Leading Australian child psychologist Dr Kimberley O’Brien and the team at Quirky Kid Clinic have launched a social emotional learning (SEL) program for use in schools and clinics.
‘The Best of Friends’™ program was developed in response to increasing demand at schools and the Quirky Kid Clinics to address social and emotional challenges that children experience.
This manualised program has been running since October last year at the Quirky Kid Clinics and is soon to be rolled out at St Catherine’s School in Sydney. It is an innovative resource that helps children to gain the knowledge, attitudes and skills necessary to understand and manage emotions, set and achieve positive goals, show empathy for others, develop and maintain friendships and make good decisions.
Dr O’Brien said SEL opportunities in school settings significantly increase student outcomes both academically and in life.
‘The Best of Friends’™ program engages children with stories, illustrations and interactive activities to help children overcome social and emotional issues in a peer group setting,” said Dr O’Brien.
The program draws on decades of clinical and school experience and extensive research and is presented in a concise format to facilitate SEL for children aged 7 to 11 years.
Publisher of ‘The Best of Friends’™ and co-founder of the Quirky Kid Clinic, Leonardo Rocker said the program integrates with the Australian Curriculum and was shortlisted for the Educational Publishing Awards Australia 2015 and received a special commendation.
The Quirky Kid Clinic has been offering workshops throughout Australia for over 8 years.
Parenting is a big project and can be challenging under any circumstances; after divorce, however, it can become even more complex due to the new dynamics between family members. Most parents want to ensure their children continue to thrive, socially, emotionally and academically at all times. To help with this process, we have compiled some useful techniques to ease the transition and help to create new working relationships between divorced couples.
Communicate with respect
When speaking to your ex-partner, it is crucial to keep it positive. This is especially important when emotions are high, and you don’t feel in control; take a break and implement some relaxation strategies to help you cope better and to think and speak rationally. For example, take deep breaths or leave the room and visualise a scene, place or situations that you consider safe, restful and happy. While living arrangements may have changed, it is essential that you continue to interact positively with your ex-partner to successfully co-parent your children. Studies have shown that parents who remained calm and communicate in a respectful manner with their former partner were able to improve their relationship as a result (Markham, 2015). In an article from the Child Study Center (NYU School of Medicine) it states that parents can have robust disagreements about a variety of topics in front of their children without necessarily causing stress and anxiety. The key here is for parents to do so in a way that shows their kids that conflict can be managed and even resolved with love and mutual respect.
Agree on a consistent schedule
One reason communication between parents is so important is to increase consistency and stability for your children. Children require consistent rhythms in their life that do not change frequently (Pruett, 2014). This does not necessarily mean that the children must be cared for in a single environment; it merely requires consistency in each parent’s responsiveness from day to day. If children can keep regular daily schedules regardless of which house they are living, their internal clocks will remain in check. Regular schedules help to reduce behavioural problems, separation anxiety, regression, and other issues which are prevalent in children of divorced parents. From the age of 7 years, children can contribute to defining their options for schedules, so make sure to consult your child when changing their plans.
Maintain consistent discipline
Like with schedules, consistent discipline is necessary for children’s well-being. This is not confined to punishment; discipline includes chores, homework, manners, and attitude. If there are fundamental disagreements about how to discipline your child, it is advisable to reach a compromise where possible. If it is not possible, maintain consistent discipline in your home (McMurray, 2008).
Stay in close contact, if possible
It is often in the best interests of your child for both parents to remain involved after the divorce (Kelly & Johnston, 2001). Certain accommodations will be necessary within the family dynamic to support the arrangement (McIntosh and Long, 2006). While shared custody is often an ideal, if the child lives with one parent, try to ensure that the child sees the other parent regularly.
Moving away is sometimes necessary for one parent. However, it is important to consider the consequences for their child. Relocating can create an imbalance in the parenting, and can create a more formal relationship with the parent who has relocated. Is it important to make it as easy as possible for the child to have a relationship with the parent who has relocated. For example, the child may benefit from having a mobile phone to contact the other parent without feeling as though their relationship is being mediated.
