Join our webinar, “Helping Your Toddler Manage Their BIG Emotions: A 5 Step Supportive Plan.”. Psychologist, Erika Stapert, PSYD, will discuss a set of research-based positive parenting skills that have been proven to increase positive behavior, language development and emotion regulation in children. She will also help you plan for reacting to minor misbehavior, set limits for dangerous and destructive behaviors; and recognize and support your toddler during a “big emotion” with the use of a specific five-step plan for both you and your child.

This is for all moms who feel super overwhelmed with parenting during Coronavirus – and beyond! Erika will help you come up with a simple, step-by-step plan.

Helping Your Toddler Manage Their BIG Emotions: A 5 Step Supportive Plan from The Motherhood Center on Vimeo.

SUMMARY
Due to school closings as a result of COVID-19, children will potentially have an increased online presence and/or be in a position that puts them at an inadvertent risk. Due to this newly developing environment, the FBI is seeking to warn parents, educators, caregivers, and children about the dangers of online sexual exploitation and signs of child abuse. 

INFORMATION
Online sexual exploitation comes in many forms. Individuals may coerce victims into providing sexually explicit images or videos of themselves, often in compliance with offenders’ threats to post the images publicly or send the images to victims’ friends and family.

Other offenders may make casual contact with children online, gain their trust, and introduce sexual conversation that increases in egregiousness over time. Ultimately this activity may result in maintaining an online relationship that includes sexual conversation and the exchange of illicit images, to eventually physically meeting the child in-person. 

In order for the victimization to stop, children typically have to come forward to someone they trust—typically a parent, teacher, caregiver, or law enforcement. The embarrassment of being enticed and/or coerced to engage in unwanted behavior is what often prevents children from coming forward. Offenders may have hundreds of victims around the world, so coming forward to help law enforcement identify offenders may prevent countless other incidents of sexual exploitation.

Abuse can occur offline through direct contact with another individual. During these uncertain conditions, where time with other adults and caregivers has increased immensely, parents/guardians should communicate with their children about appropriate contact with adults and watch for any changes in behavior, including an increase in nightmares, withdrawn behavior, angry outbursts, anxiety, depression, not wanting to be left alone with an individual, and sexual knowledge. 

RECOMMENDATIONS
Parents and guardians can take the following measures to help educate and prevent children from becoming victims of child predators and sexual exploitation during this time of national emergency: 

ONLINE CHILD EXPLOITATION

• Discuss Internet safety with children of all ages when they engage in online activity.  
• Review and approve games and apps before they are downloaded. 
• Make sure privacy settings are set to the strictest level possible for online gaming systems and electronic devices. 
• Monitor your children’s use of the Internet; keep electronic devices in an open, common room of the house.
• Check your children’s profiles and what they post online.
• Explain to your children that images posted online will be permanently on the Internet.
• Make sure children know that anyone who asks a child to engage in sexually explicit activity online should be reported to a parent, guardian, or other trusted adult and law enforcement.
• Remember that victims should not be afraid to tell law enforcement if they are being sexually exploited. It is not a crime for a child to send sexually explicit images to someone if they are compelled or coerced to do so.

CHILD ABUSE AWARENESS

• Teach your children about body safety and boundaries. 
• Encourage your children to have open communication with you. 
• Be mindful of who is watching your child for childcare/babysitting, playdates and overnight visits. 
• If your child discloses abuse, immediately contact local law enforcement for assistance.
• Children experiencing hands-on abuse may exhibit withdrawn behavior, angry outbursts, anxiety, depression, not wanting to be left alone with a specific individual, non-age appropriate sexual knowledge, and an increase in nightmares.

VICTIM REPORTING
Reporting suspected sexual exploitation can help minimize or stop further victimization, as well as lead to the identification and rescue of other possible victims. If you believe you are—or someone you know is—the victim of child sexual exploitation: 

• Contact your local law enforcement agency. 
• Contact your local FBI field office (contact information can be found at www.fbi.gov/contact-us/field or you can submit a tip online at tips.fbi.gov). 
• File a report with the National Center for Missing and Exploited Children (NCMEC) (1-800-843-5678 or online at www.cybertipline.org).
• As of the date of this PSA, NCMEC is closed due to COVID-19. Their website provides valuable information regarding child sexual exploitation and safe online activity.

When reporting, be as descriptive as possible in the complaint form by providing as much of the following as possible:

• Name and/or User Name of the subject. 
• Email addresses and phone numbers used by the subject. 
• Web sites used by the subject. 
• Description of all interaction with the subject. 
• Try to keep all original documentation, emails, text messages, and logs of communication with the subject. Do not delete anything before law enforcement is able to review it. 
• Tell law enforcement everything about the online encounters—we understand it may be embarrassing for the parent or child, but providing all relevant information is necessary to find the offender, stop the abuse, and bring him/her to justice.

For more information about the FBI’s guidance on child sexual exploitation, visit 

https://www.fbi.gov/scams-and-safety/protecting-your-kids. 

With COVID-19 running rampant, we are living in unusual times. Parents of young children face a particular set of challenges.  With schools in New York (and elsewhere) closed indefinitely, children everywhere are now at home. That means it is up to us to not only homeschool them but keep them occupied as well.  With strict social distancing in place, outside adventure options are limited, and kids and parents alike may feel cooped up. Complicating matters further, many parents of young children may need to simultaneously telework.
Helpfully, many schools have sent home recommended schedules and virtual assignments, but every parent will still need to figure out a structure and strategy that works for them. Here are some tips to help facilitate success, ease some stress, and get you in the groove of our temporary “new normal”.

Understand Where New Behaviors are Stemming From
We often see with our clients that even small changes in daily structure can prompt new behaviors that impede their success.  Even with realistic goals and proactive strategies, the current situation is likely to motivate behavioral changes for at least some children. They may be afraid about the virus and not know how to express their anxieties. Children may sense the stress emanating from their caregivers and react. Being cooped up in an apartment or home all day can elicit challenging behaviors from some children.

