Ask the Child Psychologist

Category: Behavior

You're right, it's not always fair

"It's not fair. He gets to stay up until 9 and I have to go to bed now."

"It's not fair, I have to do homework and she gets to go to play."

Ever have your child give you the "it's not fair" statement? Most parents have. I jokingly call the problem, "it's-not-fair-itis." Many parents tell me they treat their children "equally" or the "same." However, the reality is each child is different with their own unique needs and interests.

Our relationships with each of our children is going to be somewhat different. So, constantly striving to be equitable is going to be a losing, guilt-ridden waste of our energy. The good news for children is that parental love is limitless and there is plenty to go around for everyone in the family.

Younger children are developmentally egocentric, which means they often see the world as revolving around themselves. Truly fair in their eyes is to get the most possible attention from the adult. As they get older, the comparisons to their siblings may grow. They may challenge their parent about giving more attention or doing more for their sibling. If we engage with children, the issue will likely lead to more and more episodes of "it's-not-fair-itis."

How do we address this? By sending a message early on to our children that the real definition of "fair" is that everyone will get what they truly need. However, getting what you need may not always be exactly the same as a brother, sister or friend. In various situations or at different ages, each child will have his own needs. For example, "Your brother may need extra help practicing his spelling and you need a lot of time to be taken to your soccer game. I love doing both because I love both of you." Schoolchildren experience the idea of fair not meaning the same every day. They will see some of their schoolmates who require extra time from the teacher while others are able to work more independently. This may change from subject to subject, including areas like gym or art.

Once you have established the premise of "everyone getting what they truly need" as a norm in the family, I would move away from even acknowledging the "it's not fair" argument. Remind your child over and over again that you love her and you will always make certain she gets what she truly needs. Jim Fey, author of Love and Logic, will advise you to respond with something like, "nice try."

This doesn't mean we shouldn't be empathic when our child is frustrated about something like doing homework while his or her sibling is playing. We can respond by validating how they feel. For example, "I see how difficult this party is for you watching your brother get so many new toys. Let's talk about what you can do when you are feeling sad or frustrated." Children are going to feel emotions like jealousy and disappointment and they need opportunities like these to learn effective coping skills.

Having worked with families for many years, I believe most parents (and teachers) really do try hard to make certain their children get what they require. One of things parents need is some relief from the "it's-not-fair-itis." So, try the above tips and give yourself a break.

Category: ADHD

Strategies to help child with ADHD succeed

In my previous blog post, I discussed ways a parent can access school accommodations for a student diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Now, I will discuss some strategies that can be a part of a Section 504 plan or an Individualized Education Plan (IEP).

These tools also can be utilized by classroom teachers without a formal plan. Be aware that each child is unique and the evaluation by a multi-disciplinary team or a psychologist should help identify the specific challenges resulting from having ADHD. Once we have a good understanding of a child's needs, we can come up with appropriate interventions to help.

Here are some common accommodations that can help students with ADHD:

• Preferential seating: The child can be placed in close proximity to the teacher to help maintain eye contract and keep the child on task. Often a verbal or physical cue can be created by the teacher and student to remind the child to stay focused.
• Extra set of books: For children who are chronically forgetful, the school can sometimes provide an extra set of books that stay at home.
• Allow breaks: Some children have a very difficult time staying in their seat and might do better if they get breaks to move around the back of the class or be allowed to have an object to hold (some examples include a Koosh Ball, Silly Putty, two pieces of Lego).
• A clear communication plan between the parents and teacher: Because many children with ADHD are forgetful and disorganized they may not be so reliable when asked if they have homework or whether they brought home necessary supplies. Many schools now have parent online access programs where homework and grades are posted. Other teachers have a Web page or a blog detailing work. In other cases, a system over e-mail or notes in a planner can be helpful.
• Plan to teach organization skills: Several kids with ADHD-related challenges will have very messy desks and lockers. In fact, when I am assessing for ADHD I will ask what the child's desk, backpack and locker look like. Some kids need a weekly time when a parent, teacher or even a peer helps reorganize the child's desk or locker. Papers can be purged and corrected papers filed in color coded folders.
• Modified assignments: In some cases where a child has extreme difficulty sustaining attention, assignments can be shortened. For example, a teacher may only require the child to do odd number problems. Another option would be to break up larger assignments into smaller ones. Usually, the teacher can be helpful here.
• Create a home daily report card: A few goals can be established such as staying at his/her desk and following directions. Depending on the child's age and ability, the teacher and child can rate how they did. The child can earn points on the card to earn rewards from a menu either given out at home or school. Rewards could include extra free time, chance to do a job, or free choice of a dessert when they get home.
• Self monitoring: The child can be trained to observe his behavior during segments of time and record this on a card. Sometimes a tape recording of nonintrusive beeps can run that cues the child to check on his behavior.

