Parent/Neurologist

My sister's email signature reads, "Paths are made by walking!"  Interestingly enough (and not surprising to those who know me), I have always pictured a brain when I read that, and think of the neural pathways that are formed by human actions and interactions.  Fascinating if you think about it, that a series of responses can become a pathway which once traveled, can't be untravelled...  Or can it?

The theory of neuroplasticity isn't new, but it's a concept which is gaining momentum in the world of behavioral and neuroscience, and is a critical part of any parenting discussion.  After all, we can all use a do-over once in a while!

Parents, did you know you are neurologists and neuroscientists?  Neural pathways are formed in brains by human experience (primarily attachment experience), beginning from birth.  Children's development is dependent on the quality of early relationships, and throughout the course of our lifetimes, when faulty pathways are formed, it is frequently through human connection and interaction that new pathways are formed in their place.  Although most neural connections are formed in the first three years of life, our brains are constantly developing.  As new neural pathways are formed, our brains "prune" or get rid of unused pathways.  Experience is the main factor in determining which pathways are used and which are pruned.

Ideally, all children would be born into loving attachment relationships with all the neurological developmental processes in place to take advantage of every learning opportunity that comes to them.  In reality, many children are victims of developmental trauma and neglect, and still other children are born with dysfunctional sensory processing and modulation systems.  The acquisition of learning and skills in difficult in both cases, but not impossible if you believe in neuroplasticity.

As parent-neurologists, you have the ability to form and strengthen neural pathways with every interaction you have with your children.  Because human beings are social/relational creatures, we know the strength of connections is increased with the excitability of human interaction, particularly within the context of attachment relationships.  This of course makes healthy attachment critical, but in cases where attachments are dysfunctional, other significant adults can also become neurologists in the process of developing neural pathways.

Following is a model which can be implemented with children of all backgrounds and developmental abilities.  It's a model that is both borrowed and original (or rather borrowed pieces to the point that it is a combined original).  The goal is to use the parent-child (or adult-child) relationship to help achieve a state of emotional and behavioral self-regulation.  This model pre-supposes adult self-regulation, and frequently when that is a problem, I work with parents in therapy to get to a point they feel comfortable regulating their emotions enough to implement this type of process.

Ready for action?

