Barbara Kalmanson: Upstream disturbances and downstream behavior

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Recently Barbara Kalmanson was a speaker at Parents Education Network in San Francisco.  Barbara is a clinical psychologist and special educator who has worked with infants, children and their families for over 30 years. She is also a founder of the Oak Hill School, a developmental, relationship-based school for children and adolescents with Autism Spectrum and related neurodevelopmental disorders.

Her two-hour lecture on the topic “Why does he do that?” – Identifying and empathizing with the social-emotional side of learning differences  – was so full of information, it was almost overwhelming.  I am reporting on a just a few of the highlights.

Ms. Kalmanson used a metaphor: down stream and up stream. By this she means some upstream activities are throwing children downstream into the river because they can’t find a solution upstream.   The challenge for parents, teachers and psychologists is to see what is causing the child to go downstream.  For example:

  • Children who seem cautions and fearful may have low tone in their muscles, or have visual and spatial issues which make them moody and anxious.
  • Some children have issues of sequencing and memory, perhaps from an insurmountable set of activities, or disorder in their environment.
  • Some children don’t seem to have flexibility.  They can think of Plan A but if that’s not possible don’t know how to develop Plan B.
  • Some kids are controlling and demanding:  could be an auditory process issues. He or she can’t figure out the sounds coming at them.
  • Some kids try to control the topic. They could be doing it because the discussion is going beyond what they can understand.

The challenge for parents, teachers and therapists is to put themselves into the shoes of their child or student to know what the child or student is feeling inside themselves.  The goal is to discover  the cause of the disturbance. Its affect predicts the future.  In other words, the upstream experience predicts the downstream behavior.

Ms. Kalmanson commented that temperament is the “how” of behavior and described nine dimensions:

  1. Activity:  how physical motion is going on
  2. Rhythmic:  regularity of movement and psychological functions.   If a child needs and doesn’t have a predictable routine there’s an emotional sequel to that.
  3. Approach/withdrawal:  reaction of a child to new stimulus e.g.: are they happy when they first go to school?
  4. Ease in modifying reactions.
  5. Intensity energy level of responses.
  6. Mood:  how much does the child feel life is pleasant?
  7. Persistence/attention space.
  8. Distractibility:  effect of extraneous stimuli to ongoing behavior.   Do they notice when a fire truck goes by?
  9. Sensory threshold:  how much stimulation does it take to get a response?

In tandem with these dimensions are Risk Factors that are associated with school performance.

  1. Low task orientation
  2. Low flexibility:  negative approach and social difficulty
  3. High reactivity which could mean low sensory input.

Principles of assessment look at upstream issues:  Usually it’s advisable to look for a specific symptom, e.g. poor eye contact.  That symptom provides information that it is a functional limitation.  Then, look at the larger functional capacity.  Is there an intimacy connection?  Is the child thinking: how does someone know what I am feeling?  Most important, can the teacher,  parent or therapist empathize with the child/student?

The above highlights some areas Ms. Kalmanson encouraged parents, teachers and therapists to observe in their child or student.  The more the child’s behavior is understood the less opportunity for upstream disturbances and downstream behavior.

Damon Korb: Meltdowns to Shutdowns

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.
  • 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.  
  • Ross Greer, The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children.