Tag

emotional problems

May 10
15

When the Worry Bug Makes You Mad: Understanding the Importance of Positive Behavior Plans for Anxious Kids

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

“Don’t Feed the Worry Bug,” by Andi Green is a wonderful book for children who are anxious or experience a lot of worrisome thoughts. The story is about a monster who constantly feeds his WorryBug, only to find that as he worries more and more, the WorryBug continues to grow until the monster is totally overwhelmed by the emotion. Eventually, he learns to control it. In my practice, I evaluate a number of children with lots of worries…but they don’t actually look worried. Instead, children may appear defiant, hyperactive and aggressive. Why do children overwhelmed with anxiety sometimes become frustrated and angry or have poor behavioral control at home and in the classroom?

Children with anxiety “on the surface” may appear angry, oppositional and defiant to adults. However, these behaviors oftentimes reflect secondary responses to an underlying cause: anxiety. Responses to anxiety can be categorized as “fight, flight or freeze.” As a classic example, if you run into a grizzly bear on a hike, your body’s natural physiological response is to fight, flee or freeze. Your anxiety about the demands of a situation send your body and brain into a state of “threat alert.” Similarly, when a child is worrying about something, is socially anxious, or is feeling nervous about their ability to handle a task, this “threat alert” system is activated and the child’s ability to make well-thought out decisions is impaired. The child may be labeled a “behavior problem” because of the impulsivity, defiance, disruptiveness or aggression (fight mode). Or the child may appear distractible, silly and immature, or avoidant of challenging tasks (flight mode). An anxious child may also show difficulties shifting gears/transitioning, problems letting go of events, or seem unmotivated or apathetic (freeze mode). It is also not uncommon for children with anxiety to have challenges demonstrating appropriate social skills, such as problems with insight into how their behaviors may affect others. They may also experience challenges reading the nonverbal and verbal cues in their environment because their brain is “soaked” with high arousal, immobilizing their capacity to apply logic to everyday situations. How do we help children manage their anxiety and the resulting behavioral challenges from that anxiety?

A neuropsychological evaluation can provide insights into your child’s behavioral challenges to determine if there may be an “underlying cause,” such as anxiety, (or other causes such as learning disabilities, depression or poor information processing) which are driving weak emotional and behavior control. Once identified, a neuropsychologist can provide guidance on the most effective interventions for a child at school and at home.

In my experience, one of the most important interventions for a child who experiences anxiety and secondary behavioral challenges is the development of a Positive Behavior Plan at school, which can then be included in a child’s IEP. However, many children with anxiety do not respond well to traditional behavioral reward systems that solely focus on increasing or decreasing behaviors (e.g. follow directions, sit calmly, keep your body safe, etc.), as these systems do not teach the child the self-regulation skills necessary for controlling emotional and behavioral responses. Instead, an effective Positive Behavior Plan for a child with anxiety includes behavioral targets or “goals” that focus on the attempt at coping strategy application. Importantly, a child with anxiety should be rewarded for trying to use a coping strategy, as it will take time, practice and reinforcement before a child develops the capacity to apply coping strategies consistently and successfully.

Sample coping strategies that a child should be taught by a special educator, counselor or other specialist include “taking deep breaths, jumping jacks, taking a break, using words to say how I feel,” or other self-regulation tools. When the goals of a Positive Behavior Plan focus on using a coping strategy before or during moments of distress rather than a plan that is tied to increasing or decreasing specific behaviors after they occur, a child builds independent capacity to appraise and react appropriately to physical and emotional responses in the classroom and the community. Children learn the signs (e.g. in their body, mind and in their environment) that the WorryBug is approaching, and feel better equipped, confident and more in control of their emotions and behaviors. For more information on how to appropriately develop Positive Behavior Plans for children with anxiety, “The Behavior Code” by Jessica Minahan and Nancy Rappaport is an excellent resource for parents and educators.

When the “WorryBug” or anxiety makes kids mad, mean and aggressive, a comprehensive and thorough neuropsychological evaluation can determine how to best tackle the anxiety “beneath the surface” through therapeutic and educational interventions. A neuropsychological evaluation can also direct the development of strategic Positive Behavior Plans that are individualized and appropriate for the child’s home and school environment.

