Mark Bertin's Blog, page 9

Mindfulness, Little League Baseball, and Parenting

Following up a previous blog in which I wrote about wisdom found in the movie Bull Durham, it's clear I'm a New Yorker recovering from a brutal winter. Spring baseball is on my mind. And with baseball and children come hours for parents of sitting around waiting for anything at all to happen on a Little League field. It wasn't until I became, in addition to a baseball fan, a parent that I realized just how slow the sport can be.



How much of our parenting time do we spend taking children to ball games, dropping them off, and then waiting for the action to begin? And then once the so-called action begins, how much actually happens? The answers, at least until children get older, are "an awful lot" and "not much." It's all fun and games and bonding together, except when it isn't.



Knowing that, can we fully support our children while also taking a moment for ourselves? The answer to that, depending on how we spend our time hanging out, is "yes." The long, slow hours of a Little League baseball game can prove both entertaining (if and when something happens) and create an opportunity for parents to use their limited free time more constructively.



Take Me Out to the Ball Game



Attention and stress are directly relate. Even at a Sunday Little League game, it's easy to get caught up in unsettling thoughts -- particularly when our kids are involved. You might worry your children are going to fail in front of their friends, or undermine a future all-Star career, or about their enjoyment or effort or anywhere else your mind goes.



In reality it's just Little League. It's for fun and to learn a little about teamwork and the sport, nothing more. It doesn't have much bearing on, say, anyone's academic future or physical health. Yet with our children, it often feels much more loaded than that. The stress of hoping our children enjoy the experience, don't get hurt, and perform reasonably well can make watching a challenge.



Even around something like baseball we can develop our ability to attend more often to what's really going on in life. Off the field, what's the difference between throwing a ball with your child while you sort through a work problem, and just throwing the ball together? With the latter, your child gets your full attention -- something most children readily perceive. And for you, you get a mental break, stop shaking your mental snow-globe of stress, and stick to the pleasure of playing ball.



So now, back to our game. We may logically know better than to get wrapped up in a childhood sport. And while some days nothing feels better than the outdoors, our children and our friends, other days may feel like a whole lot of sitting around waiting for whatever comes next. Little League mindfulness is an opportunity to notice yourself caught up in it all, and then let go and return to real life once again.



Mindful Little League



You are going to be on the sidelines for the next two or three hours. Your child may bat three or four times, and you better be paying attention the one time the ball heads his or her direction. You or your child may even have some investment about the outcome. So here's a potential new mindfulness practice -- Little League Awareness.



• Set your intention. Pick a few minutes to set aside for mindfulness. If you need to catch up on email, or want to talk to friends, choose to do that at some point -- there will be plenty of time. Socialize and cheer on your team. Have fun, enjoy the day and the game. Get caught up in the excitement. But also select a short stretch of time and dedicate it to mindfulness.



• Pay attention to your real-time experience. Mindfulness isn't meant to disconnect you from the world, but the opposite. Keep your eyes open. In an unforced, natural fashion, notice sounds in and around the game. Observe what you're seeing, smelling, and feeling in your body. Notice your emotional state -- whether you are bored or excited, rehashing a tough week or wrapped up in following a tight game. Notice your thoughts and where they tend to go. And at the same time, observe your child's experience with care and direct attention.



• Practice being responsive instead of reactive when stressed. Unless there is something that actually needs fixing right now, do nothing but observe for a few minutes. Whether whatever you think or feel seems peaceful or restless or anything else, practice not getting caught up in your internal world quite as much. Give yourself a break. Notice your experience as you might the weather, coming and going without any need to do more.



• Accept things as they are right now. Mindfulness in public requires flexibility - not a bad habit to cultivate. If someone approaches, talk to them. When something exciting happens in the game, join in. Perhaps set an intention to approach the game, other parents, coaches, umpires and your child with particular traits you value, such as being calm, supportive, or humorous.



• Pay attention again. Life is distracting. Each time you find yourself daydreaming and off somewhere else again, come back to the game. When your mind wanders use the physical feeling of breathing as an anchor, guiding your attention where you choose. Breathing in, I watch another ball roll to the backstop. Breathing out, I bring my attention more fully to the next pitch.



Little League mindfulness may carve out a few minutes for practice you might otherwise struggle to schedule. Of course, the same might apply to any sport or activity. Relish the event, cheer for your child, hang out with friends, and throw yourself into the experience. When you find yourself excessively seeking distraction or lost in daydreaming, return again to paying attention, real time, to whatever is going on around you. Mindfulness and family weekends create an opportunity to give your attention more fully not only to your own life, but your child's.

