521840?1348844371
Rebecca Resnik, PsyD  
Female
Bethesda, MD

Specialties: ADHD, dyslexia, developmental delays

Interests: Developmental Disabilities
MindWell Clinical Psychology
Bethesda Office
301-581-1120
Bethesda, MD
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Me First and the Gimmie Gimmies*

Nov 18, 2008 - 3 comments
Tags:

child behavior




Me First and the Gimmie Gimmies*

The holidays are supposed to bring out the best in all of us, but it can bring out the worst in our children and in us as parents. The winter holidays is a time of stress and high expectations, and both are hard for children to handle. Pretty much all humans, except for Gandhi or Mother Theresa, are insatiable beings. We all have limitless wants and wishes. Our desires can lead us to great things and achievements, and they can also lead us towards greed and envy. Children have those same feelings, but unlike adults, they don’t understand why all of their wants can’t (and shouldn’t) be granted.

This time of year, children are bombarded with toys, Santa, treats, and commercials. We really can’t blame them for craving all the terrific things they see, especially when so many of them believe that Santa will bring whatever they want. While we would love to curb their greed, the usual methods reasonable parents try don’t work very well against the holiday hype. We try to explain to children about limited budgets, how we need to save for college, and how it’s impossible for grandma to know exactly what Barbie is the perfect one. But kids don’t understand, not really. You can talk yourself blue in the face to a four-year-old who wants a toy NOW, and he’s not going to understand anything beyond what his experience tells him. He knows that you could buy whatever it is he wants (you’re his parent, you can do anything right?), but you won’t until he convinces you that he really, really needs it.

We parents all know that this becomes a cycle. First the child demands, then the parent refuses. The child gets more upset, and the parent starts feeling guilty, then frustrated, then angry. The child escalates until the parent punishes, leaving both people feeling terrible. Another awful situation arises when you give a child a beautiful, expensive, difficult to assemble gift, only to have him cry that he doesn’t like it. The holiday combination of stressed-out parents, too much excitement, and unrealistic expectations sets our kids up for meltdowns.

So here are some ideas for the holidays that might help take the edge off a bit:

   1. Avoid the danger zones. Try not to take your child to the toy store, the mall, and turn-off the Saturday morning cartoon line-up and kids cable channels (where all of the toy commercials are). The stores are overwhelming and crowded this time of year. All those toys are just too tempting for a child to ignore gracefully. If you must take your child shopping, let her know at the outset what you will and will not be purchasing. Be ready to leave the store if your child is not cooperative.
   2. Focus on the giving. Keep your child’s attention directed towards all of the things he is going to give to others. Take him to the craft store and get lots of supplies for making ornaments, menorahs, scrapbooks, paintable coffee cups and cards (get lots of glitter). Help your child buy gifts online so you won’t have to go to the stores. Shoot for having your child have a gift or card for everyone who will be giving him a gift. Teach your child about giving to charities. A child can pick out a Toys-For-Tots (just have him pick out one for a child of a different age or gender so he can part with the toy without tears) or help choose items for a care package to a solider in Iraq (www.anysoldier.com). Don’t forget your child’s teacher!
   3. Limit the Loot. Limit yourself and your relatives in the gift giving department. Keep it to one or two gifts at any one occasion, and put a cap on the amount people will spend. Never let a young child see a gift that he can not open and play with immediately (such as one that takes hours to assemble), otherwise you are sure to provoke tears.
   4. Practice how to accept gifts. Role play how to accept a gift with your child. Try scenarios where you don’t like it or already have it. Teach the child to say a warm ‘thank you’ and to write or color thank-you notes.
   5. Empathize. Children sometimes do get disappointed at the holidays; we can’t ever get them every wonderful, expensive gift they desire. Part of our job as parents is helping our children deal with disappointment. Resist the urge to lecture or call your child ungrateful. Nothing will make your child cry harder than you trying to argue him out of how he feels (e.g. Stop that crying, its a beautiful present! You're acting like a spoiled brat!). Instead, find that part of yourself that can relate to being a sad little kid who didn’t get what she wished for Christmas morning (I never did get a pony). Give a hug, give some cocoa, and then gently help steer your child’s focus back on all the things to be grateful for. Empathy is one of our best gifts we can give a struggling child, especially during the holidays.

