Family conflict is normal. It can be healthy for parents to argue in front of children. Kids can learn from parents how to argue effectively, with purpose, and how to apologize and move forward.
We arrive into this world with our own, unique temperament. Developmental psychologists look at a range of issues related to temperament.
Teenagers are commonly given a bad reputation for being unnecessarily angry. It is important to remember emotions are not bad or wrong.
Parents want their child’s IQ tested for a variety of reasons. Some are seeking admission to elite schools, where a score in the gifted range is a prerequisite. Others want to know if their child has a learning disability (fact: most people with learning disabilities have average or higher IQ). Still other parents are curious about their child’s intellectual strengths and weaknesses. Lastly, many parents understand the value of incorporating an IQ test into a battery of psychological tests for diagnostic purposes.
Widely-used IQ tests in Illinois include the Wechsler series. David Wechsler was an American psychologist who created IQ tests for adults, children, and very young children. Although he designed the tests several decades ago, they’ve gone through revisions and updates.
Children as young as 2.5 through 6 years old are eligible to take the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Children ages 6 through 16 years old are eligible to take the Wechsler Intelligence Scale for Children (WISC). When a high IQ is suspected in a 6 year old, the WISC is usually administered.
To optimize performance, most kids should take the IQ test in morning hours. (The exception is the rare “night owl” whose thinking is sharpest in afternoon or evening hours). Avoid scheduling an IQ test to occur after school; mental fatigue is likely to detract from your child’s performance.
Depending on your child’s age and test-taking style, IQ tests usually last between 1.5 to 3 hours. Typically, younger children require less time to test. Many children (especially younger ones) need to take breaks between subtests. Snacks, games, a walk outside, or other non-thinking activities are part of testing youngsters. Breaks help them test better.
The IQ test is actually a set of subtests. Children have described the subtests to me as, “kind of like school but funner,” and “like a game sometimes,” “tricky a little,” and “OK.” Your child’s subtest scores are compared to the scores of others within 3 months of his/her age.
IQ is not just one number. IQ tests yeild as many as 15 subtest scores, 4 index scores, and a Full Scale score. Each of these scores is associated with raw scores, percentile ranks, and more. The most meaningful IQ report will include a sea of scores…in a very understandable way.
In order to do well on the IQ test, a child must be: (1) motivated to do his/her best, (2) engaged, (3) focused, and (4) emotionally regulated. A child can do poorly on an IQ test for a variety of reasons, but can do well only if truly able. So, IQ scores can underestimate but not overestimate your child’s intellectual functioning.
Preparing your child for the IQ test should include: ensuring a good night’s sleep, a healthy breakfast (whole grains, fruit, and/or proteins), and the selection of comfortable clothing.
If your child is sick the morning of the test, cancel the test. Even over-the-counter medicated children should be called in sick. Be aware that many medications for colds and allergies can decrease mental processing speed…a highly used skill in IQ tests.
You should also talk to your child about the IQ test. But, avoid using the word “test.” It can create unnecessary anxiety. Instead, say something such as: “You’ll be working for a couple hours with Dr. Ann. She has activities planned for you. Some are like what you do in school. Some are more fun, like word games, blocks, and puzzles. You should ask for breaks when you need them. Ask questions if you’re not sure what you’re supposed to do. The work you’ll do is very important because it helps us know how you think and learn best. Please be on your best behavior and try your hardest. There’s no way to fail in your work. Almost every kid sometimes makes mistakes. Just keep trying and do your best.”
The psychologist should help your child feel comfortable upon introductions. Since anxiety can seriously interfere with test performance, the effective psychologist will be sure to use a variety of strategies to make your child feel mentally prepared and engaged.
Several bright and insightful St. Charles High School students recently visited Plum Tree. They’re finishing Psychology courses and had great questions for a clinical psychologist. Here’s what they wanted to know:
1. How many years of experience have you had in being a therapist?
About 10 years.
2. What are your areas of expertise?
3. How would you describe your treatment style?
Solutions-focused, collaborative, evidence-based, and genuine.
