Throughout life upsetting events, also known as traumas unfortunately occur. The National Child Traumatic Stress Network (NCTSN) differentiates between a trauma and a traumatic event.

According to NCTSN, a trauma is a dangerous and scary event.
A traumatic event is when there is danger and threat of injury or death as well as fear and helplessness. This is an important differentiation because not all traumas (scary/upsetting events) are traumatic events.

Types of traumatic events include but are not limited to:

• Abuse (physical or sexual)
• Accidents / Injury
• Neglect
• Witnessing violence (domestic or within the community)
• Natural disasters
• Fire
• Crime
• Terrorism
• Unexpected death of a loved one

Children exposed to traumatic experiences have varied responses. A child that experiences a traumatic event may have difficulties and experience stress. Their stress reactions may resolve quickly or they may become ongoing. A child may also have a delayed reaction. Each child is different. When a child’s ability to cope and their functioning is impacted for more than a month, a child may be experiencing traumatic stress. They may meet the criteria for the psychiatric condition Posttraumatic Stress Disorder (PTSD). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) stated that PTSD can occur in all ages beginning at age one. Not every child experiencing stress related to a trauma meets the criteria for a diagnosis of PTSD.

PTSD is a psychiatric condition. In addition to exposure a traumatic event symptoms of PTSD are the following:

• Intrusive memories /re-experiencing the event (flashbacks, nightmares)
• Avoidance behavior / numbing feelings
• Negative mood and thoughts
• Feelings of arousal (irritability, sleep troubles, restlessness)

Trauma can impact a child and their family in large ways. The way that traumatic stress appears will vary among children and will depend on their age and developmental stage. There are various emotional, behavioral and cognitive responses you may see in your child.

Below are some, but not all, noteworthy signs exhibited in children that suggest they may be struggling:

3- 5 years old

• Anxiety
• Difficulty focusing or learning
• Acting out in social situations / disruptive
• Separation difficulties
• Somatic complaints (stomach troubles or headaches)
• Unusual clinginess / regression in talking
• Bedwetting
• High level of anger or excessive temper
• Changes in play

6-12 years old

• Anxiousness
• Sleep or eating changes (nightmares)
• Irritability / agitation / acting out
• Shame / guilt expressed
• School problems (concentration difficulties, incomplete work, refusal to attend school)
• Withdrawal from others

Parents do not wish for their child to have difficulties or experience scary events. If your family or child has experienced a traumatic event and you are concerned, seeking professional help can be useful. Regardless if they meet the criteria for PTSD, children may benefit from support if they have been exposed to a traumatic event. Individual, group and/or family therapy can provide education about reactions to trauma, assist with how to reestablish safety and provide a child as well as parents, a place to appropriately process and express feelings in a helpful and planned manner.

http://www.apa.org/pi/families/resources/children-trauma-update.aspx

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

For many parents and children, back to school is an exciting time of year filled with enthusiastic conversations about new teachers to meet, after school activities to join and new classmates who will soon become friends. For children who struggle with learning or social issues, who suffer from anxiety, attention difficulties or who have trouble controlling their emotions at school, this time of year can be filled with equal parts hope and dread by children and parents alike. Hoping that this year will be different and dreading that it will not, parents start the school year struggling to convince their child to keep trying and to stay positive, even when the parents may not feel that way themselves. If you are a parent who feels more anxiety than excitement at the beginning of the school year, here are some proactive things to do to help your child transition smoothly back to school and to set them on a path to success in the school year.

With the teacher/school:

• Set up a time to speak with your child’s teacher in the beginning of the school year to help them get to know your child and how to best work with him. Does he respond best to prompts before transitions? Does she need an extra motivator to help her engage in work that is challenging? Does he sometimes not try when a new challenge is presented because he is nervous about giving a wrong answer? Giving the teacher the tools to best work with your child and helping the teacher to better understand and feel empathic towards your child before any issues arise will help set up both parties for success.
• Set up frequent communication with the school. Check in with the teacher via phone or email every other week to make sure everything is going ok and to be on top of any issues that arise. Ask them to let you know about the good things your child is doing at school as well so that you can share this with your child and help to create a positive relationship with their teacher.
• Introduce yourself to anyone else who will be working with your child throughout the year such as the guidance counselor or reading specialist and let them know you are available to speak and are interested in being involved in their work with your child at school.
• Introduce yourself to any of the “specials” teachers (art, gym, music…) who will be working with your child, especially if it is an area where your child normally struggles or excels. If your pre-teen daughter has a difficult time maintaining her emotions during gym class, let the teacher know ahead of time so that he can react appropriately. If your son is particularly gifted or interested in music class, tell the teacher so that she can help make this a part of the day where he will feel good about himself.

