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Preschooler Sleep – February 2016

Q: Help! My 3 year-old won’t let me leave his room when it’s time to sleep. He keeps coming out and won’t settle into bed unless my husband or I are in there with him. Sometimes it only takes 10 minutes for him to fall asleep but sometimes it’s longer and we often fall asleep ourselves. We haven’t been able to figure out what the problem is. I’m concerned about it becoming a habit. How do we get him to stay in his room and fall asleep on his own?
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A: A preschooler’s sleep problem is everybody’s sleep problem. Late night crying or playing can wake family members or keep them from falling asleep in the first place. Nighttime wandering (not to be confused with sleepwalking) can be a safety issue. And then there is the joy of waking up at 3 am with a small face an inch from yours, or jolted awake from cold little feet on your back.

True sleep disorders are rare in children (but they do occur, so talk to your pediatrician to rule that out) but sleep problems are common in preschool years. It’s likely that there are some habits that are interfering with their ability to fall asleep. And that’s a good thing because that’s where you can make some changes.

It’s good to start with knowing how much sleep your child needs. In general, kids ages 1-3 need 12-14 hours of sleep in a 24-hour period. Kids ages 3-5 need 11-13 hours of sleep. Three can be a tricky age because they might be phasing out of napping. If they fall asleep toward the end of what is now Quiet Time, resist the urge to let them nap late in the day because it could make falling asleep at bedtime more difficult. That said, being overly tired can also interfere with their ability to fall asleep. If you’re now thinking that it sounds impossible to find the perfect moment to put your child to bed, take heart. Most likely you just need to change a few things and give them a chance to adjust to a new routine.

Good sleep hygiene is imperative when sleep is amiss. Start by getting rid of factors that can keep your child from getting sleepy: any kind of monitor or screen in the hour before bed (blue wavelength light is deeply stimulating), spicy foods or caffeine (in chocolate cookies or coffee ice cream), sugar, bright light (which can trip up their circadian rhythm), and roughhousing before bed (gets adrenaline pumping). If their bladder is interfering with sleep, restrict liquids for 2 hours before bed. If a pet is interfering with their sleep, remove it from the room.

Other sleep hygiene habits that are important for many kids to fall asleep or stay asleep include doing a relaxing bedtime routine and waking at the same time every day (so their body gets into a rhythm), using the bed only for sleep (so they don’t associate their bed with energizing activity), having a positive association with their bedroom (if they are sent there as punishment it can be hard to associate it with relaxing sleep), enjoying the regular pre-bedtime quiet activity (to get them into a relaxed, positive mood), and dimming the light for 30-60 minutes before bedtime (to release melatonin, which makes people feel sleepy). Keep their bedtime routine consistent, allow them a security object, and keep the bedroom cool, quiet, and dark. Many parents have found it helpful to keep the door cracked open, use nightlights, white noise or soothing music, or quietly play a relaxing children’s audiobook (might help a restless child focus and drift into sleep).

Now for ideas to help your son let you leave their room easily so you can have that small window of time before your own bedtime that can be important to a healthy marriage (or your own sanity). First, explain to him that the expectation is that once you’ve left he stays in his room and doesn’t turn the lights on. Now, ditch the idea of punishing him for his poor sleep – he doesn’t like it any more than you do. Give him an incentive – figure out a reward that you could reasonably give for several weeks the morning after he’s met the expectation (a temporary tattoo, hand stamps, sprinkles on his oatmeal or a squirt of whipped cream on his waffle if there are no food-related concerns). If he forgets about the reward at night, put a picture of it where he can easily see it. Give him praise the next morning for earning it when he does; say little or nothing about it when he doesn’t (if he asks for his reward without having earned it, calmly and briefly explain why he isn’t receiving it and end with a vote of confidence that he will stay in his room tonight and earn it tomorrow).

