Archive for November, 2010

Nov 14

Damon Korb:  Meltdowns to Shutdowns 

In early November, 2010, Parents Education Network in San Francisco presented Damon Korb, MD, whose specialty is developmental and behavioral pediatrics. He is the Director of The Center for Developing Minds which provides care for children and young adults who struggle at home and at school.  This specialty clinic, located in the Silicon Valley, focuses on behavior issues, learning difficulties, attention problems, social skill deficits, Autism spectrum disorders, developmental delays and psychological disorders. 

Dr. Korb’s topic was Meltdowns to Shutdowns. He began with an encouraging statement.  Most children grow out of their meltdowns meaning that they have learned the skills they need to handle their behavior.  He went on to state that oppositionality is a normal behavior as the child matures. Beginning at birth, a baby chooses either to gaze directly or averts it. At 8 weeks a baby begins to initiate a “dialogue” showing what he or she wants. At 9 months, they want Mum.  At twelve months tantrums can begin.  At 4 years the child has confidence and will start wandering off and so it goes. 

According Dr. Korb there are four ways that oppositional behavior can be defined: by becoming familiar with a child’s temperament, environmental facts, a child being thwarted of a need and failure to learn pro-social behavior. 

Dr. Korb throughout his two-hour presentation kept returning to the importance of understanding the child’s temperament. He cautioned: if you are a parent set on a path that your child needs to take in life and it is in conflict with the child’s temperament, this is a recipe for oppositional behavior. 

When defining the child’s temperament he suggests considering several components: a) what is their rhythm to determine their regularity, b) how do they respond to new information, c) how adaptable are they, e) are they intense by nature? f) what is their mood pattern? g) what is their attention span – are they easily distracted, are they persistent and h)are they sensitive?  

He offered several temperament tips that increase results between a parent and child.  Remember to appreciate your child’s strengths, give positive messages about the child to the child along with lots of praise. Keep in mind you can help your child change behavior but not their temperament. Avoid criticism for things that are just about individual style.  Let your child know that you are listening. 

Environment factors revolve around the kind of environment parents are providing for their child. If a child is growing up in a stressed environment caused by marital discord, poverty, legal problems, mental health, depression, anxiety, drugs or alcohol it is most like that the child will exhibit oppositional behavior. He commented that he and his staff spend a lot of time working with parents, encouraging them to focus on their unresolved issues.  He cautioned: parents who are not managing their behavior be aware, your children will copy your undesirable behaviors.   

The third characteristic, thwarting of a need is both simple and complex. The simple: ensuring the child is being given food that serves him best, has lots of sleep and many hugs. The complex revolves in part around issues like – the need to provide regulations/house rules so that the child can learn how to regulate his or her life. In Dr. Korb’s family, dinner every night is at 5 pm and his five children are expected to be present. They have specific times when they are to be in bed. A special effort is made to control noise to avoid over stimulation. 

Dr. Korb made reference to Dr. Eric Erickson, a DanishGermanAmerican developmental psychologist and psychoanalyst talking about his theory on social development. There are eight stages, four of which were mentioned during this talk:

  1. Hope: basic trust is the first ingredient for an infant.  If trust exists at that age, the child is more likely to grow up believing what you say.
  2. Will: autonomy versus shame and doubt.  This is tricky.  The toddler wants freedom and must be offered it and at the same time the child needs to learn how to limit him or herself.
  3. Purpose: initiative versus guilt.  The kindergarten child needs to express creativity but can easily put into guilt if the discipline process is not consistent and generous.
  4. Competence – Industry versus inferiority. Age 6 to adolescence. Self worth becomes an issue here.

 Failure to learn pro-social behavior.  Dr Korb was clear that the responsibility for the child to learn social behavior lies with the parents.  Setting criteria and keeping to it is essential for every aspect of the child’s life.  So, when the child doesn’t turn off the computer when asked, set the criteria and then hold to it.  Give warnings:  “You have five minutes more on the computer.  It must be shut down within five minutes.”

 If a child is given time out, when they re-join the activity find a reason to complement them.  Then, later when the issue is no longer a sore point, find time to discuss with the child what happened and re-iterate the criteria. 

Dr. Korb spent some time talking about behavior patterns coming from a learning disorder and offered several areas to consider:    

  1. Executive skills. This function is controlled by working memory.  The child’s ability to organize and plan his or her life is a component.  They need schedules, lists, routines so the parent doesn’t need to nag so much.  They need to be prepared to handle change.  . 
  2. Language processing skills. These children need to know how to communicate, how to express what they feel. This is essential for them to stay out of trouble. 
  3. Find ways to send a message that celebrates the strengths of the child.

 If a child experiences a meltdown, recognize that it is a panic attack. Be with them helping them to find a way to calm down.  Once the meltdown is over consider the steps to take. If it’s a teenager who experienced the melt down, it’s time to consider where they are developmentally when they are in the behavior of melt down.  It may be necessary to back up with parenting to that level. Remember: to the child, it’s not about the meltdown it’s about everything that happened before the meltdown.  Later, when discussing the meltdown with the child, make an effort to diffuse the situation by offering collaborative problem solving.  In summary Dr. Korb said behavior problems are learning disorders. Meltdowns are 99.9% predictable. 

Dr. Korb recommended three books:

  • Carol Gray’s Social Stories. These books describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format. http://www.thegraycenter.org.
  • Michelle Garcia Winner and Chris Abildgaard’ book  Social Thinking and Applied Behavior Analysis is one several publications addressing the needs of individuals with a broad range of social and communication challenges in their communities. www.socialthinking.com.  
  • Ross Greer, The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children.
Comment on this post