How To Help Young Children Develop Strong Social Skills

Reprint of my article published by Family Focus Blog on July 17, 2013

Social-emotional wellness refers to the ability to experience, express and regulate emotions, form secure positive relationships, to and individuate and acquire increasing independence. A child who has healthy social-emotional skills is able to label and understand his or her own feelings as well those of others. He can manage his own emotions and express them in a way that is positive and helpful to him and appropriate for his social situation. As children grow, they learn to empathize with people in their environment and are able to form and maintain positive relationships with adults and other children in their community.

Children, however, are not born with these abilities and must learn them.  It is up to caregivers and educators to teach social-emotional skills implicitly and explicitly from early on. In order to be successful in this endeavor, adults need to read the child’s cues, acknowledge which stage he is at, and understand what is to be expected at each age. In the first year of a child’s life, he sends cues to parents and other caregivers to express how he feels. A young baby will cry when in distress and smile at the voices, faces and smiles of familiar people. Her little face and body will react when she is interested, surprised or frustrated. It is our responsibility to interpret and react to these cues in order to teach the child that we are in tune with their needs. Parents foster social development by changing their baby’s soiled diapers, smiling in response to their smiles, and talking to their child.. Parents should also play games like peek-a-boo and naming the things in the child’s environment such as toys and parts of the body. These activities increase attachment between baby and primary caregiver. As attachments are formed, your child will respond differently when an unfamiliar person attempts to hold, stroke or even feed him or her. The little one responds with anxiety. These are normal reactions indicating that the child’s social-emotional development is proceeding well.

Children 12 to 36 months of age see themselves as the center of the world and begin to be more self-aware. They begin to become more independent. As a result, they can have short-lived and rapid mood swings in which tantrums can be expected. They start testing their limits, are not keen to share and will not play with other children as much as play next to them. At this time, routines are very important. To support his or her development of social skills, you can begin by praising your toddler for doing things independently and give them toys to play with. You can start planning playdates and encourage your child to make decisions and explore. Continue to sing songs, clap hands and dance together. Encourage your child to imitate your silly moves. In his third year, listen and talk with your child. Talk to them about how you feel and teach them to do the same by identifying and acknowledging how they feel. When conversing, do not stand above them: get to their level, look them in the eyes and speak face to face.

At three to five year old, children begin to enjoy playing with other children. They need to learn how to share, take turns and talk about their feelings in order to express themselves and resolve conflict. Teach them implicitly by modeling such behavior. Explicitly teach them the language of feelings and social negotiation.  They’re eager to please and want to be trusted. At this stage, it is important to set clear and consistent consequences for what happens when they break the rules. As their mind develops, they will begin to show an understanding for the point of view and feelings of others (empathy). Let them participate in role-playing games with others in which they can play pilot, doctor, policeman, etc., to gain independence, build confidence and learn the roles of adults around them. Discussing books and movies and giving them small household chores, such as setting the table or cleaning up their toys after a game also helps with development of strong social-emotional skills.

Solid social-emotional skills are crucial for young children to thrive and handle difficult situations. The key is to establish secure relationships with caregivers that will teach them about compassion, trust, generosity and empathy through experience. 

Image Credit: http://www.flickr.com/photos/nwardez/3740406214

On Peer Pressure: Trying to understand and help your teen

Reprint of my article published by SurfNetParents.com on July 12, 2013

 

You have been raising your child from infancy and suddenly he's turned into a teen. The days are long gone when your child used to look at you for approval after doing a good deed. Now he is looking to his friends for approval and some of his peers may not have the type of value system that your family does. When your son or daughter is under the influence of peer pressure, don't underestimate the amount of pressure there really is. Your child is growing up, and while he is trying to maintain his own individuality, there is still the point of fitting in with his friends that is vitally important to him.

You're standing on the outside looking in 

Somewhere along the way you have lost control over your child, and you probably can't even pinpoint the exact moment when this happened. One day he was in diapers and the next you are getting a phone call from a concerned parent about a party your son or daughter was attending with a group of teens where things were occurring that you wouldn't approve of. Your child is growing up and somehow finding his way into trouble.

It is extremely frustrating to not know exactly what's going on in your child's life at any given moment. Somehow you just have to trust that the values you have instilled in your child will remain, but you know that peer pressure is also going to be a problem. How can you solve this dilemma and still retain your own dignity as a parent? 

Trying to understand your teen

As a parent, you need to get an understanding of what's happening inside your teen’s head. You have to realize is that at this point in your child's life, the difference in years between you and your child is going to become a factor. Since you are older, he will feel that you automatically cannot understand anything that he is going through. Although you can tell him time and time again that there was sex and drugs back in the days when you went to high school, he'll still think that everything was different.