Another idea is to start the routine you described, but instead of staying there until he’s asleep you stay in his room until he gets sleepy. Then tell him you’ll be in to check on him in one minute (or if he can’t tolerate one minute say “I’ll be right back” and come back in 30 seconds. If he’s not easily letting you go at all and is getting riled up and more awake, tell him you are going to use the bathroom or something else that he can understand and be okay with). Check in on him when promised but don’t stay; say “I’ll be back in 2 minutes” and then maybe next time it’s 5 minutes. Gradually increase the amount of time you stay out of the room so that he gets used to being in there without you. After one or a few nights, start leaving right after putting him to bed. Maybe you can start with “I’ll check on you in 5 minutes.” Maybe you don’t need to give times after a while, and just say “I’ll be back to check on you.” If he comes out of his room, gently lead him back without talking or emotion and put him back in bed saying that you’ll be back to check on him. The point here is to help him develop trust that you’ll come back, that he can be alone in his room without you at bedtime, and eventually that he can fall asleep on his own.

Remember that it can take up to a month to change a habit. Give something a try for 2-4 weeks before deciding that it doesn’t work. Don’t lose hope – something will work or change on its own in time. I guarantee you won’t find yourself falling asleep on your 17 year-old son’s floor.

Cultivating The Habit of Being Grateful

“Cultivate the habit of being grateful.” Ralph Waldo Emerson

Imagine going for a walk in the woods on a sunny winter afternoon. It starts off as a pleasant walk, the sun has warmed the air enough so you left your hat, scarf, and gloves at home. You know the trail well and you plan on turning around after a mile or so. You are almost there, but then clouds appear and quickly blanket the sky. The sun’s warmth dissipates and cold rain starts to fall. You know this isn’t a good thing so you head back. The clouds thicken even more, it becomes extremely dark, the rain turns to freezing rain, and it’s hard to see on the trail. You are cold and shivering, and all you want to do is get back home. On the way back you slip a few times almost twisting an ankle, your limbs are starting to get numb from the cold, you really question what might happen to you if you don’t make it back. Eventually, you make it back home. How do you feel? I imagine most of us would feel a deep sense of relief and gratitude that we are safe. We would be thankful to be back home where it’s dry and warm, and we wouldn’t care at that point whether our house was big enough, if we had a nice enough car, or if we had the latest tech gadgets. At that point, all we would want is for our basic needs to be met. The gratitude we feel when we don’t have our basic needs met, to when we get our basic needs met is an amazing feeling. We feel grateful for what we have and we don’t complain about wanting more. Why is it so hard to feel that way every day? Because our perspective is so focused on what we don’t have rather than what we do have. There’s a reason why research has shown that keeping a gratitude journal has so many health benefits. Keeping a gratitude journal reminds us each day of the things we already have, we focus on the positives, it allows us to be more empathic to those who have less, and when we feel thankful we are more likely to return the appreciation to others. Feeling grateful feels really good, and you can feel good every day if you make gratitude a habit.

Happiness and Super Bowl Sunday

WOOO!!!! Chicken wings, jalapeno poppers, new commercials, and musical performances are only ancillary things to be eager for on one of the biggest sports nights of the year. The anticipation can be found in most restaurants, stores, organizations, and schools. We are excited to sit in front of the largest TV we can find with neighbors and friends to see what team will be crowned the Super Bowl 50 Champion.

Despite all the excitement and disappointment of the play-off season, I love the Super Bowl because it brings a strong sense of community regardless of the two teams. It’s a time for family, friends, food and celebration. It may even be the time of year where we feel most connected with our neighbors and coworkers. We complete our grids at work the week before game and then discuss the best and worst plays, commercials, and musical acts for the following week. I encourage you to bask in the sense of community during this year’s Super Bowl and keep your fingers crossed!

Happiness and Openness

Remember those optical illusion images? You would have to look at the abstract image just so in order for some shape to pop out in 3-D. I always felt stuck when looking at those books because I could never see anything. I blame it on my own inflexibility because I relied on the same strategy over and over without adjusting the way I looked at the picture. This same inflexibility or rigidity can lead us to feel stuck in other areas of our lives. When emotions are aroused, it’s easy to cling to rigid rules, strategies, and behaviors without considering different approaches.