Dr. Rebecca Resnik

* Title inspired by the rock band by that name

Power Struggles

Jun 20, 2008 - 8 comments
Tags:

child behavior

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power struggles

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tantrums

,

Rebecca Resnik

,

mindworks





     I do not know of any parent who does not dread power struggles. This is one of the most common problems that brings families into therapy. There is nothing like a battle with your own child to cause intense frustration and self-doubt. Not to mention that our kids seem particularly adept at picking times when we are late for work or when your mother in-law is there to see the whole thing.

     The only power struggles you truly win are those that you avoid. Once a child has engaged you in a negotiating, arguing, or tantruming battle, everybody loses. From the toddler who throws himself down and screams to the teen who becomes a prosecuting attorney, your best bet is to avoid ever being drawn into battling like an equal. It is very strange to think about it, but power struggles keep undesirable behavior going. Its not that they are pleasant for children, but during a 'battle' with you, your child is actually getting something he wants. When he can engage you, the child gets your full attention, ‘blows off steam’, and sometimes gets you to give in. Even if you are only loosing the occasional power struggle, that rare reinforcement of the unwanted behavior is enough to make it worse over time. Once your child learns that every now and then you will give in, it is just like he’s playing the slots in Vegas. He will keep going with more and more determination until the next big ‘pay off’ comes. Then the pattern becomes very difficult to break.

   So the real answer is to keep power struggles from happening as much as humanly possible. First off, you can be proactive. Watch out for situations that make a power struggle more likely. The big triggers include: video games, low blood sugar, fatigue, an anxiety provoking situation, having to share, going to/staying in bed, not enough opportunity to burn off energy, and transitioning from a preferred activity (watching TV) to an unwelcome activity (going to school).  We parents can anticipate most of these things coming and plan our strategy in advance by setting up expectations. Give lots of warnings and let the child know explicitly what to expect (“In 2 minutes, it will be time to turn off the TV and put on your coat”). If you are going to a trouble zone like a grocery store candy aisle, tell the child in advance what you will and will not be buying. Set a timer to tell your child when it is time to stop playing computer games. If you are going out, let the child know what behavior you expect to see, and what behaviors will lead to having to leave. Once you set an expectation, make sure to stick to it!


    The other two big ways to avoid the power struggle is giving choices and just plain empathizing. I am borrowing here from a terrific book called How to Talk so Kids will Listen and Listen so Kids will Talk, which I can not recommend enough. Your kids will be less likely to battle with you if you give them two things everyone wants, including choices and the feeling that you understand their perspective. While the ‘forced choice’ does not work every time, it can stave off many battles. Give kids lots of little choices whenever you have wiggle room. Choices are great for their sense of independence and for helping them learn to take responsibility for their own decisions. You can offer choices related to when the child will do something (now or in 5 minutes), how it will be done, and what the child would like (which cereal, which shirt, which homework assignment first etc.)

     If you can not give your child a choice, such as when its time to leave for school, let him know that you understand how he feels about it. We all feel so much better about unpleasant things when we feel that the important people in our lives care what we are thinking. This is NOT the same thing as giving in to our child’s demands! Empathizing is about helping your child tolerate the frustrations we all face in our day to day lives, not trying to make the frustration go away. We all have to do things like get shots and wait our turn, and kids need to learn to cope. However, we can help kids feel better with such simple statements like:  “You wish you could play that game all day instead of going to Grandma’s”, “You’re really disappointed about not being able to have more cake” or “Having to leave your teddy bear feels sad, you miss him when you’re at school.” By empathizing with our children and giving voice to their feelings, we can help them feel that we are on their side, and that we care about their experiences. For an older child or teen, tell them to write you a letter/email describing their grievances. A little empathy goes a long way towards making them feel willing to go along with our directions.

