Kids in the Syndrome Mix of ADHD, LD, Asperger’s, Tourette’s, Bipolar, and More! The one stop guide for parents, teachers, and other professionals
By Martin L. Kutscher MD
Jessica Kingsley Publishers, LondonPhiladelphia, 2005
Outlineof Chapter 2:
General Principles of Treatment
(It is assumed that parents and teachers “do treatment” too.)
Outlined by Joan Maynard, I & R Coordinator, Wisconsin Family Ties
This is a wonderfully wise and readable book that I feel all teachers, parents and professionals might do well to read. Chapter 1 gives general principles of Diagnosis. I have outlined chapter 2 on Treatment. To get the full impact of this chapter I recommend you read the book. Dr. Kutscher states, “…general guidelines apply to most kids with any of the syndromes…You don’t need any formal classification or diagnosis to adopt them.” I would add that many of these principles are good to remember and use with ALL kids. I hope you find this outline useful and the principles as true to your experience as I have to mine. Joan Maynard
Adjusting your own mindset
- A teacher can make or break a child’s year.
Kutscher states that when asked why some years were great and others were not, the answer from parents was “In the successful years, he felt that his teacher really understood him and was rooting for him. In the disaster years, he didn’t click with the teacher, and just completely shut down.”
- Don’t necessarily overestimate your role in a child’s failures.
Factors out of anyone’s control may be at play: issues that are academic, personal, family stressors, medication. Re-evaluate strategies with parents and school guidance personnel. Maybe this year isn’t the year to do much fixing, especially when some problems can’t be totally fixed.
- Remember: “The thing I like about you best…is that you like me.”
Cartoon character Ziggy said this and Kutscher feels it applies to many human relationships, especially to “kids who find themselves suddenly zapped from all angles – even from inside their own brain.”
- Don’t take the difficult behaviors as personal affronts.
Your child simply can’t be like other children. It isn’t a personal thing. The child suffers the most from the behaviors. These problems are not fully within their control!
- Adopt a “disability outlook.”
The perspective of viewing your child as “standard” is NOT an option. Validating the child as having a disability helps caregivers to see themselves as “therapists,” not as victims.
- Accept that there are no obvious physical markers for most of the conditions.
- The child with behavioral problems doesn’t ask for help in an easily loveable way which can make it harder to accept the disability.
- “Personality,” “will,” and “soul” are aspects of each of us that are under the influence of neurotransmitters. Kutscher states that “the human brain is physically a bunch of chemicals with illusions of grandeur.
Not seeing the disorder as a true disability “will dismiss the problems, and instead, blame the person for not taking control of them.” What a burden we then place.
- Minimize frustrations by taking a realistic look at the child you get every day.
Doing this helps to not take things so personally. Anger arises when there is a discrepancy between what you expect versus what you get. Special needs kids are “works in progress.”
- Overcome a fear of “coddling.”
Can you help too much? How much help is appropriate? If they cannot accomplish what they need to do, “then we must step in. …the ‘sink or swim’ approach often does not work with kids in the syndrome mix. If they can’t do it yet, then…they can’t do it yet.” Worrying about making life too easy? Kutscher states, “Even with our help these kids will still be getting more than their fair share of dealing with failures, frustrations, criticism and pain.”
- Provide a safety net.
Consider analogy of acrobats, trapeze artist, gymnasts, who use safety nets and spotters. “Similarly, we may need to intervene…because the penalty of messing up [one’s future] is not commensurate with the ‘sin’ of poor organization…If she gets it right, she won’t need you…If she doesn’t get it right, you are there to provide a softer landing – and make sure that the consequence is appropriate to the mistake.”
- Communication between teacher and parent is key.
Phone calls, emails, postcards, anything! Kutscher warns against expecting the special needs child “to be the purveyor of information!”
- If it is working, keep doing it. If not, do something else.
Failure is not an option, problems can’t be fixed overnight, and “many of these kids will be working on their issues as part of a ‘Fifty Year Plan’.”
- Forgive yourself.
Daily! We’re human, all of us – parents, children and teachers.
- Review this text, and others, periodically.
You will forget, and different principles will be needed at different stages.
Understanding the child’s mindset
- Learn about the child’s problems
The blame you may have had for a particular behavior may dissipate with knowledge of what’s going on. Read books which help you to understand neurological differences. (An excellent list is at the end of Dr. Kutscher’s book.)
- Seek to understand.
“Often the behaviors make sense if we remember that these children are so overwhelmed by what is happening that they live almost exclusively in the present, without much ability for foresight.”
- Not all brains see everything the same.
Odd, different and inexplicable behaviors are why these kids have a diagnosable condition. We begin to see into the brain’s workings when we carefully pay attention to – and legitimize – the child’s reaction to a situation. Rather than see it as over-reacting, see it as “over-feeling.” Dr. Kutscher claims we might benefit from saying “Wow, if that’s how it feels to him, we should calmly discuss this!” Seek to understand first, and then plan a reaction.
