Childhood Obesity

 (Third of a series of blogs related to this issue)

Some good news caught my attention lately.

First, this new season of “The Biggest Loser” (NBC) addresses childhood obesity; it includes three teenagers- a 16-year-old and two 13-year-old- to the cast. Kudos to NBC!

Second, a recent LA Times’ article about six big city school districts (LA, New York, Chicago, Dallas, Miami and Orlando, Fla.) uniting for healthier meals. We are talking about 2.5 million daily meals. The goal is to reduce fat, sugar and sodium. Less corn dogs, coffee cakes and chicken nuggets and more whole grains and fresh produce. “The alliance marks the biggest step yet to transform school meals,” said David Binkle, L.A. Unified’s food services director.

Are diabetes and obesity in children finally becoming a national concern? Will other school district join the crusade? Hopefully, yes.

I visit 11 LAUSD schools on a weekly basis. I still see field trips to the burger and donuts shops, and pizzas and cupcakes for celebrations. Why? Can field trips be planned a little more carefully?  Can they provide healthier options in the classrooms?

So, what’s being done is a good move in the right direction, but there is still plenty more to do. Although tough to confront, childhood obesity is an issue that has to be addressed by the professionals who work with children and adolescents (pediatricians, teachers, counselors, sport coaches, etc.), and even more so by parents.

In order to make a difference, serious behavioral changes need to be made at home surrounding the family’s eating habits and lifestyles. These kinds of changes can be difficult after years of bad habits have been created but here are some tips with steps you can start taking TODAY to slowly create new healthy habits.

-        Involving the whole family: Healthy eating should be part of the family culture. Sit down with your kids at a calm time and explain it to them in simple language they can understand. You can say something like “From now on we are going to eat healthy foods so we can feel better.” Involve your kids in planning weekly menus. They can search the Web for healthy and delicious foods. By educating them on the topic and involving them, they will make healthy eating their own goal.

-        Reducing the portions: Give your children smaller portions of food. When they ask for more, make some physical activity contingent to it (clean up the toys, take the trash out, do 10 push-ups, take a walk around the block, etc.)

-        Avoiding/Reducing junk food: Less pizza, sodas, candies, ice-cream, donuts, cheeseburgers, etc. You can replace them with healthy food, such as whole wheat vegetables pizzas, juices, low fat ice-cream, whole wheat pancakes, nuts, turkey burgers, etc. Add more vegetables and fruits to your kids’ diet. Make McDonald’s a just once-a-week family outing.

-        Keeping a meals schedule: No more eating throughout the day. Keep a schedule. Allow at least a couple of food-free hours between meals and snacks. 

-        Exercising: Take your kids to the park, if possible, every day. Make them ride their bikes more often. Park far away so they have to walk. Take stairs rather than elevators. Enroll them in sports activities: they will not only get good exercise, but also they will have the opportunity to socialize and learn important skills. Have them help with household chores.

-        Rewarding healthy habits: You can even use “some” junk food during weekends outings, for example, as a reward for good behaviors during the week. In order to chart progress use a visual starts board or put money in a glass jar towards those treats.

-        Educating yourself: Learn about healthy eating habits. Consult with a nutritionist. Search the Internet. There is lot of information out there, most of it for free.

Mom, dad, it is your turn.

 

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

 

Daniel Adatto, MA, BCBA

 

 

I’m bored!

One of the most dreaded words from our kids’ mouth. And I don’t blame them. Nobody likes to be bored, right? Advertisers and video games and TV producers know this very well. Images change every few seconds and are full of visual and auditory stimulation. And viewers have the ultimate control tool- the remote control. If we don’t like it, we change it. Programs that do not produce instant and intense gratification are gone in a click (from “The ABA Program Companion”, by J. Tyler Fovel).

And this also applies, of course, to our kids and students. They “change the channel” by simply not paying attention, ignoring and exhibiting all kinds of disruptive behaviors. A lot of the challenging behaviors we deal with on a daily basis (not all, of course) are based on boredom. So, teachers and parents should pay special attention to the speed of instruction and activities and should have appropriate materials to keep children stimulated and engaged. It could drastically change the dynamic of the classroom and the household. Like hunger, if we wait until the child is bored is too late.    

