Bad School Behavior

Dear Melissa,

My 8-year-old had a lot of problems at school this year. He was impulsive, interrupted often, did not follow directions, and was often defiant with the teachers. He was frequently sent to the principal's office. The school called me 3 times during the last month of school to come pick him up. HELP! I really don't want to repeat this all over again next school year.

It sounds like it was really a difficult year for your child, you and likely your child's teachers as well. In my recent "Naughty - Bad - Misbehaving" Post, I stand firm that there are no bad kids! Rather, we must get to the root of the problem, take a closer look and see what is causing the bad behaviors.

Investigate

Investigate what may be causing the problems. If school is on break because of summer vacation, observe whether the behaviors are still present at summer camps, vacation bible school, etc. Be prepared for the upcoming school year. Have a classroom observer ready to investigate. Regardless of the setting, it is better if the observer is someone other than a parent because children often behave quite differently when Mom or Dad are nearby. When the next school year starts, don't wait. Talk to the school and see if a counselor or school psychologist might be available to observe. Things to look for include:

• Too much noise
• Disorganized space
• Other kids in his personal space
• Other kids “picking” on him

Identify missing splinter skills

Over the years, I have seen over and over again that splinter skills are the root of bad behaviors. On a monthly basis a child is referred to me for “bad” behavior at school. I complete fine motor testing and determine that the child has significant delays in writing skills (and SO much of the school day is spent writing!). In addition, while I am testing, I see a very willing child misinterpreting my verbal directions. For example, I may say “sort” the cards, and he begins to “shuffle” the cards.  I say “stand” on the bench, and the child “sits” on the bench. When I repeat myself or correct the child, he is often confused. Poor guy!  He is trying, but he is not properly interpreting my words. This is where speech therapy can greatly help as well. The most common splinter skills I see missing include:

• Social immaturity
• Emotional immaturity
• Inattention
• Impulsivity
• Decreased expressive/receptive language skills
• Decreased handwriting skills
• Decreased self-help skills
• Poor motor planning skills
• Sensory processing disorders

If these splinter skills are not addressed, all of the behavior modification skills in the world will be completely ineffective. As I have mentioned in the past, most children would rather be viewed as bad than stupid! The good news is that summer is a great time to target splinter skills (though this can be done any time of year). Talk to your pediatrician about your concerns. They may give you a referral for an Occupational Therapy and Speech Therapy evaluation. This is a great way to investigate the possibility of splinter skills. 

Set a behavior plan

This is where you can take proactive steps to address behavior concerns. Given all that you learn from taking a closer look at what has caused your child's misbehavior, be prepared to talk to your child’s teacher and principal when the new school year begins. Set up a meeting and create a behavior plan to meet your child’s needs. If your child works with an occupational therapist, speech therapist, behavior therapist, or psychologist, then they can assist with this process as well. If you don’t have these professionals for support, you can also ask for the assistance of Arkansas Support Network at this behavior meeting. They are a wonderful free service here in Northwest Arkansas which helps out families of children with various special needs. They can not only help you navigate the school process, but other services as well. 

Several components of a good behavior plan include:

• A developmentally appropriate workload
• Frequent breaks (It is great if these breaks involve physical exercise which will also help address attention, motor planning, and sensory processing skills)
• Clear-cut expectations and consequences (consequences that do NOT involve calling the parents to pick up a child from school, except for the most extreme situations)

If this is still not working, then assemble the village! Gather parents, grandparents, occupational therapists, speech therapists, teachers, principals, psychologists, behavioral therapists, and anyone else who knows your child well, and create a new plan. As I said at the start, there are no bad kids...only kids that need extra help. 

How have you worked with your child’s school to create a plan that worked?  What worked for you and your school? What did NOT work? Again, it takes a village! Please share your ideas!

Resources:

Aggressive Behaviors, Healthychildren.org, (accessed Feb 2015)
Arkansas Support Network, a local Northwest Arkansas support agency  
Children's Therapy TEAM, provides occupational therapy, speech therapy, physical therapy and developmental therapy to families in Northwest Arkansas

The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children, Ross W. Greene, (2014) 

The Out of Sync Child: Recognizing and Coping with Sensory Processing Disorder, Carol Kranowitz, (2006)

The Sensory Sensitive Child: Practical Solutions for Out of Bounds Behavior, Karen A. Smith and Karen R. Gouze, (2005)

Why we love our SLP's!