If you experience some of this in your home, understanding why your child is behaving the way they are is the first step to making a meaningful, functional behavioral change.  This is because we have to understand the function of a behavior in order to effectively address it. It may be challenging, but do your best to be observant. Then, address the functions. Maybe your child needs some education about COVID and what steps your family is doing to keep them safe. Perhaps they are cooped up and doubling the movement breaks in your home will be regulating. Possibly they are used to having all of your attention when you are home and don’t understand why things have changed now. If you’re not sure what’s going on, give us a call and we will help you figure it out.

Have a Visual Schedule
During pandemics or typical school days, children consistently benefit from knowing what is going to happen and when. Children with special needs who have processing challenges or are not yet able to read will especially benefit from a visual schedule—this is a schedule of pictures indicating what will be happening and when during their day. There are a lot of ways to make a fancy version of a visual schedule. Platforms like BoardMaker and TeachersPayTeachers.com offer ways to print visual schedules. You can also use free apps such as FirstThen, iCreate or Social Story Creater and Library (some of these have in-app purchases). Or you can use my go to which is writing and/or drawing a schedule on a white board or piece of paper. You can play around with these options and find what works best for your family.

When implementing a visual schedule, you will be more likely to find success if you intersperse demands with preferred activities. If your child sees the next four hours include cleaning their room, doing homework, and reading the dictionary; they are likely to resist. Try to intersperse breaks as often as feasible. Additionally, it can be very hard for children to separate from preferred activities. If you try to take your child off of their iPad to work on geometry, they will likely be bummed. As much as possible, try to transfer from a preferred activity to something that is also preferred. For example, transitioning from a highly preferred activity to a preferred snack can help ease the pain of separation.  The great thing about snacks is that they are consumable and parents do not have to take them away—they are just gone when they are done. This can make it easier to move on to something new from them.

Here are some sample schedules for a few different age ranges. They can be tweaked and adjusted to fit your family’s needs.

4-6 Years Old

7:30 Wake up

7:45 Brush teeth/get dressed

8:00 Make/Eat/Clean Up breakfast

8:30 Educational games on tablet

9:00 Play break—if possible an educational game with a concrete ending like Zingo or The Sneaky Snacky Squirrel

9:15 Assigned School Work

9:45 Skype call with family or friends

10:00 Make/Eat/Clean up Snack

10:30 Reading

11:00 Assigned School Work

11:30 Movement break—take a walk outside, jump on an indoor trampoline, fill the stroller with heavy things and push it down the hallway, etc

12:00 Lunch

12:30 Assigned school work

1:00 movement/play break

1:30 Art/Sensory play (again, an activity with a concrete end like coloring a picture or creating something specific)

2:00 Assigned school work

2:30 Tablet/Play break

2:45 Snack

3:15 Assigned school work

3:45 Movement break

4:00 Clean their room/play space

4:30 Skype call with family or friends

5:00 Free play until dinner and bedtime

7-10 years old

7:30 Wake up/Brush teeth/Get Dressed/Make Bed (Maybe aspirational but we are all spending more time at home and keeping our spaces clean will keep us healthy!)

8:00 Make/Eat/Clean Up Breakfast

8:30 Math

9:15 Movement break

9:30 Reading

10:15 Make/Eat/Clean Up Snack

10:45 Science

11:30 Tablet/Play Break

11:45 Social Studies

12:30 Make/Eat/Clean Up Lunch

1:00 Writing

1:45 Movement Break

2:00 Language Arts

2:45 Break

3:15 Homework

4:00 Break

4:15 Independent Reading

4:45 Clean up school supplies/study area

5:00 Free play until dinner/bedtime

Reward the behaviors that you want to see
Maybe you are managing two children who are different ages and don’t get along. Maybe you’re going crazy being the only person in your household trying to keep things clean. Perhaps you just want your child to sit and focus independently for 5 minutes. Whatever your goals, identify them for your family and figure out a reward system. Token economies are really effective in these situations.

A token economy is when a child earns tokens for good behaviors or completing tasks. Once a child has earned enough tokens, they can cash them in for a preferred isolated activity or reward that is specific to that behavior. For example, if your goal is to have your child help around the house then every time they clean something up without being asked they can earn a token. If they earn enough tokens (this is subjective), they can cash them in for an extra episode of paw patrol before bedtime, or a bag of chips or some extra screen time. Try choosing a reward that does not require supervision so that you can have a break. Again, you can be flexible with the number of tokens and rewards here—as long as your child is contacting potent reinforcement often enough to be motivated by the tokens, it should work well. As much as possible, they should access the chosen reward only when they have earned the requisite amount of tokens.

You can make token boards easily with a piece of paper. Just indicate however many tokens your child must earn and what their reward will be. If you want your child to earn 10 tokens by being nice to a sibling and then get a 30 minute tablet break, you can draw 10 boxes on a piece of paper and draw a happy face inside a box each time you notice your child behaving nicely towards their sibling. Your child will be able to see how many more times they need to exhibit the chosen behavior to earn their reward, and you will get a break to do your own thing while they are earning.

Set Realistic Goals
It would be great if you could use this forced time at home to potty train all of your kids, teach them to read, finish their future college applications, and have the whole family learn Chinese. But setting yourself up for too much will make you feel like you’ve failed if you cannot achieve all of your goals. Feeling like a failure is not a great way to cope or set your family up for success. Try setting small realistic goals at first and then they can get loftier if you achieve them consistently. For example, you can start with a goal of helping your child get 80% of their school work done while you meet your own career demands. If your child’s academic demands are not realistic for your current set up, talk to their teachers about making adjustments to fit your situation. If there is a stay at home parent who already can spend all day monitoring the kids—more power to you! If not, this is an unusual time and your child will not suffer permanently if they get shifted to a reduced virtual workload for a while.

