Changing The Way We Give Directions

"Ah well, we come from a society which treasures 'obedience' in children...I guess we must shift our focus from "because I said so" to "because you have as much to gain from it as we do."  The way I give her the direction, my daughter must also feel ownership—isn't that what you mean about changing the way we direct Ananya?" her father asked.

Here are some examples on how Ananya's parents gave directions:

When starting any activity, the directions were very clear in their expectations.

• “Today these are your two choices. Which one do you want to start first? Remember we can do the second activity only after the first one is completed.”
• Giving two choices gave her control over the routine without being overwhelmed.
• Reminding her beforehand that she had to finish one before moving on to the next prepared her what she had to do.
• If she tried to negotiate for something completely different (and the parents didn’t want to do that activity) then they were asked to address it and say, “Sorry, you have to choose between these two. That is not a choice,” instead of “No! We can’t do that now.”
• If Ananya got upset, they just had to wait her out.

The directions also addressed time constraints.

• “You have 15 minutes to finish your art project. I’m going to set the kitchen timer for 15 minutes. When it goes off, it will be time to stop and clean up.”
• When the timer sounded, they said, "It is time to stop and clean up. Go put your project to dry first." The specific step (putting the project to dry) gave her a starting point for the clean up. 
• If she didn’t stop and clean up, her parents had to remind her once and ask, “Would you like me to help you clean up?” or “You can start cleaning up yourself or I’ll have to help you clean up. Which one would you rather do?”

When Ananya wanted to negotiate for longer play time or a different activity, it was up to the parents’ discretion—but always followed by possible consequences.

• “If we don’t leave the playground now, we won’t have time to make the special treat at home. Is that ok with you? Remember you are making this choice. Even if you are sad later we can’t work o the treat.”

When Ananya got upset, parents were asked to validate her feelings. Some situations can’t be changed and the child has to understand that. At the same time there doesn’t have to be a long drawn out explanation or apology.

• “I know you are angry because we can’t stay longer. But we have to go to…it is not a choice.”

Other instances provided opportunities to learn coping skills.

• “I know you are disappointed because you couldn’t play with XYZ. He has a doctor’s appointment...maybe we can call and make a play date for another day instead?”
• Ending the sentence with an alternate plan reiterates that something can be done about the situation.

Ms. S

Tightening Ananya's Routine

After School:
Right after they got home from school, Ananya's day was broken up in to periods of unstructured time (for play, snack, freshening up) and structured time (for homework, special project work from school, special classes like swimming and dance). The key was not to overwhelm them with too much of the same kind of activity. Additionally, Ananya had separate activities with her mom or dad as part of her ‘special time.’ This way she got attention in a positive situation without having to share with her sibling.

Dinner Time:
As mealtimes were a major cause of discontent leading to a hungry and upset child and delayed activities, the parents decided to make it a pleasant experience. The focus changed from getting through dinner to engaging the children.

The girls identified a special activity they wanted to do after dinner time with either parent—sometimes it was working on a jigsaw puzzle or a card, other times it was reading a favorite book. One parent was left to do any additional work which came up while the other engaged the children. This served as an incentive for the girls to finish dinner on time and saved the parents from having to ‘get on her case.’

Ananya was given a special chore at dinner time. This was another step to foster a sense of control over her routine.

To expand Ananya’s food choices, her parents decided to include the her in planning the menu and in some of the preparations. They knew that there would be no changes overnight. But all these were for long term benefits anyway:)

Preparing For The Next Day:
Ananya’s parents used a checklist of steps such as setting aside the clothes, packing school bag, and lunch, to get ready for school. Ananya did these with a parent’s help before bed time. Her bags were put in the same easily accessible spot for the morning. While her lunch was packed fresh in the morning, she picked a special treat for dessert the night before.

Winding Down
All physically vigorous activities, TV or computer programs were scheduled before dinner, while after dinner activities were more calming. The day almost always ended with a book, helping the children wind down before bedtime.

These were some of the changes at the start of the program for Ananya...with the idea that as her self control improved or her needs changed the approach too will change.

To be continued....