Some proven effective strategies include:

-        Keep them busy: Plan ahead of time and structure the day in a consistently stimulating schedule of activities, including breaks and free time.

-        Choose very stimulating materials: The new technologies available (tablets, mini computers, smart phones, etc.) makes it much easier. Attention: Do no overload them with video games. Intersect arts & crafts and physical activities, including outings and outdoor playing.

-        Provide them with physical outlets and opportunities for social interactions in structure setting, such as sport/arts classes and community centers activities. Plan play-dates.

-        Eliminate the competition: make undesired items/activities unavailable as much as possible.

-        Set up the physical environment so that the opportunities for misbehaviors are reduced or eliminated.

-        Teach and encourage choice making: include in your daily schedule opportunities for your kids to make choices. Too many rules can create oppositional behaviors. If they feel they have no control, they will fight for it, I assure you.

 

-        And schedule times to play with them. See our previous blog “Special time” for more information.

Avoid boredom and you will be ahead of the game.

 

Daniel Adatto, BCBA

 

 

Special Time

Spending quality time with your child every day can help prevent behavior problems and helps build a loving family environment. Special time with your child is also an excellent way to reward your child for good behavior and to teach your child appropriate ways to behave.

Quality time consists of those special moments when parents give their undivided one-on-one attention to their child and needs to occur on a regular basis. It is the one-on-one time that really builds intimacy and a positive relationship.

If your child is playing quietly in his room, don’t sneak away to make a phone call. Reward your child for the good behavior with some quality time and then explain to him that you need to make a call. Playing with your child is also an opportunity to demonstrate and model appropriate behaviors, for example taking turns, sharing, winning, losing and waiting. Comment on what he/she is doing and commend him/her by saying something like “You won – good job”.

Most parents, especially working parents, do not get down on the floor to play with their children enough. You can change the dynamic of your household by making a daily habit of setting aside certain times of day to spend quality time with your children. The outcomes and the effect on your child’s behavior will be immeasurable.

Here are some tips for successful quality time with your children:

1. Schedule it ahead of time.
2. Schedule regularly – daily is best.
3. Quality Time is to be spent between parent and child alone, no others present.
4. Your child chooses what to do, he/she is the captain (parent may impose limits such as amount of time, amount of money spent, if junk food allowed, etc.).
5. Activities should be age appropriate for the child.
6. Parent gives the child their full attention. No phones and no TV allowed.
7. Parent follows the child’s lead. Child gets to be boss and direct the parent in their play.
8. Parent does not discuss limits or discipline during this time. It is positive interaction only.
9. Parent does not talk about other family members or their own issues. The child is the center of the universe during this time.
10. Special time is not to be canceled as a result of misbehavior. Choose other consequences.

Spend special time with your kids. And start now. The Holidays are a great opportunity.

Happy Special Time!

 

Daniel Adatto, BCBA

 

Bribing or Rewarding?

“Parenthood” (NBC- Tuesdays at 10PM) is an excellent show. Good actors and good and unpredictable scripts that present believable stories that make it easy to identify with the characters and their lives.

One of the families just adopted a boy and they are having a hard time making him do his homework and household chores. The mother goes to her sister, who has three kids, one of them with Asperger’s Syndrome, and asked her “How do you do it?”

“We bribe them. As much as they called it rewarding, we bribe them. A piece of candy for taking out the trash, two pieces for doing homework, and so on.”

She goes home, tries it with her adopted son, and, oh surprise, it works.  

Is she bribing, or motivating her child to perform a non-preferred activity? Are they bribing me when they pay me for doing my job? Do parents bribe their kids when they tell them “First eat your food and then you can have dessert”?  Do teachers bribe students when they tell them they have to finish their work before they go to recess? Or give them points towards a pizza party? Do you bribe your plumber when you pay him to fix that annoying leak?

According to Wikipedia, bribe is “Something (usually money) given in exchange for influence or as an inducement to dishonesty.”

Does working, doing homework, helping with house chores or learning at school fall under that definition?

Allow me be very clear, NO. I think it’s time to understand that we engage in behaviors because they work, we get something. And when we ask children to do something they don’t want to do, we need to motivate them, so they want to do it. Plain and simple.