What if I cannot implement these strategies by myself?
As always, we are here to help you to design and implement at home behavioral strategies via telehealth (phone, zoom, etc) if you need help understanding and/or executing these or other behavioral strategies during this time.

In so many ways, the world our children are growing up in is very different from the world that we may remember growing up. There are some wonderful changes, such as a greater awareness of different learning styles and increased educational and job opportunities. There are also ways in which things are more difficult, such as increased stress and competition in schools, the dangers associated with electronics and the internet, and the number of mass shootings that have been taking place, both in schools and in other important places in a community such as places of worship or at large community gatherings. It can be very difficult to know how to approach our children when there is a mass shooting.  It is easy to feel overwhelmed trying to figure out what to say and what to hold back, what feelings to show and what to keep inside, and how to best help your child deal with the event. Although each child may process these events differently and require a slightly different response from their parents, here are some general guidelines for how to talk to your children about mass shootings. The guidelines are divided into four different age groups ranging from pre-k and kindergarten through adolescence.

General guidelines:

• The American Psychiatric Association (APA) recommends that you do not talk with your children about mass shootings until they are 8 years old unless they are directly affected by the event or if you believe they will hear about it from other sources. Because of the multitude of news sources (television, radio, various internet screens), it may be likely that your child has heard about the event.
• Before speaking to your elementary age child, it is best to decide what you want to say and what message you want to convey, this way you go into the conversation feeling more prepared.
• It is best to start by asking your child what they know about the event, this way they are leading the conversation and you have the opportunity to clear up any misinformation and immediately answer any questions they may have.
• With any age child, this is a good opportunity to model your own coping skills to your child, such as speaking in a calm voice and talking about how you deal with frightening thoughts or use social supports during difficult times.
• If you are watching or listening to news of the event, make sure that your younger children are not around as this repeated exposure can be detrimental to children.
• Children may be looking for reassurance that they are safe, that this will not happen at their school. Although this is not a promise you can make, you can talk to your children about all of the adults around them whose job it is to keep them safe such as teachers and school personnel, police officers, firefighters and paramedics. Since most schools have lockdown and other safety procedures in place, you can talk about how the school is prepared in the event of a shooting.
• Let your child know that it is ok to have big feelings about this and validate what they are feeling. Some possible phrases to use are “I understand that you are feeling scared” or “I know this is really hard”. It is possible that your child will not have any noticeable reaction in the moment and that is fine too, let them know that you are around to talk about this whenever they would like so that it does not feel like the topic is closed after the initial conversation ends.

Pre-K/Kindergarten:
The important message for children at this age is safety.  Children need to know that there are many adults whose job it is to keep them safe, and these adults are always working very hard to keep everyone safe. If your children ask about something like this happening at their school, although you may have urge to reassure your children that this type of event will never happen to them, a more realistic message is to state that it is highly unlikely and if it did, there are many people and who will be working to make sure that everyone is safe.

Elementary age children:
Children at this age can have a slightly longer conversation than those in pre-k or kindergarten but it still may not be a very long conversation. At this age it is still best not to use images of the event in the discussion.

Middle school age children:
As children get older, the conversation may be longer and more involved. Answer any questions they may have with age appropriate language and details, and know that it is ok to tell your children “I don’t know” if they ask a question to which you do not know how to answer.

High school age children:
Teenagers will be able to process the events differently and may want to have a longer conversation about what happened. They may also prefer to talk with their friends instead of parents and that it ok too. It is important to let your teen know that you are there if they want to talk, without feeling forced. With teenagers, actions and solutions will also be important to them. It can be helpful to discuss possible actions they can take in response to the event such as attending a rally, as well as talk about what actions are currently taking place such as increased security measures at schools or safe gun legislation.

At any age, children may react to a shooting with increased difficulty paying attention, anxiety, irritability or defiance, difficulty separating from caregivers or wanting to stay home, changes in sleep and appetite and thinking a lot about the event. All of these are normal reactions and should abate within a few weeks. If these reactions persist or interfere with a child’s ability to function, the child may need the help of a mental health provider to learn how to cope with their feelings.

Whether your child is neurotypical or not, there will be times during your role as their caregiver when they will need you to advocate for them. It could be a situation as simple as having gluten free options at school lunch or as complicated as getting proper intervention for a medical diagnosis. Knowing how to effectively assess what your child needs and get it for them can be confusing—especially if people are giving you inconsistent opinions and feedback. Below, find some tips to make this process a little easier.

1. Understand your child’s rights
Children living in New York State are entitled to certain services based on their levels of need. For example, if your child is between the ages of 0 and 3 has been diagnosed with Autism Spectrum Disorder, they are entitled to free Early Intervention

Services provided by New York State. If your child has a disability they are entitled to a free and appropriate education under the Individuals with Disabilities Education Act. If your family income is at or below 130 percent of the poverty level, your child is eligible for free meals at school. Understanding what your child is entitled to is an important step to making sure they get it.

If you live in New York and want to know what government services are available to your child, you can call 311 or visit: https://portal.311.nyc.gov/about-nyc-311/. You can also speak to their teachers, doctors, therapists and other providers for tips and suggestions.

2. Trust your gut
There are situations that some parents are comfortable with, and other parents are not. Some families choose to vaccinate their children, and others do not. Some parents don’t want their kids to eat sugar. Some families don’t believe in therapy. If you find that your instincts as a parent don’t align with the people around you, that does not mean you are wrong. Feel free to discuss different perspectives and adjust your opinion if it feels right; but if you do research, talk to professionals you trust and your opinion doesn’t change—there is nothing wrong with that. Sometimes in social situations it can be uncomfortable to disagree with friends and loved ones. As your child’s advocate, you will need to find ways to navigate these situations. It might be fine to just say “in our family we do ______”. If people push back, it may be uncomfortable and you may have to sit with that feeling of uncomfortability—that is ok too. It’s being a responsible parent.

