Archive for July, 2014

When your little guy cannot control himself!

Monday, July 28, 2014

A mom came to see Dr. Kay last year, with a story we have seen countless times in our office. Her little guy who is but 5 years old and headed to kindergarten is adorable, creative and full of imagination. He behaves beautifully 1:1 and minds his manners. However, with his peers at preschool, he would get just a bit out of control with name calling, like “stupid baby” and with shoving or silliness that disrupts.

This little guy could share, take turns and manage frustration perfectly fine at home or in a structured setting. BUT, put him in with a group of kids in an unstructured situation on the play ground, at camp or at preschool, and watch out.  That is when his filter dissolved and the “stupid baby” spilled out.  He may push, shove or even spit.  His comments may not be situationally on-task, and he may look as if he is in his own world responding out of his own ideas, separate from the group activity.

This can be embarrassing for  mom and dad who are wondering where they may be going wrong.  Is this simply an immature child? Is this ADHD?  When he gets overwhelmed by crowds and “acts out,” is this a sensory processing problem?  Or is our son just full of the dickens, perfectly normal and in the habit of attracting attention in a negative manner?

First things first, pay attention to a child’s strengths. This little guy is best able to manage his feelings as well as the give-and-take of socializing when in a smaller more structured group. Yes, we expect that with maturity, he will better be able to manage how to direct himself and join others, as well as how to manage what is now overwhelming in a large unstructured situations.  With maturity comes the ability to calm one’s self  and step back rather than react. With maturity comes the ability to think in order to temper reactivity [take perspective and problem-solve]. And, with maturity, this little guy may be better able to verbally articulate and manage his own needs as well as the needs of his peers in a social exchange.

Is it ADHD? Everyone wants to know…

Well ADHD- Attention Deficit Hyperactivity Disorder- a neurological deficit that impacts self-regulation, can involve hyperactivity, impulsivity and/or inattention. The behavioral problems resulting from such difficulties would have to be seen across environments and persistently from early childhood to present, to some degree and in some expressed form.

While little ones with ADHD may be more prone to “melt downs” and being “driven like a motor,” older children may be more fidgety and inclined to daydream, interrupt and/or prone to excessive talking or to changing topics randomly.  Structure is key because it is far easier to manage ourselves in context of consistent direction, guidance and clear expectations.  It helps to be matter-of-fact, without a lot of talking and explaining. Just clear and simple and delivered with a good heart.  Scolding, threats or harshness typically evoke opposition, defensiveness and inability to cooperate.

Many children/teens or adults who are prone to acting out when overwhelmed, who may not be able to “filter” or “hold it together” appropriately in a social setting, lack patience and have a high sensitivity to the environment, thereby feeling easily overwhelmed. In essence, they may not be able to tune out sufficiently, in order to focus on what is at hand, in order to respond effectively. Or, on the contrary, they hyper-focus and are annoyed by extraneous factors that impede upon their intense needs.

Imagine if the brain cannot be turned off or down, it’s just impossible to redirect or regulate all that is going on inside at a really fast pace. This is when the “acting out” may occur, in the form of silliness, aggression or an outburst expressing anger and frustration.  And yet, there are also children without ADHD who have been accidentally reinforced when they act up and are silly because they are so darn cute and funny. This is a bit dangerous and confusing b/c on the one hand, they are encouraged and the other hand discouraged.

What to do?   There are many components to “out of order” behavior. There is hardwiring which involves neurology. There is temperament which involves one’s outlook and mood. There are hormones in the brain that impact our emotional responses, and there is our thinking which serves as a manager to our feelings as we sort through all the stimuli coming from both the inside [feelings, sensations, needs and desires] and the outside [stimuli and behavioral expectations, cognitive and emotional challenges].  Then, there is the environment that may pull for better or worse.

So, to sum it up, the more we are able to slow down and practice, the more likely we can think and manage behavior. Any overload may result in anxiety and an implosion.

If you have a little one who is in overdrive and possibly receiving attention and reinforcement for all the wrong behaviors as he tries to manage an overwhelming environment full of demands, here are a few tips for helping your little guy manage himself a little better:

  • Pay close attention to the environments that bring out the best and adjust the environment so his anxiety does not spike. So, if a harsh critical teacher is resulting in your son’s chewing his fingers and going into “fight or flight,” work with that teacher while also working to help your child cope.
  • Seek professional help that will enable your child to build tools for managing his feelings prior to overwhelm.
  • Teach your son to ‘stop and think.”
  • Keep play dates and social events brief and fairly structured.
  • In the face of an acting out, simply correct and redirect your son and avoid long lectures or too much talk! It is not about punishment. It is about “start over,” “stop and think,” “what can you do now?”  or simply direct his focus on what he needs to be doing and step over any commenting on the negative behavior which can accidentally reinforce it.
  • Use a calm voice of authority. Say what you mean and mean what you say, and that is not “mean.”
  • Save the talk for an indirect story or a revisiting later, not in the middle of a reaction.
  • You can offer empathy while giving a directive, i.e. “you are frustrated but you can finish putting the game away”
  • Avoid personalizing. A child is not behaving FOR you, so try to avoid directives that end with “for me?” or “you’re making mommy mad” kinds of comments. Stick to behavior, “the coat belongs on the hook” or “three more bites and your done.” Stay neutral [and that is not robotic], just objective specific language. “That was good” means very little. But, “you were patient with your brother at lunch today.”  You do not need to end it with “and that is so great.” They do not need to always be ‘good’ and ‘great’. They just need to learn to master themselves and get along.
  • Separate behavioral management for doses of love and praise. Save the love and praise for other moments. When correcting and redirecting behavior, you are guiding your child so he can better build an internal muscle we used to call self-discipline. We now call it self-regulation.   And, that is an essential tool for getting along in the world.