These ideas are far from exhaustive and just scratch the surface of the many ways we can help students with ADHD succeed in school. Maintaining a good working relationship and open communication with your child's school can help tremendously. Additionally, many great resource books are available with educational strategies and ideas.

Family conference on Nov. 8
Sandra Rief, M.A., will be highlighting this year's Anita Naftaly Jewish Family Circle Conference on Nov. 8 in Southfield, which is open to the public. Rief has written several extremely helpful books, including a best-selling ADHD book called, "How to Reach and Teach Children with ADD/ADHD". By utilizing resources and developing strategies we can make sure all children with ADHD can have every opportunity to succeed.

Category: ADHD

Parents can work with schools to make accommodations for ADHD

Kids with Attention Deficit Hyperactivity Disorder (ADHD) can face many challenges and many have to do with school and education. One of the many ways we try to help these students is through environmental accommodations.

Using environmental accommodations, teachers and parents make changes in some of the ways the student is taught. For example, some students with attention difficulties may do better sitting closer to the teacher and/or in the front of the class. This is called preferential seating. In other cases, a behavioral modification plan might be needed to encourage positive behavior.

In some situations, a parent can ask the teacher to help make some of these changes. In many cases where the ADHD is having an impact on the child's ability to learn, the parent can request an evaluation by the school to determine if the child would qualify for formal accommodations. The way this process usually begins is by a parent putting in a written request asking for an evaluation to be completed. In some cases, the school may initiate the process with the parents. If the primary diagnosis is ADHD, a written letter from the diagnosing physician is also helpful. This gets the ball rolling and will lead to an invitation for a parent meeting at school to discuss the request or to sign forms to begin the evaluation process. Once the school has agreed to complete the evaluation, it has 30 school days to complete its work (in other states they may have up to 60 days).

There are two main types of plans a parent and/or school can seek, either a Section 504 plan or an individualized education plan (IEP). Section 504 of the Rehabilitation Act of 1973 is a civil rights law that prohibits discrimination based on disability. ADHD is included as a disability if the impairment substantially limits a major life activity such as the child's education. An IEP is rooted in the Individuals with Disabilities Education Act (IDEA), which was written to ensure all children receive a "free and appropriate education" while meeting some of the unique needs of children.

To receive formal accommodations, the child has to be qualified by the school through documentation at the school. A request by a parent does not guarantee qualification nor can a school qualify a student without permission from the parents. Evaluations can vary from some observations and behavioral data to more formalized psychological testing to determine if there are learning problems. Once the process is underway, the school's team of professionals should work with you to determine what tests are necessary.

In general, I find most schools to be cooperative in working with the parents I see in seeking the accommodations for their child. The best approach is to maintain a positive working relationship. If a parent is experiencing difficulty with the process, he may choose to find an educational advocate who can help navigate the system and look out for what is in the child's best interests. Some great educational resources in this area include the Citizens Alliance to Uphold Special Education (CAUSE), which offers classes for parents on school advocacy and other great resources and bridges4kids.org. On the national level, Pete Wright, one of the nation's leading experts on educational advocacy, has a Web site, Wright's Law, that is full of very helpful information.

