Written by Charles Galyon, Ph.D. & Carolyn Blondin, Ph.D.
Following a psychoeducational evaluation, you should have a results session with your examiner to discuss the results and the meaning of the results. However, even an extended results session may leave you with unanswered questions. The time to discuss results is limited, your examiner will not be able to anticipate all of your questions, the amount of information you receive may feel overwhelming, and you likely will have many other questions come up after the results session. The information provided below is here to help you figure out what to do next after your results session and how you can get additional help and information when you need it.
What does a diagnosis mean?
First, remember that a diagnosis is only a “functional label.” By itself, a diagnosis is not helpful. The reason you might seek out a diagnosis is to get better ideas about what you can do to improve the problem. With a diagnosis, then you can get an idea of what may happen in the future, and what kinds of accommodations or treatments may be helpful. For example, when you know your child has a cold, then you can expect it will be unpleasant for a period of time, but that your child will get better without need for medical intervention. On the other hand, if your child has a severe case of the flu, then you can expect the child may need medical assistance, and that a pediatrician will have an idea of what treatment will prove most helpful.
How reliable and permanent is a diagnosis?
When making a diagnosis, the examiner is looking for a combination of symptoms and characteristics that tend to occur together, which may indicate some underlying condition (for example, a learning disability, an Autism Spectrum Disorder, or a developmental delay). The examiner is well-trained in a variety of disorders, their symptoms, and how to test for other characteristics that would be consistent with a disorder. However, it is ultimately “clinical judgment,” and some individuals simply do not show symptoms in the same way. Also, the examiner only sees you or your child for a limited period of time and typically only in one setting (such as a clinic). While the examiner is aware of these limitations and tries to take them into account, you may have important information that would affect the diagnosis. For that reason, be sure to share all information you believe may be important with your examiner.
Keep in mind that as you or your child grows, learns, and develops new skills, things may change with respect to the diagnosis. Many diagnoses are considered “permanent” (such as Autism Spectrum Disorder), meaning that if the diagnosis is received earlier in one's life, then it stays the same regardless of changes in the symptoms. However, the degree of impairment can change considerably, which is ultimately the goal of receiving a diagnosis and treatment.
Is there a cure?
Generally speaking, there are no “cures” for disorders; however, many disorders are better understood now and can be greatly helped with different treatments. For psychoeducational disorders, many of the treatments are called, “interventions.” Interventions may include skill training, behavior modification, or therapy. Medical treatment is also often used in conjunction with interventions to improve the effectiveness of interventions and reduce potentially more severe symptoms (which may interfere with the ability to benefit from interventions). Though your examiner may be able to discuss medical treatment to a limited degree, remember that they are not trained in medical practice. To gain more information regarding options for medical treatments, you should speak with your family physician.
What is involved with “training skills, modifying behavior, or receiving therapy”?
Skill training. Training skills is used for academic difficulties (improving math, reading, or writing skills), adaptive behavior (day-to-day activities), and to teach compensatory strategies (such as for problems with organization, memory, communication, or social skills). Skill training usually occurs periodically (such as once per week), involves assessing the current skill level, using a scientifically-validated training program, and measuring improvement in the skill to make sure the training is working. Skills training can be an invaluable approach to addressing disorders and may reduce problems associated with the disorder. It generally provides significant improvement, but does not completely eliminate the problem.
Behavior modification. Behaviors may become a regular habit over time, and often occur without thinking. Most behaviors are appropriate and desirable, but sometimes behaviors are not desirable (misbehavior) and need to be changed. Many problems may be effectively addressed by modifying behavior or replacing an undesirable behavior (for example, throwing toys), with a new desirable one (such as, expressing anger verbally). Behavior modification requires several steps, including identifying the “antecedent”, “target behavior”, and “consequences”. This process is known as “Functional Behavior Analysis” and is done before behavior modification begins. The “antecedent” is what occurs before the behavior and may act as a trigger. A simple example would be: when a traffic light turns green, the driver applies his/her foot to the gas pedal of the car. The “target behavior” is the behavior to be changed. The “consequences” are what occur after the behavior that increase or maintain the behavior. This is easy to understand if you consider how you might respond if you got $50 each time you said, “Hello” to someone (you would probably say, “Hello” a lot!). A major goal of behavior modification is promoting “successful behaviors” (behaviors that we desire and that result in good things) and making them more enjoyable than the previous, undesirable behavior (typically by using rewards for the good behavior).