Bull Durham, Mindfulness and Providers of Care

In the baseball comedy Bull Durham, a mercurial pitching prospect nicknamed Nuke LaLoosh is shepherded towards stardom by his girlfriend Annie and his catcher, Crash. Nuke's career turns the corner when Annie advises wearing a garter under his uniform and breathing through his eye lids on the mound. Neither of which I've ever recommended to anyone myself, but both touch on a basic premise of mindfulness: Nuke is too ensnared in over-thinking everything to actually pitch well. Getting out of his churning, chaotic mental storm, aiming to attend somewhere else for even a moment, allows him to find his own capacity to act skillfully.



Focusing attention on breathing through the eyelids doesn't change anything directly. It isn't even, as far as I know, actually possible. It does break Nuke out of his mental cycle long enough to just throw. It's a reminder most of us would benefit from in our lives, with or without continual guidance from a wise, sardonic baseball catcher and equally sanguine girlfriend.



Baseball for Care Providers



This astute advice doesn't only apply on the baseball diamond. You are a caregiver -- maybe a parent, teacher, psychologist or doctor, and you put a lot of energy into taking care of others. And then your day gets busy, and your mind even busier. What happens when you become lost in over-thinking what you should have done, ruminating over decisions to be made, swamped by logistics, or worried about what everyone else is thinking of your performance?



Real life throws up obstacles and challenges. The paperwork or the intensity or the physical exhaustion can take over, not to mention pressure around decisions that profoundly affect the lives of others. Now the day is focused on treading water, keeping up, or getting home. Caught in the daily grind, when was the last time you found enough breathing room to settle down and think clearly again?



It's easier than it seems to lose touch even with compassion, which is probably a feeling that led you to this position in the first place. A child, student, client, or patient is angry or scared and acts ... less than skillfully. Even when logically you know better, how easy is it to remember that their challenging behaviors are probably driven by anxiety, fear or suffering?



Meanwhile, you may feel self-judgment wanting to do something when there is actually nothing to fix, or when you do not know the answer but feel you should. You may feel self-judgment when you're tired and burnt out, a sense that you shouldn't feel what you actually do. The pressure to be perfect, to know everything, and to repair all can feel consuming. How often do you manage to sustain a supportive perspective towards yourself?



In Bull Durham, one idea that Annie and Crash are demonstrating for Nuke is how much of stress has to do with attention. Unsettling thoughts grab hold, our fight-or-flight brain takes over, and we stop thinking and acting at our best. Stress tends to escalate itself. Churning, unsettled thoughts and feelings lead to similar thoughts and feelings, perpetuating the experience beyond whatever triggered it in the first place. You're worried about pitching your first game, which creates a mood, which changes how you interpret what your catcher says to you, which makes you feel even more rotten, and on and on.



Choosing to break the self-perpetuating cycle by paying attention to what it feels like to breathe allows the brain to settle. Since most of us don't know a Crash Davis, we have to break ourselves out. Taking a moment to attend carries great benefit and does not require anything as extreme as eyelid breathing.



Getting Ready for a New Ball Game



Mindfulness is not magic. (Baseball may be, but for that watch Field of Dreams.) The mind gets busy, and our stress escalates over moments or days or weeks. Breaking the cycle starts with attention. We choose to focus on something more neutral, like breathing, instead of remaining immersed inside our chaotic minds.



The practice of refocusing yourself whenever you are caught up in your inner world brings you back to your best game. When any of us gets tired, distracted, and stressed, we think less clearly and the thoughts themselves hold our attention. You needn't focus on breathing in particular, which also isn't magic. You can use eating, walking, the feeling of your feet on the floor, or practically any experience you choose. Your call on the garter belt.



Catching Yourself



Try this compact practice any time you find yourself rattled, overly stressed, or distracted from the person in front of you -- or get started right now.

Notice that there is a physical sensation to breathing, whatever most grabs you. It might be the rising and falling of your belly or chest, or perhaps the air moving out of your nose or mouth (or your eyelids, I suppose).

Take 10 to 15 breaths focusing only on that physical sensation. You will almost certainly get distracted even during this short practice. That's normal for all of us. Each time you're distracted, return to wherever you were.

When you're done, choose what you'd like to do next.