With the child:

• Set up a routine. This will help you all get back into “school mode” and will ensure that everyone is getting their work done and is in bed on time. It is also very helpful to have a structured morning routine in order to ensure getting to school on time.
• Instead of asking “How was your day at school?” ask something more specific such as:
  • what was the most/least interesting thing you learned today?
  • What was something that happened that made you laugh?
  • When were you happy/bored today?
  • What is the most popular game to play at recess?
  • Who had the best lunch today?
  • If you had to pick one of your teachers to go have ice cream with, which one would it be? Which one would it definitely NOT be?

Outside of the classroom:

• Sign up your child for an after-school activity that they are interested in doing. This way you know that they will be engaging in an activity that is enjoyable to them and where they can succeed. For children who do not often have moments of success in school this is an important component in ensuring they engage in an activity where they succeed and feel good about themselves. For children who struggle socially in school this can be a place to try and make friends who are not connected to school, another opportunity to make social connections.
• Schedule some time alone with your child where there is no talk of school or homework or teachers. Spend a few minutes each night talking about something they are interested in and that they enjoy talking about. This is an important tool in maintaining a positive relationship between parent and child for those times during the school year when things may get tough with missed homework assignments or calls home from teachers.

While these tips may be helpful for many children and parents, there are also times when outside help is needed. Cognitive Behavioral Therapy (CBT) is an effective treatment for many different difficulties that may be getting in the way of a successful school year for you and your child. Finding a clinician who can work with you, your child and your child’s school can be an important element in helping your child have a positive and successful experience at school.

Sleep is a restorative process that helps us function physically and emotionally and has a direct effect on our behaviors and in our ability to sustain attention. Sleep gives your body a rest, like a mini-vacation, and helps it prepare for the next day. Sleep is essential to our well-being. Reduced sleep can have a negative effect on our overall functioning throughout the day.

Sleep hygiene involves a number of different steps necessary to have a normal, quality night sleep and subsequently leading to daytime alertness.

Why is a good night’s sleep important for children?

• contributes to both physical and mental health
• helps kids feel good, and do well in school
• plays a role in mood and behavior
• can reduce aggression, hyperactivity, depression and anxiety, and increase attention

How can poor sleep habits affect children in school?

• Decreases ability to stay focused
• Can become easily distracted
• Exhibit hyperactivity
• Can be impulsive
• Show irritability and fussiness
• Increased sleepiness in the classroom

What are the basics of sleep hygiene?

• Routines
  • Establish a bed time – based on the child’s age
    • Toddlers: 12-14 hours of sleep
    • Preschoolers: 11-12 hours of sleep
    • School-age children: 10-11 hours of sleep
    • Teens: 8-9 hours of sleep
  • Limit screen time or high stimulation activities before bed
  • Calming bedtime routine
  • Engage in activities that promote relaxation such as taking a bath and reading a book
  • Child should wake up at the same time everyday
  • Bedtime should follow a predictable sequence of events
• Security objects such as a doll or a blanket are often helpful for children to feel safe and secure
• Engaging in physical exercise during the day can often help with sleep at night
• Bedroom should be cool and comfortable
• Bedroom should be dark and not too distracting
  • Limit bright lights, clocks, and phones
• The bed should be used only for sleeping
  • Teenagers often use their beds for homework and TV – this can decrease their ability to go to sleep at night.
  • Beds should be associated with sleep
• Consistency is key!
  • Stick to your routine
  • Predictability is important

What to avoid?

• Drinking many liquids before bedtime
• Caffeine such as sodas, chocolate, tea
• Doing stimulating activities before bedtime
• Using the bed for activities other than sleep
• Putting the child to bed after falling asleep somewhere else
• Staying up past their bedtime

What happens if children come into their parents’ room in the middle of the night?

• Limit attention
• Get them back to their bed as soon as possible
• Minimize conversations
• Do not let them come into the bed
• Walk them back to their room

If the child continues to need comfort to fall asleep, parents can sit in a chair next to their bed until they fall asleep. It is important that children learn to sleep in their bed, and to fall asleep on their own.