3. Talk to other parents
You are a parent, which means you are always behind on something. When do you have time to research how to navigate your kid’s IEP meeting or the best therapy for a specific diagnosis? How do you even know if your child needs services anyways? One of the great things about being a parent is other people have been through the same thing and done the research already—and they are often willing to pay it forward. You don’t have to be a big social media person to find a special interest parent group on Facebook. These groups are wonderful platforms for parents dealing with similar challenges to inform and empower each other. In addition to parent support groups available, there are other parent’s in your pediatrician’s office, the park or the PTA who may have navigated your situation last year. They say it takes a village to raise a child—it’s ok to ask the village for some guidance!

4. What if I disagree with my child’s provider?
There may come a time when your child’s teacher, pediatrician or therapist says something that just doesn’t feel right. It may be awkward to disagree, even though you don’t feel comfortable. After all—they are the professionals…right? In order for a provider to care effectively for a child, parents need to be on board. Good providers understand this. For example, in ABA, if parents are uncomfortable with a recommended research-based intervention, the therapist will do their best to adjust and tailor their approach to fit the family they are working with. If a family is working on sleep training and they know they cannot let their child “cry it out” for hours, the ABA provider will not ask them too. Telling parents to do something they know they can’t do is setting the child and parents up for failure. Instead the therapist will do their best to create an individualized research-based approach that feels comfortable to those implementing it. If they cannot, the provider will talk to the family about future steps. Respectfully sharing your concerns with the approach your child’s provider wants to take is an important part of your child’s success.

5. When to advocate
There will be many situations your child experiences that could be improved in some way. Maybe they aren’t crazy about the school lunch options. It’s not the best day of the week for their favorite after school activity. They really prefer to always write in blue pen instead of pencil. Sometimes our children have to learn to sit with being uncomfortable or not having their way. Other times they need their Caregivers to advocate to get them what they need. They don’t like starting the day with their least favorite subject? That’s a bummer. They will fall asleep if they can’t get physical activity after lunch? That’s something that needs to be addressed. If your child’s health or safety is in question, it’s time to intervene. If your child cannot get through their school day or function as they need to, it’s time to speak up. If your child isn’t getting things exactly their way—it’s good to let them sit with that and learn about how to cope with frustrations and disappointments. If you’re not sure if it’s time to advocate, you can always ask other parents, teachers, therapists or your pediatrician.

6. Remember, the people you are addressing are people too
It’s very easy to become an outraged parent. A parent’s job is hard, high stakes, and emotional. It does not take much to make a parent feel angry on behalf of their child, and there is nothing wrong with that. Unless it inhibits a parent’s ability to get their child what they need. As hard as it is, most parents will get results by being respectful, honest and authentic–not getting angry. The majority of providers are doing their best to help you and your child, so speaking to them as a concerned parent—not an outraged parent, is likely a more effective way to get the response you are looking for. The same is true when dealing with any type of service provider.

What is an FBA?

The acronym FBA stands for Functional Behavior Assessment.  This refers to a process a behavior analyst completes to understand the function of your child’s behavior. FBAs are a necessary first step to change behaviors that interfere with your child’s ability to learn or function successfully. FBAs are conducted when children are persistently engaging in interfering behaviors that are negatively impacting their functioning and/or educational development. These behaviors can be anything.  They do not need to be violent, but they do need to interfere with a child’s success. For example, a child may be so busy picking at their skin that they cannot take notes in class or look where they are going.  An FBA can be ordered to better understand this behavior. An FBA would also be appropriate for a child who leaves the classroom, demonstrates physical aggression or throws toys. If a behavior is interfering with a child’s functioning, an FBA can help parents to understand why it’s happening and intervene effectively.

Who should perform an FBA for my child?

An FBA requires extensive training and experience from an expert in behavior.  There are a swath of professionals who perform FBAs, but if they have not been trained by a BCBA, this is not appropriate and often leads to a misunderstanding of the true function(s) of a child’s behavior. This is a serious problem because any interventions based on a faulty FBA are likely to exacerbate a child’s problem behavior(s).  Ideally, a Board Certified Behavior Analyst would perform an FBA for your child. Someone studying to become board certified who is directly supervised by a BCBA could also perform an FBA.

How does it work?

A host of direct and indirect measures are used to complete an FBA. The person conducting the FBA will need to observe your child in the setting where the disruptive behaviors are occurring. They also may need to observe your child in environments where the behaviors do not occur. There will be interviews with you, other adults your child interacts with (like their teachers, therapists, etc.) and your child may be interviewed as well depending on their level of functioning. An assessment of your child’s skills may be necessary. ABC Data will be taken, and other assessments may be completed as well. The “ABC” in “ABC Data” refers to “Antecedent, Behavior and Consequence”. A seasoned BCBA will take ABC data to get a clearer picture of what may be triggering or maintaining your child’s behavior. Understanding what happened immediately before a behavior and immediately after a behavior can help us to understand what triggers or maintains a behavior and then we can accurately diagnose how to implement meaningful change. For example:

Antecedent: Billy is sitting alone with his lunch. Billy’s mother is on the phone talking to a friend.

Behavior: Billy looks at his mother and begins to pour his juice on the rug.

Consequence: Billy’s mother hangs up the phone to scold Billy and clean up the mess.

In the scenario above, it appears that the behavior was triggered by Billy’s boredom/his mother attending to something else. The consequence of the behavior was his mother giving him lots of attention in the form of scolding. Therefore, from this observation we might deduce that Billy is engaging in this behavior to gain attention from his mother.

If only it were that easy! Behaviors are usually more complicated than this. In order to get a really accurate picture, a BCBA would need to do multiple observations across settings and scenarios. For example:

Antecedent: Billy is eating breakfast at Grandma’s house. Grandma is sitting next to him.

Behavior: Billy looks at his Grandma and begins to pour his water on the floor

Consequence: Grandma says “Oh! Looks like you wanted chocolate milk! Here you go!”