Once the child has qualified for services, a variety of accommodations can be explored to help the child. For kids with ADHD who are chronically disorganized, an extra set of books for home can be provided, modification on assignments, tests administered orally or in small groups, copies of teacher notes and study skills classes are just a few examples. In my next blog post, I will go into much more detail on possible school strategies and interventions for kids with ADHD and learning differences.

Family conference on Nov. 8
There is also a terrific speaker coming to town in November whose expertise is in providing practical strategies in helping kids in this area. Sandra Rief, M.A. will be highlighting this year's Anita Naftaly Jewish Family Circle Conference on Nov. 8 in Southfield, which is open to the public. Rief has written several extremely helpful books including a bestselling ADHD book called, How to Reach and Teach Children with ADD/ADHD. If you have a child who is challenged in school due to ADHD, I encourage you to consider attending the conference.

Category: Behavior

Set expectations, consequences and reward good behavior in public

Handling children's behavior in public places is often a topic that is brought up by parents in my office. "How can I get in and out of the store without my child badgering me about buying something?" and "How do I get my kid to cooperate when I need to do errands?" are just a few examples. There are several approaches a parent can take to encourage the positive behavior and minimize the challenges. Here are some ideas:

Set up the expectations for the child before going out. This includes giving children some advance warning (when possible) of where they will be going. Use good eye contact with the child, set up a few rules or expectations before you get in the car to leave and again when you arrive and before going into the store. Some examples might be, "You need to stay with me in the store" or "We are only buying things on our shopping list today." Each time, once the child has been given an expectation, have him repeat back to you. You can then show the child the shopping list and even give him jobs that might help you get done quicker. You should also tell the child what will happen if they misbehave.

In situations where you are all right with the child buying something, set a budget and parameters beforehand. For example, if you are going to a store with food, tell the child he can buy something up to a set amount. Also, be clear as to what types of treats are acceptable. You can also set an expectation that if the child badgers you about something more expensive, you will deduct a set amount off her budget for your troubles. Conversely (and on occasion), you can add a surprise bonus if the child has been cooperative, such as an extra dollar.

Be realistic when taking children to public places. We all know the feeling of being dragged somewhere we don't want to go. For some children, being confined to a table at a restaurant and needing to wait to be served can be difficult. Sometimes, children are tired after a long day at school or it's just getting to be that tough time of the day. I also realize parents have so many demands on them and often not enough time. My best suggestion is know your child and plan ahead when you can. If you think your child is going to have trouble, try to problem solve ways to keep her busy or decide how essential it is to bring the child.

Before I get into how to handle misbehavior, I want to stress the need to attend to good behavior. If the child is cooperating, take the time to point it out in a specific way, such as "I really appreciate how well you are helping Daddy find things in the store," or "Thank you for asking in a nice voice" are just two examples. One of the best ways to prevent misbehavior is to encourage the positive behavior you are looking for.

If a child is misbehaving in a public place, your options are more limited than at home. However, there are things you can do. You can establish a time out area when you set your expectations beforehand. This could be an area by the store's bathroom, a really boring store aisle for the child, stepping outside or a return to the car. If you are forced to leave due to negative behavior, the child may be expected to pay you back the time you lost by coming up with something he needs to do for you. Another option is carrying a marker and putting a slash mark on the child's hand for each minute he owes you for either a time out or work around the house. Whatever you decide, share with the child what will happen if they behave and misbehave.

Managing behavior in public places can also be challenging for parents because we feel that others maybe watching and judging us. Remember, most parents have dealt with this issue at one time and many parents will have empathy because they have been in your place. If not, put on a smile, take a deep breath and tell yourself you know what's best in managing your child.

Category: Behavior

'I'm sorry' isn't always enough - teach kids why

Kanye West, Congressman Joe Wilson and Serena Williams are recent high-profile examples of celebrities using poor judgment followed by an expression of contrition toward those they caused harm. This is not surprising, as most people have been conditioned from a very young age to say, "I'm sorry," when they do something wrong.

