Parenting Lisa S. Spector MD Chief, Division of Developmental and - PowerPoint PPT Presentation

Positive Parenting Lisa S. Spector MD Chief, Division of Developmental and Behavioral Pediatrics – Nemours Children’s Hospital Professor of Pediatrics - UCF 1

Disclosure  I have nothing to disclose 2

Objectives  How chronic stress effects brain development and child behavior  Effective behavior management strategies 3

Brain on Trauma

THALAMUS • Relay between subcortical & cortex • Translates senses into language of the brain • Regulating arousal, AMYGDALA awareness and activity • Emotional Computer and • Involved in memory Alarm System HYPOTHALAMUS • Responds to threat – Fight, Flight, • Link CNS to Endocrine System Freeze • Send and receive hormones • Formed at Birth • Activate Autonomic Nervous System - Immediate • Fight or Flight or Freeze • Epi & Norepi • Release hormones from Pituitary - Slow • HPA axis - cortisol from adrenals

HPA Axis Metabolic & Cardiovascular response to stress Excess Cortisol  Increased BP  Diabetes  Immune suppression  Infection  Atherosclerosis  Osteoporosis  Muscle atrophy Cortisol

Negative Feedback Loop

HIPPOCAMPUS • Determine if Threat is Valid PFC • Links experience – sensations, • Make decisions about emotions, thoughts, facts & cognitive and emotional responses reflections - into memories - • Abstract concepts - time which we can recall and • Executive Functioning: describe • Making, following & alt plans • Develops in first 5 years • Control & focus attention • Inhibiting impulsive behaviors • Developing ability to hold and incorporate new information in decision making • Develops over 25 years

Studies of Trauma/Stress  Increase in Cortisol – – increased levels of cortisol measured in 24 hr urine in children with PTSD  Hippocampus smaller – adult veterans with PTSD; – adults with childhood abuse related PTSD  Loss of neuronal Integrity in Prefrontal Cortex – – reductions in N -acetyl aspartate (NAA) in PFC of children with new onset PTSD Bremner, JD. Traumatic Stress: effects on the brain. Dialogues Clin Neurosci. Dec 2006;8(4):445-461

Summary - Always under Stress  Amygdala is Continuously Activated – Increase in Cortisol – metabolic, immune and CV changes  Deficit in Hippocampal Structure and function – Unable to classify and organize information properly – Typical process for storing memories is altered and information remains perceptual (smells, sights, sounds) and not stored as verbal language  Deficit in PreFrontal Cortex Structure and Function – Can not make meaning of what happened and grow and learn. – Emotionally Reactive; easily triggered into a state of arousal – sensing threat in innocuous situation & may have no verbal language to describe it

The child….. 12

How to Help  Help them feel - Safe  Focus on the positive to build – Self Esteem  Provide them - Predictability  Give them opportunities for - Control  Model and promote - Self Calming / Coping Strategies  Use Play to build skills – Emotion Regulation

Discipline = Guide and Teach! Children learn how the world works by:  Watching what we do and say  Imitating what we do and say  Experiencing how we Respond! We can change their behavior by changing what we do/say and how we respond!

Children….  Do well with Structure and Routine  Need some Prep Time – We are going to leave in 5 min – One more time down the slide  Learn through Repetition – Especially kids with ADHD and traumatized children  Get better with Practice  Respond well when there is Consistency and Calmness

Monkey See, Monkey Do They look up to us and they watch & listen even when we think they are not!

Be on our Best Behavior:  Use our Manners  Point out when we ‘share’ and ‘take turns’  Label our Feelings – “You are driving me crazy!!” - > “Mommy is feeling frustrated” – Helps kids label their feelings and know feelings are OK  Model Good Coping Skills – “I need 10 big breaths to calm down. Lets do it together.” – “Daddy needs a Time Out to calm down”

Be Proactive instead of Reactive  Give lots of Attention for Good (desired) behavior  Remove Attention for ‘Bad’ (undesired) behavior

Build a Positive Relationship & Reinforce Desired Behaviors Attention O’meter  All Children Want Attention  All Children Seek Attention  Children don’t care what kind of Attention ..Attention is a POWERFUL TOOL