     Finally, the important thing in managing power struggles is to diffuse them if you can not prevent them. Keep in mind, it is always better to be proactive in managing behavior than reactive. When you have to be reactive, start by labeling the feeling (“You look frustrated” “I can see you are getting annoyed about this” or “This makes you very grumpy.”), and then state your expectation firmly (“And now we are going to have to leave for school” or “But I expect you touch the dog gently” or “Use words, not fists!”). If the child starts to calm down, you can offer a forced choice at this point (“Now, do you want to wear your coat or your jacket to school?”). If the child escalates with negotiating or a tantrum, it is time to get very firm and direct about what you are going to do (“If you do not choose, I will choose” or “We can discuss it later, right now it is time for school”, “If you need to calm down, I expect you to sit on the steps for two minutes.”). You’re your statements short. Then once you have told the child what you expect, it is time to ignore him until he complies. Some children will become very provocative trying to re-engage you, but ignore all behavior except something that puts your child or someone else in danger. Once the child complies or gets close enough towards acceptable behavior, praise and give attention again.

     Across the board, your goal is to give lots of attention, descriptive praise, and affection for desirable behavior, and as little as possible for unwanted behavior. In most families, we tend to pay little attention to the kids when they are doing what we want, and give then our undivided attention when they are being inappropriate. A power struggle is our children’s way of trying to get control over us, so keep in mind that once we are engaged in battling like equals, they have already won. Lastly, it is important to remember that our children do NOT really want to win power struggles. A child who wins power struggles is not a happy child, instead he becomes anxious, angry, and contemptuous (Remember Veruca Salt from Charlie and the Chocolate Factory?). What truly makes a child feel happy and calm is when he knows that his parents are in-control, protecting him even from his own worst impulses.

Dr. Rebecca Resnik
Licensed Clinical Psychologist
Mindworks Clinical Psychology


NOTE: please do not comment by asking for medical assistance. I am a psychologist, and can not provide any medical advice or advice regarding your psychotropic medications. Seek medical attention or emergency room care for any medical issues or life threatening behavior. If you wish to ask a question, please do so in the Parenting or Learning Disabilities Forums.

Behavior Plans

Jun 17, 2008 - 9 comments
Tags:

Behavior Management

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child behavior

,

Behavior Plan

,

psychotherapy




Some Thoughts about Behavior Plans

'Behavior plans' are one of the most popular approaches for trying to systematically change a child’s behaviors. Decades of research has shown that even an earthworm can respond to a simple behavior plan. So why do so many frustrated parents come to us at Mindworks (our private clinic) with the classic lament “We tried that, it didn’t work.”? As with most things in life, it’s because there is almost never a simple answer to a complex problem. Lets face it, if we could all fix out children's behavior by watching Dr. Phil or just buying the right book, lots of psychologists would be out of a job. In fact, many of us have wait lists for therapy appointments.

Helping our children develop self-control is one of the most challenging tasks we parents face. One reason behavior plans can fail to make lasting changes is that people understand them as ways of making a child comply. Getting people to comply for a little while is pretty easy. I can get you to do anything I want if I threaten you with a nasty enough consequence. However, once I’m not around or I can’t make good on my threat, you’re going to go right back to doing what you want. Believe it or not, longer or harsher punishments do not have a greater impact on eliminating unwanted behavior. There are decades of research showing that punishments have very limited effectiveness. While we absolutely need our children to comply with our rules, the true goal of a behavior plan is to teach the child to do something new.

When we take a teaching approach to modifying behavior, we come at the problem differently. Now our goal is to help the child choose a better set of behaviors than whatever behaviors are causing problems. As the psychologist Reginald Lourie noted, we must not eliminate a behavior without giving the child an attractive option for how to handle a stressful situation. If we just focus on stamping out a particular behavior, the child will find another way of dealing with his anger, frustration, boredom or shame (e.g. the child goes from hitting to biting). Remember, the goal is not just short-term compliance, its long-term development of self-control. Helping our children learn self-control can make all the difference for their happiness in life, not to mention making them better human beings.

Behavior plans have many common pitfalls. A major problem is lack of consistency, or using the plan sporadically or for too short a time period. This inconsistency creates a situation like a person gambling at a slot machine. Your child is the gambler, hoping for a pay-off (i.e. you giving in!). Guess who is the slot machine? When the ‘gambler’ never knows when the machine will ‘pay-off’ he is very, very, motivated to keep pushing buttons until it does. Kids are always looking for how to ‘beat the system’ and many parents give up as soon as the child finds a weakness in the plan that he can exploit. Every plan has weaknesses your child will find. That’s a delicate phase in implementation.