Therapy can take many forms, but when applied to psychoeducational disorders, it often focuses on desensitization, counter-conditioning, restructuring thoughts, and other anxiety reduction strategies. Therapy should be “solution-focused”, meaning it identifies a specific problem, creates a plan to reduce the problem, and evaluates progress throughout therapy. Therapy in this context is typically relatively short (for example, 7 to 12 sessions over a period of 2 to 3 months).
Now I've got a diagnosis, what should I do next?
There are a variety of steps that you may take next. Some disorders may benefit from medical treatment, such as Attention Deficit/Hyperactivity Disorder or severe Anxiety Disorders. In such cases you should meet with your physician to discuss your concerns and bring your evaluation report with you. You may want to request a letter for your physician from your psychoeducational examiner. The letter is a helpful way for the examiner to briefly state the evaluation procedure, results, and provide contact information for the physician.
It is also appropriate to begin treatment planning following the diagnosis. Treatment planning can include a variety of steps, such as those mentioned above, as well as identifying additional resources that may be helpful (such as local support groups, clinics, or material resources). If the disorder has an educational impact, then it is appropriate to begin the process of requesting accommodations from the school. An educational impact generally means the disorder interferes with the ability to succeed in academic work, or that the disorder produces behaviors or stressors that interfere with the ability to function in an academic setting (which may include social difficulties).
Though your examiner has provided a brief description of the diagnosed disorder in the evaluation report, it is usually helpful spend some time learning more about the disorder yourself. Your examiner is one useful source of information and should be consulted if you have additional questions, but there are also a variety of helpful resources that can be located elsewhere, including books, support groups, and internet resources. You should be careful to evaluate the credibility of these sources, though, because not all sources are factually accurate or well-researched. Your examiner may also be able to provide some suggestions for resources that are reader-friendly and scientifically valid related to the diagnosis.
I didn't get the diagnosis I came in for, now what?
Possibly one of the most frustrating experiences is to come in for evaluation due to problems, but not get a diagnosis to confirm or explain the problems. Just like getting a diagnosis does not solve the problem, problems can exist even if a clinical diagnosis is not made. Sometimes problems are “sub-clinical”, meaning that a problem is evident, but the degree of severity of impairment is not enough to warrant a diagnosis. Your examiner may still provide recommendations related to the problems you are experiencing, and these recommended solutions can still be beneficial. It is also possible that a problem may change over time and become more or less severe, which would change the eligibility for diagnosis. If you feel a problem has persisted or becomes worse over time, then consider requesting a re-evaluation.
Why does my child struggle despite not having a diagnosis?
This is a common question and point of frustration for parents, particularly when a child is struggling in school, but there is no apparent explanation. There is not a simple answer, but there are a number of possibilities that may make it easier to understand (though not necessarily easier to deal with). When making a diagnosis, there are two primary questions that must be asked: 1) does the child exhibit the symptoms consistent with a disorder, and 2) is the impairment significant enough that it affects daily functioning? Most often, when a child does not receive a diagnosis, it is the second question that comes back with the answer, “No.”
To help improve the reliability of diagnoses (so that different examiners will reach the same conclusion), certain scores must be reached to indicate significant impairment. A child may struggle, but their scores could be right on the edge, meaning they will not get a diagnosis. However, it is possible that if the problems continue, the child will qualify in the future. Therefore, if you do not receive a diagnosis initially and the problem is still present (or worse), then it is often a good idea to ask for a re-evaluation.
Why won't the school help my child?
Rest assured, the school wants to see your child succeed and is not intending to frustrate you. Similar to the previous question, schools are required to use certain criteria in deciding if a child will receive services. Because schools have limited funds, they often must be cautious with regard to identifying children for services. As a result, there are a limited range of disabilities and disorders for which children may receive services in a school setting.
Unfortunately, if a child struggles academically because of a cognitive processing deficit (for example, poor short-term memory, low processing speed, or difficulty with recalling information), then they may not qualify for services because these are not recognized “disability categories” within education. These difficulties are still very real and can cause a great deal of frustration for the child. In such cases, it is strongly encouraged that you try to work with your child's teachers to see if some reasonable accommodations can be made (such as extra time on assignments or tests or allowing the use of scrap paper for jotting down notes during tests). Keeping communication open with teachers about behavior, progress, and/or concerns can be very helpful. Many teachers are willing to work with students and parents to help the child succeed.
Should I get a re-evaluation? When?