This was the same behavior in a different place, with a different beverage, and a different adult at a different time of day. In this case, the function of the behavior could have been attention in the form of a reaction from Grandma, but it could also have been access to chocolate milk. If every time Billy pours out juice with Grandma he gets chocolate milk, he might be trying to generalize this to Mom. So now, from these two observations, we see the behavior may be triggered a desire for attention, but could also be maintained by access to chocolate milk. It could be happening for both reasons, or just one. More observations are necessary to come to conclusion that is likely to be accurate.

What is a BIP?

So once we know the function—what do we do? This is where the BIP comes in. BIP stands for Behavior Intervention Plan. A BIP cannot be designed for your child until an FBA has been completed. The reason for this is clear—if we do not know why a behavior is happening, we can’t accurately address it. Your child likely needs a BIP if they have a behavior that warrants an FBA.

Here is an example of a BIP for Billy without an FBA:

Billy has been throwing his drink on the floor. This must be because he likes the sound it makes when it splashes. We should let Billy splash in the sink before lunch, so he won’t need to throw juice on the floor.

We know from the data we’ve collected during our FBA that the possible functions of the drink-throwing behavior are attention and access—so designing a BIP based on an alternate sensory function will not likely be effective in reducing this behavior.  Using the results of our FBA, we can design effective proactive and reactive strategies to reduce this behavior.

Now we can create a BIP from our FBA data with Proactive and Reactive strategies.

Proactively, we can teach Billy to request for chocolate milk, and provide him with attention during meals so he does not feel the need to throw juice. If Billy still throws his juice, our reactive strategies will be to have him clean it up while providing him with as little attention as possible. An alternate beverage will not be offered.

This plan proactively addresses what we suspect are the function(s) for Billy’s behavior without reinforcing the behaviors which would make them more likely to reoccur. Since we are addressing the actual functions of this behavior, it is much more likely to extinguish the drink throwing behavior than having him splash in the sink before lunch.

A real BIP would be much more complicated than this. BIPs should be designed to fade until they are no longer necessary for a child to successfully cease engaging in the interfering behaviors. BIPs often need to be amended after being implemented. Even when a BCBA has done a thorough FBA, until a BIP has been implemented they cannot see how effective it will be. Data should be taken to ensure that a BIP is effective, and if it isn’t, it can be modified accordingly. This data should be taken every time the behavior(s) occur. If a change isn’t seen in a timely manner, the BIP should be amended. It is important that BIPs be closely monitored because if they aren’t working, the risk exacerbating the target behaviors.

If you think your child may need an FBA, a BIP or both, we are here to help you!

What is Infant Mental Health?

According to ZERO TO THREE Infant Mental Task Force , “Infant Mental Health (IMH) is the developing capacity of the child from birth to 3 to experience, regulate (manage), and express emotions; form close and secure interpersonal relationships; and explore and master the environment and learn -all in the context of family, community, and cultural expectations for young children.

• Developing capacity is a reminder of the extraordinarily rapid pace of growth and change in the first 3 years of life
• Infants and toddlers depend heavily on adults to help them experience, regulate, and express emotions.
• Through close, secure interpersonal relationships with parents and other caregivers, infants and toddlers learn what people expect of them and what they can expect of other people.
• The drive to explore and master one’s environment is inborn in humans. Infants’ and toddlers’ active participation in their own learning and development is an important aspect of their mental health.
• The contexts of family and community are where infants and toddlers learn to share and communicate their feelings and experiences with significant caregivers and other children. A developing sense of themselves as competent, effective, and valued individuals is an important aspect of IMH.
• Culture influences every aspect of human development, including how IMH is understood, adults’ goals and expectations for young children’s development, and the child rearing practices used by parents and caregivers.”

Why is IMH important?

During infancy, a child’s brain is rapidly developing and the foundation for how the child will relate to others, manage and express emotions, and learn is being laid.  Because of this, if warning signs of poor infant mental health arise, interventions during this stage can have a more powerful and lasting effect than interventions during a later stage of development.  Therefore, it is important that we monitor an infant’s mental health status, know what influences it, and understand the warning signs that the child might be struggling in some way.

What factors affect IMH?

Attachment

An infant’s relationship with their caregiver has the biggest impact on their mental health.  These caregivers include the child’s birth parents, adoptive parents, foster parents, grandparents, and childcare and education providers as well as other significant adults who share the primary care and nurturance of infants and toddlers. Infants are born with a predisposition to seek out others and look to their caregivers to be emotionally responsive to them.  When this is not present (due to a variety of factors such as parental stress, depression, lack of knowledge of how to respond, illness, homelessness, hospitalization, a history of abuse, attachment challenges, and psychological vulnerability), the child becomes disturbed.

Because of this, a secure, responsive, predictable and stable relationship with a caregiver can lead to overall infant well-being and the ability to effectively manage stress; and it also lays the groundwork for all other development – physical, motor, language and cognition.  This is in stark contrast to an unhealthy relationship (due lack of caregiver responsiveness, harsh responses or an inconsistent approach), which can lead to putting the child at higher risk of later school failure, social difficulties, medical issues, substance use, and mental health issues (e.g., depression).

Infant Characteristics

Infants are born with their own personalities and temperaments (i.e., individual differences in physiological responsiveness including how an infant responds emotionally to people and objects).  According to two theorists, Thomas and Chess, who extensively studied child temperament in the late 1970s, the 3 main temperaments are as follows:

• Easy children usually have positive moods and approaches to new situations. They adapt quite well to change. Easy children are somewhat predictable in their sleeping, eating, and elimination patterns.
• Difficult children tend to have irregular sleeping, eating, and elimination patterns. They often experience negative moods and withdraw from things which are new. Difficult children are slow or non-adaptive to change.
• Slow-to-warm-up children may react to new situations in a negative but mild manner. They are low in activity levels and tend to withdraw in new situations. These children are more likely to warm up when approached in a way which respects their temperament traits.