When to seek help?
If your child continues to have serious trouble falling asleep and consistent sleep routines are not working, consulting with a pediatrician or a mental health professional can be beneficial to assist in determining the cause and learning techniques to help children relax before bed in order to fall asleep more easily.

Obsessive-compulsive disorder (OCD) is a long-lasting psychiatric condition which causes impairment in a person’s overall functioning. OCD was once part of the Anxiety Disorders category within the Diagnostic and Statistical Manual of Mental Disorders, 4^th edition (DSM-IV) however in the newest edition; DSM-5 OCD has been moved to its own category with other related disorders.

Two characteristics of OCD are:

1. Obsessions: unwelcome thoughts/worries, urges, or images that are experienced as intrusive and cause anxiety
2. Compulsions: behaviors or mental acts (rituals) that a person feels determined to perform, continually to decrease the anxiety experienced from obsessions

In addition to the presence of obsessions and/or compulsions other key factors of OCD are the amount of time a person is occupied by them and the level of impairment a person experiences.

The behaviors and the amount of difficulties are important to differentiate from a person that is highly organized, fixates over details or is perfectionistic in nature. A person with OCD will exhibit symptoms that are excessive or persistent causing challenges in their everyday routine and impact the quality of their life. This is different than a person who is successful or able to achieve due to their habits. Insight into symptoms varies from person to person.

Children can be impacted by OCD and their symptoms can often continue into adulthood. Children may also have a more difficult time recognizing their symptoms or expressing their troubles. The DSM5 states that females are more impacted than males in adulthood however males are more affected in childhood. Other psychiatric conditions likely may occur along with OCD, most commonly, depression, other anxiety disorders, or tic disorders.

Research shows that Cognitive-Behavioral Therapy (CBT) is the most valid and effective psychological treatment for OCD when symptoms are mild to moderate. CBT is appropriate in conjunction with medication when symptoms are more severe. If left untreated, OCD can significantly impact overall abilities to function easily. OCD cannot be cured however treatment is helpful.

Features for the treatment of OCD include:

• Psycho-education about the disorder provided by the clinician at the start of treatment.
• Exposure and response prevention using a gradual approach (hierarchy) to help a person face their fears and hold back from engaging in a behavior that typically lowers their anxiety (ritual or compulsion). A person learns to get used to the anxious feeling or the feeling is eliminated altogether (called habituation). Exposure exercises occur in and outside of sessions.
• With children incentive programs are useful to increase their motivation, preserve enthusiasm to engage in treatment and reward behaviors when completing exposures.
• Cognitive restructuring is taught to a person to help with changing their faulty thinking related to obsessions and increase useful self-talk.
• Parent training and family participation is important to recognize and reduce accepting or enabling OCD behaviors. Frequently, family members or parents help with behaviors (i.e., make changes in routines or participate in the behavior) in order to provide relief to their loved one.
• Relapse prevention is useful to help plan for bumps in the road after treatment ends. Symptoms may resurface which some people may interpret as a setback. Relapse preventions is to increase awareness for signs of relapse, organize a response and address the concerns before treatment has ended.

Lastly, booster sessions with the clinician, is a positive practice to help if OCD symptoms resurface. Booster sessions assist with reviewing skills and address any issues that arise.

 

American Psychiatric Association: Diagnostic and statistical manual of mental disorders. 5^th Edition. Arlington: American Psychiatric Publishing; 2013.

Freeman,J., Garcia, A., Frank,H.., Benito, K., Conelea,C., Walther,M., & Edmonds (2014). Evidence Base Update for Psychosocial Treatments for Pediatric Obsessive-Compulsive Disorder. Journal of Clinical Child & Adolescent Psychology, 43:1, 7-26.

Mancuso,E., Faro,A., Joshi, G., & Geller, D. (2010). Treatment of Pediatric Obsessive-Compulsive Disorder: A Review. Journal of Child and Adolescent Psychopharmacology, 20, 299-309.

Wagner, A. (2003). Cognitive- Behavioral Therapy for Children and Adolescents with Obsessive-Compulsive Disorder. Brief Treatment and Crisis Intervention; 3:3, 291-306.