Manage your new relationship with your children
Divided loyalty is common but needs to be managed. Avoid making children choose sides. It is likely that your relationship with your child will change as a consequence of the divorce. You may choose to take a more proactive role during after-school sports; be more present in the school setting; or perhaps due to circumstances, have less time with your child after the divorce. During this new stage you may develop new routines and experiences to share with each other.
Try to keep activities inexpensive with a focus on quality time to avoid competing between parents and encouraging divided loyalties. Consider attending key events together, like graduations, concerts, school meetings. By role modelling positive relationships in the community, your child will feel safer and securely attached with both parents. During special events and celebrations, if spending them together is not an option, try to ensure your child is involved and informed about what decisions have been made. If your child it is not happy about the arrangements, acknowledge their feelings and try to encourage children to spend time with both parents.
For more information on helping children through a divorce, please contact us.
Kelly, J.G., & Johnston, J.R. (2001). The alienated child: A reformulation of parental alienation syndrome. Family Court Review, 39(3), 249-266.
Markham, M. S., Hartenstein, J. L., Mitchell, Y. T., & Aljayyousi-Khalil, G. (2015). Communication among parents who share physical custody after divorce or separation. Journal of Family Issues, 1-29. 10.1177/0192513X15616848
McIntosh, J E. and Long, C. M. (2006) Children Beyond Dispute: A prospective study of outcomes from child focused and child inclusive post-separation family dispute resolution. Final Report. Australian Government Attorney General’s Department. Canberra
McMurray, S. (2008, 08). Discipline after divorce. Today’s Parent, 25, 43-45. Retrieved from http://search.proquest.com/docview/232888210?accountid=12528
Roffman, A (2016). The Art of Arguing: Tips for Handling Parental Conflict around Your Kids http://www.med.nyu.edu/child-adolescent-psychiatry/news/csc-news/2016/art-arguing-tips-handling-parental-conflict-around-your-kids?mc_cid=f08198a623&mc_eid=039ce82960}
Children present with a whole range of interesting characteristics. Amazing vocabularies, confidence in the company of adults, endless creativity and emotional intelligence beyond their years. While others struggle with background noise and refuse to put pen to paper due to sensory issues and perfectionism. The start of a new school year is often when parents decide to have their children assessed to gain clarity and direction for the year ahead. Armed with information for teachers, parents are empowered by an expert opinion.
Deciding to seek a professional opinion can take months or years of deliberation. Some put off an assessment in the hope their child will ‘catch-up’ or ‘settle down’ with maturity. Others proactively seek a standardized assessment with the view to access evidence-based intervention as soon as possible. In my experience, young people respond positively to intensive support tailored to meet their needs in the home, school and community setting. They thrive with extra attention and understanding.
A significant event or developmental milestone, such a starting kindergarten, changing school or starting secondary school may trigger parents to make an appointment with a psychologist. Common goals for intervention include ‘behaviour management strategies‘, ‘greater classroom support’ and ‘to help my child maintain friendships’. Whatever the precursor, the assessment process begins when parents engage in a joint appointment to provide background information. The initial interview is an opportunity to learn more about the child’s developmental history while gaining a detailed account of the child’s presentation at home and school.
Many parents bring school reports or previous assessments to pinpoint their child’s strengths and weaknesses. Telephone consultations are often recommended between the teacher and the psychologist to gather current insights into any social or behavioural issues. The information provided by teachers and parents is essential to establish the best way forward. The psychologist’s plan is referred to as a ‘case plan’.
A case plan may include a selection of standardized assessment tools to be administered in the clinic setting; playground and classroom observations or programs to be facilitated with same-aged peers. Popular goals identified by young clients in their initial appointments are often on par with developing academic confidence, gaining independence and establishing organizational skills. For children, this often equates to greater understanding from the adults around them, as opposed to frustration or pressure to perform. For parents and teachers, the assessment process often brings about clarity, direction and initiates a team approach to solving the issues.
In some cases following an assessment, parents and teachers are divided by a diagnosis or lack of diagnosis. According to some parents, pre-school teachers have been known to confidently diagnose Autism based on observation alone. We also hear from schools seeking “a DSM-V diagnosis” in order to apply for funding. In these circumstances, a psychologist is likely to suggest a case conference at the school, involving parents and teachers to mediate around the pros and cons of a diagnosis or a label.