So often, we parents witness our child doing something wrong such as hitting a sibling, taking away a toy, talking back, yelling or hitting. A very common response is to demand the child say he or she is sorry to the other person. While this is a good starting point, remember "sorry" is just a word. As we know in life, actions speak louder than words. If we want to help our children develop empathy and better social skills, there are some additional steps I suggest.

I typically approach a child by asking him whether there is something he would like to say. If he is not ready to apologize, I would not force him to right away. Instead, give him a few minutes to cool down the emotion. Younger children may often not understand the concept of showing remorse, so we may need to model for them. "We say we are sorry after we hurt somebody else with our hands," or "Your sister looks sad because you took the toy away from her and we say sorry when we hurt people's feelings." For older kids, we can help them acknowledge they did something that hurt the relationship. An example may be, "I'm sorry I made you feel bad when I didn't give you a turn." This is teaching the first part of being sorry, which is admitting to our wrong.

One of the ways we can show children ways to be truly responsible for their actions is to teach them to make amends. If they broke something, they should somehow fix it or get help in doing this. I also recommend helping kids learn to not only say what they are sorry for, but to do something above and beyond just fixing the situation. This could come in the form of a hug or handshake, sharing a part of their lunch, drawing a picture, writing a letter, doing a chore, cleaning up a sibling's toys or room, etc. If the child seems ready, you could have her propose some ideas.

On the other side of this is helping kids to learn forgiveness. We need to talk to kids about how to accept an apology and that people make mistakes. One of my favorite expressions I use with kids is, "Every pencil has an eraser," meaning the very smart people who invented pencils know we are not perfect.

Don't forget that some of the best ways children learn is through modeling and positive reinforcement. If a child sees her parents arguing, she should also see them apologizing. A spouse bringing home flowers or going out of her way to do something nice are just two examples. When we do see children beginning to take positive steps in showing contrition, be sure to positively reinforce their behavior. A statement such as, "I noticed you really tried hard to make your sister feel better after you pushed her" would be just one example.

Giving kids an opportunity to own up to their mistakes and take steps in healing makes for improved relationships for our children and better moral development.

Category: Learning abilities

Gifted children often present quirks, school challenges

Does your child complain about being bored at school? Has he or she been thought of as lazy, unmotivated or not working to his or her potential? Is your child emotionally intense, oppositional and defiant toward you and other adults? Does your child show signs of perfectionism, avoiding tasks that he is afraid he cannot do well the first time they are presented? Does she complete her homework but fail to turn it in the next day? Is she very bright but bringing home average to poor grades? Does he have severe sensitivities that cause him to cover his ears, cut the tags out of his clothes or avoid whole categories of foods? Is she struggling with peer relationships, but able to carry on highly sophisticated conversations with adults? You might have a gifted child.

Gifted children are different from their nongifted peers. Despite the popular misconception that gifted children are so smart that they will have no problems academically or otherwise, gifted children can face a host of challenges. This can create unique situations in parenting and teaching.

Think of the bell curve. Most of us fall in the middle with average intelligence. We all recognize that children with low intelligence that fall at the far left end of the curve need special support academically and emotionally to help them meet their full potential. What many people fail to consider is that gifted children fall at the other far end of the bell curve and they need special support academically and emotionally to help them meet their full potential.

Gifted children who are not in an appropriate educational setting often refuse to do school work that they feel is repetitive and that they have already mastered. They may act out in class and are frequently accused of not paying attention. While gifted children can have attention problems, one must consider the whole child and look closely at gifted traits vs. true ADHD. Gifted children are prone to anxiety, as they often have advanced awareness of what is happening around them but may not have the emotional maturity to handle the information. For example, a gifted 4-year-old may be able to read the headlines of the newspaper but will be frightened by the information.