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Jan 21
13

More Than An Inkblot: Measuring Problem-Solving and Critical Thinking Skills with Projective Tests

By | NESCA Notes 2019

Image Cred: SlidePlayer.com 2019

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

What might this be? A saxophone player? A woman’s face? A bunch of black and white paint? Or is it something else entirely? This classic optical illusion engages the parts of the brain responsible for perception, critical thinking, and problem-solving so that humans can “make sense” of a somewhat ambiguous picture. We know that everyone perceives and experiences the world differently. In order to best support a child’s growth and development, parents, educators, and professionals need to understand a child’s “lens” or “brain habits” that guide how they think, how they feel and how they behave. Projective testing assesses these “brain habits” and sheds light on a child’s problem-solving style.

If you google or look up “projective test” in the dictionary, an array of definitions pop up. The general theme is: a projective test is a test designed with ambiguous stimuli upon which a person presumably “projects” hidden, unconscious emotions and conflicts. Yes, a person’s internal thoughts, feelings, and assumptions sometimes outside of conscious awareness do influence your response to projective tests and your behavior in everyday life. However, projection is only one piece of the puzzle. A broader, more accurate definition is:

A projective test is a “performance-based” test that requires the respondent to perform a task that has little structure, direction or guidance. These tasks might, for example, involve completing a sentence, telling a story, or describing inkblots (i.e. the famous Rorschach Inkblot Test).

So why do we care about assessing a child or teen’s ability to make sense of an unstructured, ambiguous task? In addition to measuring a child’s concrete knowledge and skills (e.g. academics, intellectual functions, memory capacity etc.), it is oftentimes crucial to understand how a child problem-solves a situation “in action” – when they must rely on themselves to formulate a solution. This is particularly true for children who have difficulties managing their emotions, children who have trouble making reasonable decisions, and children who can’t seem to make or keep friends. For youth with these challenges, understanding how “in the moment” problem-solving and critical thinking skills work or don’t work gives parents, educators, and professionals insight into learning style, challenges and strengths, and most importantly, guides individualized therapeutic interventions.

A growing number of business and education leaders have begun to recognize the importance of performance-based assessments to evaluate student learning in the classroom and the workplace. Creativity, ingenuity, “thinking on your feet” and the capacity for critical thinking and analysis are clearly key skills in today’s innovative world. Therefore, to set kids up for success, it is understandably helpful to evaluate a child’s thinking and feeling “brain habits” that affect their choices, behaviors, and aspirations. As assessors, teachers, professionals, and parents, we want to better understand how each child applies knowledge to solve problems they face now and in the future – social problems, work problems, emotional problems and beyond. Projective testing provides not only a current evaluation of a child’s capacity to problem solve “on their feet” but provides a direction for how those “brain habits” might pose a strength or a challenge for that child as they grow.

Are you thinking about referring a child, teen, or young adult for projective testing? Here are 5 “fast facts” to guide you:

  1. Projective (also known as performance-based) tests are powerful diagnostic tools when administered and interpreted in conjunction with observation and other standardized test results by a skilled, experienced practitioner. It is important to ask a potential evaluator about their training in projective testing and how they utilize the results.
  2. Projective testing is helpful for children and teens with various complex, social and emotional challenges. Common referrals include questions related to: thinking problems/emerging psychosis, trauma, attachment-related concerns, depression, anxiety, bipolar disorder, developing personality traits and disorders, high-risk behaviors such as suicidal or homicidal thoughts and actions, substance abuse, poor emotion regulation, and self-injury.
  3. Projective testing provides information about a child’s thinking patterns, how they experience emotions, self-esteem, and their habits of interacting with others. For example, is a child more likely to “keep everything inside” and avoid or do they dysregulate and “explode” when they experience anxiety? Are a child’s difficulties making and keeping friends because they get “stuck” on the details of a situation, is it because they “miss the big picture”, or are they in a constant state of worrying that others will let them down? Answering these questions results in a more individualized intervention plan for therapy, at home and at school.
  4. Projective testing is not for everyone. There is little research on the use of projective testing with children and adolescents with low visual acuity, below average verbal and/or non-verbal IQs, impairments in visual-spatial processing, social-communication challenges, or language disorders. Be cautious of practitioners who do not inquire and evaluate these important aspects of a child’s functioning, as they are crucial components to determine the appropriateness of a projective evaluation.
  5. Projective testing sheds light on not only a child’s areas of difficulty, but can also provide an individualized analysis of a child’s strengths. For example, projective testing can identify capacity for insight into choices and behaviors, ability to engage effectively in a therapeutic relationship, capacity for empathy and perspective-taking, as well as a child’s inclination towards imagination, creativity, and ingenuity.

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment, and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills, and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate, and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT), and family (solution-focused, structural) modalities. Her school, home, and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel, and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence, and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

 

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, MA, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.