Mad River Behavioral Health

A Sledgehammer Is ...

A Sledgehammer is ... Not ... a Behavior Change Tool.

Constructive Feedback

Behavioral kids and teens*, typically get absolutely inundated by crushing waves of criticism. Pause for a moment right here. Read this again to establish a deep empathic connection with this reality. Imagine crushing waves of criticism inundating you every day for years and years. Close your eyes. Breathe gently and deeply. Imagine how it would feel.

Not only do behavioral kids tend to get subjected to frequent negative feedback on their problem behaviors, but they are very typically hyper-criticized for ordinary behaviors as well.

Behavioral kids tend to get scrutinized frequently, in everything they do. Many behavioral kids know this and say it very clearly.

This is extraordinarily destructive to the child and very counter-productive. Imagine for a moment, being hyper-criticized at work; moment to moment, day-in-and-day-out, for years and years. Would your well-being and job performance be improved or would it decline?

As the responsible adults -- whether parents or staff -- we cannot psychologically "smashulate" children and believe that this will turn out well.

A sledgehammer is not a behavior change tool.

Yes, I am using the word "smashulate". I made it up one day while working with a very guarded child who tended to smash things when angry. I needed a humorous way to approach the subject. "Smashulate" worked. He laughed and we were able to talk about the struggle in a very real way.

My point here is, as the responsible adults we cannot continue to "smashulate" kids and teens who have behavioral problems with large doses of criticism. It is not healthy. It does not work. It makes things worse. It is destructive. It is not congruent with our mission or purpose. Stop doing it.

In order to grow into healthy adults, kids need a diet of feedback that is more constructive than destructive. The positive to negative ratio should tilt to the positive, constructive side.

For children with significant behavioral problems, the objective is to increase the use of constructive feedback to achieve a ratio of positive:negative feedback of approximately 10:1 – this is the number one, most immediate priority.

10 positive, uplifting, constructive comments regarding the child's behavior, attributes, interests, characteristics, accomplishments, etc. to every 1 negative comment or criticism. The gardening metaphor, if you can imagine it, is one of watering / nurturing the flowers and for the most part ignoring the weeds.

Note: This is important for parents, but it's particularly important for behavioral staff working in a program to remain mindful of this ratio. If the program ratio of positive to negative feedback gets too low, or worse, inverts, the program will be in for a very rocky ride. I'll say more on this on the staff training page.

Ordinary children benefit from a ratio of 6:1, positive to negative feedback.

Think about it. Each child has tremendous positive energy and many excellent attributes.

They are really terrific kids with lots and lots of positive potential. We want to encourage and support the growth of these very important positive elements while gradually, patiently, carefully working to address the lesser, but significant problems and concerns. (See previous blog post: The Whole Child)

If we attend too heavily to problems and concerns we risk increasing these elements to the point at which they may consume and diminish the really terrific positive qualities that make up the bulk of who each child genuinely is.

We must work with intention, purposefully and progressively to address concerns while fully encouraging the growth and development of the whole child.

* I'm using child, kids, children, teen interchangeably.

Photo credit, sledgehammer: All rights reserved by Antti Tassberg

Kenneth H. Little, MA / 603-726-1006

Leadership

Excerpted from Ken's Parenting Guide

Leadership

Parents are the leaders of the family. Parents lead children in growth and development toward adulthood. Parents lead by example. Leadership is not power. Leadership is wisdom.

Vision / Long Term Desired Outcome

In order to lead, parents need to have a sense of what their long-term desired outcome is. As a parent, what are you trying to accomplish in raising children? Having a good sense of the desired outcome will help you navigate through difficulties more effectively. Keep the big picture and the long-term plan in mind. Don't get lost in the small stuff, the immediate challenges.

Know Your Family's Value System

Keep your value system at the forefront of your parenting effort. Write it down. Talk with your children about your values. Parents instill values in their children gradually over time. Live according to your value system. Guide accordingly.

Keep the Whole Child in Mind

Often as parents we lose sight of the whole child and begin to focus too vigorously on the problems, concerns, and shortcomings. As parents, it's important to attend to the whole child, to develop children across the many years into well-rounded adults.

Focus on Constructive Feedback

Avoid using negative feedback and criticism. Keep the feedback loop corrective, constructive, positive and uplifting; pointing toward the long-term desired outcome. As parents we are constructing, building-up our children toward adulthood, not tearing them down.