Many gifted children are perfectionists. This may not always show up in neatness, but rather as avoidance. Think of the gifted student who brings a host of personal knowledge to school and knows many if not all of the answers without needing to learn anything new. Imagine when he hits middle school and is put into a foreign language class - for the first time he is being presented with something of which he has no prior knowledge and this can often lead to anxiety and school work refusal.

Additionally, gifted children can have learning disabilities; these students are often called twice exceptional, being gifted and having a disability. They require even more specialized academic planning and emotional support.

Gifted children are often more difficult to parent, too. Gifted individuals are independent thinkers and are less likely to comply with authority figures just because they are authority figures. Parents are often frustrated by the fact that traditional parenting strategies may not be effective. While independent thinking will likely serve the child well as an adult, it makes it difficult to parent them. More positive nondirective parenting strategies are often highly effective. Love and Logic and Collaborative Problem Solving are two such strategies.

So if you know or think your child may be gifted, seek guidance and support from qualified individuals who are familiar with typical behavior in gifted children. With the right educational and social emotional support your gifted child can thrive and you can enjoy them.

Kim Waters, M.S., L.L.P, is a limited licensed psychologist at the Child and Family Solutions Center in Farmington Hills. One of her specialties includes assessment and treatment of social and emotional issues in children related to giftedness..

Category: ADHD

ADHD conference a boost for patients, parents

Michael Golds was a young man with many special talents and great potential that was only beginning to be realized. He was a master diver and a pilot. He had been accepted into a graduate program at the Florida Institute of Technology. However, for many years academics were a challenge - until he was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and began receiving treatment.

He enrolled in Project Bold at Oakland Community College in Farmington Hills, a specialized program that provides support to students with ADHD, and learned the strategies he needed to become a successful college student. He went on to earn a BA from Eastern Michigan University. While he was working at an airport in Florida, he was killed in a freak accident.

In his memory, his parents, Barbara and the late Dr. Jack Golds, created the Michael Golds Memorial AD/HD Conference, bringing together parents, educators and professionals to inspire those affected by ADHD and learn about the latest in ADHD assessment and treatment. The annual conference, which began in 1999, has grown to more than 350 participants. This year's conference is scheduled for Oct. 2 at the Orchard Ridge Campus of Oakland Community College. Over the years, so many of the parents I work with have attended and found the presentations and event to be very informative and worthwhile.

This year, the keynote speaker will be Dr. Michael Ginsburg. Dr. Ginsburg was raised in southeastern Michigan, went on to Stanford and the University of Michigan Medical School. He will share his inspiring story of how he faced his own challenges with ADHD and what he learned that can help others.

Following Dr. Ginsburg's talk, participants will be able to choose from a broad variety of breakout sessions addressing different issues that children, adolescents, adults with ADHD as well as and parents might face. Topics address areas such as defiant behavior, organizational skills, relationships, sleep, parenting, current and alternative treatments, medication, lesbian/gay/bisexual/transgender issues, learning difficulties and a panel discussion of learning specialists and students with ADHD. The lineup of speakers includes some of the top professionals in our community.

Beyond the various sessions is the opportunity for people to interact with one another and connect with parents facing similar issues. So often, I hear from parents how they feel so isolated or judged and others do not understand the challenges they are struggling with. For those who are directly or indirectly effect by ADHD, I hope you will consider joining me on Oct. 2.

For more information about the Michael Golds Memorial AD/HD Conference or to register, call 248-522-3645 or visit the conference Web site.

Category: Communication

How was school today? Go easy on questioning kids

"So, how was your first day or school?" a parent asks. "Fine," the child says. The parent goes on to ask, "What did you do today?". Child responds, "Not much."