Ms. S

Sensory Motor Development, Sensory Integration, Sensory Processing

In case you are wondering...this has to do with how we make sense of the world around us.  We use our senses to gather information, process the same and respond accordingly. 

This includes vision, auditory (hearing), tactile (touch), Olfactory (smell), Oral (taste, texture of food), vestibular (balance and movement) and propriceptive (position of body in space)Normally we take this for granted.  But sometimes there is either an over or under sensitivity and our body has to work harder to make sense of it. 

Sensory integration deficits can be in varying degrees—and limited to just one area of sensitivity. It can occur withor without other conditions and disablities. 

Sometmes I hear people say, "Oh no, one more thing to work on!"  There is a very good reason to work on your child's sensory integration—because a child trying over run by sensory stimuli

• is not available for learning 
• has difficulties in social situations
• needs more emotional support than otherwise.

Imagine yourself with a severe migraine and sitting in a brightly lit room or walking through a crowded and noisy street.  I know I will want a respite from all that sensory overload. 
 
Typically a developmental occupational therapist will do the evaluation and suggest a 'sensory diet' based on the child's needs.  Here are some links, incase you want to know more...

www.sensory-processing-disorder.com/

http://www.comeunity.com/disability/sensory_integration/

http://www.ldonline.org/article/5612

Ms. S

The Why And How Of Intervention For Ananya...

All of us agreed on one important point—we had to be consistent with the intervention and not give up after a week or two. Some of these were long ingrained habits. We had to eliminate the behaviors and replace them with appropriate behaviors which will serve the little girl all her life. We weren’t looking for quick fixes or trying to mould the child into anyone’s vision of ‘perfect’ness. So we chose behaviors which particularly interfered with her learning and socializing, and her self esteem. If a particular strategy was difficult to follow or put extra pressure on the parents/ teachers, we decided to come back to the drawing board and ‘tweak’ it up.


It was not all about teaching Ananya. We, the adults too had to learn some things.

• To prevent melt downs we had to give directions in such a way that Ananya would be inclined to follow them and set boundaries with Ananya’s input
• To stop an outburst from escalating we had to work more on redirecting and supporting Ananya during stressful periods 
• To raise her self awareness and self regulation skills we had to remember when and how to discuss her behavior and set consequences.

Parents had to accept these even if they were tired after work, and teachers, even if they had other students clamouring for attention.  The mom remarked, "This is like rewiring my brain—to take the same problem and see what I must do differently before I can expect her to respond differently."

Ananya’s parents felt that when they were able to give her attention by doing things with her, it made a big difference to Ananya’s behavior. So they decided to spend more time with her. They had two choices—reduce the number of hours they worked (at least for one parent) or hire someone to do household chores when they got back from work.

In addition to this we suggested that they see a developmental occupational therapist—there was a possibility that Ananya had some sensory integration issues, especially with her tactile defensiveness.

Next we'll discuss the changes to Ananya's routine and the behavioral intervention...

Ms. S

Ananya's Routine...

On good days, Ananya's parents were able to engage her in tasks before she had a meltdown, prepare her for transitions and follow the day’s routine. She enjoyed playing with her sister and helping her at dinner and bath. She liked doing household chores like setting the table before dinner.

The parents' work hours fluctuated based on deadlines and meetings. On long work days they were tired and stressed. They noted that Ananya picked up on these cues and called the shots on those days. She had a much harder time following directions—even simple tasks like putting away her toys led to power struggles. Every activity got dragged out delaying the next. If either parent spent time with her sister, she started competing for their attention by whining and crying. She got upset if she had to wait for her turn, or if her parents set boundaries.

Ananya ate very few types of foods and preferred junk food. (Which 6 yr old doesn’t?) When offered other choices, she took more than an hour at dinner time. (This was a problem at breakfast time too-making her rush to school). This in turn reduced the amount of time she had with her parents before bed. Planned activities were put on hold and she felt that it was not fair. Calming down took a long time and usually took the rest of the night.

One fact stood out—Ananya didn't always sleep well. Once she was up, it took her a long time to fall back asleep.