A psychologist can help you get through it without having the whole plan go down in flames. It is vital to get help from an expert to make sure your plan is developmentally appropriate! Lots of great plans fail because they are better suited to older children or for those without disabilities. The child must have the maximum chance for success, because there’s nothing harder than trying to implement a second, third, or fourth plan after failed attempts. A psychologist can also help you avoid pitfalls like inappropriate consequences. Too many well meaning people enact consequences that make the situation worse for everybody. For example, some people take recess from a child who desperately needs to let off steam, cancel birthday parties, or put a withdrawn, avoidant child into time-out.

Keep in mind that changing troublesome behavior does not happen overnight, and can be incredibly discouraging to find yourself constantly battling with your own child. The good news is that when behavior plans are proactive, fair and a good match for the child, they can and do help children change!  Whether its called Parent coaching, Parent Guidance or Parent Management Training, learning new skills for setting limits is an important part of psychotherapy for children. But don't stop there--a really good psychotherapist will complement behavior modification skills in with improving your communication skills, learning to be proactive instead of reactive, and learning to understand your child's emotional life as he develops. It is well worth the time and expense to improve your relationship with your child. Learning these skills is a gift you will give them that they will pass on to the next generation.

-Dr. Rebecca Resnik

Why seek a private psychological assessment?

Jun 17, 2008 - 13 comments
Tags:

psychological testing



Why should I have a private psychological assessment?

I recently spoke with a very happy father. He told me that he was canceling our appointment for psychological testing because his insurance company was going to arrange for him to have his child tested for only $15. And as I wished him well and hung up the phone, I understood why he sounded so excited. Fifteen dollars compared to the cost of a private assessment, well who wouldn’t be thrilled? And if you get an assessment though the school system it is free. Free sounds awfully good compared to expensive private testing, but the problem is that like with many things in life, if it sounds too good to be true to be, it probably is. As a former special education teacher, I have seen some very good assessments done by school system staff, however I also know the limitations of time, resources and even training that can negatively impact the quality of your child's assessment.

So what are you paying for when you invest in a private assessment? You are paying for time, expertise, and information you can trust. One of the first considerations is time. There’s no getting around the amount of time that a psychologist should spend producing a quality report, and ideally it is the psychologist’s time. Some psychologists do not do their own testing, instead they pass you off to a technician after the initial interview. The test administration, consulting, scoring and writing is very labor intensive, and in my opinion, it should be. No one wants to be treated by someone who is in a rush or taking short-cuts. Its worth paying for someone to make your case a priority. A private psychological evaluation should be custom designed around what you want to determine, as well as your child’s strengths and weaknesses. Tests and procedures should be thoughtfully selected, not simply used because they are the only ones you have. It is crucial to find a psychologist (or neuropsychologist) who has many tools at his or her disposal and the expertise to know how to use them.

It is unlikely that a psychologist will make useful recommendations unless he or she takes the time to study how an individual solves a variety of problems in the form of tests, tasks, and even play. When you walk out of a psychologist’s office, you should have a large document in your hand that gives you insight into how your mind (or your child’s mind) works and lays out a plan for what steps to take next. A comprehensive assessment should lead to specific, concrete, recommendations that address educational interventions, therapy, strategies for home, parenting advice, and information to inform medical treatments as appropriate.

When I do a psychological evaluation, I begin by budgeting six hours of ‘face to face’ time with the individual and his/her family. This is as much as three times the amount of time many people spend doing a psychological evaluation. My psychological evaluations resemble the neuropsychological assessments that I was trained to do as in intern at a pediatric hospital in Baltimore. I study the individual’s functioning exhaustively until I’m satisfied that I understand the problem, both what it is and what I can safely determine that it is not. After gathering my data, I start calling everyone I have permission to consult with (physicians, teachers, tutors, even relatives) to get a complete picture of how the person is doing across home, school, and work. I review old testing reports and work samples. Then I set up to work writing your evaluation. I do not fill your name into a template. I do not dictate my reports to a transcription service. I do not cut and paste ‘cookie cutter’ recommendations into the report. Finally, the family and I sit down and have a feedback session, where we talk about the findings in detail and spend time problem solving. I believe this level of care is what every person suspected of having mental health problems or disabilities deserves.

Rebecca Resnik, PsyD - Licensed Clinical Psychologist