Build Strength - Strengthen Weakness

Raise resilient children, strengthen and develop character and skills patiently, intentionally, and incrementally across the many years of child development. Help your children develop the strengths and skills necessary to cope effectively with the difficulties of life and to succeed despite obstacles. Do not avoid weaknesses - strengthen weaknesses through a planned, intentional, practice-to-mastery approach.

Strength is nurtured, not demanded.

Kenneth H. Little, MA / 135 Lee Brook Road / Thornton, NH 03285 / 603-726-1006 / Achieve-ES.com

Focus on the Whole Child

Excerpted from Ken's Parenting Guide

Problems and Concerns v. Health, Well-being, Interests, Activities, Hobbies, Skills, Attributes, and Characteristics.

There is a common tendency to focus on the negative. Problems just seem to call to us, to demand our attention. Our parental anxieties fuel our focus on problems and concerns. We imagine future disasters. A sense of urgency grows -- must fix the problem now, this minute!

Pause for a moment. Breathe. Imagine a warm, sunny beach ... waves gently washing against the sand, a gentle breeze, ....

Take a step back. Ask two key questions: 1) is anyone or anything on fire right now, 2) is blood gushing from a wound? If you answer yes to either of these questions, stay calm and take immediate action. If the answer to both is no, stay calm take no immediate action. We have time to think about the situation, formulate a coherent plan, and implement corrective actions steps.

Without some caution, most of our attention will naturally and inevitably end up being focused on the child’s problems and difficulties.

There are risks associated with focusing only or mostly on problems and concerns.

The first and foremost is the risk that we will lose sight of the whole child and her many wonderful, terrific, and beneficial attributes, interests, and characteristics. The whole child may become obscured behind a veil, lost in the haze of difficulty.

The second risk is that by attending only or mostly to the negative we will inadvertently increase the frequency and intensity of the problems. The reality is, that by attending only to the negative we make the positive qualities less important and the negative qualities more important.

It's demoralizing to be constantly criticized. Think about this for a moment. Have you ever worked in a critical, hostile, or toxic work environment? Morale is the stuff of life. Everything floats on morale. When morale is high, all aspects of performance are improved. When morale is low, performance declines. Children will still muddle through for a time, driven by character and desire. But, eventually their energy will drain away. (More on this another time).

Focus on the whole child.

Your child is a whole person. The problems and concerns, even when significant, are only a small part of who he or she is as a human being. It is very important that we spend more time acknowledging and celebrating positive qualities than we do attending to the troublesome ones, even when the problems are severe.

The Whole Child is a Well-Rounded Person.

Imagine that each section of this pie chart is some part of your child. Blue might be educational. Yellow might be community and social. Green might be music, art, sports. Imagine adding in other colors to fit your idea of what a whole person is.

Note the red. Red represents problems and difficulties. Notice that it is smaller than the whole. Now imagine drawing a line through about 20% of the red.

Just 1/5th. This is the amount of the problem section to work on at any given time.

If you make a list that has 5 problems, only focus on the one that matter most. Master that gradually, then pick another problem to work on.

While working on problems, be sure to continue to encourage growth and pay attention to all of the other areas.

Celebrate both successes and mistakes. The greatest learning opportunities often come from making mistakes. Help your child to see mistakes as learning opportunities. Mistakes are not emergencies.

I will continue this another time. For now, intentionally pay attention to your whole child. Nurture growth and improvement in all areas, encourage expanding into new areas and activities, manage problem focus carefully, and ... don't sweat the small stuff.

Kenneth H. Little, MA / New Hampshire / 603-726-1006 / Achieve-ES.com

Synchronizing Values with Rules (worksheet)

The following is excerpted from Ken's Parenting Guide.

One of the most important things that parents can do while raising children is to teach them the importance of having strong character traits (more on this later) and a strong value system. A strong value system will guide children through the many challenges and difficulties they will likely encounter as they grow into adolescents and begin to move out into the world on their own.

Sometimes, family values become lost in the day-to-day grind and parents lose contact with the values that are so very important to them. By staying in touch with our values, we can keep them in the forefront of our parenting efforts where they will guide us to do the most good and be gifted by example to our children.

As an exercise, sit down and consider what your family value system is. Make a list of the most important values, the top 5 for starters. Then examine your family's rules as they are expressed in day-to-day interactions -- how they actually play out. Sometimes or often there is a conflict between what we think the family rules are and what they actually are in practice.

