A Newsletter About Caring for the High Maintenance Child by Kate Andersen, M.Ed. Editor's Note: Kate Andersen is a parent educator and mother of a difficult child. She writes, lectures and consults with parents about dealing with their spirited children. Kate is listed on the Providers page. Kate also writes a monthly column called 'Ask Kate' to answer individual questions about real children and situations. 'Ask Kate' is now included as part of every issue of BDINews. Send your "Ask Kate" question to bdi@temperament.com. Due to the volume of mail, not all individual questions can be answered in this column. BDINews - A Newsletter About Caring for the High Maintenance Child by Kate Andersen, M.Ed. Published by Behavioral-Developmental Initiatives Issue Theme: Back Talk, Marital Conflict Volume 5, Issue 11 - June, 2003 www.b-di.com or www.temperament.com

ANNOUNCING: The Temperament Guides, Volume II: Activities for Early Intervention Professionals and Families, by Kate Andersen, M.Ed., with Sean C. McDevitt, Ph.D. Published by Behavioral-Developmental Initiatives. The Temperament Guides, Volume II - Activities for Early Intervention Professionals and Families is a very practical workbook to help parents understand and cope with the temperament of a two to twelve-year old child. It offers a step-by-step approach for learning new and positive ways of responding to temperament-related behavior and mild behavior problems. The principles and strategies in the workbook apply to any temperament profile. The workbook can be used as back-up material for families undertaking a program of individualized temperament guidance, such as that outlined in our first volume, The Temperament Guides: Resources for Early Intervention Professionals, or it can be used on a self-help basis by parents. The workbook is also very suitable for professionals who are seeking additional material to supplement the principles and practices outlined in the first volume. Over 40 new exercises have been developed for this workbook. Exercises which match parent handouts in the first volume are marked TTG 1, followed by the number of the page on which they appear in that guide. In the workbook, parents reflect on their hopes and dreams of parenting, consider briefly the situational stresses in their lives as well as their own childhood role models, explore their emotional and behavioral responses to challenging behavior, and learn about the distinction between behavior stemming from temperament and behavior which represents secondary problems. Parents are provided an arsenal of positive ways of responding to temperament and are introduced to a set of research-based tools for reversing true behavioral problems. To order by mail, send a check or money order, stating that you are ordering Volume 2 of the Temperament Guides, to: Behavioral-Developmental Initiatives 14636 North 55th Street Scottsdale, AZ 85254, USA 800-405-2313 602-494-2688 fax Cost: $39.95 US plus s&h. (Please note that there is a special price for ordering both Volumes I and II at the same time: $89.95 US plus s&h). To order online, go to www.b-di.com/shoppingindex.html For further information, email us at B-DI at bdi@temperament.com Letter to Kate Dear Kate: We took our 'high maintenance' eight-year old son to a child psychiatrist last week because we were so worried about his deep-seated resentment about being adopted. A social worker told us that our son had "adopted child syndrome". We've been reading your newsletter for over a year and find that our son really fits your definition of a 'high maintenance child'. The psychiatrist said that our son had Oppositional Defiant Disorder. He said that 'high maintenance temperament' was a load of rubbish and so was the adopted child syndrome. We are relieved in some ways, concerned in other ways. Can you help us sort out high maintenance temperament, adopted child syndrome and oppositional defiant disorder? Sincerely, Overwhelmed Kate's Answer Dear Overwhelmed: First of all, here's what Oppositional Defiant Disorder is, according to the American Academy of Child and Adolescent Psychiatry: "All children are oppositional from time to time, particularly when tired, hungry, stressed or upset. They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behavior is often a normal part of development for two to three year olds and early adolescents. However, openly uncooperative and hostile behavior becomes a serious concern when it is so frequent and consistent that it stands out when compared with other children of the same age and developmental level and when it affects the child's social, family, and academic life." They state that when children display "an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the youngster's day to day" they may be diagnosed with Oppositional Defiant Disorder (ODD). Symptoms of ODD include: frequent temper tantrums excessive arguing with adults active defiance and refusal to comply with adult requests and rules deliberate attempts to annoy or upset people blaming others for his or her mistakes or misbehavior often being touchy or easily annoyed by others frequent anger and resentment mean and hateful talking when upset seeking revenge Other Points About ODD § symptoms are usually seen in multiple settings § may be more noticeable at home or at school. The causes of ODD are unknown. The Academy states that many parents report that their child with ODD was more rigid and demanding than the child's siblings from an early age, suggesting a role for temperament and well as environmental factors. The Academy states: "A child presenting with ODD symptoms should have a comprehensive evaluation. It is important to look for other disorders which may be present; such as, attention-deficit hyperactive disorder (ADHD), learning disabilities, mood disorders (depression, bipolar disorder) and anxiety disorders. It may be difficult to improve the symptoms of ODD without treating the