You don't need to go to a child psychologist to figure out your teen. What you need to do is try to establish the best form of open communication possible so that you can know what he is up to at all times. The best way to go about this is by letting him know what's going on in your life, so that hopefully he will open up about some of the things happening in his. At this point, you'll have to use a lot of understanding and try not to judge him too harshly for anything he says. The idea is to get the communication lines open enough so that you two can discuss things better.

Your teenager is probably having a harder time than you think

Even though your child may seem defiant at this difficult age, you should not give up. Peer pressure is probably affecting him a lot more than you could ever imagine and he is deep down actually counting on you to guide them through this rough spot. Although he would never admit it, his defiant nature is just a manifestation of his own wrongdoings. Deep down he is still the innocent child that you have brought into this world and although he is now subjected to many more external influences, you still need to maintain open communication and never give up on your child.

Parents must understand that although a teenager may test their limits, he will mature over time. Eventually your child will reach an age when he is less influenced by peer pressure and easier to communicate with. You must get through these difficult years and provide consequences for your child's actions, enforcing punishments when it is necessary. you will come out at the other end and your child will develop into a mature adult with real-life values.

Image source/credit: http://www.flickr.com/photos/imagination_indie/983296851/

 Link to original publication: http://www.surfnetparents.com/3980/on-peer-pressure-trying-to-understand-and-help-your-teen/

 

Would You Use Your Smartphone as a Therapy Tool?

Reprint of my article published by HealthWorks Collective on July 8, 2013

When feeling depressed or anxious, some people do not want to go to a therapist, either because of the cost, the stigma, or both. MoodKit is a smartphone app that can help with depression and other psychological issues through the use of a modified, self-administered Cognitive-Behavioral Therapy (CBT). Depression can often lead to more depression, as people look at their situation in distorted ways and withdraw from activities that would otherwise make them feel better. CBT disrupts that process by helping people keep track of their moods and activities and then prompts them to do the things that make them feel accomplished and connected.  MoodKit allows users to track the connections between their activities, moods, and thoughts. For example, they may indicate that today they ate alone at a fast-food restaurant and during the meal, thought about their friend, who did not respond to a text message, and felt that the friend does not care about them. They may also record that they were in a poor mood. MoodKit helps users associate these three things in order for them get a better idea of what thoughts and activities make them feel depressed or anxious, and which ones make them feel good. Another benefit to MoodKit is that, as many people carry their smartphones with them all of the time, it is constantly available, and much more portable and discrete than a self-help book.

This app can also be used in tandem with more traditional CBT with a therapist. While many therapists may harbor mixed feelings about implementing mobile technology as part of their clinical practice, it is likely that programs such as MoodKit can improve the efficacy of their treatments. CBT emphasizes skill-building and active participation on the client’s part through use of homework assignments. When MoodKit is integrated into more traditional CBT, it can act as the homework assignments, with activities such as daily mood ratings, a calendar to keep track of activities, a journal, and activity suggestions including suggestions to increase productivity, physical activity, healthy habits, social activities, with the possibility to mark favorites for easy access.  The journaling option has multiple pre-formatted templates to develop various skills. There is an option to export all mood charts, journals and activities to the therapist, or to print them wirelessly. When used in conjunction with traditional therapy, MoodKit is likely to reduce the number of required CBT sessions, because it provides the therapist with statistical data about the patient. This data allows therapists to identify the triggers which cause anxiety and depression.

One of the more helpful features in the MoodKit app is the behavioral activation tool. Based on the analysis of the user's data, it suggests activities that will help them feel better. Over 150 activities are available in the app, along with examples and tips for implementation. After the user engages in a few of these activities, the app has an intelligent algorithm that suggests future activities based on the ratings that the user has given for the activities he has tried. Another tool allows the user to describe their situation (e.g.“I didn’t get that promotion at work that I expected”), their initial thought about the situation (e.g.“I’m never going to move up in my job”), identify the distortions in their though process(in this case “catastrophizing” and “fortune telling”), and come up with a modified thought (e.g.“It might take longer than I hoped, but that doesn’t mean I’ll never get that promotion”). On the same screen, users can list their feelings and rate the change between their initial and modified thoughts. This is a part of the cognitive restructuring tool in the app, which helps users manage their negative feelings related to a situation by generating adaptive alternatives to these thoughts and feelings. These situations, initial and modified thoughts,  feelings, and distortions are all recorded through step-by-step prompts.