Re-evaluation may be recommended under a few circumstances. If the previous evaluation did not produce a diagnosis, but the problems persist or have gotten worse, then re-evaluation may be helpful after some time has passed. Usually you should allow at least a year to prevent a “practice effect” (when a test scores artificially high because it has been seen before). You should also be sure to inform the examiner of any previous evaluations that were done, when they were done, and (if known) the tests used for evaluation. This helps the examiner select an appropriate test.
Re-evaluation is also necessary periodically to check progress and to figure out if a new plan should be developed. This kind of re-evaluation is typically conducted once every three to five years. Information from these evaluations can help determine if there is improvement, if there is a new need, or if a different approach to treatment would be better.
And finally, an evaluation may be periodically required for progress monitoring. Schools often require recent evaluations when determining if accommodations and services are necessary. Many colleges and universities also require recent evaluations for services. Though “recent” may have different meanings between schools, in general, evaluations should not be older than 3 to 5 years.
Should I get more evaluations from other professionals?
The initial psychoeducational evaluation may only be a starting point in terms of identifying needed services. Psychoeducational evaluations typically assess cognitive, academic, and psychological functioning. This means that other skills, such as motor skills and language skills, are not evaluated in depth. Though the psychoeducational evaluation may provide some information about language skills, it is not intended to be a thorough evaluation of language skill, which is more thoroughly examined by a speech-language pathologist. Motor skills are also not thoroughly evaluated as part of a psychoeducational evaluation, and are usually assessed by an occupational therapist.
Depending on the diagnosis, your examiner may recommend follow-up evaluations by other health professionals, including speech-language pathologists and occupational therapists. If unsure, ask your examiner if it would be appropriate to seek further evaluations.
Should I share this report with anyone?
You may share your report with anyone you desire (it is your report); however, it is typically helpful to share your report with your family physician, any counselors or social workers with whom you visit, and schools. Your family physician may need the information to begin a collaborative treatment plan (as is often the case with Attention-Deficit/Hyperactivity Disorder). Your counselor or social worker may need the information to better understand how to best help you. And schools may need the report to set up a program of services and accommodations for your child. For example, you may require services under an Individualized Education Plan (IEP) or Section 504 Plan. Ask your examiner for a further explanation of these programs and what is involved in them. Similarly, sometimes it is appropriate to share the results of the evaluation with your employer to secure workplace accommodations (as protected by the Americans with Disabilities Act).
Written by Crystal Wilson, RBT
What is positive specific behavior praise? It is a statement that describes the observable behavior with a positive label. Examples include, “I like how you put your clothes away.” And “Thanks for using nice words when asking me if you could have a cookie.”
When using praise, we are identifying the behaviors we enjoy and want to increase.
Acknowledge what a person is doing correctly or appropriately. Can they appropriately play by themselves for 5 minutes? Can they ask you for items and activities using nice words? If so, praise them while the are being appropriate and engaged in the behaviors we want to see increase!
We enjoy making others smile. Being specific when praising your child will boost their self-esteem and allow the child to know exactly why they are being praised!
Written by Dr. Charles Galyon
Part of raising a child means teaching them almost all of the skills that they will need to get by as an adult (schools and the community pick up some of the job too). This means lots of correcting misbehavior. However, for many parents (especially those who have more “spirited” children), it may feel like this begins to dominate their interactions with their child and leads to frustration on the part of the parent and the child. It may begin to strain their relationship. Nobody wants to have a relationship with their child that is dominated by yelling, scolding, or other punishment, but this pattern often develops naturally and for good reason.
Is My Child Always Misbehaving?
In truth, the answer is definitely, “No, they are not.” Why does it feel like you always have to get on their case and correct their behavior then? Let’s use one somewhat extreme example to explain this: Are you more likely to remember all of the people that waved at you and said, “Hi” or the people that slapped you in the face whenever you walked by? One of those is common and expected, the other is unusual and extremely offensive. As an adult responsible for the child’s behavior, you will naturally notice misbehavior very quickly. Misbehavior, by its nature, tends to be offensive (meaning it aggravates us), which means it will get your attention.
Why Does It Feel Like That’s All I See?
Some children are more prone to behaviors that are considered “wrong” than others for a variety of reasons (hyperactive, anxious, easily frustrated…). Some children may specifically engage in behaviors that are antagonistic (such as aggression, defiance, or non-compliance). Almost all children engage in a variety of common appropriate behaviors. Appropriate behavior can range from common (playing quietly, eating food…) to uncommon (helping someone, doing chores voluntarily…). Uncommon appropriate behavior is likely to be noticed, but common appropriate behavior is usually overlooked. Why is this?