1. Remove the stimulus.  When a tantrum or melt down occurs, there is usually someone or something which can be identified as the "stimulus."  The object or individual should be removed from a setting long enough for the child to redirect focus from an event/object to the overall goal of self regulation.  Side note about time-outs:  The concept of "time out" has become so distorted that the focus is number of minutes, or "time served" vs. the real goal of learning self-regulation.  If a child can return to a regulated state in 5 seconds, why do they have to sit somewhere for 5 minutes?  Neural pathways are forming during that time, and if they calm down and immediately receive positive feedback about this accomplishment, a neural pathway has formed, and their brain knows what to do the next time.  If they calm down in 5 seconds and have to spend the next 5 minutes in time out, what neural pathways are formed during that time?  Are they "thinking" about what they did?  Really?  More likely they're thinking about how unfair this is, and plotting ways for pay-back against who or whatever got them into time-out.  It's better to use time-out for emotional/behavioral regulation.  The "thinking" comes later.
2. Ensure predictability and safety.  During the removal of stimulus, does the child know what is expected?  Will they get the toy back or be able to return to the activity when they are calm?  Clearly state the expectation and limits.  Adults can help ensure safety by making sure that the "time out" location is as stimulus-free as possible so children do not become destructive if they are angry (more about how to handle that later in the process).  If children are physically fighting, adults should be aware that safety comes before emotional regulation.  Children cannot regulate unless they feel safe.  If they are carried, dragged, our forced into another setting, this often increases physical aggression as a normal "fight or flight" response.  In spite of fighting back (and especially when fighting back) children are seeking the security of knowing what to do.  Angry reactions are frequently a response to fear and happen in the absence of other skills.  Alternatively, adults can communicate they are in charge of the "time-out" by stating, "It looks like you're taking  your time-out right there.  I'll stand here with you until you're calm and we can talk about what happens next."  The plan of refusing to comply with specific time-out requirements is thwarted.  Who says time-outs have to take place in a corner?  The goal is emotional self-regulation, and forcing compliance can derail that process.
3. Identify target emotional states.  It frequently takes children who are distressed a long time to calm down.  If there are "lulls" in the tantrum, an adult can identify that as a calm emotional state.  True story:  I had a mother once tell me that she had this in mind while her daughter (who had attachment disorder) was calming down.  She said it was taking forever for her to be calm, and she couldn't find a pause to identify any emotion that was remotely close to calm.  At one point her daughter was sobbing and she gasped like people do when they have been sobbing for a long time.  As she drew in a breath, her mother quickly noticed and said, "Oh, you calmed down just for a second."  That small identification of "calm" gave her daughter a target and literally within seconds her daughter drew another breath and her mom identified "calm" again.  When the daughter returned to crying, it was more of a "fake cry" for a few minutes, interspersed with "calm" breathing.  As the crying decreased, the mother identified to her daughter that the crying wasn't as loud and it sounded like she could calm down.  The daughter acted upset at the mother telling her this, but she allowed it and continued to allow her self to be guided in the self-soothing process.   Interestingly enough, tantrums after that were lessened significantly.  Mom used a calm emotional state to help the daughter to self-regulate, and the daughter's neural pathways for self regulation continued to form.
4. When everyone is calm, talk about the behavior.  Parents think they have to talk about behaviors right when they happen.  Children as young as three or four are capable of remembering earlier behaviors.  Parents can identify the positive (the child is calm) and agree to have a talk about the behavior later.  "Later" when you have the discussion, identify target behaviors.  Let the child know if they become upset or whine, the discussion has to take a time-out until later, but no toys, TV, etc. until the discussion has taken place.  The child's natural drive to return to activity is on your side!  This step sometimes requires going back and forth between step 3 and 4 until a conversation takes place in a calm emotional state.  It is critical for everyone to be calm during this phase, because in a state of dysregulation, the brain's main goal becomes survival, and cognitive neural pathways are not formed in extreme emotional states.
5. The discussion should include three main components:  a) What happened?  b) What could you do differently? and c)  How can you fix it?  A variety of responses are acceptable.  Adults should not be looking for "right" responses.  The only "right" response is the child having a thought process about their actions and thinking through problem solving and repair.  As this process is repeated (The first thousand times are the hardest!) they form cognitive skills that can override emotionally dysregulated responses.  It's all about forming neural pathways.  If the words come out of your mouth "telling" them the "right" answer, they'll nod agreeably so they can return to their activity, but the only neural pathway being formed is the one that says, "Nod and smile when adults speak to you so you can get out of uncomfortable interactions a lot faster!"  No matter how long it takes, the responses should be their responses.  If their answers are inappropriate, you can redirect the responses with more questions rather than telling them the answers.  The "How can you fix it?" portion of this discussion is a great place to introduce the concept of destructive behavior.  If the child was destructive during the tantrum, help them fix what was broken or work with them to earn money for a replacement so they recognize what happened.  The next time when they're upset and begin destructive behavior, the new neural pathway in their brain will recognize the prompt of "We'll have to fix that later," if they choose to break something.  (It may take a lot of fixing broken things to get good results.  Neural pathways take time to form, hence the caution to make the time-out location be as stimulus free as possible.)
6. Recognize the need for early redirection.  Children often give signals they are beginning to get overstimulated, which may lead to a meltdown.  It's easier to prevent and redirect negative behavior than to stop it.  If you see the signals (hyperactivity, change in tone of voice, not responding to redirection, etc.), suggest an alternate activity before the child gets to a dysregulated state.  If they learn to redirect, this also becomes a neural pathway.  As adults, we "redirect" all the time by taking breaks.  Notice the need to redirect, but only draw attention to the more calm, redirected behaviors.  If transitions are difficult (as they often are in children with developmental delays) you may have to engage them in an alternative behavior you know they are interested in as you make a transition.

Again, the first thousand times are the most difficult.  You'll forget.  They'll forget.  You'll get distracted.  You'll be exhausted and need a few time-outs yourself.  Neural pathways take time to form.  Think of a brain injury or stroke patient working with a physical or occupational therapist.  It takes literally hundreds and hundreds of attempts and repetitions to regain skills lost to injury.  The same may be true for children who have not had a typical course of neural development.  The point of encouragement is that change is possible.  Brains are plastic...and you're now a neurologist!

Say No To Drugs

In 1985, Enrique (Kiki) Camarena, a drug enforcement agent for the DEA, was close to exposing a multi-billion dollar drug pipeline when he was kidnapped and killed by some of Mexico's leading drug traffickers.  Saddened by the loss of a great officer, friend, and family member, those closest to him organized community groups to speak out against drug trafficking and to make drug free pledges in his honor.  Participants wore a red ribbon, symbolizing their commitment and pledge.  Thirty years later, Red Ribbon Week has become one of the nation's largest drug awareness programs.  Schools, businesses, media, community, and faith based organizations continue to sponsor drug free awareness events to publicize what is now known as  "Red Ribbon Week."

