk out of the checkout line. Often this involves taking your child for a walk or to the car until he calms down. This is usually the hardest part for parents. It is frustrating to leave a fully-loaded shopping cart, but this is the only way to extinguish tantrum behaviors for the long term. If you can follow through once or twice, your child will quickly learn that you mean business and won’t attempt a tantrum to get what he wants. Remind him of the rules and expectations, and try again. If it does not work, be ready to go back home.

·        Validate your child’s feelings and remind him of the expected behaviors and rewards. Be very specific and clear. For example, “I know you are mad; but if you use a quiet voice and remain standing, you can earn your treat”. Help your child to communicate his feelings. “Active listening” can help calm your child down by decreasing his frustration: you are showing him that you understand and respect his feelings. You can help your child by modeling the words for him to use. For example, “I know you are mad at me because I won’t buy you a candy bar.!” If possible, encourage your child to express his feelings “Tell me ‘I’m mad Mommy”. 

·        Always provide praise for good behaviors. As parents we focus too much on scolding or punishing our kids for bad behavior but we forget to reward the good ones. Catch them being good. If your child is standing patiently in line, even for a few seconds, use it as an opportunity to praise him for the good behavior.

·        If your child is upset, try distracting him with humor, act silly or change the topic of conversation to something your child is looking forward to, such as a weekend trip to Grandma’s. Redirecting your child’s focus of attention is sometimes enough to calm the storm.

·        In any case, the most important thing a parent can do during a tantrum is to remain calm. This can not be stressed enough. Children are like little sponges that absorb your anxiety. If you lose control while the child is throwing a tantrum, expect it to feed the tantrum. Encourage your child to vent his feelings and modeled coping skills; for example “You are so mad, it will help you to stamp your feet or take a deep breathe like this”. This is another way to validate the child's anger and frustration and will help him to feel understood. By remaining calm and demonstrating to your child the appropriate way to behave, you set a positive example and teach an important life-skill: Self-Control. 

·        Do not, out of embarrassment or frustration, succumb to your child's demands, no matter how fierce the fit. Young children learn quickly just how loud and long they have to scream to get what they want. If you feel embarrassed you can modestly apologize to the people around you and say something like "Sorry, we are having a rough day"; but your focus should be on your child. Remember, you probably will never see those people again, but you will have to live with your child and future shopping trips for years to come. Following through WILL help prevent future tantrums and will make your life easier in the long run.

·        Remind your child of the limits, for example “I understand that you’re mad but you can not have a candy bar right now”. If this is a limit you have set, make sure you see it through to the end. Follow-through and consistency are keys in extinguishing bad behaviors.

This process gets easier with time. With consistent implementation of these strategies your children know the consequences. Then usually a few reminders are enough to control their behavior. And you will be so happy!

 Daniel Adatto, MA, BCBA