Oppositional Defiant Disorder (ODD) is characterized by symptoms and behaviors that fall into three different categories including:

• Angry/Irritable Mood – often losing temper, being easily annoyed, often being angry and resentful

• Argumentative/Defiant Behavior – arguing with authority figures, actively defying or refusing to comply with requests, deliberately annoying others, blaming others for his/her mistakes

• Vindictiveness

In order for a person to be diagnosed with ODD, they must exhibit at least 4 symptoms and/or behaviors that are characteristic of the disorder and these symptoms/behaviors must cause distress to the individual or those close to the individual such as friends, family members, and co-workers. Lastly, ODD can vary in severity from mild to moderate to severe depending on the number of settings in which the individual exhibits symptoms/behaviors.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013), the prevalence of ODD ranges from 1% to 11%, with an average prevalence rate of 3.3%. The disorder is more prevalent in males than in females before adolescence, but then evens out in adolescence and adulthood. The first symptoms of ODD often arise during the preschool years with their frequency often increasing during this time and into adolescence. ODD may also precede the development of conduct disorder and increases the risk of developing anxiety disorders and major depressive disorders as well. Risk factors for developing ODD include temperamental factors that lead to emotional dysregulation; harsh, inconsistent, or neglectful parenting practices; and a number of neurobiological markers (e.g., lower heart rate and skin conductance reactivity; reduced basal cortisol reactivity; abnormalities in the prefrontal cortex and amygdala).

What are the most effective and evidence based treatments for ODD?

Due to the stress that this disorder can cause in the individual as well as those around him/her, and the comorbid conditions that may develop such as anxiety and depression, early intervention is crucial. According to the American Academy of Child & Adolescent Psychiatry (2009), Oppositional Defiant Disorder treatment usually includes a combination of:

• Parent Management Training and Family Therapy to teach parents and other family members how to better manage their child’s behaviors through positive reinforcement of appropriate behavior and consistent discipline strategies.

• Cognitive Problem-Solving Skills Training to teach children more appropriate ways of handling stressful situations.

• Social Skills Programs and School-Based Programs to teach children how to interact appropriately with peers and improve their schoolwork.

• Medication to help manage the more distressing symptoms as well as symptoms due to comorbid disorders such as anxiety and depression.

According to Comer, et al. (2013) behavioral treatments that target behavior problems indirectly through helping parents develop different parenting techniques with the goals of increasing in-home predictability, consistency and follow through, and effective discipline have been the most studied forms of psychosocial treatment for ODD. These treatments help parents end negative coercive cycles through helping them increase positive attention for appropriate behaviors, ignore negative attention-seeking behaviors, and provide consistent time outs for noncompliance. Some of these best practices include:

• Parent-Child Interaction Therapy (PCIT) – Designed for children between the ages of 2 and 7 years-old that focuses on developing a secure attachment between the parent and child by teaching parents how to use positive attention to increase positive behaviors and consistent limit setting to decrease negative behaviors. Sessions include teaching of the skills with live coaching through a one-way mirror. Results include more positive parent-child interactions with increased compliance, social skills, language use, confidence and emotional regulation.

• Incredible Years – Designed for children up to 12 years-old and includes:
  • A parenting program focused on strengthening parent-child interactions and attachment, reducing harsh discipline and fostering parents’ ability to promote children’s social, emotional, and language development.
  • A child program focused on strengthening children’s social and emotional skills, such as understanding and communicating feelings, using effective problem-solving strategies, managing anger, practicing friendship and conversational skills, and behaving appropriately in the classroom.
  • A teacher program focused on strengthening teachers’ classroom management strategies; promoting student’s prosocial behavior, emotional self-regulation and school readiness; and reducing children’s classroom aggression and noncooperation with peers and teachers.

• Triple P-Positive Parenting – For children up to 13 years-old that focuses on teaching parents simple and practical strategies to help them confidently manage their children’s behavior, prevent problems from developing, and build strong, healthy relationships.

• Helping the Noncompliant Child (HNC) – A skills-training program aimed at teaching parents how to obtain compliance in their children ages 3 to 8 years old.

As this is not an all-inclusive list of treatment options for ODD and research is continually being done in order to identify current best practices, it is important to keep an eye on the literature in order to ensure that the best approach is being used. Although having a child with ODD can be stressful and trying, as one can see, there are a lot of treatment options that have been identified as being highly effective in decreasing oppositional and disruptive behaviors and therefore progress can be made.

The following resources were utilized in the development of the above:

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5^th ed.). Washington, DC: American Psychiatric Publishing.

American Academy of Child & Adolescent Psychiatry. (2009). ODD: A Guide for Families. Retrieved from https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/odd/odd_resource_center_odd_guide.pdf.

