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Dr Timothy Verduin, you are clinical psychologist for the Institute for ADHD and behavior disorders at the NYU child study center, how did you end up there? Well, I started out at the NYU child study center about four years ago, and I interviewed their for internship, and I really love that place, and I ended up getting mashed at different place, and ever since that first interview, I really wanted to come back, so I found the way that I could do a fellowship there when my internship is over, I came back and got trained in a number of different behavior therapies for kids with ADHD, oppositional to find disorder and other disruptive behavior disorders, and ever since I just really love them work, and I recently accepted the faculty position there. So we got to talk about parenting, your strong willed pre-school, one or two good questions about ADHD, if you live in a main stream America saturated by media culture. Can you really avoid having some form of ADHD as a child? That's a very good question, and when you say some form, I assume you mean the source of symptoms that we think, and we think of ADHD problems with focus, attention and that sort of thing and from that angle, now it's very difficult given the level of stimulation that kids encounter now a days to really always be focused, always be well behaved in that sort of thing, when we are talking about ADHD parse, what we were talking about is the upper five percent of kids who do display some difficulty at one time and another with attention, focus and composing their behavior. Yeah, what is the effect of being a 16 old girl and having you're my space page and your facebook page and IMing and text messaging and you are on the phone and you are consuming You tube videos and - you are just multi tasking beyond multitasking as we knew years ago, what's the impact of all that on on the brain structure on on human behavior or what do you see that as a social impact today? Well, I think in addition to all of those stimuli that are bombarding kids now a day, there is also this demand for achievement in academics and in other areas such as sports and music and all those sorts of things, that especially in the in the North East, where were I live is really - parents perceive as an increase in all the demands, as well as in all the stimulation that's coming on their kids and some people think that's responsible for the rise and diagnosis and identification of things like ADHD, but really when we work with kids, that have what we consider be bonafide ADHD, what we find is, it's more a matter of how children and teenagers are able to take what ever resources they have and apply them to their situation and we see pretty consistent rates of kids who just simply aren't able to do that, even though it seems as though over time, the rates of those disorders have gone up, it seems is though it's the same percentage over time, that have that difficulty managing all those different lines and doing all those different things. So when you talk about strong willed pre-scholars of your area focus - What's the typical response to disrupted behavior? Well, all parents that I work with and certainly most parents I have ever met really mean well and when they first encounter disrupted behaviors in their pre-school aged kid which happen all the time as we know terrible tows and ferocious fours and that sort of thing, typically - unfortunately, the human responses basically to focus in on horn in on the negative behavior and what we tend to do as human beings has give negative attention to negative behavior, that's some thing that just happens, - happens to people, to you with your spouse happens to with your co workers, happens it with your friends, it's just some thing we do, unfortunately for pre-school kids, we were really learning how to manage their own behavior, getting very stimulating negative attention for negative behavior can often have the effect of raising the level of negative behavior, especially if the choice is between no attention and negative attention, many times kids will do the sorts of things, that get negative attention, if they are simply being ignored by their parents, so unfortunately the typical parental response to misbehavior very frequently is very stimulating, very consistent, negative response. And so solutions for that that for effective parenting, you have talked about positive attention, what does that mean? Well, positive attention in my opinion and in the opinion of the field really is one of the most important tools that parents have in terms of shaping the behavior of their kids, and in terms of teaching their children how to manage their behavior on their own, which is really the long term goal, positive attention I think is some thing that doesn't get a lot of attention in general parenting circles, it certainly has got more press lately, sometimes in negative press and we can talk about that in a moment if you would like in terms of the phenomenon of over praising kids, but really positive attention for the most part plays many times second fiddle to negative attention when it comes to dealing with kids that are very strong willed. Let me give you an example, if a child is is eating at the dinner table and he is using his fingers to eat his food, most parents without even really meaning to do this, will show attention immediately to the behavior of eating the food with one's fingers and say no that's not the right way to do it, what they will often fail to do in a scenario like that is to recognize that the child is sitting in the chair, may be eating a nutritious meal, may even be using a napkin or something like that. So, in a scenario like that where there are many child behaviors going on, really what sucks parents in