4. What type of therapeutic strategies do you think work most effectively?
• For ADHD: Coaching strategies, where the focus is on developing organization, improving attention, managing restlessness, improving time-management, and establishing priorities
• For Self-injury/Suicide: Dialectical Behavior Therapy (DBT)
• For children’s mental illness: play therapy, behavioral parenting, and cognitive-behavioral therapy
5. Do you think our society overemphasizes happiness?
No, but society isn’t clear about how to achieve happiness. Particularly teens are bombarded by social media emphasizing fame, fortune, and beauty. In fact, none of these are linked directly to happiness.
6. What made you want to be a psychologist?
I enjoy a challenge. No science seems as complicated and nuanced as that of human thoughts, feelings, and behaviors.
7. Why did you pick to work with children and adolescents?
I’ve always “spoke their language.” This population of people is easily misunderstood. There’s nothing so fulfilling as being the interpreter between a child and his/her caregivers, teachers, and other important adults.
8. How do you decide which approach is best for the patient?
I weigh a combination of patient (or parent) goals, treatment history, symptomology, research, and clinical experience.
6. What has to happen during a session for therapy to be successful?
The patient should feel validated and also supported to change.
7. What are the measurable criteria you use to assess how well treatment is working?
It varies per person. Every patient has a treatment plan with measurable goals and timelines. I also conduct intermittent screenings with psychological tests to monitor progress. Of course, patient (and parent) feedback is an important part of assessing the effects of treatment.
8. Do you believe the effects of labeling are true? In the way that when a patient is diagnosed with a certain disorder they act in that labeled way and also the people around them treat them differently according to their diagnosis?
A diagnosis is not a judgment; it’s a fact. Just as there are criteria and scientific evidence to medical diagnoses (e.g., diabetes, colds, cancer) mental illnesses have criteria and scientific evidence. So, just as it’s appropriate and effective to label someone with flu symptoms as having the flu, it’s appropriate and effective to label someone with anxiety symptoms as having anxiety.
Diagnoses (or, labels) are tied to evidence-based treatments, scientific literature, and clinical outcomes. So, when a patient is accurately diagnosed, then treatment pathways become clear. It also allows for different treatment providers to speak the same language about what issues/treatment goals are.
Overwhelmingly, patients can be relieved by learning about their diagnoses. They may have felt “different” all along. The knowledge that there is a name, a treatment, and a community of people with similar issues can be—in itself—an effective therapeutic experience.
Of course, there’s still a lot of public stigma around mental illness. People who have it can be embarrassed or feel inept. Since the idea of mental illness can make others uneasy, patients may experience some ostracizing. Public education is needed.
9. In your opinion, what is the most common diagnosis? Has that changed in the last several years, if so, how?
Trending shows that—for pediatric populations—Bipolar Disorder and Autism Spectrum Disorders, are on the rise. ADHD has been on the rise for at least a decade now, too.
10. Do you think that therapy is the best choice for all who may need it?
Good self-esteem is the ultimate buffer in kids’ lives. It bolsters them during failure. It navigates them through social pressures. It weathers their emotional (and hormonal) storms. It keeps their negative self-statements in check. Good self-esteem encourages kids to try new things. It helps them understand other people, and treat them well. It makes life more enjoyable. Self-esteem is not something kids build on their own. In fact, building self-esteem can have more to do with others than it does with the self.
Parents, your role in your child’s self-esteem is critical. From your child’s birth onward, you get more and more jobs in helping her develop positive self-esteem.
Birth to 1 Year: Good self-esteem starts when babies learn to fulfill their basic needs (love, hunger, comfort) by manipulating parents and caregivers. (“When I cry, Dad hugs me.”) There are 3 jobs for parents.
- Love, adore, and cuddle your baby.
- Give her everything she demands. There is no such thing as spoiling a child who is 0-6 months old. It takes a newborn a few months to realize he’s actually a separate person from his primary caregiver. (Can you imagine that a-ha moment?) After age 6 months, parents usually notice their child’s manipulation strategies are developing remarkably. You feel like a sucker. Still, meet her needs. But also start to teach effective communication skills. Children between 6-12 months are usually still in the pre-verbal stage; they cannot say what they want. For example, suppose a toy is not working and your son screams and shoves it in your face to fix it. First, validate his frustration (i.e., “Oh, it’s not working? That’s a bummer!”) Second, have him practice handing it to you nicely (i.e., “When you hand it to me without screaming, I’ll help you buddy.”) Third, think out loud as you fix the toy (i.e., “See this thing here. It’s not turning right. If I do this, it will work, see? Here, you try it.”)
