MENTAL SHIFT 5: Passing Judgment on Parents is a Self-FulfillingProphecy

Perhaps nothing characterizes a family-centered approach to early intervention more than being nonjudgmental. This characteristic is not just about early intervention of course: It is central to the idea of inclusion and acceptance.

Stockholm 2016

What behaviors or attitudes of parents might lead an early interventionist to pass judgment? The categories could be (a) parenting, (b) lifestyle, (c) so-called personality, and (d) implementation of interventions.

Parenting. Early intervention is essentially a parenting program, so, when parents engage in parenting behaviors that early interventionists might think are ineffective or even bad, it seems almost part of the job to do something about it. Ineffective parenting might be getting the timing wrong on reinforcing a child's behaviors, behavior management strategies that actually reinforce the behaviors parents don't want, or giving children tasks too difficult for the child's developmental level. Many other examples exist. "Bad" parenting might be things we know are not good for kids, either from research or from our own professional experience. These things might be corporal punishment, poor feeding, and providing the child with a physically unhealthy environment. One of the mantras of the Routines-Based Model is We have an ethical obligation to provide parents with information. If we see parents engaging in ineffective parenting and we have information that would help them meet their own goals, we should give the information to them. Meeting their own goals is important. For example, if the parents let the children graze all day, you might know this could cause a problem at meal time and, possibly, lead to obesity. Should you say anything? As always, begin with a question, such as, "Is it OK with you that he grazes all day?" If the parent gives an answer that essentially indicates yes, you can follow it up with, "Do you have any problems with his eating his meals?" If the parent says yes, you have the opening to provide information about the problems with grazing. If the parent says no, just be patient. An opening might come up later. It could be that the child causes a mess when grazing, for example. There's your opening.

Lifestyle. Parents in early intervention might lead their lives very differently from the early interventionist. They might be messy or neat freaks. They might spend all their time in front of the television or they might be constantly on the go. They might be loud and raucous or they might be quiet and withdrawn. They might be rich or they might be poor. Any deviance from the early interventionist's own way of life could lead to judgment on the part of the professional.

Personality. Parents might have behavior patterns in their interactions with others (i.e., a "personality") that's difficult for the early interventionist to deal with. Some parents are friendly, others are withdrawn. Some are sarcastic, others are sugar-sweet. Some are rough around the edges, others are cultured. Some are bitter, others are happy. This is where reframing is particularly helpful.

Withdrawn = thoughtful
Sarcastic = funny
Rough around the edges = down to earth
Bitter = cautious

Implementation of interventions. Perhaps nothing irks an early interventionist more than parents who don't implement interventions the professional thought the parent was going to implement. In the Routines-Based Model, we professionals take responsibility for that situation. We must not have arrived, jointly with the parent, at a feasible intervention. So we need to ask more questions, working with the parent to find out whether the parent really wants to work on that problem and, if so, what other solutions might work. By taking responsibility, we quickly avoid passing judgment on the parent.

Is it acceptable to pass judgment internally as long as I don't act on it? To some extent, acting nonjudgmental is what's important. By continuing to practice nonjudgmental behavior, the mind can follow: You will become less judgmental. On the other hand, if you harbor judgment about a parent, even if you don't say anything, the parent might sense it. The pursed lips, the lack of response, the tone of voice.... Parents are smart: They'll pick up on it. Understanding that we can't tell people how to think, we are left with guidance about how to speak and write about families, not to mention how we work with them. I'm reminded about the privilege I had of working at the Family, Infant and Preschool Program (FIPP) in Morganton, NC, in the mid-1980s, when Carl Dunst was the Director. The culture of the program was such that no one said negative things about families, even back at the office. Our peers would correct us if we used judgmental language, such as saying a parent was in denial.

