How is Parenting a Challenging Child Like Trying to Lose weight?

After decades of research and millions of dollars spent on diets we now know the secret to losing weight – eat fewer calories and move more! Not exactly a major news headline, yet millions still struggle with this simple strategy. Why? Because our thoughts and emotions get in the way of making better choices (e.g., eating healthier foods, getting more exercise). Anxiety can cause you to lose your willpower and eat that chocolate cake. Stress and thoughts of your past failures make you once more skip that trip to the gym. Our new research is finding that some of the same obstacles that interfere with successful weight loss also face parents who are challenged by their child’s outbursts. Despite hours of parent training, many families simply are not able to follow through on the techniques they learn because of interfering thoughts and emotions.

Picture a child screaming in a supermarket for a candy bar. Now put yourself in the place of the child’s parent. What are you thinking or feeling? If you are like almost half of the families we serve, you might be thinking what a catastrophe this is. You are becoming anxious and feel that all eyes are on you. You might also be feeling judged as a bad parent and can’t wait for this to stop. And because this seems to happen so often no matter what you seem to try, you think that your child is just not capable of behaving. Despite your better judgment you decide to give your child the candy because you know the tantrum will end. Negative thoughts about your skills as a parent and perhaps about your child’s ability to improve seem to get in the way of good parenting skills – sometimes “giving in” just to keep the peace.

In our 5-year study across two research sites in Florida (University of South Florida St. Petersburg) and New York (University at Albany), we recruited families who had a child with significant behavior problems (e.g., severe tantrums) and who self-reported being pessimistic about their abilities as a parent and their child’s ability to change. These parents would often make statements like, “I feel that everything is out of control,” or “I get upset because I feel others are judging me as a parent.” One group received 8 sessions of behavioral parent training which included finding out the reasons behind their child’s disruptions and various methods for reducing these problems. A second randomly assigned group received the same 8 sessions of parent training with the addition of “optimism training” (adapted from the pioneering work of psychologist Martin Seligman). Here we taught them to become aware of the interfering thoughts and taught them skills to either distract themselves (sometimes with humor) or perhaps substitute the negative thoughts with positive ones (“I have a plan for dealing with this tantrum and things will get better.”). So they learned both how to help their child but also how to be more positive and hopeful in their application of these plans.

At an invited address at the annual meeting of the American Psychological Association this summer in Washington, D.C. I presented the results of this study. First, it was encouraging to note that the children from families in both groups improved their behavior at home significantly after only 8 sessions with the parents. And the group that received the optimism training reported even larger improvements in their child’s behavior than the group that did not receive this form of cognitive behavior therapy. Interestingly though, when we looked at how the children were behaving at home through videos before, after and one year following treatment, the child from both groups were better behaved, but not significantly different. Why would the parents from the optimism training group report bigger improvements?

To answer this question “we went back to the video tape” and looked at what the parents were doing with their children to make them better behaved. What we found was shocking. In the families who only received parent training we saw that they became experts at avoiding problems. For one mother whose son tantrummed at bedtime, she adapted the routine by lying down with him in bed and let him watch television until he fell asleep. He was much better at bedtime now, but this was not our goal. We wanted him to get to the point where he would go to bed and fall asleep on his own. She and other parents in this group just became better at avoiding problems – a process we call the “concession process.” On the other hand, parents who received the optimism training did not concede to all of their child’s demands and persisted in getting their children to do things like put their toys away or get dressed without problems. Their optimism training helped them to keep it up and not concede.

This work points out how important it is to look closely at how our treatments actually work. An important goal in clinical research– much like what is done in medicine – is to find the active ingredients in the treatment. It may also teach us to talk to clients about these cognitive obstacles (“What were you thinking to yourself when this happened?”) to following through on our suggestions.

A Second Look at Faces

In a previous post (Looking at Faces) I reported on one of a growing number of studies that investigate why people with autism have social difficulties. This research shows that - unlike people without autism - individuals with autism spectrum disorders tend to avoid looking at pictures of faces. Obviously, if you are avoiding looking at people, you will be at a major disadvantage when trying to learn social skills. But why would they avoid faces?

Some have looked at arousal and have theorized that other people make those with autism anxious - therefore, resulting in avoiding others. But when researchers have looked at arousal, they often get mixed results. A new yet-to-be published study seems the help explain these puzzling results.