When it comes to temperament, the factor that plays the biggest role in IMH is how well the child’s temperament matches their environment – otherwise known as their “goodness of fit.”  Poorness of fit occurs when an infant’s temperament is not respected and accommodated.  Therefore, a caregiver’s natural temperament and way of parenting may fit quite well for one child while it may not fit for another.  When this occurs, it is important to change the caregiver’s response so that “goodness of fit” results and the child can reach their full potential.

What are the signs that my infant might be experiencing mental health difficulties?

Since an infant or very young child cannot tell us when they are having a problem, it is important that we keep an eye out for warning signs such as:

• Not wanting to be held
• Not being able to be comforted when upset, or being upset for longer than seems right
• Fussiness (e.g., screaming, whining, crying)
• Eating and sleeping difficulties
• Not making eye contact with the parent or caregiver, or avoiding eye contact with others
• Not seeming to interact with others
• Not making noises very often, like cooing or babbling sounds
• Not using language as expected for their age
• Losing skills they could once do
• Tantrums
• Aggression (e.g., hitting, biting, pinching)
• Anger, frustration, head-banging
• Separation anxiety or withdrawal from parent
• Developmental concerns (e.g., autistic behaviors, language problems)

Who should I seek help from if my infant is showing any of these warning signs?

If any of these warning signs are present, consultation from a medical or mental health provider who specializes in infant mental health should be sought out. Some specific programs are as follows:

Parent-Child Interaction Therapy with Toddlers – An evidence-based early intervention program for 12-24 month old children and their caregivers. It focuses on increasing emotional regulation and building self-esteem in toddlers through teaching parents supportive and nurturing parenting practices.

Healthy Families New York – A home visiting program that matches parents with knowledgeable and caring workers who provide information and support during pregnancy and early childhood. Services include helping families access community resources and services, educating families on parenting and child development, connecting families with medical providers, and assessing children for developmental delays.

Nurse-Family Partnership – Home visitors work with low-income young women who are pregnant with their first child, helping these vulnerable young clients achieve healthier pregnancies and births, stronger child development, and a path toward economic self-sufficiency.

The Incredible Years – A series of interlocking, evidence-based programs for parents, children, and teachers, supported by over 30 years of research. The goal is to prevent and treat young children’s behavior problems and promote their social, emotional, and academic competence. The programs are used worldwide in schools and mental health centers, and have been shown to work across cultures and socioeconomic groups.

In addition, the below resources may provide further information and guidance:

https://www.zerotothree.org/espanol/infant-and-early-childhood-mental-health

http://www.nysaimh.org/about-babies/

Resources used for this blog include the following:

https://www.healthyfamiliesnewyork.org/

https://www.nursefamilypartnership.org/locations/new-york/

https://keltymentalhealth.ca/infant-mental-health

http://www.incredibleyears.com/

https://www.zerotothree.org/espanol/infant-and-early-childhood-mental-health

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933050/#b11-pch-21-5-239

http://www.nysaimh.org/about-babies/

http://csefel.vanderbilt.edu/documents/rs_infant_mental_health.pdf

https://www.mentalhelp.net/infancy/emotional-social-development-temperament/

https://www.mentalhealthamerica.net/issues/prevention-and-early-intervention-mental-health-prenatal-period-early-childhood

 

According to American Adoption News, “A recent study from the Institute of Family Studies reveals that transracial adoptions have increased by 50 percent over the last decade.”  This rise in transracial adoptions appears to be due to a change in perspective from one of which “race-matching” with adoptive parents was recommended by adoption agencies to a more current popular opinion that transracial adoption can be a great way to build a family…and it definitely is.

It is clear that transracial adoption can be a beautiful, meaningful and enriching experience for both the adoptive family and adopted child, but it is also important to keep in mind that specific issues related to differences in race may arise throughout the child’s lifespan, which will need to be addressed in a sensitive and caring way.  More specifically, the Evan B. Donaldson Institute found that transracially adopted children face challenges in coping with being “different;” they may struggle to develop a positive racial/ethnic identity; and a key life skill for transracially adopted children is the ability to cope with discrimination.

Despite these challenges though, there are ways that adoptive parents can help their adopted child cope with these challenges and develop a positive racial/ethnic identity.  More specifically, The Iowa Foster & Adoptive Parents Association recommends that children living in transracial homes have parents who recognize their need to know their cultural roots, which can be achieved by providing the following:

• Interacting with people of your child’s race – forming friendships with people of all cultures.
• Living in a diverse, integrated neighborhood.
• Recognizing multiculturalism as an asset and something to be valued.
• Seeking out mentors within your child’s culture – for yourself and for your child.
• Choosing integrated schools that offer unbiased educational materials.
• Standing up to racism and discrimination – If discrimination happens, talk to your child and validate that bad things like this do happen and they do hurt; tell your child he or she does not deserve to be treated that way, noting how good of a person he or she is; tell your child that nobody has the right to say these things, and that the person being hurtful does not really know the child; if it is an adult discriminating against your child, you will need to step in and address this for the child; and if it is another child discriminating against your child, give your child phrases to say in these circumstances.
• Providing the appropriate hair and skin care for your child.
• Making your home a bicultural home – this can be done by in a variety ways such as displaying art from various cultures; creating crafts/art from various cultures; creating a book about your child’s country and culture; displaying maps or flags of your child’s country; planning a vacation to your child’s country; playing games and listening to music from various cultures; visiting libraries to learn more about your child’s culture and other cultures; visiting cultural museums; learning a new language as a family; purchasing clothing of your child’s culture; making food that reflects your child’s culture and various cultures as the norm in your home; and celebrating holidays that are significant to his/her culture.
• Talking about race and culture often.
• Going to places where your child is surrounded by people of his/her same race and culture.