Looking at the situation in our class, we noted that Ananya liked a predictable routine. When there were changes (like a school trip, guest speaker) she did much better when an adult was near her to support her. Otherwise she wandered around, or talked out of turn constantly and distracted others.

We realized that she was more irritable on the days her sleep had been interrupted. And there were a few observations by the different members at the meeting which made some sense when we put them together.

“Ananya doesn’t like to walk barefoot at all! Even at the swimming pool her toes curl up if she doesn’t have her sandals on.”


"Ananya doesn’t like anyone coming too close to her, especially if they are moving fast. If by accident anyone touches her, she cries that he/she hit her, when in reality they just brushed past her."

"On the playground you can see her engaging almost always in sedentary activities rather than active play. She likes strenuous physical activities only if it is something she can do on her own (like riding a bike)."


"She says brushing her hair is really painful. I am thinking of cutting it short to help reduce our battles in the morning."

The next step was to draw up a plan to help Ananya at home and at school.  These involved making changes in the classroom, at home and seeking other professional help.
To be continued...

Ms. S

“How can so cute a child be so much work?” was the question in the teacher’s room.

“Is she just spoilt? Her parents seem so matter of fact and non fussy. What is going on?”

Yes, Ananya had a lot going for her—quick witted, pretty eyes, curly hair, smart and a beautiful smile. Except that the smile was not always forthcoming if she didn’t get her way.

If a peer joined her in an activity, you never knew how she would react. If it was an irritable moment, that’s it. You could hear her yell across the classroom. If someone brushed against her accidentally, if her written work was not to her liking, if she had to clean up before moving to another activity, if she had to wait for her turn…the list of ifs was getting longer.

For all that Ananya was a very kind and considerate child. Her classmates genuinely liked her and sought her out in between her outbursts.

We knew we had to find out the whys and the whats to help Ananya. We compared notes with the parents at conference time. They looked exhausted because she controlled everything at home. Both of them worked and had someone in to care for the kids after school. Ananya was extremely rigid and wanted everything only her way. If they tried to compromise, they needed the rest of the day to deal with her tantrums.

All of us put our heads together and looked at her daily routine to find more information in the following areas:

• Eating habits
• Sleep patterns
• Ananya’s chores (if any)
• After school schedule
• Caretaker’s role
• Triggers for tantrums
• Patterns in Ananya’s behavior when she threw a tantrum (crying, yelling, throwing, any self injurious behavior)
• How was her behavior dealt with by a) parents, b) caretaker?
• Did the parents find any specific approach to be positive/negative?
• Given the choice, what were Ananya's favorite things to do?

Some of the information surprised us and others not at all.

To be continued...

Ms. S

"He is weird, Mom!"

I don’t know why he has to be my partner!” the girl whined as she walked home with her mother. I happened to be walking back from the vegetable market and my ears pricked up. (I know it is a bad habit to listen in on other people’s conversations but I’m sure everyone in a 2 block radius could hear this. They were loud).
The mom replied, “Did you talk to your teacher that you don’t want to be in the same group with him?”
“Yes I did. She asked me why and I told her he was weird and laughs all the time. Then she said she’ll help both of us to see how we can learn to work with each other. Everyone in class will laugh at me because he is my project partner!”

I thought to myself “Hat’s off teacher.”

Children have a natural tendency to be kind. When group dynamic sets in, they are equally capable of picking on one another or at least not standing up for the other child. A good teacher will pick up on the signals and make sure that the students get the necessary academic and social skill support.

The teacher in the example recognized that both students-the complaining girl and the weird boy needed help maybe on the academic but definitely on the social skill front.

Cooperative learning is an excellent strategy to teach these skills in the classroom. Teachers, remember that cooperative learning is more than just breaking up the pupils into small groups.

Students in each group will have varying abilities. The task must be challenging and interesting to motivate all of them to work together.

All students in the group must participate…otherwise one or two end up doing all the work while the rest play around. There is no equitable academic learning in this situation and poor social interactions don’t really lead to acceptance either.