The relationship with the parent gives you leeway. Our language is perceived as judgmental, in part because of how we say things but also because of a lack of trust. If the parent hasn't developed a good relationship with us and we say something--even just ask a question--the parent might think we're passing judgment. But if we're like a friend to the parent, the very same statement or question is perceived as a friendly, helpful gesture, because the parent trusts us. It's another reason to work always on building and maintaining a positive relationship with the family. Furthermore, if we really like the family, we are less likely to be judgmental, so the positive cycle of nonjudgmental behavior is enhanced.

MENTAL SHIFT 4: ANYONE SPENDING TIME WITH THE CHILD HAS THE OPPORTUNITYTO TEACH THE CHILD

Children learn from those around them, but there must be a threshold amount of time. Or perhaps the time spent is correlated with the impact one can have on the child. The mental shift in this post is from thinking that intervention comes from people who spend short amounts of time and not from those who spend long amounts of time.

The work of Mary Beth Bruder, Carl Dunst, and Carol Trivette on "learning opportunities" has documented that ordinary routines in a child's life are where learning naturally happens. And the work of Tom Weisner and Cindy Bernheimer has shown that everyday routines are the chunks of time that families construct to make their lives work, and that these ecocultural niches are the context of child and family development.    

The discussion here is about substantial time. I've used 15 hours a week as an informal, unscientific criterion for deciding whether a caregiver should be included in a Routines-Based Interview (RBI). If the relationship between time spent and influence on child functioning is linear, those spending fewer than 15 hours a week can't be said to have no influence. The issue becomes one of efficiency. If the amount of influence is small, then it's not worth their time or ours to be interviewed. Families, however, can always have anyone they like at the RBI.

Who spends substantial time with the child? Almost always the custodial adults, such as parents. Custodial adults, therefore, are the parent figures in the child's life, so, from now on, I'll just call them "parents." Adults who are responsible for care of the child, perhaps while the parent is working, also spend substantial time with the child; these are child care providers or preschool teachers, for example. 

What about influential people who don't spend the requisite amount of time, such as grandparents. They can give children enjoyable times, new opportunities, special moments, and so on--all of which can create memories, if the child is old enough. But early intervention should focus on those adults who are around during the everyday routines: They have enough teaching opportunities distributed through the day that can make a difference. Furthermore, they're teaching when, where, and with whom the child needs the skills. By teaching in the moment, the child is learning to respond to the naturally occurring "discriminative stimuli." When someone walks in the room, the child learns to say hi. That's a lot better than repeating hi in multiple trials in an early intervention session with a professional. Children can learn context-specific behaviors that reinforce the adults in charge of those contexts, and here I'm talking about the short-time caregivers, such as visiting grandparents or early intervention professionals. The child can learn not to touch the ornaments at Grandma's house or to take his seat in the therapy room. The issue now is one of functionality. How do these help with the child's functioning in everyday routines? If they generalize, fine, but young children, especially if they have developmental disabilities, do not transfer well. If the adult also "transfers," then you get a bit more bang for your buck. For example, if an early intervention visit focuses on the parent interacting with the child, perhaps practicing how to teach the child something during a routine, the parent can then use the same task directions and prompts during regular life. Therefore, because the adult generalized his or her strategies from the short-time session to the long-time real life, the child has a chance of learning the skill.

In the Routines-Based Model, early intervention supports (i.e., services) are aimed at the long-time adults, usually parents and teachers. In future MENTAL SHIFT posts I'll discuss how we provide those supports.

MENTAL SHIFT 3: CHILDREN ARE LEARNING FROM THEIR CAREGIVERS, WHETHER YOU WANT THEM TO OR NOT

Continuing the mental shifts necessary to provide functional, family-capacity-building early intervention, here I discuss the fact that caregivers are teaching their children already. So what is the role of early intervention (birth-6)?

We are building on the foundation caregivers (parents and teachers) have already established with the child. As Vygotsky pointed out early in the 20th century, children learn from other people who do things at a little more advanced level than they do (i.e., in the zone of proximal development). Obviously, adults are way more advanced, but, when they're teaching children, they elicit behaviors that are minor advancements to the child's existing behaviors. If they're too advanced, the child doesn't learn them well. If they're not advanced enough, no learning occurs although the child might get in some practice. Similarly, when we work with adults, our best efforts should involve ideas for tweaking what the adults are already doing. This is for a different reason from why we work only in the child's ZPD. With adults, it's more about homeostasis: Adults tend to develop their ecocultural niches that are not terribly malleable.