frequently is the negative behavior and when I say we want to focus in order to improve the behavior of pre-school kids on positives, what I am saying is that we can often get a lot more effectiveness out of attending to the behaviors the child is already engaging in that are very positive and to - when a child is engaging in more negative behaviors, it actually, temporarily withdraw one's attention and wait for the first instance of positive behavior that we can praise. And what sort of behaviors should be praised in particular? Well it really depends on the child the sorts of behaviors that we want to go out of our way to praise are the behaviors that the opposite of problem behaviors that that child normally shows and this can be a very difficult thing to do because most parents when I meet with them will say that, how can I praise the opposite of this behavior, he never does this the right way and the truth is actually that once you get very good at spotting these positive behaviors, most children do engage in in positive opposite of their problem behavior several times a day. I will give you another example, so, a perfect behavior to praise for a child who tends to be may be some what protective of his possessions is if there is a moment even a brief moment where that child doesn't show any sort of bad attitude when another plays with their toys, now that wouldn't may be we would call sharing parse in the granter sense. There really is an example of the child being okay with other kids playing with his or her things and if that's the case, that's a perfect opportunity for a parent to come in and say Johnny I love the way you are sharing your toys with Chris, that's a really "Big Boy" thing to do. So there will be perfect example of an opposite behavior that you would want to praise and there are many other examples such as turn taking or using the prior example, one silver ware even if a child just touches the silver ware briefly a perfect example of praise the opposite, Oh, Johnny is using a silver ware that's a "Big Boy" way to eat. So, any of those things when you see the opposite of what the normal behavior is perfect target for for praise. And is it possible to praise your child too much? So, that's something that has gone a lot of attention in the press recently and the and the notion is if we praise our children too much, if we praise them and say that they are the smartest or the prettiest or the best, do they get an inflated sense of self importance, or they become arrogant, that sort of thing. So this really brings us I think to the appropriate way to praise kids. The short answer to that question - no, you can't praise your children too much. Can you praise them the wrong way, possibly? The right way to do it is to be as specific as possible about what you are praising and really what that means is you want to get you want to label exactly what behavior you are seeing in the child that that you like and that you would like to see more of. So, instead of saying to a child that - when they are doing a drawing, saying you are the best artist I have ever seen, or you are the smartest kid in your class, or you are much drawer than so and so is, a better thing to do is to pick a very specific behavior that you see and say, "I really love the way you chose those colors to go together" or "I really like the way you are coloring on the paper". Those sorts of things and when you praise specific behaviors, it's much less likely that a child is going to kind of think of himself as better than other children and it's more likely that you are going to see more of the behavior you are praising them. So, you told about positive attention. You also talk about clear expectations and consequences. So, even though positive attention is really portent way of shaping up positive behaviors and that's even sometimes a portent way of replacing negative behaviors with more of the positive, there are definitely going to be times with any togler or pre-scholar or you need to set limits and one of the things that I really try to help parents think about is how the limits they set and the directions they give, can either potentiate a greater increase in positive behavior or make things very confusing for kids and so before we even talk about consequences the the thing I think is very important to talk about with parents is how to give good directions and really to give good directions, the first thing that one must do is think about the level of the child that you are working with. Try to give directions one at a time, try to make them simple, try to use words that are easily understandable, and above all else, make sure you are giving positive directions instead of negative ones. So instead of saying, stop running around the room, say please sit down next to me, instead of saying being vague and saying be careful, say "hold my hand when we cross the street". These are things that are much easier for kids to do. And of course when they do those things. You want to follow that up with a very specific praise. "I love the way you listen the first time", "I love the way you are being safe crossing the street", that sort of thing. What are some of the common pitfalls of given consequences? One of the I think the literature says, more than any thing else about parenting styles that - really the worst approach to parenting would be to vacillate between a very permissive open parenting style and a very authoritarian, strict, punitive parenting style. And so what can very frequently happen especially with parents of kids who are - do have problems with listening or following directions or keeping their hands themselves, that sort of thing is that parents will let a lot of misbehavior go by and then will provide a very harsh consequence and this is exactly the opposite