In addition to increased academic skills, cooperative learning lessons must be structured so that students gain
1. Social skills such as:

• Listening to each other
• Turn taking
• Leadership
• Decision making
• Social problem solving
• Communication skills

2. Work Skills such as

• Staying on task
• Participating in group tasks with limited adult supervision
• Interdependence and
• Accountability

If teacher foster all these skills in their coooperative learning activities, even competitive parents will take a step back and appreciate the social gains.

Ms. S

"Here comes ‘brainy.’

Let’s have some fun,” one student signaled to his friends. As the unsuspecting 9th standard student walked past the teasing began. “So Brainy, are the answers for the test engraved in your brain?” asked one peer. “Come on this is Brainy you’re talking about. He’s got the text book for this year and the next memorized. He’s ready for college guys!” another retorted.

How familiar are you with this scene? You were either being teased or you were the teaser, right? In most cases these are friendly and fun filled rites of passage.

Young children are more receptive to adult influence and so it is easier to direct them to learn or participate in activities. Peer influence is greater starting in the pre teen years. If your child’s peer group feels that learning is important then your child is prone to be comfortable with the idea of academic success. Which teenager wants to stand out as being different?

One of my closest friends (an excellent student because she enjoyed the process) always came out of exams complaining that she didn’t do well. I used to wonder about it but in retrospect I realize it’s because she didn’t want to make it seem too easy in front of the others. Some of my classmates did make unkind remarks in the guise of complimenting her. Yet, when the results came, she was almost always the topper. The side story is that I learned a lot from our group studies...not the subject matter but how she targeted her study prep. I learned to make organizational charts, use visuals as memory aids and checklists to monitor my prep work. Much later she told me that I helped ease some of her test anxiety because I was goofy and kept things in perspective. (I wish I had known that then:))

As parents and educators we understand the value of education. I suppose that is what causes us to search high and low for the ‘right school’ for our two year olds. But over emphasis of just one aspect of this ‘value’ can lead to harmful effect too. We can’t all have children who are focused on academic achievement. Nor should there be a grouping of only like minded and similar ability groups in the classroom.

As a teacher I would be bored to death if all my students held the same ideas or came with similar capabilities. More than that, I would be extremely concerned if my students stayed within their comfort zones and interacted only with those who shared their values. Pairing peers with strong academic skills (and motivation) with students who need to be nudged in that direction gives both parties an opportunity to learn and appreciate what the other has to offer. It takes away the element of competition and fosters cooperation. Along with the academic skills there is all that social learning happening simultaneously.

Teaching respect, understanding and acceptance of the differences in human beings can happen naturally in the classroom if teachers (and parents) push for it. This is mental health too.

Ms. S

The child refused to let go off his mother's hand...

This was turning into a pattern. Rajan walked up to the school but balked at the gates. After being cajoled into the classroom he cried for about ten minutes. But if you saw him after the first period you wouldn't know that he had had such a difficult start to the day. Rajan participated in all the activities and seemed to enjoy himself with his friends. 

His teachers worked out plans where he could choose to call his mom, make a card for her or send an email—all to help alleviate his anxiety. But they knew it was a stop gap measure. One afternoon at dismissal time they sat with Rajan and asked him how they could help. “What can we do to help you come into the classroom without feeling sad?”

“Maybe I can play with a friend when I come in,” was his very thoughtful answer.

The teachers took his idea and widened the scope a bit. At the beginning, any peer who came to class before Rajan walked up to the entrance (with a teacher) and waited for him. The transition was much easier. The boys walked to the class and then spent about 5 minutes reading together, organizing the blocks shelf, or drawing. After a couple of weeks, Rajan walked up to class himself and asked a different friend to join him in his ‘special activity’ for the day.

Six weeks later Rajan’s teachers reported that he no longer needed any time set aside…occasionally when he felt anxious in the morning Rajan did ask his teachers “Can I sit with a friend for a few minutes?” The teachers recognized this as a self help strategy.

The teachers have had to manage other tricky aspects too. They had to be careful not make Rajan seem needy in the eyes of the other students; they also had to make sure that they supported other students who were looking for attention. How often do we hear kids ask, “But, but…why does (s)he get to do that?”

It is difficult for kids to understand that being fair doesn’t mean being the same for everyone. The teachers were matter of fact about the program and their students responded by being accepting. Watching the program being weaned off also helped them understand that, “At times people need extra help.” This chimed in with their idea of being ‘fair’ (as Rajan didn’t get to use it all the time).

