Saturday, June 23, 2012

Sexual Abuse Scandals

If there is any good to come out of the newspaper today, it is that people become more aware of sexual abuse.

Three stories sadden me to no end, each story related to child sexual abuse.  The links I could find below are slightly different from those in the Kansas City Star today (June 23, 2012):

Unless you have been living in the wilderness without any connection to the outside world, you have heard of the Sandusky trial.  It represents that not all abusers are scary looking men who are unkempt, dirty, undereducated, or any of the number of images that come to mind when thinking what an abuser is supposed to "look" like.  They are typically well groomed, friendly people you would trust. They often abuse many children over many years without getting caught.

The Monsignor case highlights the misconception that authorities always do the right thing.  Authorities, whether they are church officials, police officers, teachers, or any other person, are human. And humans fail sometimes.  Unfortunately it appears that he knew a priest abused children, but allowed him to continue to serve the public and did not notify authorities as he should by law.  I will never know the full story.  Maybe he had so much faith in this man that he could not see clearly.  Maybe he thought he was not a threat or his solution would work.  In any case, he allowed the opportunity for more children to be hurt.  I can see how many of us could be convinced at some level that a problem is less than it is, and turn the other cheek.  Maybe we witness something concerning at the store, but decide that it isn't our business, we are overreacting, or we don't know what is going on and shouldn't get involved.  At what point are we wrong for looking the other way?  If we intervene every time a parent disciplines a child with a harsh word, we certainly will offend some otherwise great parents and possibly cause damage to their healthy family by misunderstanding their discipline and getting authorities involved.  But what if their yelling at a child in public is only a fraction of what will be done in the privacy of their home? It is a slippery slope...

The "In Brief" story from Lawrence (page A7, Kansas City Star, June 23, 2012) of a man being found guilty of raping a 5 year old girl has one sentence that haunts me: "The girl, from Eudora, first accused Walker of abuse in 2010 but recanted."  Does this mean she was subjected to pressure to recant her story? Did her family fear retaliation? Was she abused further after telling the adults she trusted?  I will never know the answers to these questions, but I hope and pray that parents hear the underlying message: believe in your children.  Talk with them openly. Watch for signs of abuse.  Seek help from child abuse experts.

Child abuse is often under-recognized by families and friends, allowing the abuse to continue for months to years before recognition and help for the child.  I have written about recognizing abuse and what to do about it previously.  Most sexual abuse victims know their abuser in some way, and often the families encourage interaction with that person because they trust them.  It is a very difficult thing as a parent to protect our children, because we want them to grow up able to have healthy relationships with others.  They cannot be excluded from sports, scouts, school, religious organizations, visiting friend's homes, and other potential risky places.  We instead need to give them the tools to recognize dangerous situations, feel confident in themselves, and be open to them sharing anything with us.  

Abusers often look for certain traits in kids: lonely, feeling of being unloved.  They groom not only the child, but the parents -- if someone seems "too good to be true" and always offering to help with your child, gives them excessive gifts, or otherwise seems to be getting very close to your child -- be very watchful.  Not all helpful adults are threats, but identifying those who are is important!  

And not all abusers are adults.  Some are other children who are experiencing abuse and are not quite sure how to deal with all of their confused feelings.  Monitor your children with other children.  Don't assume it is just "child's play" if they are being very secretive.  

Look at the lists of warning signs in the picture above from  Sometimes there are other reasons for these signs, but be sure to address the issues if identified, preferably with an abuse expert. 

Abused children have an increased risk of psychological disorders and drug or alcohol dependency. The are also more likely to grow up and abuse more children.  We must stop the cycle.  If you suspect a child is being abused, call the hotline, 1-800-422-4453 (1-800-4-A-Child) from a safe phone.  Be sure the children get help:  not just separating them from the abuser, but also therapy to be sure they appropriately deal with the confusion, pain, and guilt the abuse can cause.  

Stop the cycle.

Friday, June 15, 2012

Speech and Language-- What is Normal, and When To Worry?

Development has a range of normals, and it is difficult for parents not to compare their kids with others (advanced or slow).  Parents worry but are often afraid they are over reacting or under reacting, since there is such a wide range of normal.  Don't be afraid to ask questions and discuss your concerns.  Avoiding the issue or minimizing your concerns doesn't help your child.  Keep a log of what your child can do at regular intervals to help you keep it all in perspective.  Before your child's well visits is a great time to review your list because you know we'll ask!

Speaking early or late does not necessarily mean a high or low IQ, so no bragging or worry is due (as long as the late talker is still in normal range).  Many parents jump to the conclusion that a child who doesn't talk by ___ months (this varies) is autistic. But they forget that Dad didn't talk at this age either, and he's perfectly normal!

Do we need to screen for autism? Yes!
Is it the most likely answer? No!
Do we need to evaluate speech and language frequently in the critical first 3 years of life? Yes!