Common appropriate behavior is generally what is expected (for example, “well, of course they should not hit their brother”) and much of it doesn’t draw attention to itself as a result. Uncommon appropriate behavior may draw attention to itself, but it is not frequent, therefore you will still feel like your child is “always misbehaving.” So if a child could receive attention for uncommon appropriate behavior, why don’t they always do that? Well, why don’t you (as an adult) stop and help every person you see every day? It would be exhausting and the opportunity doesn’t actually present itself that often. Children do not have that many opportunities to engage in uncommon appropriate behavior, and it’s a lot of work. It’s great when it happens, and we want to pay a lot of attention to it, but it’s rare.
Though a child may often demand your attention for their inappropriate behavior, this is not the only thing they do, it just feels like it. Many children will misbehave precisely because it has gotten parental attention before. However, it would not make any sense for a child to always engage in behaviors that will receive corrections and punishment. They would undoubtedly prefer enjoyable, high quality attention from you.
What Can I Do Then?
There is no simple, fast cure for misbehavior, but there are things you can do to begin improving it and at the same time strengthening your relationship with your child. This article is about one thing: Changing the attention you give to your child’s behavior.
You need to learn how to identify and give attention for the appropriate things your child does (the common and uncommon appropriate behaviors). It is extremely difficult and you will have to train yourself to do it. Think of it as building a new habit. Learn to look for things your child does right (even “playing quietly”) and give them attention for it. Your goal is to get in there and give your child attention for appropriate behavior before they demand your attention with inappropriate behavior. It’s almost a game, and a very tricky one because we’re not really well-practiced at it. It may help to set a timer for yourself to remind you approximately every 5 to 10 minutes until it gets easier for you. In addition, you have to learn how to ignore some of the small misbehaviors that don’t really need attention or things that we specifically want to avoid giving attention (such as whining). Some of these behaviors will worsen before they get better (particularly whining), but if you give your attention to them, they’re likely to become stronger and last even longer.
Addressing misbehavior can be a complicated and challenging process. The first part of improving your child’s behavior is re-training yourself to identify and give lots of positive, high-quality attention to common appropriate behaviors. Later, you start learning more effective ways of dealing with the misbehaviors (including selectively ignoring them). Though a challenging task, keep in mind that your child would almost certainly to have praise and positive attention. We want them to learn how to get that attention appropriately instead.
by Mary Staub, M.Ed., BCBA, LBA
Independent play skills do not always develop naturally and sometimes must be taught. One way to teach independent play skills involves breaking play into a doable schedule in which the child receives reinforcement for completion of the activity. Some ways that independent play can be encouraged in the home involve using “play bins” in which a single mastered play activity is put in a bin and an activity schedule is made to signal what the child is to complete before earning reinforcement. All materials can be things that you already have at home and that the child would typically have access to so that the presence of designated bins can be faded out for more naturalistic play.
Following are steps on how to use in the home:
Teaching the use of a play schedule can be useful for increasing independent play and can also be a tool to use when your child might not have immediate access to parent/adult attention and must engage in an activity independently. An example of when this might be useful could be when you are in the kitchen cooking or need to make a phone call and cannot play with the child.
Task analysis teaching steps
Example of a play schedule
Blog entry written by Mary Staub, M.Ed., BCBA, LBA
What are visual supports?
Visual supports are any picture or object that are used to communicate information. This can be in forms of actual objects, pictures, words, or lists. We have visuals in our daily lives that communicate certain information to us such as: 1) traffic lights are visuals to help us know when to go or when to stop; 2) grocery lists remind us of things to get at the grocery; and 3) we place certain objects by the door to remind us to take it to work the following day. When it comes to children with autism spectrum disorder, visuals help communicate information in a way that is easy for the child to understand.
Two Effective and Popular Visual Supports
Blog entry written by Jenny Baggett, M.Ed., BCBA
IEP and 504?
There are many options for students to receive additional support and services in school. Parents are encouraged to discuss their child's needs with the school. Collaboration between parents and schools can help build a good relationship and tends to be far more helpful for the child. It may be possible for a child to receive unofficial accommodations (such as the child being seated closer to the teacher to improve on-task behavior) without the need of a formal plan. However, sometimes a child needs more support, which may include an Individualized Education Plan (IEP) or a Section 504 Plan. These terms and the processes involved in them can be confusing for parents. It can also be challenging for a school to explain these services to parents.