Some Spring (Mindfulness) Training Resources



Mindful Practice from the University of Rochester

Self-compassion research and guidance from Kristin Neff

Fostering Resilience in Health Care Providers - a weekend retreat in Garrison NY this May

The House We Build for ADHD: A Blueprint for Long-Term Care

You're building a home and a family -- one with ADHD in the mix. The sheer volume of information and misinformation about ADHD can compromise your designs and make your house seem built of straw more than bricks. But it needn't be this way. Reinforce the foundation of evidence-based care, build upwards to address the rest of ADHD and your home can be as solid as every other one on the block.



ADHD Care from the Ground Up



ADHD is a common disorder of child development that influences self-regulation and self-management, not just attention and activity level. Seen from this perspective, it's understandable why ADHD potentially affects all of life. It has been linked to everything from behavioral and academic concerns, to difficulty with sleep, eating and, as children grow older, substance abuse and even auto accidents.



Yet while those perils are real, when ADHD is addressed fully, everything changes. A successful blueprint for managing ADHD has two levels. As with construction, ADHD care starts from a strong base on which to build. his solid foundation integrates everything research suggests works for ADHD management into practical, real-life decision making. From there, move beyond crisis management into proactive 'well care' for ADHD, more fully fashioning the home you imagined for your child.



Setting a Strong Foundation



You can consider ADHD management, therefore, in two parts: A foundation, and the house you build on it. The foundational parts are most proven to have large effects on ADHD symptoms. When they are under-emphasized, stress related to ADHD often continues. Three care components (listed below) are the bedrock to consider whenever acute difficulties arise, typically around behavior or academics.



There's no one pre-fabricated plan (or home) to fit all families, and a child's needs may change over time. But when crises flair or progress slows, reconsidering this solid base helps organize your thoughts and leads to concrete actions to take (and what better way to build a foundation than with something concrete?). Consider these three core options whenever you feel unsettled about ADHD, reinforcing the foundation on which everything else stands:



Educational interventions that fully consider all aspects of executive function and ADHD. Consider expanding support services, or addressing associated learning disabilities. When children feel more confident and successful at school, it often impacts their life outside of school too.



Family-based supports outside of school, such as parent training, ADHD coaching or cognitive behavioral therapy, that help with the stress and strain ADHD creates, along with providing specific tools to manage ADHD and make daily routines easier.



Medical interventions have been shown beneficial for many children and are safe when used appropriately, in spite of often specious suggestion otherwise. Recent research even suggests ADHD medication may help children outgrow ADHD by adulthood.



Finishing the House







But a foundation is not a home. After addressing acute concerns, you can build upwards, an oft-overlooked perspective on ADHD care. Less intense ADHD effects frequently persist and affect how a child and family live. Details (some quite large) related to healthy sleep, eating, efficient time management, technology, safe driving and even communication can be managed proactively to avoid pitfalls. So can the impact of ADHD on parents and their marriages.



The rest of crafting a customized, comfortable ADHD home therefore addresses its broader everyday impact. ADHD gets in the way of daily routines, but routines can also be stabilizing. Paradoxically, sustaining new habits are harder when living with ADHD, often continuing a cycle of difficulty. Some patterns to consider are:



ADHD tends to cause sleep problems, but better sleep improves ADHD



ADHD affects eating and weight, while healthier nutrition may influence ADHD symptoms.



Exercise benefits children with ADHD, but sustaining these routines may be challenging for reasons related to scheduling, time management, distractibility and all the rest of executive function.



Media and technology can be both entertaining and useful in assisting with organization and planning, but with ADHD, children are at risk for disruptive, intrusive relationships with this part of our modern world.



Holding it all Together



And then there is mindfulness, cognitive fitness training aimed at building real-time, objective and compassionate awareness of our lives... instead of remaining lost in distraction, on autopilot. Mindfulness does not replace any single aspect of ADHD care, but supports all of them. One way to look at mindfulness, to push the metaphor, is as the mortar that holds together the rest of ADHD care:



ADHD increases stress; mindfulness helps with stress management.



ADHD management often requires changing habitual behaviors and thoughts; mindfulness supports flexible thinking and the changing of habits.



ADHD often leads to emotional reactivity, and mindfulness helps cultivate emotional awareness and responsiveness.



ADHD often affects self-esteem and feelings of self-worth, and mindfulness builds compassion for yourself and others.



And of course, mindfulness is a form of attention training, which has been shown to benefit individuals with ADHD (although there is no proof as of yet that suggests mindfulness can actually replace any other aspect of care).



To build a solid and joyful home around ADHD typically requires seeing the full picture of what it is and what it does. When ADHD-related problems become acute, reexamine the foundation of care. Are there changes to consider within the big three of school, home, or medical choices? If some specific detail requires attention first, like an intense sleep problem, start there, but over time, emphasize the foundation whenever questions arise.