For example: many families value respect: respect for self, respect for others, and respect for property. Is respect represented not only in your family rules, but does it guide your family's daily interactions? Is respect guiding your parental interactions with your children?

What is your family value system?

List Values:

Ex: Respect -- self, others, property

___________________________

Family rules should be logically connected to your family’s value system.

What are your Family's Rules?

Examples of respect-based rules: speak respectfully to others; brush your teeth, bathe, wear clean clothes, eat healthy food, etc.; don't jump on the furniture or write on the walls, put your bike away, clean up any mess you make, help with chores, etc.

List rules:

___________________________

Please keep in mind that the way we behave as adults in any given moment may or may not express our value system. The purpose of this exercise is to help us remain more consistent with our value system, even in the heat of the moment.

Kenneth H. Little, MA / 135 Lee Brook Road / Thornton, NH 03285 / 603-726-1006 / Achieve-ES.com

Parents Are The Lighthouse

The Lighthouse

The lighthouse stands on solid, stable ground. It is a beacon of hope. It warns of danger and guides to safety. The waters around a lighthouse can be turbulent at times.

Parents are like the lighthouse. Parents are strong and stable. Parents are a beacon of hope, warning of danger and guiding children toward safety.

When children are emotionally unstable, when they are being tossed in the emotional turbulence of life, parents do not jump into the turbulence with their children. Parent/s endeavor to remain stable and calm. Parents invite children to come out of the turbulent waters.

When the parent/s become emotionally unstable, when they join their children in the turbulent waters … all is lost … until the parent/s can regain their composure, return to the safe, stable ground above the crashing waves.

Parents invite children to come out of the turbulence, to come to safety, to join them on the safe, stable ground.

All of the above applies to behavioral staff.

Printable PDF

K. H. Little Consulting Services

Kenneth H. Little, MA

cell: (603) 726-1006

kenlittle-nh.com

Medication Risks

Washington Post: Study Finds Possible Link Between Childhood Deaths and Stimulants for ADHD - washingtonpost.com

My response to the above headline is just below. Further down, I added some of the follow-up discussion from people who have struggled with ADHD.

Children with ADHD are several times more likely to have accidental injuries requiring emergency room treatment and die from accidental causes; ADHD teens are more likely to have serious automobile accidents and are at a much higher risk of unwanted pregnancy. The negative impact of ADHD on academic performance, peer acceptance, and self-esteem can be enormous -- all contributing to negative adult outcomes. ADHD is a significant childhood difficulty with many significant risks. All of the pros and cons have to be weighed in making a decision on how to support ADHD children in achieving better outcomes.

Best wishes,

Ken

See some of the follow-up comments posted in this Washington Post discussion:

Greg Sleter at 9:34am June 16
"As a parent with a son who has ADD, we did a great deal of research into behavior modification before going to medication. My son does not take Ritalin, but takes another medication and it has helped him immensely. He was not completing school assignments and losing focus when taking test. Since his diagnosis, his school work has improved immensely... Read More and his confidence has grown as well. While constant study and review of this topic is necessary, please don't paint everyone with a broad brush stroke. And thanks to Ken (see above) for his comments. In many cases this is not about "bratty" kids or drinking too much soda. ADD is a medical condition no different than, say, diabetes and needs to be treated."

Josh Rouch at 9:37am June 16
"Ken Little: you're awesome. Its like seeing my childhood summed up in one paragraph. lol. There are always risks involved when taking medication, particular narcotics but that does not mean that the risk isn't worth taking. It depends on what degree of risk. And I can personally attest to Ken Little's comment in that without ADHD meds like Ritalin ... Read MoreI would of been at higher risk of accidental injury. As it stands (or stood?), before I was medicated I got part of my finger cut off in a door, cracked my head open several times, and had my foot partially amputated by a riding lawnmower all before I was 7 or 8 years old. Then in college when my meds weren't working properly, I fell off a forklift from 18 feet and now have a traumatic brain injury. Thank god though for ADHD meds when I was growing up. I wouldn't have survived childhood socially, academically, or perhaps even literally."

Bonnie Brownstein Schendell at 9:37am June 16
"Ken Little hit the nail on the head with his post. I have a son with ADHD. It was my husband and me who knew something was awry long before school even began...and to the person who said it's soda related, get real. My son drinks no soda! His hyperactivity is not much of an issue anymore, but his impulsiveness and lack of focus are. And if you... Read More knew much of anything about the drugs, they don't make kids into zombies. That was the old days. And there are many drugs out there. Also, any informed pediatrician will have the patients go for heart scans, etc. My son just had his annual EKG...perfect results.