Individualized Education Plans (IEP) and a Section 504 Plans are both formal plans to help a child receive additional support and accommodation in school. They both offer protection for the child as well. Both require the child to have an identified disabling condition, and the disability must affect the child's ability to function in the school environment. This article provides a brief primer on these two options for students, but it is not exhaustive and cannot accurately capture the variations in each state's, district's, or school's implementation. It is important that parents consult with their schools to learn more about the processes involved in developing these plans.
Individualized Education Plan (IEP)
An IEP is part of the Individuals with Disabilities Education Act (IDEA), which is designed to ensure that all students receive an appropriate education regardless of a disability. I usually explain to parents that an IEP is basically a more substantial support system. It will involve more paperwork, more meetings, and can provide more protections for the child. IDEA is federally-mandated and partially federally funded. The funds supplied may not actually be sufficient to cover all of needs of students within a school (the notion that schools "profit" by identifying disabilities is not unsupported by evidence). A student may receive an IEP for any of 13 categories of disability. Some of these are fairly obvious and easy to understand (e.g., blindness, deafness, autism, learning disabilities...), while other disabilities tend to get lumped into the category of "Other Health Impairment" (or "OHI"). OHI includes medical disabilities that may have an educational impact, such as Attention-Deficit/Hyperactivity Disorder. Another category, Emotional Disturbance, can be harder to understand, but essentially includes any persistent, severe emotional disturbance that impacts the student's ability to function in the school (such as severe depression or anxiety). Students with severe behavioral problems may not be covered under an IEP.
An IEP includes identification of the primary (and secondary) disability, a set of goals for the student (e.g., significant improvement in academic skills) and a set of accommodations and services that will be put in place to help the student achieve the goals. All of this is established at a meeting with the parents and school representatives. Parents play an important role in setting and agreeing to goals and, if parents are not satisfied with the goals and accommodations, then they can refuse to sign the IEP and enter Due Process. However, whenever possible, the parents and the school should reach an agreement to help the child receive the support they need and to help maintain a collaborative relationship between school and home. It is important that parents ask questions when unsure about something, to prevent later disagreements or frustration. The meetings can be intimidating for parents, which is also why it is important that they take their time in reading through and understanding all of the materials and decisions involved. The school psychologist is an advocate for the child and an important resource for parents to make use of.
ADA - Section 504 Plan
A Section 504 Plan is part of the Americans with Disabilities Act, which is intended to ensure that all individuals with disabilities receive free and appropriate accommodations. Because of this, Section 504 Plans can serve a very broad range of situations, including temporary medical disability (for example, a broken leg). Any medical condition that may impact the child's ability to function in the school environment and school activities may receive accommodation under Section 504. As mentioned, this may include temporary medical conditions, but also long-term or persistent medical needs, such as Attention-Deficit/Hyperactivity Disorder. Section 504 Plans are typically "lighter" than an IEP in that they may not have as long of a duration, may require fewer meetings and less paperwork, and may not provide as extensive accommodations. Nevertheless, Section 504 Plans can be very valuable for students.
Section 504 is federally-mandated by law, but does not receive the financial support that may be available under an IEP. More intensive accommodations and needs are usually served under an IEP instead of a Section 504 Plan. However, it is possible to have both a Section 504 Plan and an IEP at the same time.
Parents are often concerned about their child being "labeled" by receiving services. This is a valid concern, though not always as likely as parents may fear. There are two broad types of services students may receive: pull-out and inclusion. Pull-out services involve the student being removed from the classroom or school activities for a period of time to receive services to meet their educational goals. Pull-out may range from very brief (e.g., 15 minutes) to very long (e.g., entire day in a self-contained classroom). Schools generally try to minimize the amount of pull-out time, partially because it has been found that students tend to develop better socially and are better adjusted if they are in the classroom with their peers. As a result, schools have increasingly relied on inclusion services, which keep the student in the regular classroom, but with additional supports or modifications to assignments or activities. Inclusion classrooms may feature two or more teachers to help tend to the individual needs of students receiving services. These teachers often help all of the students in the classroom, though, which helps reduce any stigma from receiving special education services.
Students and teachers are often unaware of the specific needs or category under which a student is receiving services. That information is considered "privileged", so only those who need to know about it are granted access. Nevertheless, it is likely that students will be able to identify differences between them and their peers, regardless of measures taken to prevent it. Students are very sensitive to differences, and even if a student received no accommodations for a disability, their peers will likely be aware of a difference anyway. Therefore, it is usually best to ensure that the student is receiving whatever services are most helpful, regardless of the potential for stigma. The benefits typically outweigh the costs.