Children often have insights into how to meet their needs. Ask them for ideas. It helps to share that control in your class. Social acceptance and positive peer relationships help many a child deal with anxiety and stress.  Make sure you foster strong social interactions. 

Ms. S

The Mind Matters-How Do We Recall?

The more we learn about the mind the more complicated it gets. Here's information on a fascinating new study on depression:

Depression and Memory

Ms. S

“We grounded her—we’re trying to decide if she can go to the senior prom.”

My friend’s daughter hid some fruity alcohol drink in her knitting kit. My friend went looking for some yarn and sure enough found the bottles. The young girl said that they belonged to her friends. (My husband called it a rookie mistake—it is such an obvious hiding place according to him).

“I believe her—they probably thought no one would suspect her. But I want her to understand that more than anything else this is a safety issue. She has been ok with the consequences but at the same time I want to be fair to her,” the mom noted as she was trying to decide on what was best for her child.

I remember another friend with her children, four boys. Every chance she got, she talked about the dangers of underage drinking—and always ended the conversation with, “If you are ever with friends and you are all drunk, call me. I will come and get you no matter what time it is or where you are. Do not drink and drive.”

The incidences were few but they always had consequences. “A lot of people think I’m permissive by adding that last bit. You know what? I’d rather have them alive to have the ‘day after’ talk with me than do something foolish from which there is no coming back.”

Parenting is a lot of fun. We start with goals based on our best and worst experiences as children. We build up ideological pyramids about how we will manage everything and how our child will turn out to have everything just as we planned.

When reality sets in the most effective parents make the necessary changes. They still manage to get their two bits in about standards and ethics, and expectations but they understand that they have to look at it from their child’s perspective. This doesn’t mean a lack of consequence but fair and reasonable consequences.

In the end my friend realized her daughter didn’t want to go to the senior prom—she had just joined the school mid way as they had transferred from a different state. The young woman had a tough time breaking into the set groups in her class. Not going to the prom would have only made her even more of a spectator. So her parents worked out a different system and she did go to the prom with a small group of friends.
Ms. S

Another Life Shortened continued...

Unfortunately for me, I read the comments to the news article. I don’t know which shocked me more—the lack of awareness in the so called 'friends' or in his critics.

Several of his friends and fellow students mentioned that they knew he was upset and depressed. The following comment is really worrisome…

For him it was his SELF-RESPECT. That was his priority.. He preserved it.. He didnt cry 4 days n months b4 he dead.. He made his decision long ago.. He LIVED as long as he lived.. He died in his fav place @ his fav tym whn he decided to die.. appreciate his courage dude!! Hw many can hav dat??

OK…What is wrong with this picture?

First off, if you know that someone has been planning suicide for a year—that person needs help! It is not the sign of friendship not to let family and others know that this person is thinking of ‘suicide.’

Second, there is no glory here—if someone lets you know that he/she has been planning suicide for a year, it means he is asking for help. He is in effect telling you, “I can’t deal with this stress. I’m thinking of suicide and am letting you know. Please help me and stop me from doing this.” It may not be all these actual words but that is what he is telling you!

Suicide has no self respect component! It is either an impulsive decision or in this case, an inability to understand the bigger picture and cope with the situational stress. If it was a case of clinical depression, that too would have been evident.

Other comments from friends also mention that the student was shocked by what his professor said. Why didn’t any friend take the time to spend the day with him? Yes, the professor maybe at fault? This tragedy have been averted if any one of his friends witing comments had spent time with the student until his family arrived

At the other end of the spectrum are comments such as:

“No sympathy for the boy. If he could not fight the simple challenge then how he can face the world.”

A sweeping assumption that everyone has to deal with everything without any help, this very attitude stops youngsters from asking for help.

We all face difficulties in life—sometimes we are strong and other times we need help. None of us is strong all the time.

“Brilliant mind yet a foolish and weak person at best.”