of what you want to do because usually by that point the parent is so fed up that the consequence is given more out of anger and frustration than out an attempt to shape behavior and this really sets up a very confusing situation for kids. So to avoid that pitfall, a more appropriate thing to do is to make sure that whenever you are in a situation that you know to be a high risk situation for your child, before you see the negative behavior, you set limits and you set them positively in terms of things you would like to see. And if you do need to establish a pattern of consequences, you also lay that out front. So you say, remember we want to be safe with our hands, if there is hitting, then we need to leave the playground, something like that and just do it in an even, neutral, tone of voice. What if parents disagree with each other, about how to handle misbehavior? Well, they frequently will, disagree with each other about such things because there are many different ways of disciplining kids and it may seem obvious, but really the first rule in terms of when parents have disagreements about parenting strong willed kids is for those disagreements to happen in private, not in front of the child and there are two very important reasons for that. The first of them is that no child wants to see conflict between people that they love that not only is disturbing the kids but also can model disagreeing with people in the family. The second of those reasons is that children are very perceptive and children are very skilled at getting the things that they need and if they sense an opportunity to work one parent against another, very frequently that will take up on that opportunity, not because - you know, not because of any character fall on their part, just because that's an easy way of getting what you want. But the second thing I would say about when parents disagree about these sorts of things. And this is something that I see all the time in parents of children that I am treating that have more severe behavior problems, is that very frequently there is more shared territory than there are differences between the ways that people parent and what happens often times is that when parents have conflict about the way that they are choosing to parent a child, they focus way more on the differences. It can be helpful to have a common conversation about things that parents agree on and move from their to articulate separate differences. What this essentially has the effect of doing is avoiding that polarization that often happens when people just focus on what is different among about their styles. So you are a leader in a world class medical institution and I hear that you are going to Europe to visit some countries which have ancient cultures that presumably have some parenting themes. Are we learning some penultimate American style or clinical style that's better than the traditions that have been passed down for centuries doing those the things that those cultures don't and do they know some things that perhaps we don't? That's a fantastic question, I think in many ways the sorts of principles I have been talking about today actually take more from different sorts of the cultures and parenting approaches than they necessarily do from the American style of parenting and and what I mean by that is that one of the things we hear all the time about American culture is that it's very individualistic and that it's very achievement oriented and that sort of thing and although I have been talking a lot about shaping children's behavior so we can set them up for success, really what all these skills I have talked about do is that they do emphasis the importance of the relationship between parent and child. And really - many peers have said that the epidemic of depression and behavior problems in America may be linked to the decay of the family and of the extended family in caring for for family members. And I think if we can focus on skills that do build relationships and that do strengthen the ties between parents and kids, we are going to get back to some of the principles that - many cultures use in order to encourage good behavior and and success. So, I am not sure what your television sitcom viewing styles are, but when I was growing up - Ward Cleaver was my role model that I have tried to emulate, I have two daughters, 25 and 21, and I am not sure of like if I made Ward standard. What were what were those standards in the 50's and early 60's in those models trying to communicate to us, were those good standards and have we lost those standards in a negative way and in in some manner? Well, you know, that's interesting because when I think back to that particular television show and many others, I think that the lessons that they are trying to teach and the lessons that they kind of exemplified many times were that especially Ward's you know, younger son, made a lot of mistakes and had a lot of mishaps and most of them were not his fault. And many of them were comical. But the general lesson that those those shows and that I think that era was was very well known for was that as long as we are communicating with each other, as long as we are talking about the sorts of pitfalls that we have fallen into as long as we are open to forgiving each other and as long as we can have a sense of humor about it, family is a very resilient thing and it can take a lot of negative experiences and really buffer children and adults from those experiences. Tell me what the NYU child study center does. Well, we do many-many things, we have several different institutes and generally, well you could say about all of them is that we strive to provide care that is scientifically based and this this is true whether we are talking about the institute I worked for the institute