Blog article written by Dr. Charles Galyon.
Have FUN! Remember the first few sessions of ABA therapy?
Remember that your child’s functional communication and language use can improve with appropriate use of pairing. Language is powerful, functional, and should be reinforcing for your child. When a child seems to be refusing, throwing, or avoiding their communication device, it is very likely that it has only been used for aversive task demands or it was only paired with a four letter word…work. Your ABA therapist most likely started with mand training (learning to request things that he/she WANTS) to teach the child that their communication system can be used to access their favorite things in the world. Once the child requests a favorite thing, model Core, Verbs, and other fringe words on the communication system. They are more likely to be engaged, attentive, and motivated when working in an enriched environment with preferred items.
Have a “spoiled rotten” play session. Place highly preferred activities/items/snacks in a clear bin and work on requesting and talking about the items with your child as you play. Example: edible sensory play! Make whip cream faces for the sweet tooth child. Language opportunities to prompt or model: I want whip cream, more whip cream, spray, push, it’s a circle (face), we need eyes, I want m&m eyes, red m&m, I want candy corn nose, this is fun/silly, table is dirty, napkin(please), model colors, shapes, numbers!
Blog article written by Elizabeth Ginder, MSSW, BCBA
Blog article written by Dr. Charles Galyon
It can be helpful to think of the brain like a muscle: exercise makes it grow and improves its capabilities. There are plenty of commercial products that claim to improve brain power (memory, processing speed, attention...), but the actual evidence for these products indicates either no real benefit or a very specific benefit (that is, improvement in that specific task, but not other tasks). There are simply no shortcuts for a "supercharged brain." That does not mean that various brain challenges are without value though. For example, crossword puzzles appear to help maintain the strength of long-term memory later in life. This article discusses a little bit about early brain development and why diverse experiences are important for children's brains, and a few specific ideas to keep in mind when trying to help your child develop their abilities.
Immature and Slow to Develop
Humans have an unusually long period of development. Our children are largely helpless for a very long time and their brains will not "fully develop" until possibly early to mid-20's. However, you can clearly see a lot of differences in the abilities of very young children and adolescents, with adolescents capable of understanding more abstract concepts and engaging in more complex discussions (Piaget and his colleagues generally explored these ideas long ago). Because the period of development is so long, that leaves a lot of time to help build a child's abilities and improve on areas that they may be struggling in. Children's brains are also very adaptable (a concept called "plasticity"). One example of that is how young children are more able than adults to recover from brain trauma. On the other hand, some neurological differences do not appear likely to ever be fully addressed. It would be difficult to discuss all of the types of abilities and differences that are "plastic" and those that are not, but we can cover some important areas that parents can work on with their children.
Critical Periods/Sensitive Periods of Development
Sometimes you may hear the term "critical periods" of brain development. This concept means that certain abilities (such as the ability of the brain to process visual information) must develop within a certain time window or else it will never develop. It may be an overstatement for us to say with certainty that some abilities will never be able to develop, but there are certainly times during which it is easiest for a child to acquire a certain skill (such as language). These times during which it is easiest for the child to develop an ability or skill are often called, "sensitive periods" instead of critical periods to help emphasize that the window of opportunity is not necessarily completely shut. Usually these periods are for very specific abilities, such as the ability to process certain types of sensory information, or to develop motor skills or language skills. We are still learning more about human development, however, and there are many areas that are less clear (such as social skills).
Impulse Control and Emotional Regulation
The ability to inhibit a behavioral impulse or an emotional response is important for success in many areas of life (jobs, social interactions, relationships...). Our capacity to do this seems to reside heavily within the front part of the brain (the prefrontal cortex). Fortunately, this appears to be the last part of the brain to reach full maturity, which means there is a lot of time to exercise it. On the other hand, this also partly explains why children, adolescents, and even young adults can be extremely impulsive or make some very questionable decisions at times. The development of the prefrontal cortex also seems to coincide nicely with our "cognitive peak." You could say that we are, essentially, at our smartest in early adulthood (though the decline afterward is actually rather slow). This means that for children we should continually encourage them to practice impulse control and emotional regulation. We can do this most effectively by giving them mild "patience challenges" that push slightly at their limits and providing them with appropriate feedback, encouragement, and (if necessary) rewards for achieving their goals. I would not recommend doing this with an overly high frequency (such as multiple times per hour, every hour, every day) as it's likely to produce so much frustration that you'll get resistance from them in the future. However, if it can be made slightly playful, then the child is building an invaluable ability and also building confidence in their abilities.