Dear Melissa,

Did you know that May is Better Hearing & Speech Month?  

Last month my "The Heart of an OT?" post inspired this question. So, this month it seemed appropriate to shed light on the work of pediatric Speech therapists, also known as pediatric Speech/Language Pathologists (SLP’s). For this, I turned to several members of our fabulous SLP team at Children's Therapy TEAM. They captured the "heart" of the discipline that is celebrating "BHSM", as our friends at the American Speech and Hearing Association like to refer to it. This is what they shared:

"There's nothing more rewarding than watching a parent see their child communicate with them for the first time. And that's just the beginning!" 

– Lynsey Decator

"Since I see a lot of babies and young children, I love the connection I get to make with the families. Parents that sit in on my sessions are eager to see their kids eat and be successful, and I love being part of that." 

– Connie Clark

"I have the coolest "office" ever, I laugh daily and get hugs frequently....and that cannot be beat! I think communication in any form is such a gift, and I love watching kids learn and grow. I also love that I can try to provide support and encouragement to parents as they navigate parenting along with special needs." 

– Amy Smith

"I love being able to give kids a way to communicate. It gives them some control in an environment that sometimes feels out of control for them. Even communication as simple as learning to point to make a choice, or learning to nod or shake your head for "yes/no" to make choices, is so powerful when you haven't had that control in your life." 

– Carmen Shumpert

"Kids have the need and the desire to learn. For me it's a cycle...I learn just as much from the kids on my caseload as they do from me. They keep me on my toes constantly. I enjoy being a positive and consistent role model in their lives. I assume when it comes to communicating that it's just one big or small puzzle that the kids and I are attempting to solve together. When the child is successful so am I. I also appreciate all the knowledge I gain from my fellow TEAM members." 
– Tabitha Mayberry

"I love being a speech therapist because I love helping kids and seeing them making progress toward their goals every week! Working with a diverse group of patients and diverse disorders is challenging to me. I love our clinic and how we are able to spend so much one-on-one time with each patient and their parents in order to provide the best treatment possible!"  
- Jill Goodwin

Speech Therapists help in more ways than you may think

When working with children, many people think that speech therapists simply work with stuttering, articulation problems, or with children who are not talking yet. But pediatric speech therapists do so much more! They also help children with eating, drinking and swallowing difficulties, conversational skills, social skills and understanding the meaning of language. 

The Last Word: Why I love my SLP’s!

As an occupational therapist working in a large multi-disciplinary pediatric team, I have the pleasure of frequently interacting with speech/language pathologists. I love my SLP’s because they are such fantastic collaborators and problem-solvers. My personal clientele includes many kiddos with speech delays which are contributing to frustration and ultimately behavior problems. I am so thankful to have a group of SLP’s that take the time to figure out the root of language delays and collaborate with fellow therapists, teachers, and the family to create a plan for communication improvement. This ultimately helps empower the child and contributes greatly to their peace and happiness. 

Why do you love speech therapists?  

What have they done to make a difference in your life or the life of your child?  

I would love to hear your stories!

email: share@childrenstherapyteam.com

Resources:

American Speech & Hearing Association (ASHA): Better Hearing & Speech Month (accessed May 2015)

Centers for Disease Control and Prevention: Developmental Milestones

Children’s Therapy Team: Speech/Language Pathology Team

Naughty - Bad - Misbehaving

Dear Melissa,

Is there such a thing as a "bad" kid?

I was asked this philosophical question recently by my husband. It is true that there are children who, for one reason or another, tend to get into a lot of trouble at school and therefore are often labeled as "naughty" children. But, my gut feeling is that these kiddos aren’t really bad, they just need help! And, news flash, ALL kids are naughty sometimes! ALL kids have periods of testing boundaries.This is normal! So if these children aren’t “bad”, then why do they act in a manner that so often gets them in trouble? In my opinion, children often act poorly for one of three common reasons.

Common reasons children misbehave: 

#1 Misbehavior works.  

Kids are often way smarter than we generally give them credit for. They are masters at manipulation. From infancy, they learn that if they cry, they get attention/needs met, and this is a good thing. This helps the child to feel loved and secure. But then this behavior can linger. They know that if they cry or have a tantrum, this may get them what they want. If they cry for 5 minutes to get the toy at the store this week, then they will cry 15-20 minutes next week because it works! 