coexisting disorder. Some children with ODD may go on to develop a more serious conduct disorder." I asked Dr. Sean McDevitt, Editorial Consultant, to answer your questions about high maintenance temperament, ODD, and adopted child syndrome. He stated: "Oppositional behavior often arises when the youngster has had too many instances of negative feedback and then refuses to try to obtain approval from adults. Often the oppositional behavior appears more intense or more negative due to the child's temperament. Trying to "catch the child being good" and giving positive reinforcement for other behaviors will lead to a decrease in oppositional behavior. Parents and other caregivers need to learn to avoid the power struggles set up by oppositional behavior. With regard to adopted child syndrome, there is no one set of behaviors associated with being adopted. Adoption and the factors that sometimes lead to taking a child from one family to another are many and complex. It would be more productive to focus on the child's temperamental characteristics, a facet of behavior that is well established in research." BEHAVIOR - When Your Young Child Talks Back When you are concerned about your child's behavior it is very important to consider first your child's age or developmental level. Much trying behavior in young children represents a normal phase of development and takes care of itself in time. However, certain developmentally-appropriate behaviors can get out of hand and turn into behavior problems. A critical factor is how the important adults in the child's life (parents, caregivers and teachers) react to the behavior. Is it really backtalk? Talking back is a common complaint of families of children with high maintenance profiles. When we ask parents to explain and give examples we sometimes find that they are referring to perfectly normal behavior, such as the tendency of almost all two-year-olds to respond to every comment, suggestion, or question, with a resounding "No!" A patient and tolerant attitude is the best way to deal with this behavior, which we feel shouldn't really be considered backtalk. One family we know had a child who responded "No!" when offered ice cream, a ride on Daddy's shoulders, and a bedtime story. They quickly realized he just found it difficult to say "Yes". So they learn to ask him good-humouredly if that was a "no" that meant "no" or a "no" that meant "yes"! Some Toddlers Are More Negative And Persistent Than Others Parents of toddlers with especially negative, intense, inflexible and persistent temperament characteristics may find their toddlers' "terrible two's and three's" especially trying, since such children express their negativism more frequently it seems, and go on doing it longer. Many parents tell us they find such children more bothersome or distressing at age three than at age two, perhaps because parents' expectations change or because the children are more verbal and seemingly 'should' be more mature. Whatever lies behind the 'terrible three's', we can only recommend patience and firmness. Serious problems can begin when parents start to see their very young children as all-powerful or bad. We understand how parents can lose their perspectives, or even get worn out, when intense negativism and inflexibility go on day after day. If you feel you are not coping well with your hard-to-raise toddler, do get guidance from someone who understands both temperament and normal development. It is important to see a counselor who provides concrete coping strategies, with not too much emphasis on changing the behavior of the toddler. Distraction, or re-direction of behavior, patience, energy and marital support are the most important ingredients. True Backtalk True backtalk often begins around the age of four or so. Some children of this age begin to call their mothers names, sometimes kicking them in the bargain. Now 'normal' backtalk is turning into a behavior problem and it is definitely time to set limits. How To Set Limits To Backtalk With The Preschool-aged Child 1. First label the behavior and let your child know it is unacceptable. When your child responds to your requests with a very insistent "No way, dummy" you can label the behavior 'backtalk' or 'being sassy', whatever term you feel comfortable with. Remember, it is the behavior that is bad, not the child. "That is sassy, Melissa, and sassiness is not allowed in his house." "I don't like backtalk, Michael, and it's against the rules in our family." Make sure you and your partner agree about these rules and ask your child to repeat the rules back to you in simple words. 2. Make a distinction between backtalk and appropriate expression of feelings Your young child is entitled to have feelings and opinions, and learning how to express these confidently and appropriately is an important part of development. Offer your child choices when possible ("Do you want a hamburger or spaghetti for lunch, Sara?") and respect those choices. Help your child understand the difference between a rude way of answering and an acceptable one. Practice what you mean. "This is what I mean by a rude voice". (Mother demonstrates rude tone.) Above all, do not take your child's good behavior for granted. Get into the habit of praising her when she expresses herself in acceptable ways. "I like the way you told me nicely that the soup was too hot for you." However, do not allow your child to get out of doing almost everything you ask, just because she refuses nicely. 