After that, a patient, methodical approach to home-building proactively guides a child wherever ADHD touches his life. When the ground seems solid, move onto wherever else ADHD influences your child's experience. If all this planning begins to feel overwhelming, focus on each step individually. Start from the foundation, build upwards and create the home you want for your child with ADHD.



Of course, each of these details can be a challenge to implement. Some resources to consider are linked within this blog, or try valuable sites such as CHADD.org or Additude Magazine. More details will also follow soon, from my 2015 book Mindful Parenting for ADHD.

Putting Mindfulness on Your Agenda: Resilience for Care Providers

As the word "mindfulness" sweeps across pop culture, it becomes vital to root larger discussion of the topic to its practical meaning. Mindfulness isn't synonymous with serenity, or even meditation. It also isn't an empty fad. Not that long ago general physical fitness wasn't widely accepted, and mindfulness is following a similar cultural arc. Beyond the trend, the underlying idea is that when we take time to care for our minds, and in essence our brains, we benefit.



My own introduction to mindfulness was presented almost as a side note to my medical training. During a lunch conference in our outpatient clinic, one of the attendings decided to lead the residents in a mindfulness practice. I found it useful for the stress I was living under at that time, decided to find out more, got hooked and have been practicing it ever since. For years, I kept it separate from my professional life. Now mindfulness is an accepted part of Western medicine. An exponential growth in research has led to publications, for example, from both the American Medical Association and The American Academy of Pediatrics.



Everyone experiences stress in some way or another, and people in caretaking roles do in particular. Our communities rely on individuals who choose these paths, and yet no one has the capacity to indefinitely give. Parents, hospice workers, teachers, psychologists, physicians, and anyone living with similar demands are at risk for exhaustion or burn out. So as a caretaker, time to take care of yourself is essential to sustaining your own well-being. Only then can you be at your best when interacting with others.



Of course, in caretaking roles other people's needs often come first, and there may not seem to be a whole lot of time available for yourself. And that's one place mindfulness has concrete benefit. While you might picture long stretches of stillness, mindfulness actually can be integrated into any job, and any lifestyle. It is not about relaxing for hours somewhere on a quiet cushion, it's about proactively changing how we live our real lives. It's meant to affect daily life, not only to act as (or even requiring) an extended break when you're able to find the time.



While there is certainly benefit to making mindfulness a consistent formal practice, creating any new habit along these lines enables caretakers to remain more resilient themselves. A few breaths when shifting from one discussion with a family to the next is a mindfulness practice. Taking time for yourself before starting lunch is too. So is mindfully walking or eating, more fully focusing on the activity instead of remaining caught up in rumination, anger, or racing through email while rushing through a snack. And it probably isn't surprising to know that people being cared for often report feeling better about their care when caretakers practice mindfulness.



The larger concept of mindfulness is to practice cognitive skills that help you remain settled and to recover more quickly when life throws you off balance. We train in it not because we expect any single session to be life-changing, but because the consistency itself allows us to handle rough situations with more ease. So if you're in a role of a caretaker, take a moment and consider your own state of mind. As you might choose to eat healthy and exercise on a regular basis, how might you focus on your own well-being, for the sake of your students, family or clients, in 2015?



Looking to get started with mindfulness as a health care provider in 2015? Check out this Harvard Health list of resources online. Or join me May 15-17 at the Garrison Institute in Garrison New York, for a mindfulness retreat, Fostering Resilience in Health Care Providers.

Thoughts of (and for) Thich Nhat Hahn: Reflections on Mindfulness and Family Living

Last week the esteemed mindfulness teacher Thich Nhat Hahn had a stroke. Countless around the world wish him well in his recovery. The latest news is that he seems stable and responsive.



In the West, mindfulness has evolved into a secular practice, meant to be accessible to all and appropriate for schools and even governments. But the practice of mindfulness evolved from centuries of refinement within Buddhist culture, translated later by various emigrant teachers. Thich Nhat Hahn is one of the most beloved, an enduring and lively source of wisdom, inspiration, compassion and grace for people around the globe.



Practicing mindfulness means taking the time to pay attention, to appreciate, to get out of our seemingly fixed and frequently habitual ways of living. We more skillfully live our lives as we hope and as we choose. That benefit transcends spirituality and religion.



The ideas behind mindfulness also transcend its recent step into pop culture. So while mindfulness is a word that's everywhere right now, the word itself doesn't really matter much. Mindfulness represents something but changes nothing; being mindful changes an awful lot. What will be left behind if the headlines pass is that simple fact.