Comer, J.S., Chow, C., Chan, P.T., Cooper-Vince, C., & Wilson, L.A.S. (2013). Journal of the American Academy of Child and Adolescent Psychiatry, 52(1), 26–36. doi:10.1016/j.jaac.2012.10.001.

Mental health in early childhood is not given the awareness it merits as a contributing factor to human development. The National Scientific Council on the Developing Child at Harvard University has written a paper and created a video that stresses the significance of early childhood mental health. The report Establishing a Level Foundation for Life: Mental Health Begins in Early Childhood: Working Paper No. 6. emphasizes the importance of focusing on this area. Below are some noteworthy key points from the paper.

1. Emotional well-being early in life is central to development

Mental health plays a role in growth, achievement and learning, coping, behaving and building meaningful relationships in all facets of life, starting in early childhood.  Mental health is as important as developmental milestones which receive far greater attention. Without emotional well-being all other aspects of growth may have shortcomings to reach full potential. The authors eloquently state that “sound mental health provides an essential foundation of stability.” This emphasizes that mental health early on in childhood positively or negatively is impacted by experiences and relationships which influences functioning and development.

2. Nature, Nurture, Stress and the Brain

The dynamics between genes and experiences contribute to development and mental health. Genetics do not determine the entire outcome for a child. Genes are like a map that can give awareness to susceptibilities. Positive relationships and early experiences can serve as a protective factor against susceptibilities. Negative early experiences and exposure to stressful situations (i.e., abuse, neglect, and violence) increases the risk for mental health difficulties. More specifically, interactions between genes and persistent negative experiences can increase a child’s vulnerabilities, when they exist, and lead to later problems. Additionally, stress in early childhood can impact a growing brain which can lead to mental health problems later in life. Long term stress creates physiological changes, even in young children, and if they do not have supportive relationships that serve as protection, brain development is at a disadvantage. Early experiences and stress have an impact on brain development, relationship and skill development as well as physical health.

3. Mental Health problems and Young Children

Mental health challenges can occur early on in a child’s life. There are differences in behaviors and symptom presentation contingent on age however young children can have difficulties too. The authors share that there have been advances in identification for early age onset of mental health disorders yet challenges still exist with young children. Young children may present with a multiple of problems similar to older children (example: anxiety and bedwetting or irritability and noncompliance) or single temporary behaviors.

4. Prevention and Early Identification

Prevention strategies and identifying mental health problems and those at risk for developing mental health problems are crucial. Strategies implemented correctly can positively impact emotional well-being and outcomes over the course of one’s life. Attention to early mental health problems is vital because early interventions with children and families can have a large impact on future development and problems. Challenges do with exist with early identification given developmental differences seen during stages of growth. However, when interventions, strategies and skills are not implemented as problems begin in early childhood they can lead to more serious problems late in life.

5. Family Role and Factors

Relationships and surroundings help shape a child. Positive relationships with others especially the adults and caregivers in the early years of life set the tone for psychological well-being. Strengthening a relationship between a parent and child can have a lasting impact. Additionally, the mental health of a parent or caregiver cannot be ignored. Caring for a child is a stressful and rewarding experience. An adult struggling with stress, depression or any other mental health condition can negatively impact their quality and style of parenting. Risk for mental health problems in early childhood will rise when relationships with parents/caregivers are lacking attention, affection and reliability.

6. Therapeutic Help

Assisting a young child with mental health needs is best done through various methods and in different settings. Often for young children a strongly supported approach is to focus on assisting the parents / caregivers. Building the parents ability to nurture and protect if stress occurs will influence the quality of their relationship. Providing support to minimize and cope with stress, increase positive parenting strategies and support their healthy relationships will likely prevent negative outcomes for children.

 

Manhattan Psychology Group provides coordinated services that can help with assisting families regarding early childhood mental health. We provide:

• Individual therapy for adults
• Parent Child Interactive Therapy (PCIT)
• In home behavioral therapy to help the child/parent relationship and routine
• Individual behavioral therapy to assist a child with skill development
• School consultation and collaboration

Source: National Scientific Council on the Developing Child. (2008/2012). Establishing a Level Foundation for Life: Mental Health Begins in Early Childhood: Working Paper No. 6. Updated Edition. Retrieved from www.developingchild.harvard.edu

Video: https://www.youtube.com/watch?v=L41k2p-YRCs

“Was that bribery or reinforcement?” is a very common (and valid!) question among many parents of young children. Are you unsure if something you give your child (or say to your child) is considered a bribe or reinforcement? Read on for some clarity!