3. Establish a suitable penalty for backtalk A suitable penalty for talking back is a few minutes on a time-out chair (1 minute for each year of the child's age.) Use a kitchen-timer and add another minute for refusing to go the chair, for misbehaving in time-out (talking or kicking the wall), for a total of 10 minutes in time-out. When your child has served her time, make sure she does whatever she was asked before leaving time-out. For example, if your child talked back when you told her to pick up her toys, she must go and pick them up once time-out is over. Refusal will earn her another time-out. 4. Make sure backtalk and time-out don't serve as escapes from tasks Some children use backtalk to distract their parents from enforcing tasks they don't like doing. Even time-out may be preferable to doing the task. If the request was appropriate in the first place, make sure your child does what he or she was asked after time-out, or you may strengthen backtalk in spite of using time-out. 5. Deliver clear, enforceable commands one at a time Many parents fall into the trap of delivering a constant barrage of requests, commands, and admonitions to their children: "Don't with your fingers, Mike. Now, come on, sit up straight. What's the matter with you? Do you hear me? Pay attention to me. Come on, now, eat your lunch. Hurry up, we'll be late." Aside from the fact that Mike can't possibly know what exactly is expected of him, his mother can't enforce all these requests and commands. (In this case, Mike responded with backtalk: "Shut up, you loudmouth dummy!") Constant parental nagging and nattering are destructive to a child's self-esteem, and are common features of families whose children engage in backtalk and to go on to develop serious problems. We know that parents' behavior often develops in response to a child's difficult and trying temperament, but it is extremely important that parents change their own bad habits first before expecting the child to change. 6. Consider age and temperament in determining appropriate expectations Ask yourself what behavior you really want and if you must demand it now. When Mike's mother analyzed the situation, she realized she wanted him to get on with his meal because they had to go out. Mike is a distractible, restless four-year-old, but he is capable of finishing a meal within 20 minutes if he is help to deal with distractions. Mike's mother could have cleared the kitchen of distractions (e.g. turned off the radio), sat down with him (instead of clearing the dishes), focused calmly on him (instead of expressing her exasperation), and said simply, in a friendly tone: "Eat your lunch up now." Having appropriate expectations may reduce some of the frustration that prompts children to talk back. 7. Respond to backtalk calmly It can be very hurtful and sometimes frightening to parents when a young child talks back. Feelings from one's own childhood are often stirred up, and confusion about modern versus old-fashioned child-rearing are common. Some parents remember being punished severely for backtalk, and these memories can trigger angry rages or helplessness towards one's own child. If you have these feelings, consider getting counseling for yourself. 8. Don't set examples of backtalk Backtalk thrives in families where the rules are not clear or inconsistent and where there are marital arguments. Parents who talk back and argue constantly can hardly expect their children not to follow their examples. (However, you can still enforce the rules about burden is even if, for some reason, you cannot prevent your child from hearing it from others.) Family therapy may improve the climate in your home and to lessen the degree of backtalk. The strategies outlined in this tip sheet may be needed in addition to dealing with family problems, however. 9. Some children have tendencies to talk back We are aware that some children, because of their individual temperamental styles, are prone to talking back and arguing and send their parents have to use the strategies outlined here a great deal and over a long period of time. It is common to hear of such children gaining some self-control in this area, only to start up again later with a new version. One child was prone to talking back at age 4, settled down at age 6, and began arguing at age 8. His parents recognized the old behavior in a new guise and used basically the same strategies to get it under control. Good-humoredly, his father commented that his son was obviously a born lawyer and had reached the age of argument but not the age of reason. A philosophical attitude is probably wise when dealing with mild to moderate tendencies to turn some issues into a courtroom debate, especially if your child is generally cooperative and compliant. It is extremely important, however, to get on top of constant backtalk and frequent noncompliant behavior, particularly when these problems are accompanied by antisocial behavior, such as stealing and fighting. Children with these problems are often diagnosed with oppositional or conduct disorders. Professional help from a therapist who understands temperament, family problems, and who have a good grasp of current behavioral therapies is what you need. 10. Some children with special needs may talk back more. There are certain conditions in children which are associated with backtalk. Attention deficit hyperactivity disorder is one. These children have problems paying attention and controlling their impulses to a great degree, along with other difficulties. Attention deficit disorder is treated with medication, behavior modification and/or family counseling, but treatment cannot be expected to eliminate all the child's difficulties, including the tendency, in some children, to talk back. There is also an unusual neurological disorder, called Tourette Syndrome, in which children have tics and may engage in compulsive behavior, including swearing and talking back. Many are also hyperactive and have attention deficits. You can obtain more information on Tourette's Syndrome from: The Tourette's Syndrome Association Tel: 718-224-2999 http://www.tsa-usa.org/ Marital Problems and Children's Behavior For a long time, counselors and therapists have been aware that children whose parents continue disagree can develop a wide range of the emotional and behavioral problems. In fact, marital problems have been found to be the