According to The Iowa Foster & Adoptive Parents Association, white parents who become transracial parents also often experience racial bias and discrimination as a family.  Due to their child’s race, they may be treated differently than they are used to, which may feel unexpected.  Because of this, it is important to educate yourself on the history of racism as well as the meaning and effect of white privilege.  One great resource for understanding white privilege is Peggy McIntosh’s book entitled, “White Privilege: Unpacking the Invisible Knapsack.”. According to McIntosh, those who benefit from white privilege do not think about it because they are in the majority and can easily take it for granted.  For this reason, it is important to understand the impact of white privilege and how this might make you experience things differently than your transracially adopted child does.

Despite a transracial parents’ best intentions, there are also some pitfalls that they may encounter such as:

• Swinging too much towards only talking about differences
• Accepting racial discrimination as a reason for underachievement or bad behavior
• Overindulging the child out of fear of being seen as inadequate

In order to avoid these pitfalls, it is important to create a balance between discussing differences and similarities, which may include talking about shared likes and dislikes, common interests, personality traits, temperament, gender, spirituality, and elements of family culture, including shared beliefs, traditions, rituals, and celebrations. Identifying and talking about these commonalities is what will help you bond with your adopted child, which will be essential for their developing a secure attachment to you. It is also important to hold your child accountable for their actions when it is clear that racial discrimination or cultural expectations do not explain their choices, and to refrain from overreacting to your child’s needs by providing them with everything that they request.

Lastly, although these tips exist to improve your development as a transracial family, as stated by transracial mother, Jana Wolff, “No blueprint or formula, however, can assure that a child will grow up feeling proud of his or her ethnic heritage.”  She went on to state, “Ultimately, we have had to come to terms with an inescapable reality: we cannot master transracial parenting. No matter how many things on the list we do, no matter how exemplary we ourselves might be as role models, no matter how much we love our sons and daughters, we cannot be our child’s color and part of his or her cultural heritage. Once we accepted that we could never parent our child perfectly, this apparently discouraging news actually liberated us. Once we acknowledged the challenges facing us, we could reduce the tasks into manageable pieces. Then we did what all parents do: try hard, stay in the game, and hope for the best.”

Resources used for this blog:

http://www.ifapa.org/pdf_docs/TransracialParenting.pdf

https://www.adoptivefamilies.com/transracial-adoption/transracial-parenting-racial-pride/

https://www.americanadoptions.com/blog/study-reveals-transracial-adoption-is-more-popular-than-ever/

There is a growing trend in kids enticing other kids to kill themselves. In previous generations, we only had to worry about who our kids were hanging out with in person, now we also have to worry about who our kids are hanging out with via the internet.  While the internet can be a great support system for children and adults alike, it can also be dangerous.

How can we prevent our kids from falling victim?
Transparency is key! Often times parents are afraid of talking about something for fear that it will happen. However, the opposite holds true. The more we talk about suicide as something that is happening to kids/teens the less likely it is to happen. The same thing is true for social media. The more we talk about the dangers of social media to our children, the more they are aware of what can happen.

Have a dialogue and be accessible for your kids.
Let them know that if they see something scary on social media to let you know and that they won’t get in trouble. At an early age, praise your kids for labeling their emotions and for sharing with you. The goal is that if someone is pressuring your child to do something, you want to know about it. If your child is saying things like “I want to die” or “I can’t do this anymore” don’t be afraid to ask for clarification. 99.9% of the time, they really don’t have an intent to kill themselves, but it can’t hurt to ask. If you do know someone that committed suicide, whether personally or through the internet, talk about it with your child. Let them know that suicide is final and that there is no coming back from that. Talk about ways the child could have sought help and could have found alternative strategies to cope.

Know the risk factors: These risk factors can’t cause or predict a suicide attempt, but they are important to be aware of.  Some of the risk factors include, but are not limited to; children who lack social support, change in mood, loss of pleasure from activities that they used to find pleasure in, have impulsive and/or aggressive tendencies or go through a hard life event. It is important to remember, that kids don’t have the coping skills that many adults have. We expect our kids to be able to problem-solve the same way we do, but their brains are not fully developed yet. As I mentioned before, if your child mentions ending their life, don’t be afraid to ask about it. Often times kids may be trying to get your attention, but sometimes it may be a real thought. 

Why are kids killing themselves at the urging of others?
Peer pressure has always been a thing, now there are just more ways to access it. The use of online chat rooms or virtual bulletin boards and forums can provide a platform for children to share their feelings with other children feeling the same way. This is often easier than talking about it in person and may present the risk of encouraging each other to commit suicide. The internet and social media can normalize and reinforce suicide. Many children write suicide notes or take videos that become viral online. These videos, notes and various other platforms glorify those who committed suicide and turn them into individuals who are now idolized by others. Sometimes kids don’t actually realize that suicide IS final. BE IN THE KNOW. It is important to keep up with the current “internet’ trends. 

How is social media a culprit?
Besides giving children a platform to discuss their suicidal ideations, social media can reinforce depression and anxiety. As we all know, people only post their happy pictures and pictures of their best selves. Social media leaves children (and us) comparing ourselves to others. Limit your child’s time on social media, monitor what they are posting, and let them know that social media is only showing a snapshot of people’s lives. Everyone has bad days, they are just not on display for others to see. Monitor who your child is following on social media. Make sure to occasionally glance at your child’s phone and see what they are looking at.  

What tools can we use to help? The more we learn about the potential dangers of social media, the more tools we have to help. USE THEM!  You will be able to see what sites they are using, who they are talking to and some even allow you to read their messages. Again, transparency is key! Let your child know that you have access to it and explain the reasons why.

Be there for your kids. Whenever your child comes to you with a problem, take the time to listen. Praise them for coming to you and help them problem solve. Kids want attention from their parents. Spend 10 minutes a day with your child doing what they want to do. Avoid asking questions about school and just comment on the activity they love. Kids are being told what to do all day every day, it feels great for kids (even teenagers!) to have their parent do what they want to do and be totally present. Whether it is watching the Kardashians or sitting with them while they play Roblox. The more approachable you are to your child, the more likely they will confide in you. If you think your child is suffering, look for help and advice. While the internet has many disadvantages, it also has many advantages. There are countless support groups and hotlines that are there to help you. Don’t be afraid to ask for help! More likely than not, other people are going through the same thing and can be your support system. 