What is bribery?

Bribery is when something powerful such as money or an object (including an edible item) is given to a person in order to encourage them to engage in a specific behavior or complete an activity or task. Bribery is given before a person exhibits that desired behavior.

What is reinforcement?

Reinforcement occurs when something is given or said to a person when a specific behavior is exhibited that increases the future likelihood that that behavior will occur again in the near future.

Real Quotes from Parents

“I offered my daughter a cookie for doing her homework.” Check to see if this was a bribe or reinforcer by asking yourself, “Did I give the cookie before or after the homework was complete?” If before, it was a bribe, if given after, it was reinforcement. It was given after in this instance and was reinforcement.

“After weeks of unsuccessful potty training, I gave my son M&M’s. I was desperate!” Check to see if this was a bribe or reinforcement by asking yourself, “Did I give the M&M before or after my son eliminated in the potty?” If before, it was a bribe, if given after, it was reinforcement. In this instance it was reinforcement. Even if the child did not eliminate successfully in the toilet, giving the candy after the attempt is a great way to encourage the child to try again next time.

“I bribed my son with a lolly. I need him to sit in the stroller!” Check to see if this was a bribe or reinforcement by asking yourself, “Did I give the lolly before my son was sitting calmly in the stroller or after?” If given beforehand, it would be considered a bribe. If given after the child was sitting down, it was reinforcement. In this instance, it was reinforcement.

Bribing a child has a negative connotation. However, rewarding a child has a very positive connotation. Many parents are rewarding their child’s positive behavior although they sometimes confuse these two terms. Children benefit from external rewards such as small edible items, points or tokens, small trinkets and labeled praise like compliments, in order to engage in appropriate behavior more often. Continue rewarding and reinforcing your child’s appropriate behavior by praising them and/or offering a small goodie after they have engaged in a behavior you would like to see them do again!

Autism Spectrum Disorder (ASD) is a broad term used to categorize a group of neurodevelopmental disorders that are present from early childhood and affect many aspects of day-to-day functioning. The core features of ASD include

• Persistent deficits in social communication and social interaction
• Restrictive and repetitive patterns of behavior, interests or activities

These symptoms exist on a spectrum, and are diagnosed based on severity and intensity of support required (very substantial support, substantial support, and support). Currently, ASD is estimated to occur in approximately 1 in 68 individuals. ASD disproportionately affects boys; however, the expression of the disorder is often more severe in girls. Despite advances indicating a genetic component, the causes of ASD remain largely unknown at this time.

What is the role of the word spectrum in ASD?

There is a saying that if you’ve met one individual with ASD, you’ve only met one individual with ASD. This is because each individual diagnosed with ASD may present differently and require a different level of intervention.

In the category of persistent deficits in social communication and interaction, some individuals with ASD “requiring very substantial support” may have little or no verbal language. These individuals rarely initiate social interaction, and may not respond to social overtures from others. On the other side of the spectrum, individuals in need of “support” may be able to speak in full sentences, but struggle to engage in reciprocal conversations or to initiate and maintain friendships.

In terms of patterns of behavior, individuals requiring “very substantial support” may engage in self-stimulatory behavior (i.e., hand flapping) that severely limit functioning throughout the day. Behavior that exists on the other end of this spectrum may include difficulty transitioning between activities, as well as organizing and planning.

Overall, it is important to remember that the behaviors in each domain that make up ASD may exist with varying severity and impact on day to day functioning.

What are the most effective and evidence based treatments for ASD?

Regardless of the severity of ASD symptoms, early and intensive intervention is universally considered to be best practice in treatment. Research on ASD intervention is primarily focused in two areas: Applied Behavior Analysis (ABA) and Developmental Social Pragmatic (DSP).

• ABA interventions are based primarily on the concept that difficulties associated with ASD can be addressed through the identification and reinforcement of specific target behaviors
• DSP interventions are focused on improving the ability to jointly engage in activities with adults and peers.