Natalia Kleinhans and her colleagues had people with and without autism look at pictures of faces (see sample) at two different times. They monitored their brain activity through an fMRI (which assesses brain function). What they found was that the first time they showed the picture of a face both groups had increased arousal in the amygdala (a part of the brain involved with fear and anger). A new, unfamiliar face may be mildly anxiety producing for anyone because of all the new features to consider. However, when they showed the picture a second time, the control group habituated - meaning, they did not have the same hyperarousal response. However, the people with autism did not habituate, and continued to show hyperarousal. Without getting use to faces, people with autism may experience stimulus overload each time they see a person. This study may help make sense of why people with autism avoid faces.

Reference
Kleinhans, N. M., Johnson, L. C., Richards, T., Mahurin, R., Greenson, J., Dawson, G., et al. (in press). Reduced neural habituation in the amygdala and social impairments in Autism Spectrum Disorders. American Journal of Psychiatry.

Looking at Faces

The characteristic social deficits of people with autism are studied in a number of ways. A recent study used an innovative technology as well as a unique comparison. The researchers compared eye gaze at pictures among people with autism, those with Williams Syndrome (which is characterized by over socialness) and those without a diagnosis. Look at the photo on the right. There is a human face embedded in the lower right corner of each photo. The colored spots in the photo represent the amount of time each group look at the parts of the photo. Can you match photos "a" (top), "b" (middle), and "c" (bottom) with the correct group?

They found that people with Williams Syndrome looked primarily at faces (photo "b" - middle), undiagnosed persons looked primarily at faces but scanned other aspects as well (photo "c" - bottom), and those with autism primarily looked at aspects of the photo other than the face (photo a - top). This interesting study helps us look at the world through the eyes of people with autism and gives us a glimpse into their world.

Reference

Riby, D., & Hancock, P. (2009). Do faces capture the attention of individuals with Williams Syndrome or autism? Evidence from tracking eye movements. Journal of Autism and Developmental Disorders, 39(3), 421-431.

Autism Controversies

A new book by Paul A. Offit, M.D. takes a look at many of the controversies surrounding the nature and treatment of autism (Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure). Of particular interest is his discussion of how people make arguments for and against particular approaches, including how celebrities use their status to promote ideas that may or may not be backed by science. See an excerpt by clicking the link below.
http://cup.columbia.edu/book/978-0-231-14636-4/autisms-false-prophets/excerpt

Early Intervention

In class I note the landmark study by Lovaas (1987) (UCLA Young Autism Project Model) that studied the effects of using applied behavior analysis (ABA) with very young children with autism (younger than 3 1/2 years of age). [now referred to as Early and Intensive Behavioral Intervention - EIBI] In that study, Lovaas suggested that almost half of the children "recovered" from their autism - meaning that several years later teachers could not tell them apart from their students without autism. That study - now over 20 years old - generated a great deal of controversy. Over the years, over 20 studies have sought to replicate Lovaas' (1987) original study. Several new reviews look at progress to date (see references below).

First, the original study did not randomly assigned children to the treatment groups. This is a potential problem because we do not know if children who received the intensive intervention (40 hours per week for 2 years) were somehow different from those who did not - potentially affected the outcomes. Newer studies have attempted to remedy this problem.

Second, the study used educational placement as an outcome measure. This is a problem because where a child is placed (for example, in a regular class or a special education class) has more to do with the educational philosophy of the school than the abilities of the child. Other studies use IQ scores as well as adaptive and maladaptive behavior as outcomes.

Third, many people questioned whether or not 40 hours per week for 2 years (which is very expensive) was necessary. More recent work suggests that the range may be more like 30-40 hours per week to achieve optimal results.

To date, these newer studies generally support the effectiveness of EIBI for some children with autism. Researchers are now examining the characteristics of children that may predict the best outcomes (for example, language ability). Overall, the treatment progress seems to greatly improve for some children if early intensive behavioral intervention is implemented properly.

References
Eikeseth, S. (2009). Outcome of comprehensive psycho-educational interventions for young children with autism. Research in Developmental Disabilities, 30(1), 158-178.

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.

Reichow, B., & Wolery, M. (2009). Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA Young Autism Project Model. Journal of Autism and Developmental Disorders, 39(1), 23-41.