We had the pleasure of having an informative breakfast with the expert clinicians here in New York at the non-profit Child Mind Institute on Friday held especially for bloggers, and we wanted to share our takeaways with everyone. Through research and evidence-based clinical care into the developing brain, the CMI is dedicating to helping children and their families coping with learning and mental health disorders. They give families accurate information that empowers the people around these children to get excellent help. Our informal breakfast discussion was led by Doctors Kristin Carothers and Jamie Howard (both clinical psychologists), and we touched upon a broad net of topics including tantrums, ADHD, and behavioral anxiety. Here is our takeaway, enjoy:
“At what age should I start disciplining my kids?” one blogger asked. The experts emphasized starting to set limits, boundaries and routines early on. Routines lead to taking and following directions and a sense of safety and security. Discipline should be developmentally appropriate and a direction must be given in the positive form of what you want them to do, not what you want them to stop doing.
Structures, limits, and the consequence of a time out from attention are the best posts to implement. There should be a time limit on this consequence, such as sitting in a time out chair for three minutes as the removal from positive attention. This teaches the child that they will get your positive attention when they are following the rules. The message is, “if you’re aggressive or destructive, you go to the chair.” You can do these time outs until about the age of seven. After age seven, you lose a privilege. It’s important to note that very young children are not intentionally being one way or the other. As far as questions about spanking, it was advised to not spank at all. You cannot usually modulate the force of your spanks when you are upset too, and oftentimes you are spanking when you are angry and it’s not most effective to discipline when you are in an angry space. There needs to be a safe space for them to have a quiet time out with nothing fun in it. Perhaps the bathroom.
Another blogger asked, “Is there such a thing as spoiling a child too much?” Apparently, yes, there is, but it depends on the child’s age. For instance, you can’t spoil a baby. As children get older you want to balance love, attention and prizes with setting limits. You really should pay attention to balance and limits and upholding your family’s values with setting limits.
“What should I do when my six year old is throwing tantrums about going to school every morning?” Well, apparently, when the child is not disregulated, have a conversation with him about what is upsetting him the most. Is it a question of, ‘when will mom come back?’ Normalize the fears for the child. Implement a behavioral system that helps them to go to school. For instance, let them know during a safe time that they can earn a sticker if they stay calm the next time a tantrum could surface. Or, let them know that upon leaving school they could get a sticker. Communicate with the teacher so that she can facilitate this reward system, a mom to teacher/teacher to mom transition. Note: something like this will not happen overnight, and it will take practice. Be mindful as a parent about how you are communicating to your child.
A substantial question that many parents have is, “How can I tell the difference between an ADHD and a high-energy child?” Doctors Carothers and Howard were very helpful in answering this. For high energy kids, they may seem very actively on the go, and require less sleep than others. In order to identify an ADHD situation, there must be the presence of symptoms in multiple settings. At school, at home, and in a therapist’s office. There are three presentations of ADHD: the hyperactive presentation (an energizer bunny type of kid), the inattentive presentation (a space cadet type of kid), and then a combination of the two. The behavior will be clinically significant if presenting itself in multiple settings and if it is difficult for the child to make friends.
“What about screen time? How do parents manage it?” The doctors advice: avoid screens for as long as you can. They’re not evil in themselves, but if seen by the children unmonitored, or if you are using them like a babysitter or a distraction so that you can have time off from parenting, it is not alright. You must be there with them to supervise, not using the device as a nanny.
“I have a 5 year old daughter. How can I tell the difference between a legitimate meltdown that requires TLC and tons of attention vs. a tantrum that requires tough love? She sometimes plays the line very closely.”
Usually a tantrum does not require TLC. If they are legitimately injured, or hurt by a friend, then TLC can be used. If they’re not getting something they want or are having a random meltdown- it’s not the time to give lots of attention. Understand the antecedent (again, provide comfort if they are hurt or injured) then remove attention until they’ve calmed down. You have to starve the tantrum out. Call it, “active ignoring” -stay in the room until they get calm, then thank them once they are. These tantrums get worse before they get better so expect a spike, then a plateau. Reinforce the calmness. Do not tell the child anything during the tantrum. Rather, in a calm moment you can talk about what you will do when they become disregulated. In the moment you don’t talk, you turn off. As we can all probably attest to, you will fuel the fire if you talk during the tantrum. Try to also implement an intervention on the front end. For instance, the kid can earn X points, or can get a reward if…. Something that they can look forward to.
Dr. Carothers is a clinical psychologist in the ADHD and Behavior Disorders Center at CMI. She specializes in the diagnosis and treatment of ADHD and behavior disorders in children and adolescents, and utilizes her background in the treatment of trauma to inform her practice and frequent workshops in schools and community settings.
Dr. Howard is a clinical psychologist in the Anxiety and Mood Disorders Center at CMI and the director of the Center’s Trauma and Resilience Service. She specializes in the evaluation and treatment of anxiety and mood disorders in children and adolescents, and has expertise in treating post-traumatic stress and adjustment disorders across the lifespan.