How to help:

As a child grows and their ability to self-sooth and self-regulate improves (along with enhanced language), we need to teach them different strategies. Crying is no longer the most powerful option. Words have power. Therefore, we need to step back, ignore the tantrum as much as safely possible, and give the attempts at using calm words.

#2 Demands are too great.

It seems as if every generation, every decade, & every year, we place more and more demands on young children. Pacifier gone by 1. Potty trained by 2. Knows letters by 3. Reading by Kindergarten. When do we just let our children play and explore their environment? This is also when we tend to overextend our preschoolers, are afraid to let our children play outside, and totally disregard bedtime. It’s no wonder that these little guys are little balls of nerves ready to explode! 

How to help:

This is when we, the adults, need to closely observe the situation and omit unrealistic demands when possible.

#3 Misbehavior is a child's coping mechanism to combat unrealistic demands. 

This basically falls under the heading of “Demands are too great”, but I feel like this point is so important that it needed its own heading. Again, kids are smart, and they know from a very early age how to manipulate those around them. If we are routinely making demands that are too great, a very common coping mechanism is for children to act out rather than to reveal that they can’t perform. So…the child acts out and gets sent out of the classroom.  Problem solved. But the problem is NOT really solved. 

How to help:

As adults, we need again to determine the causes behind these negative behaviors and work on these causes before we ever have a hope on fixing these negative behaviors.  

Key Question: What is causing the misbehavior? 

Here is the million dollar question:  How do you know when it is a tantrum because “It works,” and how do you know it is a tantrum because “demands are too great”?  As a mom, and as a therapist, I feel that this is the trickiest part! You want to stand firm, set clear boundaries, and not cave in, but then you start to second-guess yourself and begin to wonder if you really DID make a request that was too great. And then, sometimes you cave in, and feel like you made a mistake when you should have stood firm. 

Even though this is the area of practice that I thoroughly enjoy the most, sometimes I feel the need to analyze with every single meltdown: it works vs unrealistic demands.  Sometimes I am right, and sometimes I am wrong. Hopefully I am right more often than I am wrong. But at least it is something that I know I need to evaluate daily in myself, and it is my responsibility to give the child the tools to handle adversity. Does this mean giving in to tantrums? Absolutely NOT!  But it does involve fostering the skills they need to solve problems and communicate effectively so that tantrums are no longer worth the energy.  

  What are your thoughts?  Are some kids just bad...or are they just misunderstood?

Also, if you have a question you would like me to address in my Weekly Blog,

send it to share@ChildrensTherapyTEAM.com

As I stated before, this stuff isn’t easy. It’s an art. It is an area that I love, and yet I know I continue to have so much to learn. Below, I have listed several of the books that have helped me over the years in the resources section.

Resources:

The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children, Ross W. Greene, (2014) 

The Sensory Sensitive Child: Practical Solutions for Out of Bounds Behavior, Karen A. Smith and Karen R. Gouze, (2005)

The Out of Sync Child: Recognizing and Coping with Sensory Processing Disorder, Carol Kranowitz, (2006)

Aggressive Behaviors, Healthychildren.org, (accessed Feb 2015)

7 Things Good Moms Do

Dear Melissa,

Have you read the article, “7 Things Good Mothers Do That I’m Not Going to Do Anymore”? What are your thoughts? 

After reading this article, I felt a wave of mixed emotions. From my experience as a mama as well as a pediatric occupational therapist, I agree that moms are under way too much pressure to be "perfect." The era of Pinterest is not helping! 

In the article the author, Leigh Anderson, says she is not going to do the following anymore:

1) Bathe kids every day.

2) Do an elaborate bedtime routine.

3) Buy organic. 

4) Force my kids to eat vegetables. 

5) Be eternally patient.

6) Have a perfectly clean house.

7) Spend all weekend with my kids. 

Let me start by saying I felt common ground with Anderson on several points and I disagree with her on other points. Here are my thoughts:

#1 Don't throw the bath routine out with the bath water! 
Yes, most preschoolers don’t technically need a bath everyday to be clean. And yes, bathing children everyday can even be hard on a little one’s skin. However, the reliable structure of a bedtime routine really does help kids. Some days may be a full bath with head wash. Other evenings it may just be a “bird bath” where the child stands in the tub and you quickly splash off the important parts. Or in the winter, it may be a “lotion bath” where I slather the child with lotion from head to foot. 