An important thing to keep in mind is that emotional regulation and impulse control (or "behavioral regulation") appear to rely on basically the same neurology. To build greater emotional regulation, it is often helpful to teach the child to voluntarily withdraw from a situation when needed (by rewarding them for doing so if necessary). This can give their brain (prefrontal cortex actually) time to catch up and reassert its control over the situation. I've seen parents use many approaches to explaining this to their child, but I think my favorite has been the idea of an "overheating engine" that needs to cool off. Teaching the child how to recognize the signs of getting emotionally overwhelmed is a helpful (possibly critical) step in teaching them to self-regulate their emotions more effectively. A variety of physical cues can help, including their heart rate and breathing, as well as how impatient they're feeling.
Frustration Tolerance and Patience
Similar to building greater impulse control and emotional regulation, the capacity for frustration tolerance and greater patience are likely to be great contributors to a child's long-term success. Tolerance for frustration or setbacks increases the likelihood a child will persist at a challenging task and, as a result, learn more skills and ultimately enjoy more success. Explaining this to a child is not likely to convince them to keep working on a particularly frustrating homework assignment though. As the parent, you effectively coach your child by encouraging them to persist, giving them just enough help when they need it (called "scaffolding"), and showing them how their continued effort has paid off. Then celebrate their success with them! The more they do this (and enjoy the success that follows), the more likely they are to persist at challenging tasks again in the future.
Building patience may be more challenging because "having it now" is always more appealing than "having it later." Individuals who are unable to wait (called "delayed gratification") are less likely to enjoy bigger successes later in life. Those who are able to wait can develop more complex plans and enjoy bigger rewards as a result of their patience. One way to help is to require the child to do "just one more time" or wait "just one more minute" on a fairly frequent basis (ideally at least a few times per day if circumstances permit it). I would not recommend prompting them to do a second round (at least not at first), because they may just get too frustrated, doubt your sincerity in the future, and decide they'll just make it happen on their own (whether you agree or not). You can also offer them bigger rewards for their patience (though starting with praise and allowing them what they originally wanted is a good idea). For example, "Sure, I'll let you have a cookie, but if you can wait until we're done with this, I'll let you have two cookies instead."
Training with ADHD
All of this comes to one final point. While reading this far (good patience and persistence!), you may have thought several times that the skills discussed sounded kind of like what is lacking in a child with ADHD, and you would be right. The neurology of ADHD appears to primarily be underactivity of the area of the brain involved in impulse control, emotional regulation, frustration tolerance, and patience. These skills are important for helping a child to persist at challenging tasks, maintain focus on one thing for an extended time, develop a complex plan, and carry out that plan. They're also important for preventing the types of impulsive or hyperactive behaviors that often get kids in trouble when they have ADHD. Because of that, the exercises discussed here are especially important for children with ADHD (though helpful for all children). This doesn't mean that children with ADHD just needed to do these exercises more, or that their parents committed "bad parenting", which lead to the problems with ADHD (there is clearly a strong genetic component to neurological development and a difference in brain chemistry for individuals with ADHD). Many children with ADHD may have more difficulty with completing these exercises successfully as well, and therefore may need a combination of medication and behavior therapy (rather than just behavior therapy). Progress in developing these skills may also be very slow for a child with ADHD (which can frustrate the parent), but slow progress eventually produces significant progress, and the time is well-spent. Remember, the prefrontal cortex seems to be the last area of the brain to mature, which means that "exercising that muscle" may help to reduce the neurological difference by the time your child is much older.
Written by Dr. Charles Galyon
Parenting is one of the most rewarding and most challenging jobs I’ve ever had. As a parent/educator, one of the most important things that I’ve tried to be consistent with is using positive communication and following through with what I tell my own children as well as the children I teach. Before I had my own children, I used to think that positive communication should be a “given” and easy to practice on a day-to-day basis. However, having my own children made me quickly realize that parenting is a learning process and some days are simply easier/harder than others. We’ve all had the day when you’ve hit the snooze one too many times and now you are running around the house trying to get lunches ready for school and children dressed all while trying to get yourself ready. Bottom line, try to realize you are only human and try to have some humor in your day because “this too shall pass”. I have put together a list of “Say this/ Instead of this” language to help (maybe) make parenting a bit easier for you. In addition to these phrases, giving children choices is also a great option because it makes children feel like they have control (even though, you, as the parent, has come up with the acceptable options). Acceptable choices may be as follows: “Meghan, you have a choice. You may clean your room now or after we eat dinner.” By giving this choice, you are still making room cleaning a priority but you are giving your child the choice of when they can do it. If a child is protesting hand washing, you might say, “it’s time to wash your hands. You may wash them in the kitchen or the bathroom.” Try not to phrase the options as a question because that gives the child the option of saying “no”. Believe me, I am guilty of this as a parent and educator. My coworkers and I catch each other phrasing choices as a question sometimes and we laugh about it and learn from it!