Being open can allow you to adopt alternative perspectives. It means looking at the future without preconceptions, considering multiple strategies, entertaining the possibility that things may not go according to plan, and practicing being nonjudgmental. Being open means taking a close look at yourself in order to create new options for how you behave, react, or think about things.

The good news is that being open can begin with some simple strategies. Are you someone who always writes with a black pen? What if you tried writing with a blue pen for a few days instead? You could also try brushing your teeth with your non-dominant hand. As you engage in these somewhat small behaviors, you will teach brain new tricks as you move away from your typical patterns and toward openness and flexibility.

Happiness and Sharing Space

I thought I’d enjoy the Jack and Jill sinks in our master bathroom. I wouldn’t have to wait to straighten my hair while he brushed his teeth because we could do it at the same time—genius idea! Three months into the new bathroom and this genius idea has created a battleground. Combs and hand lotions left on the sink countertop are strategic moves to conquer additional territory. Every day we dance around one another as we reach for soap while arguing about how there isn’t enough space for me to do my makeup. We entertain the idea of one of us moving to the guest bathroom, but haven’t accepted this as a viable alternative to our predicament.

You may be wondering, “Why doesn’t one of you just move out?” Because life isn’t always so easy and there aren’t always extra bathrooms. We have problem-solved and acted on many ideas, like switching sinks and rearranging our hygiene products, but none have helped us. We persist because compromise and learning to share space is critical for all our relationship. We don’t view the bathroom as a hindrance, but as an obstacle we will overcome somehow. After all, it’s the space where we connect in the morning by discussing national news, planning our days, and joking with one another. I wouldn’t trade it for anything!

We sometimes need outside help for the Jack and Jill sinks in our lives when they feel unsolvable or unbearable. Check out our couple’s therapists who can help you make some improvements in your relationship.

Happiness & A Beautiful Day in the Neighborhood

I grew up watching Mr. Rogers tie his shoes as he taught me about life’s lessons. Being raised near his home of western Pennsylvania made his grip even stronger because his presence was everywhere. My sister and I loved trips to Idlewild Park where we rode Trolley into his neighborhood of make believe as his friends greeted us to “Come along, come along to the castle hug and song.”

These days, I find myself returning to Mr. Rogers for guidance when I question my core being, seem lost, or feel a bit rattled. His wisdom is reflected in numerous quotes that he left behind through his many years on television and philanthropic work. These quotes help me stay true my values and morals while guiding me back to myself.

Where do you turn to when you feel rattled? Maybe it’s loved ones, your favorite book, or inspirational quotes. These people and things can remind us of who we are and help guide us toward our path in life. Consider this gem of a quote below:

“Some days, doing “the best we can” may still fall short of what we would like to be able to do, but life isn’t perfect on any front-and doing what we can with what we have is the most we should expect of ourselves or anyone else.” – Fred Rogers

Competency to Stand Trial: Effort v. Malingering

Imagine you are interviewing a 17-year-old young man about his knowledge of court proceedings. The young man is unable to explain the role of the judge and cannot describe the charges against him. He appears to have average intelligence, which makes his responses even more perplexing to you. He suddenly turns his head to look at the wall and informs you that he hears someone else speaking, but you assure him this is not the case. His medical records reveal several psychiatric diagnoses throughout his life. Your opinion: Competent or not competent to stand trial? Is he malingering? Is he even trying?

The critical task for psychologists in these situations is determining whether the individual is malingering or not putting forth adequate effort. The former is a deliberate and intentional misrepresentation of oneself that is driven by secondary gain while the latter is sometimes intentional, but lacks purposefulness.