Semantics aside, most parents are more interested in the recommendations included in an assessment, as opposed to a diagnosis. This detailed list of practical ideas is designed to harness individual strengths while addressing areas in need of support. Community-based programs, such as daily swimming or kid’s yoga courses, often compliment clinic and classroom interventions.
Encopresis (or faecal soiling) is one of the most frustrating difficulties of middle childhood, affecting approximately 1.5% of young school children (von Gontard, 2013). It is a debilitating condition to deal with as a parent, as it usually occurs at a stage when children are past the age of toilet training.
Encopresis is a common complaint amongst parents who visit the Quirky Kid Clinic as it often occurs in the context of other behavioural issues such as oppositional defiant disorder (ODD) or separation anxiety.
According to the Diagnostic Statistical Manual (DSM-V) (American Psychiatric Association, 2013) encopresis (or otherwise known as Elimination Disorder) is essentially the repeated passing of stools into inappropriate places, after the age at which toilet training is expected to be accomplished. In order to receive this diagnosis, 4 features should be present:
Patients chronological age must be at least 4 years
A repeated passage of feces into inappropriate places, which is either intentional or involuntary.
At least one such event must occur every month for at least 3 months.
The behaviour is not attributed to the effects of substances (e.g., laxative) or any other medical condition.
There are two basic categories of encopresis i) primary encopresis-which refers to children who have never attained bowel control, ii) secondary encopresis-which refers to soiling after successfully attaining toilet control usually brought upon by entering a stressful environment (such as family conflict).
What causes encopresis?
Parents of children with encopresis often feel frustrated as they often believe that their children play an active role in controlling their bowel movements. While in some cases, soiling may be intentional, in other cases it may be involuntary and beyond the child’s control. It is important to be aware of the many possible causes for this disorder.
Biological factors: Functional constipation (persistent constipation with incomplete defecation without evidence of a structural or biochemical explanation) is one of the main causes of encopresis, accounting for 90% of cases amongst children (Har & Croffle, 2010). Children may withhold stools often because he/she is constipated and therefore experiences pain when there is a bowel movement. Chronic withholding of bowel movements causes children to lose the ability to defecate normally, and causes partial bowel movements of which children are often unaware. Other medical causes such as spinal cord damage, celiac disease or damage to the bowel can result in encopresis. Medications may also lead to non-retentive fecal soiling. Tricyclic anti-depressants, narcotics, and iron are likely to cause constipation that is severe enough to lead to encopresis and laxative abuse can cause severe diarrhea and fecal incontinence.
Psychological factors: Overall 30-50% of children with encopresis have a comorbid emotional or behavioural disorder (von Gontard, 2012). In a large population study, school aged children with encopresis had significantly increased rates of separation anxiety (4.3%), specific phobias (4.3%), generalized anxiety (3.4%), ADHD (9.2%) and oppositional defiant disorder (11.9%) (Joinson et al., 2006). Children who present with Oppositional Defiant Disorder or Conduct Disorder (that is, children who are intentionally defiant and non-compliant to their parents or caregivers) may use inappropriate soiling as a form of retaliation, as a means to communicate their anger, or as an attention seeking strategy. There is also evidence to suggest that children who have encopresis experience higher levels of anxiety and depression as a result, and these symptoms can exacerbate the symptoms of encopresis. A population study by Cox et al., (2002) found that children with encopresis had more anxiety and depression symptoms, exceeding the clinical threshold by 20% compared to control children.
Family and social factors: Children may develop delays in toileting due to unsuccessful toilet training as a toddler and intrusive toilet training. It may have been that children recieved discipline for having accidents or have been encouraged into toilet training before they were ready. Negative toilet training practice can cause children to associate using the toilet with punishment. In other cases, encopresis occurs when there is a stressful family situation such as divorce, birth of a sibling or transition to a new school. In severe cases, frequent soiling may occur in a child who has had a traumatic or frightening experience such as a sexual or physical molestation.
What are the potential risk factors for Encopresis?