#2 Simplify your bedtime routine as needed, but keep the routine, routine! 

Again, kids need structure, routine, boundaries. Most of the children I work with in the clinic have trouble sleeping at night. What's the first step to fixing this? Bedtime routine! Each step of the bedtime routine is another clue for your child’s body that it is time to hit the sack.  Some parents are blessed to have children who fall asleep as soon as their heads hit the pillow.  Most of us are not. The more consistent the bedtime routine, the better chances you have for a restful night's sleep yourself. 

#3 Don’t get worked up about buying organic.  
Personally, I simply try to provide as many fruits and veggies as possible. If the organic happens to be on sale, or we are at the local farmer’s market, great, I’ll buy it. But in reality “organic” can really mean so many different things. So I will focus my efforts on simply eating more plants. 

#4 Don't force but rather strongly encourage kids to eat vegetables.
Several pediatric feeding courses that I have been to, including Food Chaining, are clear that adding plants of any kind to a child’s diet is the priority. Vegetables are often an acquired taste, so a child is likely to enjoy more fruits than vegetables. But, how is a child going to learn to eat their veggies unless he tries them? I refuse to engage a child in a “just take a bite” debate at dinner time. However, the child does need to recognize a vegetable’s right to exist on the plate, and then be praised like the dickens when he decides to taste it!

#5 Patience takes practice. 
Patience is a virtue! (My children have heard me tell them this hundreds of times!) We are our children's first and most consistent teachers. Yes, we parents are human. Yes, we will lose our patience. Nevertheless, it is our job to TEACH patience to our little ones.  We have had many, many more years of practice with patience than our kiddos, so we should be their models. They should be allowed to see us get frustrated, then MODEL how we deal with that frustration. Many times I have told my own children that I am walking away and taking a time out, taking some deep breaths, or counting to 10 (or 20!) to calm down.   

#6 Don't give up on a clean house.  
Now I’m not talking perfectly clean.  I don’t care about dust-free book shelves and shiny mopped floors.  Rather, I am talking about an environment relatively free from visual clutter.  This one is particularly tricky for me! There have been many times that I have simply run through my house, filling up an empty laundry basket with stray items to be dealt with later.  In addition, I am a HUGE fan of various toy bins with word/pictorial labels and encouraging the children to put their OWN things away. 

#7 Take a respite.
Anderson recommends a Downton Abbey-style respite time where each person gets a weekly, 8am-noon period completely free from kid, work and house responsibilities. I LOVE my kids, both my biological kiddos and my kiddos at the clinic…but, um… sometimes it would be nice to have a couple hours a week/month with NO risk of the random tantrum, and NO laundry duty. I might just have to take this piece of advice to heart! 

In summary I feel that Anderson has often chosen the wrong battles. I agree that children need some freedom and autonomy from their parents. They need to go outside and learn to get dirty. They need to be allowed to make mistakes and learn from them. However, some of the items which Anderson said she wasn’t going to worry about anymore are the very things that actually make a mama’s life EASIER. Some children may be able to “go with the flow” a bit more than others and not deteriorate into a total meltdown, but for most children

structure, routine, and boundaries are the keys to unlocking a happier child with fewer meltdowns. And, happy, calm children help to create a happy and calm family. 

So what do you think?  What items do you think are the most important to worry about in parenthood, and which ones do you think we need to toss out the window? Feel free to share!

Also, if you have a question you would like me to address in my Weekly Blog,

send it to share@ChildrensTherapyTEAM.com

As we gear-up for Mother's Day this weekend, 

I wish all my "mama readers" a healthy, 

happy and relaxing Mother's Day! 

Resources and References:

“7 Things Good Mothers Do That I’m Not Going to Do Anymore” Anderson, Huffington Post, posted April 9, 2015
Sleep Worries, Mondays with Melissa Blog, Children's Therapy TEAM, posted August 2014
Busy Moms' Resolutions, Mondays with Melissa Blog, Children's Therapy TEAM, posted December 2014
Sleep Training 101, Mondays with Melissa Blog, Children's Therapy TEAM, posted November 2014
Picky Eaters, Mondays with Melissa Blog, Children's Therapy TEAM, posted January 2015