Behavior + Attention = More Behavior = + = +

3 ways to Positive Attention  Catch them being “good” or even just “OK”  Quality Play time, Time-In  Loving Touches 50-100 times a day

Catch them being ‘OK’  Praise behaviors you want to see again – Manners, quiet, kind, helpful, following directions – Makes children feel GOOD!  Don’t wait for perfection, ‘OK’ is good enough – “ Good job walking next to mommy ” – Makes children want to do it MORE!  Compliment an other child’s good behavior – Stop there! – stay away from comparison/criticism

Catch them being ‘OK’ more often! Goal: Praise desired behaviors 5x more than disciplining undesired behaviors

Praise BEHAVIOR & EFFORT  Praise Behavior and Effort not ability working hard • sticking with it • Not – “you are so smart” If fail, will persist longer if effort was praised

Changing the Caregiver’s FOCUS

Actively work to Change the Focus I….  Runs around like an  am an animal! animal!  never listen!  Never listens!  always cry!  Constantly crying!  always lie!  Lies all of the time! 26

Instead Focus on the Positive Opposite I….  Sitting quietly  Sit quietly  Listening the first time  Listen the first time  Coping when things don’t go my way  Cope when things don’t go my way  Telling the truth  Tell the truth 27

Self Esteem National Violent Death Reporting System (NVDRS) 03-12 for 17 states  Compared Suicide rates 5-11 yr and 12-14 yr  In the 5-11 yr old age group – 85% were boys (70% in EA group) – 60% relationship issue, 32% school problem, 38% recent crisis – 30% disclosed intent – 1/3 a current MH issue (same in EA group)  Of the 5-11 yr ADHD was the most common known mental health disorder in children who died of suicide – 60% experienced ADHD and only 33% experienced depression/dysthymia (30% ADHD & 65% depression/dysthymia) 28

Getting our PLAY ON!!  Let the child run the show – Decrease Demands: • Asking questions • Telling what to do • Criticizing (no, don’t, that’s not right)  Increase attentive responsiveness: – Describing what they are doing – Repeating what they say – Catch them being “OK ” – sitting still, using inside voice, sharing and taking turns

Nurturing Touches 50-100x/day  Hugs, high-five, fist-bump!  Brief physical contact – Head, back, shoulder  Attention without talking  Acknowledge good behavior without distracting  Therapeutic Massage – Youtube Tina Allen -PMT *Always ask for permission first

Give Good Instructions  Get their attention First!!  Be Calm, Neutral tone of voice  Tell them what you WANT THEM TO DO – “Don’t climb the tree !!” – “Put your feet on the ground”  Do not frame as a question unless they have a choice – Be Polite by using “Please”

Give Good Instructions  Short, concise, and specific  How long is a reasonable time to wait for compliance? – 6-10 seconds  Praise for compliance

Kids Learn through Play – So Teach them with Play  Social Emotional Skills – Sharing, turn taking – How to engage others in play – Conflict resolution  Dolls take pressure off of the child  Window into their minds  Opportunity to reframe to provide a different perspective 33

Good Ole Role Play  Help practice key skills – Sharing – Sitting in circle time – Conflict resolution  Learn empathy and perspective taking  Ask What questions to engage them to set the stage – What do if some does something you don’t like ? – What else can you do? – Let them come up with answers and help if they need help  Okay lets pretend and you be ____ 34

Standing Rules  Engage them in creating the RULES Use your inside voice  Modeling what rule-following looks like  Posting the rules in prominent place  Practice following the rules – Using Descriptive Praise and Rewards

Predictability and Control  Preparation for changes/transitions – Talk about The Plan ahead of time – One more time down the slide – We are going to have to leave in 5 min,.. 2 min,..1 min  Allow child to have control when appropriate – Try to find choices for child when appropriate no matte how small – We have to go, do you want to put your shoes on or do you want me to help you? 36

Predictability and Control  Provide Visual Schedules  Calendar to mark down days – until visit/return

Most Behavior Charts  Geared towards kids with good behaviors  Doesn’t account for individuality - All kids do not start out at the same point 38