Earlier this year I volunteered with PTA to help with Red Ribbon Week events at my daughter's school.  Early in the planning process, we thought it would be a great idea for every Sunrise Elementary student to be able to plant a red bulb that would come up in the spring, reminding students of their promise to grow up drug free.

What was I thinking?!?

Dig a hole, throw in a bulb, cover it up.  How hard can that be?  Not so difficult, really.  ...Times 760 students and 29 different classes...  Thankfully a small army of parent volunteers made "Plant the Promise to Grow Up Drug Free" a huge success.  The final bulb went in the ground this afternoon, and with any luck, there will be 760 red tulips surrounding Sunrise Elementary in the spring.

Through the week as each group of students came outside to plant their bulbs, we engaged them in a short discussion of the importance of growing up drug free.  The other volunteer coordinator of the project shared with me today that a little girl in one of her groups said something about her mom not being healthy because of taking drugs and drinking alcohol.  Off and on through the planting process I heard a few other similar comments, and even specific references to drugs by name and terms associated with drug use.  It was disheartening to think that for some of the students, the only positive discussions they will ever have with adults about drugs comes from PTA volunteers.

At the same time I heard comments which reaffirmed what a powerful force parents are in the goal of helping children to grow up drug free.

"My parents talk to me about drugs," one girl told me.

"I know how to plant bulbs because I plant them with my mom," said another boy.

My favorite was from a fourth grader who had to dig a hole in a difficult spot of ground.  As he dug he told me how strong he was, and said, "I get it from my dad," then added, "I'm growing up to be just like him."

Parents, you really are the anti-drug.

There is a lot of current research supporting the role of parents in drug prevention.  In fact, most anti-drug campaigns target parent involvement as the key to children and teens avoiding drug traps.  When teens are surveyed about influences that keep them from trying drugs, parents are at the top of the list.  Yes, they really are listening.

Other ideas for helping to prevent drug abuse:

• Talk early and talk often.  Preschool is not too early to introduce discussions about drugs.  At this age there should be a foundation and vocabulary for discussions that will follow.  They can know there are drugs to help you when you're sick and drugs that make you sick and unhealthy.  They can know that drugs should come from a doctor and they shouldn't take them unless their name is on the label or prescription.  
• By early elementary school, children will hear references to drug use from peers and media.  A foundation of previous drug discussions leads progressively into continuing discussions about drugs as children's awareness grows.  Parents should let their children talk about the things they hear without discouraging the discussion or labeling it as "bad."  This is a great age to start referring specifically to health risks of smoking and alcohol abuse.  As you see advertising about cigarettes and alcohol, view it as an opportunity to point out myths associated with advertising and to discuss how the job of companies is to make money by getting people to buy their products.
• Later in elementary school children may start to seem bored with discussions about drug and alcohol use, but parents should initiate discussions, especially when opportunities present themselves (a unit in school, a drug reference on TV, etc.)  Many opportunities for discussions at this age occur informally, while driving, while engaging in an activity together, etc.  These are natural opportunities for discussion about the effects of drinking and driving, or the effects of drugs on health that might prevent engaging in sports or recreation.
• The same is true for teens, with a twist.  Teens have to develop autonomy.  That's the developmental goal of the teen years.  Parents have to strike a balance between involvement and control.  Ask questions, but be sure to avoid interrogations and make your questions come from a genuine interest in your child's life and friends.  Also, don't stop taking advantage of natural opportunities for discussion.  Let teens know that privileges are an extension of responsibility.  Love is extended unconditionally.  Trust is earned.  (I can love you enough to help you get where you need to be, but if you crashed my car three times last week, I probably won't trust you with the keys.)  