So when our character offers candy to her child she is motivating him, not bribing him. By the way, it doesn’t have to be candy. Moreover, I don’t recommend using always candy, because then you have to deal with the sugar rush and the side effects of unhealthy food.  Good rewards can be preferred activities, such as playing computer or video games. Allowance is another option. Points to earn a special treat or a day at Disneyland are always very effective if your child is old enough to understand delayed rewards. I have a client that earns pieces of a puzzle that shows the McDonald’s logo. Once he completes the puzzle, parents take him to McDonalds on Sundays after church. Raffle numbers, lotteries type systems, playing favorite games, are more examples. And candy on moderation if your child is healthy is OK. After all, they are kids.

You don’t bribe when you motivate your kids to do something in their benefit. Do you bribe your mechanic when you pay him to fix your card, or the dentist to take care of your teeth?

So, three words: Motivation, Motivation, Motivation. Let’s get out there and motivate our kids instead of forcing them, or hoping they will comply.

 And if it doesn’t work, try bribing them.

 Daniel Adatto, BCBA

 

The Five Most Common Parenting Mistakes

Making positive behavioral changes can help every parent avoid these common parenting mistakes:

1. Giving attention to bad behaviors
2. Ignoring good behavior
3. Placating the whining or crying request
4. Saying No when you can say Yes
5. Using time-out as a punishment

1. We parents devote far too much time attention when our children misbehave. In a child’s mind, negative attention is better than no attention so by eliciting a negative reaction (yelling, punishing etc.); the child has in essence won the battle. By rewarding the bad behavior with attention, you are teaching your child that bad behavior (crying, hitting, non-compliance etc.) is the way to get your attention and you are perpetuating the bad behavior.

2. This brings us to common mistake no. 2. We punish the bad behaviors, but do we take notice of the good ones? Reverse your negative patterns by catching your child doing something good and reward the desired behavior. Is your child playing nicely? Don’t turn away to make a phone call. Commend that behavior first, reward your child with a positive interaction and you will increase good behaviors while reducing the undesired ones.

3. Placate now – pay later. And pay dearly you will! We parents are so irritated by the crying or whining child that we so often give into the request just to make it stop. Children are very clever. They know that this works.  But ask yourself, is the price worth it? By giving into the request, we are teaching the child to cry or whine to get whatever he wants. I can not stress this enough - Never ever give in to a crying, whining or tantrum request! If your child requests something while crying, you must request that he stop crying and ask nicely before you give him whatever he wants. If you are consistent, the crying and whining will decrease over time.

4. We say no 100 times a day and I can almost guarantee that 75% of those NO’s could be YES’s. If we rephrase our response to a more positive alternative and redirect the child instead of just saying no, we can reduce the child’s frustration in being told NO.

·       Instead of saying just NO, what he CAN’T do, tell the child what he CAN do. “Can I have a cookie mom?” Instead of immediately saying no, you can say “Yes, you can have a cookie when you finish your dinner”.

·       Do not forget to give at least two YES’s for each NO. “I want to play outside” Try “It’s too cold right now but we CAN play blocks or dance inside”.             

 

By the way, when you say “NO” to your child, you are teaching him/her to say

“NO” to you when you place a request on him/her. So, save the NO’s for when it is

necessary. If you child is running to the street or playing with a knife, that’s a NO.

5. A Time-Out should be used to remove a child from an environment where he is being rewarded for a bad behavior, such as getting attention, and place him in an environment where he receives NO reward for the behavior. If you are in the grocery store and your child throws a tantrum, be ready to leave the cart full of groceries and remove your child from that environment where he is getting a lot of attention from you and the rest of the customers, and take him to the car, where you are able to ignore the crying and screaming, thus placing the behavior on extinction: no attention. Be sure that the tantrum is your child’s way to get attention. If your child is over stimulated by the environment, in pain, scared, hungry or tired, do not use time-out, do not ignore the behavior. Your child needs your help.   

Learn how to behave so your child will too.

 

Daniel Adatto, BCBA

Social Skills and Autism

Going to the movies, hanging out with friends, chatting on the phone – these are simple rituals most individuals take for granted. For a person with autism, these experiences are few and far between. A lack of social skills and the inability to relate to people, are two seminal characteristics of autism. But the mistake most people make is to assume that someone with autism does not want to have social interactions.  In reality, it isn’t that they don’t want to interact socially, it’s that they can’t.