The following is a more in depth look at evidence-based interventions for the treatment of ASD

• The most notable treatment for ASD is Early Intensive Behavioral Intervention (EIBI). EIBI consists of 20-40 hours per week of treatment for 2-3 years. As previously indicated, earlier intervention is critical, and EIBI is recommended prior to 5 years of age. Comprehensive ABA programs are adult led, and focused on all areas of functional deficit. Most comprehensive programs begin with an assessment of age appropriate behavior milestones, which are then addressed by an individualized curriculum. Depending on level of support needed, therapy may take the form of Discrete Trial Training (DTT) or Natural Environment Teaching (NET). DTT is a highly structured teaching method in which skills are broken down and individually taught. Each trial is typically reinforced with a tangible reinforce (i.e., candy, toy). NET is primarily delivered in the natural environment, capitalizes on opportunities for incidental learning, and makes use of natural reinforcers in addition to tangibles.

• Pivotal Response Training (PRT) – PRT is based on the principles of ABA, and primarily targets “pivotal” responses rather than individual target behaviors. Pivotal responses include: motivation, response to multiple stimuli, social interaction, as well as self-management. The overarching philosophy is that improvement of these pivotal responses will lead to improvement in a variety of other functional behaviors. As PRT is play based and child initiated, this intervention may be more effective for children who possess already established behaviors including: increased social initiation and toy play.

• Picture Exchange Communication System (PECS) – PECS is an augmentative/alternative communication (AAC) intervention based on the principles of ABA. PECS encourages the initiation of communication. That is, the child must initiate a request by presenting a picture of a desired item to a communicative partner who then fulfills the request. As the child masters various stages, the communicative repertoire is expanded to include sentences, attributes, commenting, as well as the answering questions. PECS and other AAC devices are primarily used with minimally verbal children.

• Early Start Denver Model (ESDM) – ESDM is a blend of both ABA and DSP approaches to treatment. ESDM integrates elements of a relationship-based approach with behaviorally based teaching strategies. Specifically, a therapist or parent is instructed to match their child’s affect and allow the child to lead the activity. The program is based on a developmental curriculum and outlines the skills that need to be taught at any given time. ESDM has been shown to be effective across a wide range of abilities.

You can click to learn more about our Applied Behavior Analysis services.

In addition to these treatments, there are a variety of treatments that are currently being thoroughly investigated. These interventions include various parent training techniques, DIR floortime, comprehensive classroom based approaches, as well as PCIT. It is important to keep an eye on the literature, as treatments are constantly evolving, and new randomized controlled studies are being completed.

The following article was utilized in the development of the above:

Tristram Smith & Suzannah Iadarola (2015) Evidence Base Update for Autism Spectrum Disorder, Journal of Clinical Child & Adolescent Psychology, 44:6, 897-922

As the variety of intervention strategies for ASD has increased significantly over time, this article was chosen, as it is the most recent evaluation of what is currently offered in the field. The future directions for research stated by the authors place value on treatments that are emerging as evidence based, supporting the notion that any review of evidence based treatment must be as recent as possible.

Finding out that your child has been diagnosed with an Autism Spectrum Disorder may be a very difficult experience, but in the face of this news, it is important to remind yourself that despite the difficulties and delays that may be characteristic of the disorder, people with ASD often have many strengths and characteristics that make them unique in a really great way. According to Stephen Short (2010), some of the strengths that a person with ASD might have include the following:

• Good attention to detail
• Often highly skilled in a particular area
• Deep interest and study of particular topics resulting in having a wealth of knowledge in this area
• Tendency to be logical instead of allowing emotions to influence decision-making
• Less concern over what other people may think of them
• Good visual processing abilities
• Often very verbal
• Direct communication
• Loyalty
• Honesty
• Nonjudgmental listening
• Average to above average intelligence

Given this long list of strengths that a person with ASD might have, it does not come as a surprise then that many people with ASD develop into leading very successful lives.

While ASD did not become a formal diagnosis until the 1940s, it has been suspected that notable people in history including Albert Einstein, Amadeus Mozart, Sir Isaac Newton, Charles Darwin, Thomas Jefferson, and Michelangelo may all have had ASD. More recently, several celebrities such as Dan Aykroyd, Matt Savage, and James Durbin have come out to say that they also have ASD. In terms of their individual strengths that led to their success, Dan Aykroyd reported that it was his deep interest in ghosts that led to his creation of the very popular movie, Ghost Busters. Matt Savage’s savant skills in the area of reading piano music led to his becoming a very accomplished pianist – performing for several heads of states and appearing on numerous television and radio programs. James Durbin’s hyper-focus on music led to his being a contestant on American Idol and a successful music career.