Really? Isn’t it amazing how the ignorant make their point of view sound like a fact?
Suicide is not about being foolish or weak minded. This is one of the most debilitating myths we Indians have about suicide. Why do I say debilitating? By putting the blame on the person who commits suicide society can continue to function in its set ways—without any introspection. We don’t have face uncomfortable questions such as “Was I wrong? Did I handle the situation correctly? What can be done differently? How do we reach out to others to prevent any further tragedies?”

Has our educational system and society become so driven by ‘technical knowledge’ that we can’t see the frailties in the other person? When did we become so helpless that we can’t read others’ distress signals and spend a day with them?

Maybe we glorify or revile suicide because it allows us to be ignorant and abdicate responsibility.

Ms. S

Another Life Shortened...

A second student from a top institute commits suicide within three monts of the first. Why? His course completion was delayed by six months. Obviously there aren’t many details in the news or what is presented is so fragmented with a lot of “He said…” “He did…”

This post is all about questions...

Questions for the institute:
Was there enough counseling? Was he given accurate progress reports? Did he have the right guidance? In light of the fact that he was given an extension, there was a difference between his self evaluation and that of his professor’s. Did someone realize this and bring it to his attention?

Did anyone keep track of possible professional psychiatric assistance he may have needed?
Was anything and/or everything documented?

Is there any awareness program for the staff who work directly with students? Do they stop to think about how they present criticism? Do they understand that not everyone accepts criticism or disappointment in the same light and prepare for it?

Questions for the family:
What level of pressure was there from his family? Did they understand that the student was facing difficulties? Was it to do with academic performance or was it interpersonal relationships (with his professors)?

Did they take the time during his growing years to explain that there maybe moments when he would fail…and that it was ok! Did they explain to him that they will listen and be there to help him if and when did fail?

Did they teach him the importance of asking for help—for academic and emotional sustenance? Did they cite examples from their lives where they faced failure and survived? Or was it all "Oh I was very accomplished, organized, always successful...?"

If I sound harsh, it is because we talk too much after the fact. Maybe some other professional or parent will read this and be proactive. Maybe they will make a concentrated effort to address these questions before another student shortens his life.

Ms. S

Don't Tell Anyone! Hide It...

My wife was very concerned that my daughter was too young to understand these issues. But I insisted. I see too much in my profession not to know that children’s lack of knowledge provides opportunities for people to take advantage of them. I’d rather my nine year old hear from us about sex and identify when a predator is making inappropriate advances than be bewildered because she doesn’t understand.

The doctor was helping us find a work place for one of my former students and he sensed the mom’s concern. Here was a vigilant parent. We’re still on the search for a safe and challenging work place for Mala but his opinion ties into my previous post.

How many children are confused through their childhood because they don’t understand what is happening? They feel uncomfortable but don’t know why. So many children understand that what happened to them was sexual abuse in high school in biology class!

Am I making you, the reader uncomfortable? I hope so! Maybe this will shake just one person out of our ‘don’t tell anyone, hide it for it is shameful’ syndrome.

I see far too many children who have had to deal with sexual abuseat the hands of adults. It is difficult to be calm about this. We shouldn’t always wait for disaster to strike us or our loved ones to do something about a problem. We can’t wait for all of us to have the opportunity to help a child make sense of this loss of trust, or support a grieving parent outside an emergency ward because their child couldn’t bear it.

What should we do?

First teach your child that no one should touch them. We all talk about strangers offering candy but please…give more details than that. Talk to your girl AND your boy. It is not just adults who can be sexual predators. Sometimes it is other children as well.

If your child reports an abusive incident—believe your child, confront the predator. A child who sees his/her parents confront the abuser learns to be confident in interpersonal relationships. As adults they will learn to develop trust in their partners.

Do not be afraid to report the person to the authorities. In the West, sexual predators go on the criminal database. If you work with children, you must have your fingerprint checked; your local police station runs your information through the database to see if you have record. It didn't happen out of nowhere in these places...parents fought for their children's rights.

Parents, if you don’t report it we will never get to the stage when our children will be protected by law. There will be no background check possible nor any punishment for the offender. He or she will be free to repeat the criminal behavior

Let’s not wait until a child we know is the victim.

Ms. S