Psychologists alert you to inadequate effort in the behavioral observations section of the competency to stand trial evaluation. They will depict an individual going through the motions of the evaluation without concern for their performance. Descriptions of behaviors will include phrases such as poor motivation, minimal effort, low tolerance for frustration, or refusing to respond to questions. Consequently, the psychologist will likely conclude that the evaluation was an unreliable assessment of the individual’s current level of court knowledge and ability to consult with counsel.

An individual who is malingering during the evaluation may deny having basic court knowledge, intentionally respond to questions incorrectly, or feign a mental health disorder that would preclude them from functioning in the court process as well as attaining competency in the future. Psychologists have several tools for assessing each of these scenarios.

Psychologists can review school and medical records for inconsistencies in functioning, administer specific tests to assess malingering, and conduct cognitive testing when an individual is believed to be intentionally misrepresenting their level of court knowledge. For example, The Test of Memory Malingering (TOMM) distinguishes malingering from memory impairments while the Inventory of Legal Knowledge (ILK) assesses whether an individual is feigning their knowledge of the legal system. Furthermore, cognitive tests such as the Wechsler Adult Intelligence Scale-Forth Edition (WAIS-4) provide information regarding the individual’s level of cognitive functioning in regards to general knowledge, abstract problem-solving, working memory, and speed of processing information.

Clinical interviews used in conjunction with psychological testing are tremendously valuable when there are concerns of feigned behaviors. For instance, individuals malingering mental health symptoms often demonstrate blatant behaviors characteristic of a disorder while often missing subtle behaviors, which are observed by psychologists during the clinical interview. Furthermore, structured interviews such as The Structured Interview for Reported Symptoms, 2nd Edition (SIRS-2) assess the genuineness of an individual’s responses as well as inconsistencies in self-reported mental health symptoms. Personality measures, such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) also provide information on the individual’s response pattern. The MMPI-2’s validity scores have the most empirical support for use in assessing malingering behavior.

Although psychologists provide opinions regarding competency-to-stand-trial based on the impact of developmental/cognitive or mental health diagnosis, clinical judgment and psychological assessment is also necessary when malingering is under question. When you read through the report, pay close attention to whether the psychologist painted a vivid picture of how the individual presented during the evaluation. Also, check the lists of administered tests as administration of the TOMM, ILK, or SIRS-2 suggests that the psychologist may have been concerned if the individual was responding truthfully. If personality testing was administered and found to be unreliable, make sure the psychologist elaborated on the reasons for this response pattern, such as random responding or presenting oneself unfavorably. Finally, remember the threshold for malingering is exceptionally high in competency to stand trial evaluations with only 10% of adults found to be malingering during evaluations.

In Defense of Roughhousing – January 2016

Q: I’m a mom of two young boys who seem intent on killing each other. Every time I turn around they’re rolling around on the floor in a tangle or jumping on each other. I feel like I spend half my time warning them to stop or pulling them apart. My husband tells me that they’re “just playing” and he even initiates it sometimes! I need advice on how to handle this.
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A: Roughhousing can look dangerous, I know. And of course, like any social and physical activity, it can end up with tears, hurt feelings, and injury. But with true roughhousing that doesn’t usually happen – and it’s not what the kids remember about it.

Roughhousing or horseplay (rowdy, physical, interactive play) starts in toddler years and usually ends in high school (and then resurfaces again in fatherhood!). Boys tend to roughhouse more than girls, which helps explain why your husband jumps into the fun. It’s a language of sorts for boys; a way of saying “I like you” without overt vulnerability. In adolescence it can be a vehicle for establishing a social hierarchy. And it’s a natural form of bonding for fathers which is great because research shows us there are a lot of benefits to roughhousing. In fact, it’s especially good for a child to practice roughhousing with a parent who’s good at it so the child learns these life skills as well as how to roughhouse with friends.