for ADHD and behavior disorders or whether we are talking about the institute for the treatment of Turrets and other tech disorders and movement disorders, whether we are talking about the institute for learning and academic achievement or new aspirers and artisans service. Really, what we try to do is first of all get a good read of the literature and a lot of that literature of course is coming out of our center and base our interventions on, treatments that I have been shown to work with the populations that we are working with. But it doesn't just stop there. The other thing that we try to do in order to provide treatment that is scientifically based is gather a lot of information about the treatments that we are currently giving to our patients and that means frequently pulling parents, teachers and children about the changes that they are seeing in the sessions so that we don't end up having what many people accuse therapists of doing and that is years after years of therapy without much benefit to anybody. We would really try to be the antithesis of that. we would try to be solution focused, we would try to provide short term treatments when we can or you are try to provide treatments that have specific goals that can measured in terms of whether they have been reached or not. So we talked about United States versus European now leave this, lets talk about New York versus rural American values. Some one who is looking at the literature and who is involved as a fellow at the NYU medical centre or someone who is getting treatment at one of your institutes, how much would that differ do you think, in broad brushed ways from someone who is trying to learn or get treatment or study the literature in an institute in rural Mississippi? So it's a great question, and the interesting thing is that I think in many ways, there aren't really qualitative differences between centers in different areas as much as really quantitative differences. And let me tell you what I mean by that, I have studied at - in different centers, I have lived in different places in the United States and looked at how the way that mental health care is delivered. And New York city in many ways, in the north east certainly are areas where a lot of these treatments are being pioneered and tested and one of the thing that's certainly the case with the NYU child study center is that we serve a population that is very much into the cutting edge of whatever is available and they will seek us out, they will redo their homework and they will research and decide what treatments they really want to receive and because of that we offer many cutting edge treatments and we offer a very high level of care. But when I said that there weren't qualitative differences, what I meant is that what we frequently see is the treatments that we offer to NYU are the treatments that we hope will be offered in rural areas and areas that don't have necessarily the same number of researchers and the same number of clinicians at their disposal later on. and we actually do frequently see that I mean this is a real buzz word in our field today is disseminating these research supported treatments to other centers and my sister living in Michigan where I come from does live in a very small town, and she works in the mental health field as well and she was excited to tell me that, a few years after I learned another research supported treatment dialectical behavior therapy, they are now implementing that treatment in Royal Michigan, so that's kind of a model, we hope to see is that these treatments that get pioneered in places like New York, in Philadelphia, in Boston and DC eventually, are going to be disseminated all through the United States, and indeed all through the world, So is there a difference between inter city, New Yorker, family values and Royal Mississippi and family values? That's a good question, I think you know what - research on those values has shown as that there are actually not as many regional differences as there are socio economic differences and in other words you - taking somebody with a certain level of education from one area and comparing them to somebody with the same level of education from another area you are liable to see many of the same values, so it doesn't tend to be regionally as specific, although one of the things about New York for certain is that there are number of different cultures in our city as well, so there are - we have to be very much attuned to those differences when we are treating children and parents we work with. So finally in in what terms some one wants to be a terrific parent for a pre-scholar, what do they do and what does their behavior look like? Number one, the first thing to do is to try to be more tuned in to the positive behaviors your child is doing already, the nice thing about that is the more you do it, the easier it gets, it's kind of like the phenomenon when you learn a new word, or you get a new red sweater, before you know and every body around you is using that word, or wearing a red sweater, the same thing can be set for attuning into positive behavior, once you seeing a few, you start seeing more, and they really increases the relation ship between you and your child. The second thing to so is that when you see negative behavior especially once their appeared to be seeking your attention, don't respond right away, wait for an instance of positive behavior and respond to that that I would think, if you can do those two things and when you need to be very neutral and calm when you are delivering limits and consequences, many a times that will affectively reduce a lot of disruptive behaviors and increase positive behaviors as well improving the relationship. Dr Timothy Verduin thank you very much for your time. Absolutely my pleasure.