In western cultures, bowel control is established in 95% of children by age 4 in 99 % of children aged 5 (von Gontard, 2013). Around primary school age (10-12 years old) 1.5% of children develop encopresis. Although every case is different, studies have shown that there are a number of risk factors, which are associated with the development of encopresis including:
Gender: encopresis is five times more common in boys than girls.
Abuse and/or neglect.
Inadequate water intake.
Presence of chaos or unpredictability in a child’s life.
Lack of physical exercise or a diet that is rich is fat/ sugar.
Presence of neurological impairment such as brain damage, autism, developmental delay and intellectual disability.
History of constipation or defecation.
What is the impact of encopresis in school aged children?
Encopresis can have a severe effect on the child, family and school environment. Encopresis is often a family preoccupation, as parents and siblings become increasingly frustrated as family activities may be disrupted due to the constant soiling. The family is left fruitlessly battling over the child’s bowel control, and the conflicts may extend to other areas of the child’s life such as school functioning and social circles such as friends. When the child becomes increasingly aware of these difficulties, they may become angry, withdrawn, anxious and depressed and may be a victim of bullying if other peers become aware. Studies have shown that encopresis children experience a greater amount of anxiety and depression symptoms, difficulties with attention, more social problems, disruptive behaviours and lower levels of academic performance (Mosca & Schatz, 2014).
What are the treatment options for encopresis in school aged children?
While encopresis is a chronic and complex problem amongst many families, it is treatable. As a parent, it is important to be aware that there is no quick fix for encopresis, the process might take months and relapse is very common. Sixty-five percent of patients are almost completely cured in 6-months and 30% show improvement (Har & Coffle, 2010). The majority of children with encopresis can be effectively treated with a combination of medical, psychological and dietary interventions.
Medical treatments: The first step to treating encopresis is to identify the cause behind the condition and seek medical advice from a pediatrician or GP. Medical examinations are important in order to rule out the existence of organic causes. Initially a doctor may prescribe a laxative to ease the passage of the hardened stool through the rectum. Once the stool has passed, substances such as fiber, enemas or laxatives may be used to empty the colon and decrease painful bowel movements.
Behavioural modification with the assistance of a Psychologist is an integral treatment component for encopresis . In order for this to be effective, family tension regarding the symptom should be reduced and a non-punitive atmosphere should be established. Parents should encourage their child to sit on the toilet for 10 minutes after meals 2-3 times a day. The initial aim is to produce a bowel movement by giving the child the chance to get used to using the toilet and to be in tune with bodily cues. Parents can create a reward system, which provides incentives for the child to use the toilet. He/she may receive a star or sticker on a chart for each day he/she successfully goes to the toilet without soiling and a special reward could be earned after an 80% success rate during the week. A recent meta-analysis by Freeman, Riley, Duke & Fu (2014) found that behavioural intervention is the most effective treatment for encopresis.
Treat other co-morbidities: Comorbid emotional and behavioural disorders should be treated separately according to evidence based recommendations (von Gontard, 2013). If your child is presenting with anxiety, depression, or oppositional defiant disorder, these associated co-morbidities should be treated concurrently to reduce symptoms of encopresis. Untreated co-morbid disorders will reduce adherence and compliance and the outcome of encopresis treatment will not be optimal.
Other tips include:
Never tease or embarrass your child and do not show anger. Supporting your child’s self-esteem is essential. Name calling and teasing are frequent results when a child soils at school/and/or smells of feces so it is important that their self esteem is not affected as a result. While it may seem like purposeful behaviour at times, it may not be within your child’s control (as in the case of functional encopresis).
Encourage your child to drink lots of water, eat fiber rich foods such as fruits, vegetables and whole grains
Consider scheduling evidence based psychological intervention if your child feels shame, guilt, depression or low self esteem related to encopresis.
If your child shows no improvement after 6 months they should be referred to a gastroenterologist for additional assessment.
American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Cox, D., Morris, J., Borowitz,S., & Sutphen, J. (2002). Psychological differences between children with and without chronic encopresis. Journal of Pediatric Psychology, 27,7, 585-591.
Freeman,K.A., Riley, A., Duke,D.C., & Fu, R. (2014). Systematic review and meta-analysis of behavioural interventions for fecal incontinence and constipation. Journal of Pediatric Psychology. 39, 8, 887-902.