A common challenge that parents often face is how to effectively communicate with their children. For the lucky ones, their children are open books. They share what homework they have, what they did in school, which friends they played with and other important information about their day. For the rest, prying out details can make breaking into Fort Knox seem like a cakewalk. With a new school year beginning, parents and children have a new opportunity to work on establishing good two-way communication. Below are some suggestions to help with this process:

• Avoid the temptation to bombard your child with questions right after school. As much as you might like to see your child come out to a podium for a news conference after the first day of school, he or she might be tired or not ready to talk. One approach might be to tell your child how much you want to hear about school. Then, you might acknowledge they seem tired or energetic or however they appear to you. Some children will be very eager to talk about school while others might need some down time or to get out their energy. If they really don't want to talk, see if you can agree to a later time that would work.
• When you ask questions, be ready to listen. This means avoiding making judgments or giving lectures and not answering your cell phone. Also, be careful not to try to solve problems for the child. If a challenge is identified, work with the child on developing a strategy for approaching the problem. For example, brainstorm how the child can seek extra help if he does not understand something.
• If you do ask questions, try to ask specific ones. Try "What did you do in science?" or "Who did you play with at recess?" vs. more general questions such as "How was school today?". If the child continues to avoid questions or give vague answers, you might acknowledge it's a difficult question or it isn't the best time to talk about the topic. Ask permission to bring the issue up later.
• Use empathy if the child expresses frustration or challenges. For example, if the child is complaining about too much homework or being bored we should validate how they feel. A statement such as, "I'm hearing that school is very hard right now" can be helpful. We don't want to be sarcastic or tell them how bad we had it when we were their age. If the child is coming home with an increasingly negative attitude, try to figure out with him what might be going wrong. Is he making friends? Are certain academic areas very difficult? Typically, there is a good reason.
• Create a "rose and a thorn" for the day. The "rose" refers to something that went well and the "thorn" might be a challenge of problem that came up. I have used this strategy for kids who resist opening and have found it effective to give some structure to the conversation. In some cases, we have even recorded it each day in a journal.
• If the child continues to not tell you much, tell the child about your day. This could have the effect of modeling for them how you share information or even bore them until they learn they are better off telling you about their own stuff.

Remember to be patient with your child (and hope they can be patient with you). Effective communication is a work in progress for many that changes as children are developing and face new challenges.

Good luck to all for an exciting new school year.

Category: Behavior

Rewards have their place, but teaching kids to do right thing is best

The other day a parent asked me if she was doing long-term harm to her children by repeatedly "bribing" them with rewards to get them to go to bed. While my initial response was to examine bedtime routines, the larger question she was asking had to do with the use of rewards to motivate behavior.

As most parents will attest, using rewards is often an effective way to get a child to do something. "If you eat your vegetables, you can have dessert" and "if you complete your homework without arguing, you can get extra time on your game system" are just two of the countless examples. This is not inconsistent with how we operate in the professional world. When we work, we get paid with monetary rewards. In fact, when the boss wants us to work harder he may offer a productivity bonus. These are all examples of external rewards.

While external rewards can be a helpful way to motivate behavior, we need to be very careful in how we use them. Most parents I know want to raise children who do the right thing for the sake of doing the right thing. When we start using external rewards for behavior too often, kids perform for the sake of the reward. The rewards may become less reinforcing, often because they continually get them or they get bored, they don't work as well or the child might appear to be very entitled. Parents are forced to come up with new and sometimes more involved or expensive rewards to keep the child focused. The child often learns he can negotiate for more to perform the desired behavior. Before long, the parents may have additional headaches on their hands.

If you are using very limited rewards, the understandable question I then get is, what else can we do to get our children to cooperate? I'm a fan of utilizing collaborative problem solving in which you continuously pro-actively problem solve with the child the challenges that are leading to noncompliant or unmotivated behavior. Making statements to the child that she should be proud of herself for a particular behavior can also help. Some great approaches to teaching kids through more natural and logical consequences can be found in the Love and Logic parenting program.