So what exactly are the benefits of perfecting the Peter Parker or leaping like a flying squirrel off the couch onto your brother’s back? Physical fitness (strength, coordination, body control, flexibility, agility, quickness, complex motor learning, and cardio), emotional intelligence (reading social cues, being tuned in to your partner’s emotional state, regulating your own emotions and actions in response), social skills (teamwork, trust, leadership, negotiation, setting and following rules, good-natured competition), intelligence (anticipating moves, faking someone out, creating new moves), and energy discharge. It also teaches that there is more to physical contact than sex and violence, that winning isn’t everything and there is strength in compassion, and it helps kids develop inner strength and physical confidence. Horseplay (particularly when done with a parent who is good at it) provides the endorphin rush of athletics with the oxytocin of loving touch. It also releases a chemical (BDNF) that stimulates neuron growth in the regions of the brain responsible for emotional memory, learning, language, and logic.

And let’s not forget the loving bonding that is forged between sparring partners in good roughhousing. Having fun is hugely important in developing a strong relationship with your child, so if this is what they love to do, figure out how to do it really well and jump into the fray!

Good horseplay starts with rules – spoken and unspoken, which means that people may need some time and assistance to understand them well. Skillful roughhousers know when to ramp it up and dial it down. They know exciting but safe moves. They’re willing to let the other person lead and take direction while working together to try a new move. They make sure that the other person is in the right frame of mind before initiating play, and they respect the other person’s right to stop at any time. It’s a good idea to have a code word since typical ones like “stop!” might be part of the game, especially if role-play is involved (eg. cops and robbers). The person with the physical advantage could self-handicap to make the play more even and fun for everybody. When roughhousing with your kids remember that their joints are prone to injuries so be gentle on those shoulders, and avoid roughhousing right before bed unless you want a late night TV buddy and the hairy eyeball from the other parent.

Parents need to be able to differentiate between horseplay, torment, and fighting. It’s not easy, especially for moms who didn’t grow up with brothers. One study showed that 8 and 11yo kids were able to tell the difference from videos 85% of the time. Adult men were right 70% of the time, as were women who grew up with brothers. Women who didn’t grow up with brothers thought all the videos were real fighting. Here are some key differences between horseplay and something more serious: in play, kids are smiling and having fun, taking turns, holding back in capability, and it often occurs with a group of boys who play together happily afterwards. In fights kids are crying or angry, trying to hurt each other, and usually involves only two kids who don’t want to play together afterwards. If you’re not sure which it is, ask “Are you having fun?” If one or both kids are having a hard time disengaging when they need to, a parent should intervene with a time out and cool down and afterwards help them talk about if they thought it was fun or scary or too rough, etc. Research shows that roughhousing doesn’t usually get out of hand. But sometimes a child does take it too far, and these kids often tend to struggle with self-control, emotion regulation, or can’t read others’ emotions accurately, and would benefit from coaching in those areas. In particular, young, hyperactive kids can develop more self-control through a lot of coached roughhousing with the parent gently and firmly dominating.

If you’re still not sold on roughhousing, consider this: studies of horseplay found that kids who do it more at home get better grades up to third grade and make better friends than those who don’t. Kids who roughhouse at home are less violent outside the home because they can differentiate between horseplay and aggression. Studies show that the more intelligent species and the most competitive societies engage in physical play in youth more than others do. Animals deprived of physical play tend to grow up to imagine physical threats where there are none. Lack of horseplay is linked to inadequate control of violent impulses in adulthood. Sold yet?

Make room (in your heart and your living room) for roughhousing because the more you allow it the less your kids will try to do it dangerously when you’re not around. Teach them horseplay skills to open them up to developing all those hugely important life skills. You will see bruises and scrapes and rug burns, but probably no one will lose an eye. (Probably.)

Happiness and New Beginnings

Hello, 2016! Goodbye troubles of 2015, otherwise known as yesterday. It’s funny how a change in one number can shift our outlook, “new year, new me!” As you direct your mind toward self-improvement, remember to keep track of all the positive aspects of your life, regardless of whether they are related to your resolution. Accumulating positive experiences and emotions can decrease or even prevent your brain from heading down negative thinking rabbit holes.

Keep Calm & Stay Positive just might be your motto for 2016!

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