Say this: Instead of this:
“Walk please” “Stop running”
“Use quiet voices inside please” “Stop yelling”
“You may yell when we go outside” “stop yelling”
“Please use gentle hands” “Don’t hit”
“You may spit in the sink after “Stop spitting”
you brush your teeth”
“Look with your eyes” “Don’t touch that vase”
“Please use your words to tell “Stop hitting your sister”
Meghan that you don’t like that”
“We draw on paper” “Don’t draw on the table”
“We build with blocks” “Don’t throw the blocks”
“Keep your feet on the floor please” “Don’t climb on the table”
“Keep you shoes on your feet please” “Stop taking your shoes off”
Blog post written by Katie Wood, RBT. Katie is an amazing mom, ABA therapist, and our preschool group teacher!
God loves to throw us curve balls, but He never abandons us…granted, He is probably laughing his holy pants off watching the beautiful chaos.
It has been one year since I moved from a small, downtown office within a cozy group of psychologists to opening the ABA Interventions center.
The ABA Interventions center is more than therapy sessions back to back, caffeinated therapists pretending standing in line at the office Keurig 3 times a day is normal (the machine takes 3 minutes so if we are 3 minutes late to the lobby this is why), it’s more than parent training while laughing and crying simultaneously when a kid says his first sentence or finally sits for an entire story, it’s more than teaching kids to communicate on an AAC device or PECS and finding out that the staff are in love with researching and learning every ounce of knowledge possible about functional communication training…ABA Interventions is a professional team of therapists that work as a beautiful unit.
This team IS ABA Interventions. I joke that I receive emails and questions about clients from the therapists 7 days a week and at all hours of the day and night, but it’s so true. These therapists share a passion that is unlike any passion I’ve seen in a workplace. Our one year anniversary of the center being open is a celebration of our staff and team we have created to help our clients.
With that being said….
Thank you Miss Mary (BCBA) for teaching the therapists how to create a natural environment for learning and setting such an outstanding example on how to make kids excited to learn. Thank you for your patience and flexibility when being faced with challenges in the field. Thank you for leading clinical meetings and facilitating discussions among the team.
Thank you Miss Katie (RBT) for being our preschool group leader, always coming to work with a smile and getting even the sleepiest therapist clapping and singing along in circle time. Thank you for teaching our clients that being messy is fun and being a shining example of how kids can learn through the natural environment.
Thank you Miss Crystal (RBT) for being the therapist that advocates for our older clients and refuses to let age stand in the way of an individual learning. Thank you for your commitment to drive all over town to make sure our older clients receive the services they need in an appropriate setting. Thank you for your commitment to parent training and always wanting to make sure that your clients generalize their skills.
Thank you Miss Melissa (RBT) for your constant desire to learn and to implement evidence based practices. Thank you for your incredible ability to balance school, a job, and a family as you work on your requirements to become a behavior analyst. Thank you for always pushing the others to become experts in their field!
Thank you Miss Cresanna (RBT) for being incredibly persistent and never accepting that a child can not learn something. Thank you for your desire to always research, learn, and implement plans to perfection. Thank you for being our go to therapist when it comes to assistive technology and DTT!
Thank you Miss Jenna (Office Manager) for your tireless hours of billing, scheduling, and answering phones and emails. Thank you for keeping us organized, in line, and busy. We have a horribly long wait list and you are always striving to get as many kids access to services as possible.
Thank you Dr. Charles Galyon (private practice psychologist) for all the time you take to join us for our weekly clinical meetings, trainings, and coordinating services! We have benefited so much with you being in our office and we most definitely think of you as part of the ABA Interventions team! We frequently hear schools and families report that “Dr.Galyon really took the time to get to know the child and he was amazing!” Well, we know you are amazing! Thank you!
We are so excited to begin another year and to always work on our goal to make sure that all individuals have access to services that they need.
written by Elizabeth Ginder, MSSW, BCBA; owner and clinical director of ABA Interventions, LLC