I believe external rewards can be healthy if used in a specific and time-limited way. Many people need that "carrot" dangled in front of them to give them an extra push. If you do use a reward system, make sure you define the specific behavior and figure out if the child can realistically meet the goal. For example, if a child has not been able to sit still for more than 10 minutes to do homework, the goal might be 15 minutes of homework for a reward. However, you would not want to start with a goal of five nights of homework for 30 minutes each. If the goal is not obtainable for the child, you will create more frustration for all parties. Make the reward easier to obtain at first and then slowly make it more challenging.

I would also explain to the child why his behavior is expected of him and the reward is just a small way to help get him started and will be eventually phased out. The rewards can be anything from a star on a chart to some toys from the dollar store. One idea is to make or buy a variety of prizes and put them in paper bags. The child can choose the mystery prize from a treasure chest when he reaches his goal.

Rewards have their place in parenting and life. If we are mindful as to how we use them with children, they don't have to be harmful. However, teaching children to do things because it's what is right can have a more positive lasting impact on their development.

Category: Anxiety

Anxiety in social situations may be Selective Mutism

"Don't worry, she's just shy. She'll grow out of it soon."

Many parents have heard this phrase from teachers, friends and pediatricians - and for the majority of children it is quite true. Yet approximately 1 percent of children will be diagnosed with Selective Mutism (SM), a specific anxiety disorder characterized by a consistent, ongoing failure to communicate in social situations. Anxiety surrounding speech generally becomes apparent in kindergarten, although most parents report their children were temperamentally anxious from a very early age(e.g., hiding behind parents in social situations, not wanting to participate in group activities on play dates, etc.). This behavior stems from deliberate self-protection, not purposeful defiance.

Children with Selective Mutism may demonstrate a variety of symptoms. The most common symptom is significant anxiety surrounding social situations, resulting in difficulty responding and initiating verbally and nonverbally. Furthermore, these children frequently exhibit blank facial expressions, poor eye contact and heightened sensitivity. Although many of these symptoms are similar in quality to autism spectrum disorders, SM can be differentiated by observation of the child in comfortable settings, such as the home. In the home, children with SM generally do not exhibit anxiety and are quite typical in social skills and communication.

In the past, parents have been wrongly blamed for symptoms of SM, as they were theorized to originate from a traumatic occurrence in the child's life. However, more recent research has demonstrated that SM stems from a temperamental predisposition to anxiety, coupled with a learned pattern of avoidance in anxiety-provoking situations. For example, on the first day of school any child is likely to feel nervous; a child with an inhibited temperament will likely feel even more heightened anxiety. When faced with this anxiety, the child avoids what is frightening: talking to new teachers and peers in the school setting. This avoidance reduces anxiety, at least in the short term, and is therefore rewarding. Thus, the child is more likely to use this same strategy (avoidance) when a similar situation occurs in the future. Eventually a pattern of behavior develops.

Research has shown that when left untreated, children with SM are at a higher risk for worsening anxiety and depression, social isolation, self-esteem issues, poor academic performance and school refusal. Intervention is key to breaking the anxiety-driven pattern.

The gold-standard treatment for Selective Mutism is behavioral therapy, including systematic desensitization. This approach includes building a "ladder" of frightening situations, from least to most frightening. Next, the child is asked to participate in facing fears at a slow, reasonable pace. Systematic desensitization stops the pattern of reinforcement of avoidance, allows for a slow decrease in anxiety and demonstrates success, which increases motivation. Furthermore, treatment frequently includes the development of a rewards system to provide incentive for communication practice, social skills training to make social situations less threatening and relaxation training to reduce anxiety.

You can find more information about the diagnosis and treatment of Selective Mutism in the book "Helping Your Child with Selective Mutism; Steps to Overcome a Fear of Speaking" by Angela McHolm, Ph.D. Given the complex nature of the disorder and treatment, it is often helpful to gain assistance and guidance from a mental health professional trained in the treatment of Selective Mutism.

Dr. Aimee Kotrba is a licensed clinical psychologist in Plymouth offering expert consultation, diagnosis and psychological treatment of Selective Mutism. More information can be obtained on her Web site, www.drkotrba.com, or by calling 734-416-9098, ext. 4.