Har, A.F., & Croffle, J.M. (2010). Encopresis. Paediatrics in review. 31,9,368-3754.
Joinson, C., Heron, J., Butler, U., et al. (2006). Psychological differences between children with and without soiling problems. Pediatrics, 117, 1575-1584.
Mosca, N., & Schatz, M. (2014). Encopresis: Not just an accident. NASN School Nurse. 28,5,218-221.
Some girls are feisty from the get go, from fussy babies to tantruming toddlers. The pre teen or “tween” years though, can be the time which parents find most confounding. At this time parents can struggle with everything from girls (and boys) becoming increasingly defiant to the ‘sexualisation’ of young girls and navigating increasingly complicated relationships with peers.
Between the ages of 8 and 13, children are expected to push the boundaries and this is a part of becoming more independent. You can therefore expect girls at this age to disagree with you, show a bit of ‘attitude’, take risks and want to be more like their friends. Remember, “this too shall pass”. In the meantime, you can support your child by guiding her behaviour with clear rules, warm relationships and an understanding of why teenagers behave the way they do.
For example, their brain are still developing: the ability to control our impulses does not fully mature until 25! Pre teens and teens, therefore, are more likely to make decisions based on emotion and have poor foresight. They are also often sensitive, moody and unpredictable. This poor ability to foresee consequences and make informed decisions can be offset by helping to build a pre teen’s confidence so that she can avoid bad situations, bad relationships and be able to say no.
Just because they are getting older doesn’t mean your girls don’t need rules and boundaries. Instead of imposing these on them, set agreed limits that teach independence, responsibility and problem solving. This will lead them to develop their own standards for what is appropriate and how others should be treated. Praise and encouragement, of course, is still important at this age so let her know what she is doing right. Also, although rude and disrespectful behaviour is common at this age that doesn’t mean it should be acceptable. Collaborate with your child on rules about this type of behaviour and then model what you would like to see youself. In the moment, stay calm and wait for the right time to talk about it. When the situation has cooled and can be talked about, let her know how you feel e.g. “I feel hurt when you speak to me like that.” Fighting between siblings is also common at this time and is a normal part of growing up which teaches us life skills like conflict resolution.
The pre teen years are a time when girls are dealing with peer pressure, possibly bullying or cyberbullying and the need to begin taking risks. An increasingly important role for parents and other adults at this time is to help girls to develop a positive self image. It is difficult for them to ignore the messages from TV, music, movies, the web and clothing stores which sometimes encourage girls to be “sexy” and base their self worth on how they look at a time when they are not physically or emotionally ready. The belief held by young girls that they must dress a certain way to fit in is part of growing up. They feel pressure to conform because dress is part of their social code. As parents we can tune in to media that is targeting our girls and then talk to them about it.
Talk about the qualities they value in their friends and how important these are versus physical attractiveness.
Have conversations about TV shows, dolls and outfits that you don’t like instead of giving a blanket “no” and encourage activities where she excels that take the focus off looks and being cool.
Most importantly, don’t lecture! Ask for your girls’ opinion and try to listen more than you speak. At this time it is also important to not avoid sex education but rather find out what the school is teaching so you can follow up at home. This goes beyond “where babies come from” and is about choices, behaviour and relationships. Ask your daughter’s opinion about these things, she is probably just as conservative as you are! Overall, be a healthy role model and avoid talking about feeling “fat”, “ugly” or going on diets around your daughter.
The pre teen years are a time when we expect girls to get a little feistier but some will show this more than others. Disruptive behaviour is known to pass through generations so if you were a feisty young girl there is a good chance your daughter will be too. You can buffer against this by fostering a warm relationship and setting firm but fair boundaries. Remember to talk to your girls so you can support them through what can be a tough time. You may sometimes get a ‘brick wall’ but meet them where they are by setting aside special time and being available when they come to you.
Helping girls develop a positive self image. Australian Psychological Society (website)
Molen et. al., (2011). Maternal Characteristics Predicting Young Girls’ Disruptive Behaviour. Journal of Clinical Child and Adolescent Psychology. 40 (2), 179 – 190
Pre-teens behaviour: in a nutshell. Raising Children Network (website)