An inability to anticipate how people think and feel in social situations is a hallmark feature of autism.  Individuals with autism might want to enter a conversation, but they don’t know how. As a child gets older, this can be devastating and cause the individual to further withdraw.

The problem is compounded when children with mild autism are mainstreamed in school with typical developing kids and forced into an environment where they feel different. The same thing happens when attending a birthday party or a family gathering. This often causes families to isolate in order to avoid meltdowns in public.

Therefore, a big chunk of our efforts should be devoted to teaching social skills. Social interaction is a must in a child’s environment since this is a skill they will need throughout life. A child’s struggle with social skills can neither be concealed nor overcompensated by any other skill. Most children learn social skills through imitation but children who have a harder time learning these skills need to be taught. Children who do not develop appropriate social skills will suffer loneliness and isolation. This can create difficulties with communication and result in behavior problems.

To help your child be successful in social situations and learn the social skills fundamental to his or her development, it is necessary to prepare your child for the social situation and prepare the social situation for your child. Here is a list of recommendations that will help children thrive in social situations:

• Prepare your child before entering a social situation by giving precise instructions and expectations.
• Make sure the social situation is appropriate for your child.
• Have a “Plan B” in case things go wrong when planning to attend a social event.
• Teach your child through role-playing games using dolls and toys, reading stories, singing songs etc.
• Teach them to share, take turns, and follow rules.
• Make use of natural situations to teach them: set examples of desired social behaviors in your everyday life; comment on what you see in videos and TV shows.
• Reward positive social behavior.
• Use photos and videos to introduce your child to different people.
• Help build your child’s self-esteem by assigning them leadership roles within the family.
• Encourage your child to help and take part in daily household chores.
• Use mistakes as opportunities to teach appropriate social behavior instead of punishing them.
• Encourage and increase opportunities for successful social experiences and offer praise.
• Avoid and minimize social failure as much as possible.

And include your child in every family interaction possible, as long as it is child appropriate. Talk about emotions so you child learns the words to express what he is feeling.

It is a battle worth to fight.

 

Daniel Adatto, BCBA

 

Behaviors and the Environment

One of the core principles of Applied Behavior Analysis is that behaviors are related to the environment in which they occur. And no, we are not talking about global warming nor are we going to tell you to “go green”. When we talk about the environment, we are referring to (a) the physical setting in which a behavior occurs and (b) the behaviors of the people who interact with the child.

a.     Physical Setting: This means the places where he/she spends the most time, home, school etc.  Lack or abundance of sensory stimuli such as lighting, temperature, noises, clutter, activities, curriculum, demanding routines (or lack thereof) are some examples.

b.     But behaviors are also affected by other factors in the environment such as the people and how they behave. “You change child behaviors by changing the behaviors of the adults who deal with that child. Pure and simple” (Cipani and Schock- 2011)

When attempting to change a behavior, a behaviorist’s first step is to assess environmental factors that trigger behaviors. Something either IS in the environment or IS NOT in the environment, which is causing the occurrence of the behavior.  One example (discussed in a previous blog, “Tantrums in Public”) of this is meltdowns that commonly occur at large retail stores like Target or supermarkets.

Another example is when parents tell us that their child behaves well at school but not at home or vice versa. When analyzing the situation one easily concludes that since the child is capable of handling himself at school, there must be something in the environment or something missing from the environment at home (or vice versa) that is causing the problematic behaviors. 

If you are experiencing problems with your child’s behaviors, take a look at some of the environmental factors that could be contributing to the problem. A few examples include:

-        Lack of structure and consistency, or too demanding routines, which can increase anxiety and/or boredom, some of the top causes of acting out in children.

-        Physical environments that don’t fit the child’s sensory needs (like the one described at Target).

-        Lack of opportunities to release energy appropriately, such as when a child is expected to sit still for too long at the dinner table or restaurant.

-        Unrealistic expectations: too many “No’s” and “Must Do’s”.

-        Lack of following through with instructions, giving in to challenging behaviors.

-        Others’ undesired behaviors that the child imitates.

-        Adults’ stress.  

If parents pay attention to the environmental factors and become aware of the cues that a meltdown is about to occur, it can go a long way in prevention.

 

Daniel Adatto, Board Certified Behavior Analyst