As the research of Bruder and Dunst has shown, learning opportunities abound in families' lives. Some families make the most of these opportunities and others are possibly unaware of their impact on their children's learning and development. In research conducted through the NICHD, one of the best predictors of children's outcomes at age 16 years was the quality of mothering they children received when they were infants. This was also true for those infants in full-time child care. Parenting makes a difference.

As early interventionists, therefore, we don't go into homes with the assumption that we're going to train parents to teach their children. Rather, we know they are already teaching their children, and we're helping them figure out (a) why the child is or isn't doing something in the course of everyday routines, (b) what strategies can be added to the routines (i.e.,  things parents can do in their existing routines) to help the child participate more meaningfully or competently, and (c) whether or not those strategies worked. These are essentially the three stages of Sue Sheridan's conjoint behavioral consultation. Early intervention is indeed a consultative process--the good, collaborative consultation, not the bad, expert consultation.

When we realize that families have already created the "teaching space" in their routines, our job is easier, more relevant, and more acceptable to families. Furthermore, we're expanding the family's capacity to teach their children by reinforcing it and building upon it. When an early interventionist creates new routines (e.g., heaven forbid, play time on the floor with select toys), it doesn't acknowledge the family's existing ecocultural niche. It sends the opposite messages: either you're not teaching your child or what you're doing isn't good enough.

Families' belief systems about their parenting role vis à vis teaching the child or their sense of self-efficacy in that role can be a factor in what we do in early intervention, as the following table shows:

 

	Parents who don’t intentionally teach their child very much	Parents who intentionally teach their child a lot
Early intervention works directly with the child	Parents are reinforced in this belief; we need professionals to teach the child	Parents might believe what they do is not enough
Early intervention builds the family’s capacity	Parents become more aware of the teaching they do and increase the amount	Parents’ self-efficacy and confidence are increased, thus sustaining and even expanding their teaching

MENTAL SHIFT 2: WHOSE CHILD IS IT ANYWAY?

T

his post continues the 12 mental shifts I described in September—the mental shifts that have to occur to move from a clinical approach to a family-centered, functional approach. This time, the shift involves asking the question, Whose child is it anyway?

The question most often crops up when professionals and the family disagree. At least, it should crop up. The two disagreements are when families want to address something you don’t care about and when they don’t want to address something you do care about.

Families want to address something you don’t care about

Javier insisted his son, Carlos, should say please and thank you. Carlos could barely say mama and dada. The early interventionist thought there were much more functional words he should be learning next, such as more, yes, finished, eat, drink, and so on. She explained to Javier that these words could be useful in different routines and were generally easy for children to learn. She noticed, however, that Javier himself didn’t use them in playing or feeding Carlos but did model thank you and please. Then she remembered Whose child is it anyway? Not only is this a true and obvious statement but because Javier had this as a priority, he was motivated to work on it, so Carlos received the intervention frequently. Signing please and thank you do no harm and actually help Carlos learn about imitation, communication, and rituals—all important for learning and family routines.

What if Javier had wanted Carlos to use the toilet at 18 months? The early interventionist would have had an ethical obligation to provide Javier with information, which is another mantra of the Routines-BasedModel. We have an ethical obligation to provide families with information.

Families don’t want to address something you care about

Philomena is a physical therapist and is working with Rose and her family. Rose gets into a four-point position, on her hands and knees. She often then sits back on her ankles, but there’s no movement—no “creeping” on hands and knees, with the tummy off the floor. Philomena thinks this is important: It would help Rose learn about reciprocal movement and weight shifting, not to mention that it would be a more efficient way of moving than the commando crawl Rose did use. But Rose’s parents were politely lukewarm about creeping. They’d heard that many babies simply skip over creeping before learning to stand and eventually walk. Also, they didn’t like making Rose do things she didn’t want to do, and Rose had no interest in creeping, even with a towel slung under her belly and held up by an adult. Philomena incorrectly thought creeping was a prerequisite to walking; after all, it was next on the mobility developmental checklist. 