While there have not yet been many studies determining the efficacy of the MoodKit app, there is no reason why it should not be at least as efficacious as traditional CBT homework assignments, especially when paired with traditional therapy. It is based on the tenets of CBT, which has been found to be an effective therapeutic approach, but it has the benefit of being portable. One of the downsides to traditional therapy is that, in the moment when someone is thinking a distorted or upsetting thought, it is not possible to always have a therapist or even a worksheet with them. There are times when it is not appropriate to journal about one’s mental health, but it is almost always socially acceptable to use your smartphone. As one user of this app noted, “As far as anyone else knows, I’m just another guy texting or checking email, not someone completing a therapy assignment”.       

image: http://www.flickr.com/photos/67914476@N04/6497720753

Link to original publication: http://healthworkscollective.com/talishenfield/113536/smartphone-therapy-tool-CBT

Executive Functions and Attention Deficit Hyperactivity Disorder

Executive function impairment has been traditionally viewed as a part of ADHD. Dr. Thomas E Brown in his new book "A New Understanding of ADHD in Children and Adults: Executive Function Impairments" (released in May, 2013) suggests that Executive Function Disorder (EFD) should be considered a distinct mental disorder. 

ADHD was initially described in medical literature in 1902 as a disruptive behavior disorder. It characterized children who were unable to sit still in class, listen to adults, and who often disrupted their classrooms. Then, as now, ADHD was seen more often in young boys than girls. In 1980, this conceptualization changed to highlight problems with attention as the key aspect of the disorder. Now called Attention Deficit Disorder (ADD), it remained categorized as a behavior disorder, despite the omission of a behavioral descriptor from the name. In 1987, the diagnosis once again placed an equal emphasis on hyperactivity in addition to attention difficulties. In 1994, a subtype that did not have problems with hyperactivity, only attention, was again acknowledged.

Regardless of the name of the disorder or to what extent hyperactivity is considered to be a major symptom, research into cognitive impairments associated with ADHD have discovered that children and adults with ADHD tend to perform less well on measures of executive function than those without the disorder. Executive function refers to the management of the brain's cognitive abilities and is the mechanism by which the brain self-regulates. When this discovery was made, some researchers began to think of ADHD as a disorder primarily of executive function because the symptoms of ADHD can be explained by problems in this area. If the brain is an orchestra, executive function is the conductor. In this perspective, people with ADHD have an incompetent conductor. Yet efforts to conclusively assess executive functions using neuropsychological measures have had mixed results. While groups with ADHD did show impairment on measures of vigilance, working memory, planning and response inhibition, researchers concluded that while these weaknesses were associated with ADHD, they could not be considered a cause. Of course, no correlational study could prove a causal link, but the true problem with these conclusions is that only about 30% of those with ADHD have significant impairments in their executive functioning.

An alternative way of considering the link between executive function and ADHD is that there are clusters of cognitive functions that make up executive functioning. These six clusters are activation, which involves organizing and prioritizing, focusing, which involves maintaining and shifting attention, effort, which involves levels of alertness and processing speeds, emotion, which involves regulating emotion and frustration, memory, which involves utilizing working memory, and action, which involves the monitoring and self-regulation of actions. From this perspective, these executive functions are situationally problematic for those with ADHD. Individuals with ADHD seem to have some areas in which they have no difficulty performing various functions, but may be completely impaired in those same areas in other aspects of life. They often describe it as being related to their personal interest in the subject. Therefore, it is not cognitive functioning itself that is impaired, but rather the systems that turn these functions on and off. If a day-to-day task does not offer some sufficient intrinsic benefit or threat, the cognitive functions are not turned on. Additionally, this perspective does not see ADHD as an all-or-nothing disorder. It is not as simple as having ADHD or not, but it is rather more like depression, which comes and goes.

While these models are significantly divergent from each other, they both attempt to synthesize the understandings of executive functions as a self-regulatory mechanism, as well as describing ADHD as a disorder that involves a problem in the individual's development of their executive functioning. The first perspective sees behavioral inhibition as aspect of executive function that all other functions depend on, and which is defective in those with ADHD. In the second perspective, behavioral inhibition is one of many executive functions that are interdependent and interconnected. All people with ADHD, in both views, have impairment of executive function; it is the essence of the disorder. There is another inherent conflict between these two views based upon how executive function is defined. If it is defined as the set of functions accurately measured by neuropsychological tests, then only a minority of those with ADHD have such impairments. The implication of this conflict is that there needs to be a redefinition of executive functioning. The typical approach in scientific research is to isolate and measure a specific variable, yet this approach is inappropriate for executive function due to its very nature. Instead, tests of executive function for ADHD should involve situations that attempt to replicate real life. 

Image source: http://www.flickr.com/photos/22498741@N02/2425844539

Link to original publication: http://www.adders.org/research83_executive_function_and_adhd.htm