The most well-known and accomplished figure with ASD is Dr. Temple Grandin who currently works as a Professor of Animal Science at Colorado State University. Dr. Grandin encountered many of the difficulties and deficits that are characteristic of ASD such as delayed and repetitive speech, a hypersensitivity to noise and other sensory stimuli, and an inability to relate to others on an emotional level, but her strengths in the area of visual thinking led to a successful career as a livestock-handling equipment designer. Dr. Grandin is a proponent on focusing on the strengths of a person with ASD instead of their weaknesses, and has proposed that there are three types of specialized thinking that a person with ASD might have: 1) visual thinkers; 2) music and math thinkers; and 3) verbal logic thinkers. With specialized skills in one or several of these areas, a person with ASD that is encouraged to capitalize on their strengths and taught in ways that appeal to their thinking patterns, may become a very successful individual who is capable of doing things that even you and I might not be able to do.

As you can see, a person with ASD has many strengths that if capitalized upon may lead to their leading a very successful life. So, if you suspect that your child may have ASD or if your child has recently been diagnosed, try to identify the strengths that make your child unique, as this will be their lifeline to success.

Gender Dysphoria (formerly known as Gender Identity Disorder) has received a substantial amount of media attention recently, with the very public gender transformation of Caitlyn Jenner and award winning shows such as Transparent. Fortunately, public awareness of gender dysphoria has opened the door to increased societal acceptance and understanding for individuals with a variety of gender identities. Despite improvements in the awareness and acceptance of gender issues, children and adolescents who present with gender dysphoria often feel confused and ashamed. Parents and family members may also experience confusion about their child’s gender dysphoria and feel unsure about how to respond. The following is meant as a starting guide for families who are beginning to navigate gender related issues with their child.

First, it’s important to understand the difference between the terms sex and gender.  Sex is a term that describes the anatomy of a person’s reproductive system, genetic makeup, and secondary sexual characteristics. Sex is typically assigned at birth based on a child’s anatomy and is usually male or female (although it is important to note that sex also exists on a spectrum and some individuals are born with intersex conditions). Gender is a more complicated term to define because it is more fluid then sex. Gender refers to the way in which a given society defines the attitudes, feelings, and behaviors of men vs. women. Individuals who are cisgender identify with a gender that aligns with the sex they were assigned at birth whereas individuals that are transgender identify with a gender identity that differs from their assigned sex (e.g., a person who identities as female but was born with male sexual characteristics). Gender dysphoria, which is a diagnostic code in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) is a term used to describe individuals who experience distress or impairment due to their persistent identification with a gender that differs from the gender others would assign him or her. Individuals with gender dysphoria have a strong desire to be treated as the other gender and in some cases to be rid of their born sexual characteristics. Gender is best thought of as on a spectrum as there is increasing awareness of various gender identities that fall outside traditional male or female identities (e.g., bigender, agender, genderqueer). Finally, sexuality and gender are separate constructs and it is important to know that an individual’s gender identity does not determine their sexual identity. For example, a person who identifies as female but was born male may be attracted to women, men, or both.

A normal part of childhood and adolescence is to experiment with different identities and interests. Thus, it is normal for children to sometimes behave in ways that do not conform to societies’ gender roles (e.g., for a male child to dress up as a princess). A small portion of children, however, are very persistent in their identification with a gender opposite or different from their assigned gender. It is important to know that some children, adolescents, and adults who identify with a gender that is different from the one they were assigned at birth do not experience distress and therefore do not have gender dysphoria. However, psychological distress, such as anxiety or depression is often common in children with gender identity questions and in these cases the diagnosis of gender dysphoria is warranted. Children and adolescents with gender dysphoria may benefit from a gender evaluation and psychotherapy or psychiatry services. Some children and adolescents with gender dysphoria choose to socially transition or to pursue medical interventions (e.g., puberty suppressors, cross-hormone therapy, and genital surgery) consistent with their identified gender. In these cases, professional psychotherapy or psychiatry services can provide support for individuals as they move through the transition process and can assist individuals in making informed decisions that are right for them.

Sadly, individuals who experience gender dysphoria are often times marginalized from peers and even their families; in these cases, the risk for psychiatric problems and even suicide dramatically increases. Thus, family acceptance and support can be critically important in the long term outcomes of children with gender dysphoria. Often family therapy or supportive therapy for parents and family members can assist families in learning how to best support their child.