And a few more important ideas:

• Pre-teens and teens will know peers who become involved with drugs.  Parents should be empathetic to the conflicting messages and emotions their children will process as they see others go through drug use or experimentation.  It can be confusing and hurtful to see a peer go through changes in behavior, academic performance, etc.  Parents should not read empathy for friends or desire to talk about a friend's drug use as a desire for their child to be in the same situation.  Mostly they will want to talk and (even though they won't say it) they're looking for support and validation as they form their own ideas and opinions about the world.  Look for signs they want to talk, and be available for the really difficult conversations.
• If children or teens experiment with drugs, parents should value their role as allies in fighting against the drugs, not in fighting against their child about drugs.  Battles create a wedge.  Empathy creates a bond.  The rules and limits should continue to be clear, but should be enforced with love.  Parents should understand enabling behaviors, and understand the difference between being a parent and being a friend.  
• If teens are experimenting with drugs, parents should seek professional help.  Many parents ignore early warning signs and think they can fight the battle alone.  Addiction isn't about behavior, rules, or ability.  It's about overcoming strong chemical and biological urges created by substances which alter brain chemistry.  Early intervention is key.  It's a myth that someone using drugs has to hit "rock bottom" before they can get help.

Like the small army of volunteers helping students to "plant the promise," it takes a small army to help kids win the day-to-day battle against peer and cultural influences.  Parents lead the army.  Without you, it's a difficult battle to fight.

Do-ing vs. Be-ing

A 9 year old boy once said to me in a therapy session, "We are human beings, not human doings."  When he said this, I was sure he was just about the smartest 9 year old I had ever met.  Since then I've heard that quote other times, in other places, enough to know that it probably wasn't his original thought, but I do think often of the wisdom in that quote, and often wish that our western world would slow down just a little bit so we could really enjoy the "being" part of our nature.

We've all heard of the Type A and Type B personality theory.  Type A personalities are described as having a sense or urgency and importance about everything they do.  They are competitive and achievement oriented, and place less emphasis on relaxation and fun.  Type B personalities are described as the opposite.  They're patient, relaxed, and easy-going.  Lacking a sense of urgency, they seem to live in the moment without a lot of concern about direction or choice.

Personally, I identify more with the former category, and have wished my entire life to be a little more Type B.  I must have had some success, because my husband (a Type B) frequently describes me as a Type C personality, which, in his words, is "Type A about turning into Type B."  At least he can have a sense of humor about it...and that would be the Type B in him again.  Go figure.

The healthy truth is that balance is good.  We are human beings, but we wouldn't survive without doing, and as parents, it is important for us to be able to model a healthy balance of being and doing for our children.  It is critical to the development of self-worth.  An over emphasis on doing creates anxiety and stress.  An over emphasis on being creates apathy and indifference.  Neither is healthy.

In reality, it's difficult to strike a balance.  How do you get an overly anxious child to relax and enjoy life?  And what about the child who refuses to even acknowledge the existence of homework?  Is there any hope at all?

Think of this as an experiment.  You acknowledge that self worth in children comes from feeling valued, and know that you play a critical role in the development of self-worth.  Then, as with all experiments, you can't be sure where it will lead, but all attempts are feedback which will lead to new discoveries and new experiments.  (Safety goggles are not required but should be available in case of emergency.)

• Start by taking a few days to notice what you value in your child.  Do they make you laugh?  Are they smart?  Do you have a self-starter?  Are they kind?  Make a list...or not.  What did you notice?  
• Notice your reaction when you see what you value in your child.  Did you smile?  Did you acknowledge it to them?  Remember, every child deserves to look into the face of a parent and see delight.
• Decide which of the things you value would go in the "doing" category, and which would go in the "being" category.  If you're the list making type, would the "doing" list be longer than the "being" list or vice versa?
• Think of a small step that might help balance the list.  If your child is loaded with "being" traits, how can you encourage more "doing" qualities?  Would adding/removing motivators help them move toward a goal?  If the "doing" category is becoming a little too heavy, how can you encourage your child in more of the "being" traits?
• Use your relationship with  your child to help accomplish more balance in being/doing categories.  When you join with your child in what it is you would like them to accomplish, they are more likely to engage.
• Catch your child doing things in the area that seems most unbalanced.  If your child is content to just be, catch them working toward a goal and become excited about it.

Warning:  It is also important to be aware of the uncomfortable emotions that come up in the process of this experiment.  Being aware can lead to acknowledgement of difficult and sometimes painful feelings about parenting.  Not acknowledging those feelings can lead to resentment, which certainly your child will hear in your voice and see on your face.  It's all feedback to a child.  Disapproval can inadvertently lead to feelings of low self-worth.  Noticing the uncomfortable might be a step best accomplished in small doses, and if you find yourself stuck in the process, try talking it out with a spouse, a friend, a sibling... or a therapist.