Resources used for this blog:

https://suicidepreventionlifeline.org/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477910/

Suicide is a growing concern among adolescents and young adults. It is currently the second leading cause of death of individuals between the ages of 15-24 years-old in the United States. Additionally, the rate of hospitalizations for suicidal ideation or attempts has nearly doubled between the years of 2008-2015, and this increase has been highest for individuals who are between the ages of 12-17 years-old.

Why do some individuals think about suicide?

According to the interpersonal theory of suicide described by Dr. Thomas Joiner (2005) thoughts about suicide, or suicidal ideation, are related to two areas of social functioning.

• The first area includes the feeling of not belonging or being accepted by others. This perception may be related to a real sense of exclusion by others or through a perceived sense of not belonging. This can be seen through higher rates of suicidal ideation and behaviors among those who have a history of peer victimization, or bullying. Higher rates of suicidal ideation are also found for individuals from historically marginalized groups, such as those in the LGBT community, and this has been related to challenges with feeling accepted by those around them. As noted above, this perception may also be present without any clear indicators of exclusion or lack of acceptance from others. This sense of exclusion may therefore be related to the negative cognitions that accompany depression and other psychological concerns.
• The second area of interpersonal functioning includes the feeling as though one’s life is a burden to others. This perception is defined by the belief by the individual that his or her death is of more worth more than his or her life. Again, this perception may be associated with depressive cognitions and interpretations of situations in one’s environment and may or may not be an actual message that is being sent to the individual by others.

What are risk factors for suicide?

Suicidal ideation is most commonly associated with a diagnosis of a psychiatric disorder, especially depression. However, thoughts about death and suicide are also seen in individuals who are not depressed. Additional risk factors for suicidal ideation and suicide attempts in teenagers include:

• A family history of suicide attempts
• A recent interpersonal loss, either through death or separation of a loved one
• Impulsivity
• Social exclusion or bullying
• A history of non-suicidal self-injury or self-harming behaviors
• A prior history of suicide attempts
• Access to weapons or other lethal means (e.g. pills or knives)

What are protective factors?

As described above, individuals who experience thoughts about suicide often feel disconnected and not accepted by others. Protective factors therefore include strong social and support networks. This includes feeling accepted by parents, teachers, peers and individuals in one’s environment. Protective factors also include strong communication and interpersonal problem-solving skills and an ability to seek help. The ability to identify reasons to live is also seen as a protective factor.

What are some warning signs that my child may be having thoughts about suicide?

• Emotional changes. Parents should look for changes in mood, which could manifest through a decreased interest in usual activities, increased agitation, and increased social withdrawal.
• Behavioral changes. In addition to increased isolation from others, parents should also be attentive to changes in sleep patterns, increased patterns of missing school or other related activities, increased physical complaints, or increased reckless behavior. Parents should also look out for statements related to suicidal ideation, notes about these thoughts, and patterns of giving his or her belongings away.

What can I do if I have concerns that my child may be having thoughts about suicide?

Many parents of adolescents who are experiencing thoughts about death or suicide are not aware that their child is experiencing these thoughts. People often feel uncomfortable talking about suicidal thoughts and behaviors due to concerns that these conversations will put ideas into their child’s mind. In contrast, you should feel comfortable addressing this topic directly with your child if you do have concerns, as you can then provide a source of support around these issues. Additionally, some statements made by youth surrounding death and suicide are not taken seriously by parents and other adults, due to the perceived function of these statements. Even if these statements are made in a moment of frustration from a teen, you should always follow up on these statements. Some questions that you can ask your children include:

• Have you been feeling sad or depressed?
• Have you been having any thoughts about hurting yourself, about death, or about killing yourself?
• Have you ever thought about killing yourself?
• Have you ever done anything to hurt yourself on purpose?

What should I do if my child is having suicidal thoughts or if I’m worried that he or she is not disclosing these thoughts?

You should always err on the side of caution and bring your child in for a psychological evaluation by a trained professional if you have any concerns.

• If you have immediate concerns about your child’s safety:
  1. You should bring your child to the emergency room or call 911 if you are worried that your child is at risk of hurting himself or herself.
  2. You should remove all dangerous objects from the immediate environment. These include medications, razors, knives, and weapons. This will prevent your child from hurting himself or herself in a moment of distress or impulsivity.
  3. You should closely monitor your child until he or she can be evaluated by a professional.
• If you are worried about your child’s emotional health but are not concerned about your child hurting themselves in the immediate sense:
  1. You should schedule an appointment with a trained professional, such as a psychologist or psychiatrist, to have him or her evaluated as soon as possible.
  2. You should continue to have open conversations with your child about his or her social and emotional functioning, including thoughts about suicide, and continue to take any statements made by your child seriously.

Numerous resources exist for individuals who may be having thoughts about suicide. Some places where you can find more support include the following websites and hotlines:

• American Academy of Child & Adolescent Psychiatry Suicide Resource Center: https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Suicide_Resource_Center/Home.aspx
• American Psychiatric Association (APA): https://www.apa.org/topics/suicide/signs
• Teen Lifeline, 602-248-8336 (TEEN) or 1-800-248-8336 (TEEN)
• National Suicide Prevention Lifeline, 1-800-273-8255

Additional References:

Plemmons, Gregory, Hall, Matthew, Doupnik, Stephanie, Gay, James, Brown, Charlotte, Browning, Whitney, . . . Williams, Derek. (2018). Hospitalization for Suicide Ideation or Attempt: 2008-2015. Pediatrics, 141(6).

Joiner T. Why people die by suicide. Cambridge, MA, US: Harvard University Press; 2005.