Then she remembered Whose child is it anyway? She’d given the parents information about weight shift and reciprocal movement, so she’d done her ethical duty. If the parents didn’t work on creeping, it wasn’t going to harm Rose. Even if Rose learned to move independently later than she would if she crept, so what? Early intervention doesn’t mean we have to push all skills to be learned as early as possible. If children or their caregivers aren’t interested, it’s futile to perseverate on the topic. 

A few weeks went by, when Rose’s mother said she wanted her to play more independently and for longer, so she could get dinner ready (the dreaded dinner preparation routine). Philomena worked with the mother to come up with solutions, and, on one visit, the mother said, “If it didn’t take her so long to get to her toys, she wouldn’t get fussy so quickly.” 

Philomena said, “How can we get her to be quicker? Or should we put the toys closer?”

“We need to get her moving better than that crawling she does.”

“We can certainly work on that, but that would require a grown-up with her, and you’re busy preparing dinner.”

“Maybe I can work on it when we’re just hanging out, playing in the living room,” said Rose’s mother.

“Is that a useful time for her to be able to move better?” asked Philomena.

“Yes, it’s the same issue. She can be more independent in her play.”

Asunción, Paraguay, where I recently spoke at the ORITEL Conference

This is an example of how, even when we acknowledge whose child it is, the skill might be addressed. It was only when Rose’s mother saw a functional need, for Rose to be engaged during dinner preparation, that the skill became a priority. After this conversation, perhaps even at another visit focused on play time, Philomena would have used family consultation (Mental Shift 12) to develop, with the mother, the specific intervention strategies.

Incorporating Parenting Into Ongoing Family Consultation

Sonny McWilliam with her daughter, Tinsley, at the Outer Banks

Early intervention is, at its core, a parenting program. I mean it is designed to help parents rear their children in ways they want to, with added information about what’s good for their child, considering his or her disabilities, delays, or risk status. The child’s situation is the key unlocking the door for the family and us to get together, but, once we’re in the same room, parenting is what we’re talking about—at least when implementing the Routines-Based Model.

I don’t mean to imply that parents are deficient in their parenting. Rather, as we engage in joint solution finding around the individualized goals, we have the opportunity to encourage five evidence-based parenting strategies.

Talk

Most people in early intervention are aware of the landmark study by Hart and Risley (1995) showing the relationship of the number of words a child hears to the child’s language development and the relationship of socioeconomic status to the number of words heard (poorer = fewer words). Hart and Risley also saw that the poorer children heard a greater proportion of negative words (stopping child engagement, redirecting unnecessarily, harsh words) than less poor and richer children heard. Other researchers have also stressed the importance of the quality of language used with and around children (Konishi, Kanero, Freeman, Golinkoff, & Hirsh-Pasek, 2014).

Read

Reading to the child can start even before birth. Reading is a good way for families that find talking to nonverbal children strange to provide them with words. On the other hand, “reading” isn’t as important as shared book time, when the adult talks to child about the pictures or about the story (Whitehurst & Lonigan, 2001). Reading with children is probably a good way to teach children to appreciate books.

Play

You’d think play comes naturally to parents, but not necessarily. I’m not talking about playing with a toy, necessarily. More about being playful. The key is really getting in tune with the child and keeping him or her engaged. Knowing when to expand on the play “schema” and when to stick with the existing one. It involves loosening up adult inhibitions. In addition to social play with adults, children do benefit from learning to play with objects independently.