- Be a model for calm effort in working through problems…and checking the stupid batteries…
1 Year to 3 Years: Good self-esteem means feeling brave and secure enough to explore and try new things. There are 4 more jobs for parents:
- Avoid “helicopter parenting” by smothering children. Nothing is so sweet as a safe moment to oneself. Encourage her unaccompanied excursions into the next room. Introduce him to the arts (i.e., banging on kitchen pans for drums). Praise her efforts, and the products of them (i.e., hang up her drawings on the fridge). Kids develop bravery by understanding that caregivers will keep them safe, and will be there if anything gets scary.
- Don’t neglect your child. Make sure he is in supervised, child-proofed environments that will not punish exploration with injury. When accidents happen (…do coffee-table manufacturers have toddlers?), validate the injury (“Ouch!”) and explain how it can be avoided in the future.
- Tell your child multiple times a day what INTRINSIC qualities you admire in her: sustained effort, working through frustration, showing care for others, athletic ability, smart reasoning, bravery, sense of humor, etc. When your child misbehaves, make a point to discourage the behavior, not the child. (“In our house, we don’t hit. You are not the kind of person who hits. Please take a time out.”) Do not under any circumstances apply negative labels to your child. Labels like “lazy,” “dramatic,” “babyish,” “worry wart,” and other unpleasant character appraisals shame your child, and have no positive impacts. Remember: Attribute good behaviors to your child’s character and bad behaviors to your child’s choices. (Behavior charts are a good way to get kids to behave without harming their self-esteem).
- Model good self-esteem. Normalize mistakes. Don’t talk down about yourself. Don’t talk down about your spouse. Toddlers are using your skills to build their own. To children, parents are the most attractive, important, effective, and powerful people in the world. (Feeling better about yourself now?)
3-6 Years: Good self-esteem is being able to do stuff for oneself. There are 3 more jobs for parents:
- Encourage and expect your child to take more and more responsibility for his Activities of Daily Living (ADL). These include: showering/bathing, brushing hair/teeth, getting dressed, using the toilet independently, feeding oneself appropriately, using the telephone/computer, taking care of pets, cleaning up after oneself, using safe behaviors (buckling self into the car seat), organizing school materials, and so on.
- Expect more from your child. It’s OK if kids don’t get ADLs perfect. In fact, they won’t. But it is important that parents have reasonable expectations for children to try their best at each job. High demandingness is one very important part of good parenting. Mandate good effort in a matter-of-fact way. We all have to do things we don’t want to; that’s part of life.
- Praise your child. Give warm support and even over-the-top, exaggerated cheers for jobs well done. Be sure to emphasize how proud you are of your child’s efforts, even if the outcome is not great. It’s not your imagination: your child IS incredibly unique, gifted, wonderful, and a genius at being himself. Let him know that.
6-11 Years: Good self-esteem means comparing oneself realistically to others and, in doing so, seeing self-worth. There are 3 more jobs for parents:
- The focus for kids this age turns increasingly away from parents to other people (particularly peers). Kids compare themselves to others and see that there are often major differences. For most kids, differences will be both positive and negative. Your child realizes that he is not the best student in math. She sees that she is a great basketball player. He understands that others are more popular. She gets that other kids have family troubles. He sees that other people have more expensive clothes and gadgets. Parents should verbalize values for intrinsic skills and character, and not necessarily for achievements. Be realistic and positive in appraisals of your child. (“Yes, I suppose he is a better pitcher than you. He has spent a lot of time practicing and he’s sure talented. If you work hard, you may be as good as him. If not, no biggie. You’re great at understanding technology.”) Introduce your child to (books about) heroes of character and effort, not heroes whose only attributes are beauty, fame, or fortune (as they see on TV and other media).