- We see only part of what is going on in a child’s life.
This goes for both parent and teacher since most of our kids spend time in both places. At home there may have been struggles with getting up and doing homework. At school the child may have repressed a lot of situations that he/she did not understand fully.
- Finally, remember that some of the difficult child/adolescent behavior is simply normal.
“Life with any child is never totally smooth.” And “…even typical pre-teens and teens go through a period where their respect for adult authority is less than maximal.”
How to Change the Child’s Behavior
Okay, I know this is what you’ve been waiting for, but prepare yourself for a shock! There are only two major rules for you to remember to affect a child’s behavior. Yes, TWO. And speaking from personal experience, having made many mistakes (these are easier said than done), I can vouch for the fact that these two are basic. You cannot expect to see results over night, either in yourself or in your child. But if you can take the long perspective, and keep practicing these two rules, I believe you will be more than pleasantly surprised with the results. (JM)
Keep it positive.
Keep it calm.
Rule 1: Keep it positive
Enjoy the child
You must seek joy and not frustration. Celebrate unique qualities. Let child be helpful, praise accomplishments, let child know you believe in him/her, and have activities to enjoy together. “Catch them being good.” Laugh.
- Use positive reinforcement when possible.
Rewards, if used, must be immediate, frequent, powerful, clearly defined and consistent. See book for outline of Dr. Ross Greene’s behavior modification system. Use different systems for different ages.
- Negative reinforcement does not improve attitude.
Good attitude is not motivated by threats; rewards (internal or external) can lead to improved mood.
- Avoid the “resentment treadmill.”
It leads to nowhere good. “Someone has to get off the treadmill first and it isn’t going to be the dysfunctional child.” You won’t get instant results or gratitude. “It’s all easier said than done: resentment and anger can be addictive.”
- Don’t be a nasty cop.
Dr. Kutscher has a great analogy in the book after which he states, “As you hand out the punishment, skip the nasty attitude. The punishment is bad enough. The nasty attitude just breeds resentment.”
- Avoid Dr. Phelan’s four cardinal sins
Don’t nag. Don’t lecture. Don’t argue. Don’t offer unscheduled, spontaneous “advice.” These “sins” are both ineffective and harmful. Instead assess the issue as aggravating but not significant enough for intervention, (i.e., stay quiet) OR make an appointment with child to discuss the issue.
- Minimize arguments with the “no-fault” approach
Again, there are good examples in the book. Deal with the end results rather than whose fault it is. The reason (excuse) for the rule infraction (e.g. coming in late)is less important than the already laid out consequence;focus on creating a plan to prevent the behavior from occurring again. This eliminates negative discussion like blaming. “Criticize the behavior, not the child.”
- Keep you relational bank account in the positive.
Consider your good times and bad times in the relationship with the goal of more good (positive account). But you need to take the good times with the bad. When dealing with my teen I had to literally tell myself in either situation: “This too shall pass.” When my teen was ready to apologize, talk, or give me a hug, I’d tell myself, “I’ll take what I can get.” JM
- Provide help for deficits at the moment it is needed.
“Children with special difficulties need enabling at the time of need, not negative feedback when it is already too late.” Negative reinforcements do not teach needed behaviors to these kids and understanding this will allow us to give guidance at the moment it is needed. Dr. Kutscher states, “…kids keep using the same unsuccessful strategies, but how many times is it going to take for US to figure out that WE keep using unsuccessful strategies with them?”
- Punishment is not your chance to inflict misery’ it is your chance to improve your child’s upcoming decisions.
Purpose of punishment is to correct future behaviors. Keep it immediate and controlled. It may not be possible to keep it positive, so Rule 2 will need to be invoked.
Rule 2: Keep it calm
Be a defusing influence, not an inflammatory one.
Dr. Kutscher says that the “treatment” for the overwhelming feelings and the over-reactions the special needs child has requires adults to defuse, not inflame. This holds true across disorders and “any human interaction.” “Negative behaviors usually happen because the child is spinning out of control, not because he is evil.” Prevention is key and begins by first “just stopping,” staying calm, and negotiating, if possible. Dr. Ross Greene’s “Plan B” can also help defuse (see below).
- Head off big fights BEFORE they begin.
Redirect rather than criticize or punish.
- Pick your fights.
Is this fight worth losing a piece of the relationship?
- Give transition warnings.
Advance discussion with child repeating out loud the agreement. Be patient.
- Watch the “stress speedometer.”
Think of child as a car’s speedometer that you want to keep below 60. Assess situations based on 60 as the speed you don’t want to get to and make adjustments accordingly. (You know how some days you can ask the world of your child, and some days you can’t even look at him or her? This point speaks to that situation.) JM
- “Just STOP!” is the key—for the overwhelmed person and for you.
After stopping, state the rule once and leave.
- Stay calm
Caregivers need to model negotiation, not inflexibility. Ultimately you will have control in that you still get to decide which compromise is accepted.