best family predictor of childhood behavior problems. That is, when a child's behavior problem cannot be attributed to a temperament-environment misfit, to hyperactivity, abuse, or a learning problem, and a family problem is suspected, the marriage is the most likely source of the difficulty. Exactly why and how marital problems affect children so badly is not known for sure, but research points to the following patterns: Boys are more badly affected by poor marriages. However, girls are by no means immune to ill-effects, but may show their suffering in less obvious ways. Boys, it is known, are more likely to 'act out'. One researcher found that antisocial behavior in nine to 12-year old children was much more likely to be from marital discord which occurred before and marital separation than from the separation itself. More recent evidence suggests that open arguing and hostility between spouses are more damaging than an unhappy marriage where parents are apathetic towards each other. Researchers and therapists have suggested that open hostility is likely to cause problems for the following reasons: Modeling Marital arguments may cause children to reject their parents as models. Marital conflict may interfere with imitation of the same-sexed parents. Marital disputes may cause children to imitate the hostile behaviors of their parents. A number of other suggestions have been made which link marital conflict more indirectly with problems in parenting. It is assumed that a change in parenting styles may occur when a marriage is in trouble. Parenting Can Be Affected Parental disagreement about child-rearing may be a main source of trouble and often leads to marital breakdown. Generally speaking,therapists find that disagreements about discipline or household rules, for example, can cause emotional distress and behavioral problems in children. This is likely to be even more the case when disagreements are open and the child feels that he or she is partly the cause of the problem. Parents of 'difficult' children, beware! Sometimes parents who are experiencing marital distress may see their children as more difficult or troublesome than they really are, creating new problems. This might occur when a parent is depressed, which is the case with many unhappy marital partners. Some believe that children's misbehavior can serve the function of distracting a couple from their own problems. The family inadvertently lets a child misbehave or fails to discipline or help the child. For the same reason, a couple might scapegoat the child. Or, in other troubled marriages, one partner may team up with the child against the other partner. All of these dysfunctional patterns can have adverse effects on children's behavior and emotions. These are just a few of the ways in which marital problems are believed to affect children. Unfortunately, many families are experiencing these difficulties. While we would like to take a positive approach, we must warn families that marital problems often do not disappear with time. Generally, both partners must recognize the existence of the marital problem and try to overcome it themselves or seek marital counseling. Sometimes an individual partner tries to protect children by refusing to get involved in arguments. While the strategy may benefit children in the short term, it is likely to be detrimental to the marriage in the long term. A more satisfactory way of resulting conflicts must be found. Changing negative patterns of marital interaction can be exceedingly difficult, but is highly rewarding when successful. Families experiencing these problems, especially when they have a child with a 'difficult' temperament or behavioral or emotional disorder, are strongly urged to get some help. Start by asking your family doctor for a list of marital therapists or call your local family services association. As well, many psychologists are qualified to do marital counseling. ONE PARENT'S STORY "Playing with our son was no fun, until...." I want to share with other parents some really important things I learned about how important it is to pay positive attention to your children. With our first child, playing with her and enjoying being around her came naturally. She was fun to be with and cooperated nicely with games like tea-party and hide-and-seek. Things were very different with our son. What made the situation so different with Jamie? Well, I guess, first of all, he had a sister to compete with. She was a highly verbal 3-year old when he was a toddler, and she found subtle ways to interfere when I tried to pay attention to him. Eventually, I had to teach my children that "This is Erin's time to play with Mommy" and "Now, it's Jamie's turn to play". Then, Jamie was different in temperament and interests from Erin. Most of the things he enjoyed, I didn't approve of. Also, because he had such a short attention span, just as soon as I got him involved in a game, he would lose interest in it and run off and get into mischief. Many friends and professional people told me: "Play with your child. Pay positive attention to him. Have lots of quiet times together." I knew it knew this was supposed to be good advice, but the problem was these people didn't know how hard it can be to pay positive attention to a child like Jamie. Finally, I got some help from a child psychologist who gave me some tips but who also listened to what I told him. Together, we worked on a way that I could play effectively with Jamie. In fact, he made us learn how to do this when Jamie was four, before he would teach us other behavior management techniques. You can read a lot of parenting books about time-out, but there's not much on playing with 'difficult' children. So that's why I want to share with others what we learned. First of all, we learned that we should try to set things up so Jamie could make suggestions. We would say: "What you want to play?" Before this could really work well