- Love the child you have, not the child you wanted to have. It’s time to come to terms with possible disappointments, and with, perhaps, your own childhood “failures.” Focus on the things you admire in your child, not on the ways you see her as falling short of your ideals. Strike the balance between pushing your child to do better and recognizing that she may be doing her very best. Indulge his passions, if they’re safe and appropriate.
- Keep close ties with your child’s school. Teachers have valuable information about how your child relates to others. Good schools help teachers structure the classroom in ways that help all children feel accepted. Good teachers ensure that children do not feel inferior.
12-20 Years: Good self-esteem is knowing who you are, and who you are not. There are 3 more jobs for parents:
- Teenagers have critical questions to answer about themselves, like “Who am I?,” “How do I fit in?,” and “What am I going to do in life?” Questions of identity relate to everything from hair color to religious views. Parents should permit this exploration, and support it. When you push too hard for your child to conform to your views, trouble happens. He may become confused about what’s important to him. Of course, there are family and societal values to be enforced: safe and ethical behaviors. Allowing your child to experiment with substances is not the thing to do. Permitting your child to dress provocatively is not the thing to do. But you may consider letting your child dye his hair. She should be able to select (safe) friends. He may wonder aloud (appropriately) about his sexual, religious, or political orientations.
- Forming an identity can take a while. Be patient. This stage spans several years of awkward fashions, silly fads, and important work on the self. Continue to love and support your child through this sometimes difficult stage. Support especially the times when she sticks to her values, while peers do not. For example, praise your son when he elects not to drink alcohol at a teen party.
- Avoid being defensive. For kids this age, everything is grist for the mill. Your child may call your rules too strict. She may accuse you of invading her privacy on Facebook or Twitter. He will say things at home aren’t fair. She may say your religious or political views are wrong. While taking into consideration your child’s view (she may have a good point!), remember that her accusations have more to do with her questions about herself. Matter-of-factly state your views, don’t attack his, and show your child how to communicate differences with respect.
An important, final note: mental illness is the arch enemy of good self-esteem. It ruthlessly attacks self-esteem. This can and does happen even for kids who have great parents. Mental illness can interfere with the development of good self-esteem from toddlerhood and up. When a child has poor self-esteem, particularly within the context of a supportive home environment, it’s a red flag for mental illness. The usual culprits are depression, anxiety, and attention problems. Signs of low self-esteem include:
- Recurrent, unjustified shame and guilt
- Hopelessness about the future
- Feeling unlucky, punished, or “waiting for the other shoe to drop”
- Suicidal ideas or behavior
- Self-harm ideas or behavior
Children with good self-esteem have experiences–often provided to them by parents–that prepare them well for their future. They expect to succeed in what matters most to them.
A common ADHD treatment is stimulant medication. Methylphenidate is popular, with trade names of Ritalin, Concerta, Daytrana, and Metadate. An amphetamine salt (trade name Adderall) is also used quite a bit.
Dosages are typically prescribed based on a child’s size. It is not uncommon for these dosages to be too high. Parents may notice a trade-off in symptoms, for example, when their child’s attention is improved but he is more physically agitated. This is one clue that the dosage may not be appropriate. Or, an “over-medicated” child might be sluggish, less creative, and (while medications are active in his system) lose his spunky personality. In other words, too much medication can smother the best parts of ADHD.
Stimulant medications take effect quickly. Within about 30 minutes, medication impacts thinking and behavior. Measuring the impact of stimulant medication has historically been difficult. Parents are left to their own observations, the hard-to-read self reports of their child, and input from teachers. With detailed behavior observations (such as how long a medication takes to act on the child, and what happens as the medication wears off), some gains can be made.
But, there is a better way to determine if a stimulant medication is effective. It’s called the Test of Variables of Attention (TOVA). It’s simple, short (about 20 minutes), and accurate. This test can be repeated time and again. A recommended use of TOVA is to compare a child’s “baseline” (performance without medication) against a medication trial. For example, baseline results can be compared for how a child does with 5mg methylphenidate. Since results are ready as soon as the test is finished, physicians and parents have real-time information to consider dosage or prescription adjustments.