Teach

Children learn from their parent, whether you want them to or not! But what is it parents do? They use reinforcement principles, for one. We point out to parents how there need to be good consequences when children are doing what the parents want him or her to do. And there should be a dearth of attention when they do what the parents don’t want him or her to do. We sometimes help parents with the timing of their interactions with the child, to promote their effectiveness at making those interactions teaching moments. Cultural anthropologists have said that, in many societies, children learn their cultural norms by observing adults who are not necessarily actively teaching them (Lancy, 2014).

Behavior Management

Behavior management of very young children is still about teaching them. Some parents have an easy time of it, either because they’re masters at behavior management or they’re blessed with children who don’t give them much trouble. Other parents might face challenges in this area, so early intervention is very much about helping families feel in control without getting into power struggles.

In the Routines-Based Model

In this model, the topic of conversation with families, especially in early intervention for children under 3, is often a child’s engagement, independence, or social relationships (EISR)—things addressed through goals, if a good Routines-Based Interview was conducted. If you focus on EISR, you still get to traditional developmental domains.

Even when we’re talking about outcomes/goals, however, we’re doing so in the context of routines. Routines as we define them (naturally occurring activities and rituals) are when parenting occurs; they provide the context both for goal-related interventions and for parenting strategies.

If we think of early intervention as a parenting program, we normalize the experience. The five parenting strategies listed above aren’t for parents of children with disabilities; they’re for all parents. Most parents are already doing at least some of these things, so our attention to parenting allows us to build on adult strengths and sometimes to point out things they could do more.

Hart, B., & Risley, T. R. (1995). Meaningful differences in the everyday experience of young American children: Paul H Brookes Publishing.

Konishi, H., Kanero, J., Freeman, M. R., Golinkoff, R. M., & Hirsh-Pasek, K. (2014). Six principles of language development: Implications for second language learners. Developmental Neuropsychology, 39, 404-420.

Lancy, D. F. (2014). The anthropology of childhood: Cherubs, chattel, changelings: Cambridge University Press.

Whitehurst, G. J., & Lonigan, C. J. (2001). Emergent literacy: Development from prereaders to readers. Handbook of early literacy research, 1, 11-29.

Call 911! Bad Parenting!

Call 911! Child waiting for parent outside rest room!

Today, our local newspaper wanted my comments on various recent stories about children being supposedly neglected by their parents. I was pretty sure I couldn’t speak for my entire organization so I declined. Instead, I’m boring you with a blog post.

According to The Week, the stories have included (a) a Connecticut mother leaving her 11-year-old in a car alone while she ran into a store, (b) an Ohio 8-year-old leaving church to play with friends, and (c) a Georgia mother letting her 9-year-old play in a public park while she worked at McDonald’s. But the kicker is that the Connecticut mother was charged with a crime, the Ohio heathen’s father was arrested, and the Georgia mother lost custody of her daughter and was jailed.

My first thought is that the principle of calculated risk has given way to the principle of shrouded childhood. 

Second, most parents want what’s best for their children and for their families. They are also trying to make life work—to keep themselves together.

Third, the villagers helping to raise the child would do better to speak to parents or look after the child until the parent returns—not call the cops.

From Managing Risk in Play Provision:
Implementation Guide

It would be easy to say child safety comes first and that parents shouldn’t do things they would regret if something were to happen. On another post, I’ll talk about how play has changed, even disappeared because of helicopter parenting. Here, the issue is more about parents either knowingly or unknowingly losing sight of their children. I heard, by the way, that the 9-year-old left in a park did have a cell phone, which has to count for something. I don’t think I’d leave a 9-year-old to play in a public park, but then I don’t have the pressures that a mother who works at McDonald’s has. 

In early intervention/early childhood special education, we have (or should have) a strong dislike for judging parents. We see families all the time doing what they have to do, sometimes what’s familiar to them. What we see might not be the way we reared our children but we respect and trust families. We do have an obligation to give families information, which can take the form of talking them through scenarios to make sure they make informed decisions. 

I love meeting parents who don’t infantilize their children—who give them room to explore, take responsibility, and entertain themselves. I don’t usually call the police on them.