Please be informed before passing judgement."

Michele Somers Cullen at 9:53am June 16
Our 7-year-old is dyslexic and must attend a school geared toward teaching dyslexic kids. It's a very intense program, but it works. Before Ritalin the school said that he was being rejected because he was simply unable to focus on the work at hand (on the trial days), and that they didn't think they'd be able to teach him with that lack of ... Read Morefocus. After Ritalin, he was able to focus just fine, and as a result of attending that school, he's reading now. Our little dyslexic boy is reading on the same level as rising 2nd graders from a traditional classroom.

I understand completely the fears that arise as a result of over-prescribing drugs like Ritalin,and we had to weigh the pros and cons. He just seemed so young to be put on Ritalin, and hyperactivity was never his problem. (His ADHD was the "inattentive type.") But there are times when it truly is the answer. Until something better comes along, we're sticking with what helps him the most.

Sons and Behavioral Summer Camps

Mr Little,

I came upon your website after seeing a link on Facebook. I have been searching for information on Behavior Modification camps, programs, or specialists in my area all week as we have reached a breaking point with my 13 year old son. I think he definitely needs a behavior modification program that is aggressive and he needs it soon. The only camps I could find in the New England area are $6000 to $8900 per month for a residential program and this is not a possible option for my family financially.

Can you make any recommendations for doctors and/or programs in Southern NH for that could benefit us? I live just outside of Manchester, NH.

Any information you can share would be appreciated.

Reply:

Dear xxxxxx,

I'm and very sorry for your struggles.

I really can't wade in with an informed opinion as I do not know your son or situation. However, I do have some thoughts and suggestions that I can offer for your consideration.

Suggestions:

Find a Child & Adolescent Psychiatrist in your area. (http://www.aacap.org/)

Find a good therapist that will help both your son AND your family. If you have health insurance you should be able to get a list of professionals that can help.

Learn about / look into Ross Greene's "Explosive Child" approach -- it is excellent! (http://www.cpsconnection.com)

I would suggest staying away from behavioral programs. They may have qualified adults who may be able to help your son, but these programs will also be filled with other boys with similar problems. There is no way to be certain, but there is a risk that your son may get worse by attending a behavioral program. Children his age are very susceptible to peer influence, often more so than adult influence. Harvard Univ. published some research on summer camps for behavioral kids some years ago that indicated increased behavioral difficulties after attending behavioral summer camps. Further, an article entitled: "Forensic Psychiatry and Violent Adolescents: Risk Factors for Adolescent Violence" described the following -- "Risk factors were demonstrated to have different effects at different ages of development. Within the late-onset or adolescent group, most risk factors had only a small individual effect. In keeping with adolescent development, however, peer group factors had a strong effect such that association with antisocial peers, belonging to a gang or lacking social ties strongly predicted antisocial behavior." (http://www.medscape.com/viewarticle/571434_3)

I suggest that you spend your time and money connecting your son with healthy, growth producing, and self esteem enhancing challenges, activities, and peers that are non-behavioral: AMC (http://amc-nh.org/index.php), hiking, biking, skate boarding, and / rock climbing camps, tennis, sports, chess, Lego's / Invention camps, etc.

There are many protective factors that he will gather while attending these sorts of camps / activities while behavioral camps have risk factors associated with them that may end up being counter-productive.

Master advanced parenting skills for difficult children (see Ross Greene, or a family therapist, or a good behaviorist (a positive and proactive behaviorist), read Alan Kazdin's book: The Kazdin Method for Parenting the Defiant Child. Home based behavior modification and management is quite possibly the most important component of a child's well-being. Community and extended family supports and activities can be of significant value too.

Study and understand the adolescent stage of life. Your son is either currently experiencing or on the verge of experiencing a massive burst of life changing growth. Puberty and neuro-biological changes are underway that will affect your son's moodiness, way of thinking about life, and feelings. Sexual feelings alone can be distressing and destabilizing to some pre-teens and teens.

A thorough assessment of your son's strengths and weaknesses, of the issues and problems he and your family are facing is the first step. Once a comprehensive understanding is developed a comprehensive plan to resolve his difficulties can be developed too.

Please feel free to write with any questions or concerns.

My best wishes to you and your family,

Ken

Kenneth H. Little, MA
603-726-1006
KenLittle50@gmail.com
https://www.achieve-es.com