A common finding from the TOVA test is that dosages are too high–meaning that unnecessary side effects can be reduced with the lessening of medication, while positive effects can remain. Test results can be very helpful for prescribing doctors. They also give parents clear directions on next steps in treatment and help with peace of mind.
The TOVA is also used as a standard part of ADHD assessments. From 2003 to 2007, there was a 22% increase in kids with parent-reported ADHD, according to the CDC. Research continues to find higher rates of ADHD. There is no single cause of ADHD, but some factors are known to contribute to it.
What is a child and adolescent psychologist?
Clinical psychologists have doctoral-level training to provide therapy (including coaching) and consultation, and psychological testing. They are the only providers who can administer psychological tests to diagnose mental illness. Training at this level allows for expert knowledge in “psychopathology”–mental illness. Child and adolescent psychologists have advanced training and backgrounds in providing psychological services to young people.
Just as you take your child to a medical doctor who specializes in children (pediatrician), you should look to a child psychologist if your child needs help with emotions, thoughts, and behaviors. A child and adolescent psychologist is an expert in developmental psychology—so she knows what is normal and abnormal for children from birth to young adulthood. It also usually means that she is “good with” kids. In order to get better, your child should enjoy (even while working hard) spending time with the psychologist. The psychologist should see the many strengths in your child—since these are the building blocks for improvement. Feedback about parenting strategies is critical when working with young people, and this is part of a psychologists’ duty, too. A child and adolescent psychologist should have strong lines of communication with parents and caregivers.
Therapist, psychiatrist, psychologist…who does what?
• Clinical Psychologists provide psychological assessments and therapy to different types and ages of people. They usually advertise their specialty. They may also obtain advanced training in types of therapeutic interventions. They do not (in Illinois) provide medications. Clinical psychologists with a Psy.D. have more clinically-based training. This means their studies focused on how theories and therapies actually impact clients. Psychologists with a Ph.D. have more research-based training. Providers with doctoral-level training have typically spent between 5-7 years in graduate studies. No matter the degree, psychologists treating clients should be licensed. This means the state government has certified that the practitioner has met educational and knowledge requirements to provide mental health services.
• Therapists include a variety of folks, and most of them have at least a Bachelor’s Degree and some training in helping people. It is more common for therapists to have a Master’s Degree. Therapists are also called counselors, coaches, mentors, and advisors. They cannot conduct psychological testing or provide medications. They provide talk-based and activity-based therapy to a range of populations. They usually advertise a specific area of interest or specialty. Providers with master’s-level training have typically spent 2 years in graduate studies. However, they must attend regular trainings to keep their license active. Licensed therapists have been certified by the state to have met basic educational and knowledge requirements to provide mental health services.
• School psychologists usually obtain Master’s Degrees (though some have a doctorate), and have extensive training in schools and educational systems. They can conduct IQ testing, but particularly Illinois schools have done away with this. They provide counseling and advice to children and academic support teams as to how best to help children at school. They are part of the gatekeeping team that determines what (if any) school supports can be used to optimize a child’s learning. They cannot provide medications.
• Psychiatrists are medical doctors that have advanced training in mental illness. They are the only providers (in the mental health field) who can determine if/what medication may be helpful in addressing psychiatric issues. Psychiatrists are also able to provide in-depth mental health counseling, although they do so less often than psychologists and therapists.
• Child and Adolescent Psychiatrists have advanced training in working with young people. Although pediatricians can write prescriptions for psychiatric medication, they do not have the advanced training and licensure of a Child and Adolescent Psychiatrist. Since they are so specialized, it can be difficult to get a short-notice appointment with a Child and Adolescent Psychiatrist. However, the appointment should be well worth the wait.
Of all mental health providers, it’s good to know: no matter the training or title, there are excellent–and not so excellent–providers at every level. A mental health provider should be a good fit for your family. You should feel informed, motivated, and comfortable with them. The provider should be implementing evidence-based treatments, where goals and benchmarks are defined as early as possible in treatment. If, after 3 months of regular services, your child has not shown reasonable improvements, it may be time to find a new provider.