We question communication skills at all well visits at this age to be sure your kids are on track. Early recognition of a delay can start the process rolling for further evaluation and treatment.  Speech and language are two related but different things. Speech involves the sounds that we make with our mouths. Babbling is an early speech. Language involves the meaning of words and the use of words.  Both are part of communicating with the people around us.  If kids miss the important milestones it can signify a problem.

Speech and/or language delay is very common and has many causes.  It is difficult for parents (and pediatricians) to identify severity of the issue or the exact cause much of the time.  Any red flags to speech and language delay deserves further investigation.  Some of the underlying problems include:

  • genetics - some families tend to have many members who were late talkers, other genetic disorders are known to cause speech and language problems
  • bilingualism - more than one language spoken at home
  • maturational delay - the kid that always seems to get there, but takes a little longer
  • learning disorders or mental retardation - delayed speech and language might be the first sign of a learning disability or low overall IQ
  • stubborn child - needs no explanation!  
  • autism - autistic children do not communicate with others on many levels, not just words
  • deafness or hearing loss - this is why we screen all newborns and at risk children as needed, frequent ear infections can decrease hearing temporarily
  • psychosocial deprivation - if no one talks with or interacts with a child, they will not learn
  • other neurologic and physical disorders 

Sometimes I think we just miss what they're saying, since early words are not recognizable.  My general rule of thumb: 2 out of 4 words will be understood by strangers at 2 years old, 3 out of 4 will be understood by 3years, and 4 out of 4 words should be understood by a stranger by 4 years.  If you are new to listening to your child talk at 12, 15, 18 months, you will not understand most of their words and take it for babbling.  Just watch the expression on their face and hear the intonation in their voice: They know exactly what they are saying!

Normal milestones include:

2 Months:
  • Social Smile (not just gas, but really looks at you and smiles!)
  • Watches your face
  • Startles with loud sounds
4-6 Months: 
  • Cooing and babbling
  • Turn to sounds
  • Blows "raspberries" and makes cough or grunting sounds as a game
  • Laughs and squeals
  • Begins to hold objects, stare at hands, and put things in mouth
9 Months:
  • Repetetive sounds, such as "da da da"
  • Imitation of sounds without meaning
  • Makes sound to get attention
  • Understands "no" (but doesn't always follow that command!)
12-15 Months:
  • Understand several common words spoken to them
  • Follow a simple command, such as "get the ball"
  • Can say about 5 words
  • Looks at something someone is pointing at
  • Most words are not entirely clear, the beginning or end of the word might be dropped. "Ba" can mean "ball" or "bath" ~ you have to use context!
  • Point by 15 months
18 Months:
  • Can say 10-20 words, again most are not clear!
  • Can recognize many words that are used
  • Able to point to objects in a book and name them
24 months: 
  • 2 word sentences
  • 50+ word vocabulary, one or more new words a week!
  • Able to use plurals 
  • Able to repeat what they are told (depending on mood!)
30 months:
  • Knows one color
  • Recognizes some letters
  • Names 6 body parts
  • Can say words with more than 2 syllables 
3 years:
  • Speaks in more complex sentences of at least 3 words
  • Able to use pronouns
  • Can speak in past tense (but doesn't always use "tomorrow" or "yesterday" correctly)
  • Commonly stutters, not a problem if less than 6 months duration
  • Very imaginative!
  • Unfortunately learns to lie (He did it!)
If you have concerns about your child's hearing, language, or speech, bring it to our attention.  We might alleviate your unnecessary worries (Brother isn't talking as much as Sister did at this age, but he is in the normal age range) or we might help you find resources for further evaluation and treatment. 

References and For More Information:

Healthy Children
Kids Health
Language Express
Parents As Teachers

Tuesday, June 5, 2012

Time Out Rules

Bench picture source: many online retailers
My last blog on Toddler Rules begs for a blog on Time Out Rules.  I have seen Time Out work effectively, but it fails often because of inconsistent use, interactions with the child during Time Out, and sometimes simply the personality of the child.

Learn the procedures below, teach the procedures to all caregivers, and practice with your child before beginning to enforce time outs.  Any form of discipline works best when all caregivers are consistent.

Children need to know what to expect, so practicing is important. Review sessions might be needed if the child has trouble staying in time out. All practices should be at a time when the child is being good! Remember that the practice is for the parents too!  Siblings who are old enough need to know to ignore children in time out-- practice with them too.

Expect that behavior will worsen before it gets better. (Sorry, no one said parenting was easy...)  Plan on getting to work late.  Attempt to start bedtime routines a little early, because Time Outs will extend the total time. When children know that parents are trying to affect their behavior, they may resist and act out even more. After a time they learn that parents are winning and they (often abruptly) begin to behave. If parents don't continue to discipline, the undesired behaviors resurface, so you must persist on Time Outs for bad behaviors when they do occur.  They catch you by surprise after the child is usually good, but you can't ignore bad behaviors or the child learns they can get away with them!