Remember, start small.  The goal is balance.  As a recovering Type A personality, I can honestly say the grass is green on both sides of the fence.  There is a lot to be gained in those being moments, and starting small can actually be the most rewarding part of the process.  Don't worry about staying too long on the observation phase of your experiment.  You'll be surprised what happens through observation alone.

Just notice.

Notice your child.

Notice your reactions.

Notice their responses to your reactions.

Notice them.

And tell them you noticed.

You Are A Good Parent

Theme for October...drum roll please!

Ok, so I'm not really sure I have a theme for October yet, but parenting has been on my mind a lot lately, so I'll go with that.

"You are a good parent."

...Words we love to hear, but don't hear often enough.

Prior to starting my private practice I led a weekly parent-child relationship group.  It was part of a cluster of groups where parents met in one room while their children met separately to work on social and relationship skills.  The children of said parents were kiddos who struggled in practically every setting.  They were children with Autism, ADHD, Anxiety, Depression, PTSD, Attachment Disorder...and the list goes on.  Parenting these children was a particular challenge, hence the parenting group.

Needless to say, parents often come to group exhausted and discouraged, with little progress to report, and they were honest about it.  Parents new to the group were always pleasantly surprised and relieved to hear they weren't the only ones struggling.  Group check in frequently became an update on the week's disasters.  It wasn't uncommon for parents to keep tabs on whose son or daughter was kicked out of daycare or suspended from school.  Parents often expressed frustration at hearing well-meaning peers, co-workers, neighbors, and teachers hint that their child's problem was a case of bad parenting.  I believe, and frequently tried to reinforce to the group, that they were exceptional parents who were dealing with issues that many parents will never experience; problems which required them daily to reach down deep inside themselves to find a level of parenting they didn't know existed.

I remember one week that seemed abnormally tough for most of the parents.  During our group check-in, I heard parent after parent describe their week.

"My son dumped craft paint all over a newly painted, newly carpeted room at daycare.  On purpose!"


"We had a huge meltdown at the grocery store and I have huge bruises on my legs and arms from trying to carry my son to the car."


"Someone called DCFS on us...same neighbor, for the eighth time."

I could tell that on that particular night the group needed a little more than the usual "hoorah" for their efforts.  Earlier that same week I had watched a television interview on the news of a mother discussing her toddler's recovery after he had nearly drowned in the bathtub.  She had stepped away for only a minute, but that's all it took.  During the television interview the mother said, "I know I'm a good mom."  That statement stuck with me because I could tell when she said it she believed it.  Inside I celebrated because I knew that her little boy would not have to grow up in the shadow of his mother's guilt at having walked away from the bathtub for only a minute.  She could forgive herself.  They could enjoy the gift of life they had been given.  In the heirarchy of importance to a child, it was a blessing equal to that little boy's life.  Every child deserves to look into their parent's eyes and see delight.  (See more on the story here.)

As I shared the story with my group, a mom in the back of the room started to cry, first little tears, but before long she was sobbing.     Other parents shared tears as well.  One by one they began to express hurt and anger at the the invalidating things they so often hear from others about their children.  It seemed that everyone had an opinion about their child, and everyone had advice, yet no one but them had to walk in their shoes all day, every day without a break.  In the fatigue of their lives, fun was often lost to function, and they were operating in survival mode.

Under ordinary circumstances, being able to say, "I'm a good parent," isn't always easy.  We beat ourselves up for everything...missed appointments, late homework, dirty laundry, a sink full of dishes.

I've done it too.  On the day of the group I mentioned above, I remember listening to the group and thinking about my own day.  I hadn't left myself enough time that morning and had rushed my kids, and doled out my own share of mommy guilt for being impatient with them.  I had also remembered half way through the day that I missed a soccer sign up for my daughter.

So how much more difficult is it for parents of children with emotional and behavioral difficulties, who hear constantly about the problems their child is having, to feel good about being a parent?  It isn't what they expected it would be, and everyone and everything in their world reinforces to them that they should be different, or their child should be different.

I came across this online video again a few days ago, and posted it to facebook.  It's an essay by Emily Pearl Kingsley, the mother of a child with Downs Syndrome.  Emily was a writer for the PBS children's program, Sesame Street.  Early in her career, Emily gave birth to a son with Downs Syndrome.  Subsequently, she used her work to create awareness of children with special needs, and people with disabilities were often included in the show's programming.  I think she beautifully captures what it means to be the parent of a child with any type of disability.



Remember:  "You are a good parent."  Go hug that kid and tell them you love them and are glad you're on this journey with them.