we had to 'label' various games for Jamie. We read stories and talked to him about the things other children play -- e.g. pirates, house, Lego, blocks, painting puzzles, art center. Sometimes, Jamie would make an appropriate suggestion but often he would suggest something we couldn't go along with - for example, "lets paint this room". It was hard to be firm and not spoil the pleasant, positive atmosphere we were trying to cultivate. The psychologist taught us how to say calmly: "No, that's not appropriate, but we can paint on paper". Often that worked. A common problem was Jamie's over-excitability once he did get involved in something he really enjoyed. For example, he'd get into painting, and the next thing you knew he'd painted on the floor, on himself, and would want to paint us. Setting limits took patience and calmness. We learned to give him several large pieces of paper, to put a shower curtain on the floor, and to make sure he wasn't wearing his best clothes (we couldn't get him to wear a smock). When it came to painting us, we let him know that was definitely out. To teach him this, we had to calmly put the paints away and tell him: "You don't paint on people". It worked! Well, most of the time. Then the psychologist told us how to watch Jamie play and make positive and non-interfering comments. He would run a car across the floor, for example, and we had to learn to say things like: "That car's whizzing along" or "The red car's going up the ramp and the blue car's coming down". It sounded stupid at first, but it was very effective. We were amazed at how often we were sending mixed messages to Jamie about playing. We used to say. "Why don't you settle down and play?" But when he started, we'd criticize: "Not on the table, Jamie". The psychologist explained to my husband and me how important playing was for Jamie to learn how to focus his attention, develop his imagination, and practice skills. For a child with a short attention span, learning to play in a constructive way is really important, but we actually had to train Jamie to do this. We developed a routine of playing with Jamie and Erin individually and that included watching them play for 20 minutes a day at first. I can't believe what a difference it made to both children in terms of their general happiness and behavior. It paid off so many ways. Jamie's attention span stretched and stretched, although he's still a frequent changer, and he learned to start playing appropriately by himself. Finally, some peace for us! Erin has stopped interrupting us so much, now that she has her guaranteed play-time with us. Twenty minutes a day isn't much, parents. Your children deserve it as much as mine. RESEARCH NEWS McClowry S, Galehouse P. (2002). J Child Adolesc Psychiatr Nurs Jul-Sep;15(3):97-105. Division of Nursing, New York University, NY, USA. sm6@nyu.edu Planning a temperament-based parenting program for inner-city families. TOPIC: The design of a temperament-based parenting program for inner-city families. PROBLEM: Selective intervention parenting programs are needed for children who are at high risk for developing behavioral problems. Planning should incorporate cultural considerations to ensure the program meets needs. METHODS: A pilot study to assess psychometrics of instruments, obtain preliminary date, test feasibility, and verify appropriateness of the intervention. Reports of child temperament, behavior problems, and maternal distress were obtained from a sample of 244 inner-city mothers of school-age children. FINDINGS: The three instruments showed adequate reliability with this sample. Attendance rate was 92% for the 18 mothers who participated in the parenting intervention. Focus groups supported the content of the program. CONCLUSIONS: A pilot study can assist nurses to plan an intervention that responds appropriately to the specific strengths and needs of the community. Blair C. (2002). Dev Psychopathol 2002 Spring;14(2):311-32. Early intervention for low birth weight, preterm infants: the role of negative emotionality in the specification of effects. Department of Human Development and Family Studies, Pennsylvania State University, University Park 16802-6504, USA. cbb11@psu.edu This study examined the relation of negative emotionality in infancy to child social and cognitive developmental outcomes among low birth weight (LBW) preterm infants participating in the Infant Health and Development Program (IHDP), a comprehensive compensatory education intervention beginning in infancy and lasting through age 3 years. In this analysis, intervention effects at age 36 months on maternal report of child behavior as assessed by the Child Behavior Checklist externalizing and internalizing scales and on intelligence as measured by the Stanford-Binet scale were largest among children characterized by higher levels of negative emotionality in infancy. Findings indicate that for LBW preterm infants characterized by negative emotionality at age 12 months the intervention was associated with a twofold decrease in the occurrence of clinically meaningful levels of behavior problems at age 3 years and a fourfold decrease in the occurrence of a high-risk profile in which both internalizing and externalizing scores are in the clinically meaningful range. The intervention was also associated with a fivefold decrease in the occurrence of IQ < or = 75 at age 3 years among children with higher levels of negative emotionality and heavier LBW (2001-2500 g). However, specific aspects of temperamental difficulty such as fearfulness and anger were related to internalizing and externalizing, respectively, in both the intervention and control groups. Findings are consistent with research linking negative emotionality in infancy with social and cognitive developmental outcomes in early childhood among normal birth weight infants. Results suggest the need for further attention to child temperament in early intervention research.