Time Out works best when certain "rules" are followed. There are rules for the child as well as the adult!

Rules for child
  • The child must stay in time out until the timer goes off. 
  • If the child leaves early, the timer will be re-set. 
  • If the child cries or tries to get attention, the timer will be re-set. This will happen as many times as needed until time out is complete. 
  • In general, 1 minute per year of age is a good amount of time.

Rules for adult: 

  • Remain calm.  It's hard, but don't yell or raise your voice.
  • Be specific about why the child has a time out.
  • Limit physical contact and limit eye contact.  (This is Time Out from human contact!) 
  • Except when giving the time out, don't talk about the event.
  • Be consistent with all behaviors and situations. (Give a time out even when you're late for work - it will pay back in the end!)
Things to do before and during Time Outs:

  • Discuss desired behaviors and behaviors that will earn a time out (hitting, yelling, etc.) during your "practice" sessions.
  • Resist any contact with the child in time out (no talking to child, avoid looking at child - other than discretely to be sure he/she is in time out).  Be covert to be sure the child is staying put safely.
  • You should continue to do what you were doing before: Talking with others in room, dishes, etc.
  • Quietly remind others that the child is in time out and cannot play/talk.
  • Set the stage for success: Be sure kids get enough sleep, eat on schedule, and have supervision.  
  • Praise good behaviors!

Things to remember after a Time Out:

The problem of over-discussing a behavior is a common mistake.  It is natural that a parent wants to be sure the child understands, but excessive talking tends to make kids more angry.  
  • After time out is complete, the crime has been punished. 
  • Leave it. 
  • Do not re-live the past. 
  • Do not keep "reminding" the child what he/she did wrong. 
  • Kids will learn best if they are left to think about issues on their own. 
  • The consequence already happened, you do not need to explain it to your child. 
  • Trust that your child is smart enough to "get it". 
  • It may take reinforcement (another Time Out) with the next behavior, but do not harp or nag about the behaviors. 
  • If I keep making my point with another bullet point, do you start to ignore me? That is what tends to happen when things are overdone.  Just drop it.  

Where and How to do Time Out?
The location of Time Out can vary depending on where the behavior occurred, but do not put the child where he/she can see television or do anything fun.  Put your child where he can be covertly monitored for safety.  It can be as simple as moving the chair away from the dinner table.  The child can see the rest of the family enjoying dinner, but is completely ignored. This is very hard for the child, but very effective. When Time Out is complete, the child can re-join the dinner as if nothing happened, but will remember the isolation of Time Out. It works well if they can see the fun going on but can't participate. Isolating to a bedroom loses some of this benefit, because they can't see others having fun.

When placing child in time out, use brief directions, such as "Time Out for yelling". Be sure to state why the time out is happening, but keep it simple. The more you explain, the less effective it becomes.

After you tell the child to go to Time Out, direct where you want her to go. If the child refuses after 30 seconds, put the child there. Be quiet during the 30 seconds, don't yell, don't give the instructions again. (Yelling shows the child you are losing control-- don't go there!)

At the beginning, you may have to physically place your child in Time Out. You can pick her up from the back (not too much physical contact ... no "hugs"). This may happen several times in one event if the child keeps running away.  Don't set the timer until he/she sits quietly. You also can help her get to Time Out with hand-holding or gently guiding from the back. Once children are pros at Time Out just naming the place and telling them "Time Out for hitting, sit on that chair" is sufficient.

Put your Time Out clock in view of the child, but out of reach. Practice with 10-15 seconds. For real Time Out, use one minute per year age.

Re-set the timer each time your child cries, gets up or tries to stop the timer early. Do not look at or talk to your child at this time.

After time out, simply say, "you are out of Time Out" and continue your activities. DO NOT continue to scold. DO NOT give a hug or congratulate on finishing Time Out.

DO give POSITIVE feedback often! When a child does a good thing or makes a good decision, be sure to smile, hug, say "good job" or "way to go". Kids love to get noticed and love attention. Give it for good behavior and the child is rewarded and will strive for those rewards again!

Always remember:  Behavior worsens when children (and adults) are tired, sick, hungry, or out of normal routines. Try to ensure regular routines, adequate sleep, healthy meals, and let children know if their routine will be different in advance. But don't use these as excuses for bad behavior! Schools, law enforcement, friends, etc. don't care if you "were just tired" and couldn't help yourself.

In a nutshell:  Patience is most important when re-directing behaviors. Yelling only fuels the fire and invites kids to yell back. Too much talking also backfires.  After the Time Out, resume normal activities. Be consistent with giving time out for all the bad behaviors you are trying to change, or the child will feel like he's getting away with it sometimes and will push the limits as much as possible.  Remember to be consistent with all providers, all behaviors and in all situations. Don't make excuses for the child (he's hungry/tired, it's the other kid's fault). If you give in once, the child will try for more leeway!