Thich Nhat Hahn has said it better than most for longer than I have been alive, though. So here are a few quotes about mindful family life to consider while wishing him a complete recovery....





"Sometimes we eat but we aren't thinking of our food. We're thinking of the past or the future or mulling over some worry or anxiety again and again. So stop thinking about your business, about the office, or about anything that isn't happening right now. Don't chew your worries, your fear, or your anger. If you chew your planning and your anxiety, it's difficult to feel grateful for each piece of food. Just chew your food." -- How to Eat



"When people's bodies and minds are relaxed, they are much less likely to speak or act in violent ways. We also can access many insights and a wellspring of energy we haven't had since childhood. Women and men throughout history have accomplished seemingly impossible things. The truth is, there's no limit to the positive changes we can make for ourselves and for our society through mindfulness meditation. We just need to begin, where we are, right here, right now." -- Huffington Post



"If in a family, if there is one person who practices mindfulness, the entire family will be more mindful. Because of the presence of one member who lives in mindfulness, the entire family is reminded to live in mindfulness. If in one class, one student lives in mindfulness, the entire class is influenced." -- The Miracle of Mindfulness

Putting Your Kids on a Healthy Media Diet

There's an interesting article winding up in parent's e-mailboxes these days containing an unexpected implied message from late Apple founder Steve Jobs: Manage your child's use of technology.



A stunned The New York Times reporter remarked "So, your kids must love the iPad?" and apparently Jobs replied that this, well, was not quite the case. "They haven't used it," Jobs replied. "We limit how much technology our kids use at home."



Screen time seems to be taking over childhood. One estimate puts combined exposure at an incredible 7.5 hours a day for kids ages 8 to 18. Surveys show that 72 percent of children go to bed at night in a room with at least one type of screen at their disposal. Hopefully, Jobs intuitive remark is helping get the message through to parents: For their own well-being, we must monitor and educate children about how to use technology well.



A Cascade of Negativity



Study after study suggests that excessive screen time is associated with various negative outcomes. Topping the list: obesity, poor academic performance, aggressive behaviors, attention problems, lack of social skills, and inadequate sleep. Having electronics in the bedroom, including television or a cell phone, may rob a child of an hour of much-needed sleep a night. Too much media time potentially displaces other healthy pursuits including physical, social, creative or academic activities.



Now a new study out of the University of California suggests that the amount of time kids devote to technology may inhibit their ability to recognize emotion. The study, published in the journal Computers in Human Behavior, found sixth-graders who went cold turkey on technology during a five-day camp trip became significantly better at reading facial expressions and with other nonverbal skills than a similar group who carried on life as usual, attached to smart phones, iPads, computers, and television.



This type of research is a wake-up call for parents as well as educators. The capacity to effectively process emotional cues is essential to personal, social, and educational success. As a species we evolved to become productive social beings through face-to-face interaction. There is already plenty of research regarding what children do and do not learn about the social world through media, and evidence suggests that most kids learn better from live interaction than from screens.



Using Technology, or Used By It?



This is not to put the kibosh on technology. When used appropriately, it is wonderful. It's part of our lives and will continue to be. We just have to make sure our children (and parents, too) use it in a considered, sensible way. When we monitor both screen time and content, children develop healthy, productive relationships with this growing part of our modern lives.



Recent research, reported in JAMA Pediatrics, shows that parental guidance around media does work. In fact, that one variable alone has a positive result on multiple aspects of child development. The study, which involved more than 1,300 third- and four-graders, demonstrated that "parental monitoring of media has protective effects on a wide range of academic, social, and physical child outcomes."



While more and more technology makes achieving end this a big challenge, it can be done. The American Academy of Pediatrics prescribes that total screen time for children 2 to 18 be limited to two hours a day. It also recommends none at all for younger children. Whatever works for an individual home, creating common-sense, firm boundaries around media is a concrete step parents can take to help children thrive.



Some suggestions:



• Set a clearly defined daily maximum for children, using timers to monitor screen time.



• Use independent sources of information about media content, such as Common Sense Media, instead of relying on the industry rating system.



• Keep screens out of the bedroom. Enhance your children's sleep habits by powering down their exposure an hour before bedtime, regarding both television and computers.



• Have a central station in your home for all media as much as possible. A household-wide screen bedtime, with everything put into a charging station away from bedrooms, can be useful as well.



• Practice good role modeling. The best way to get screen compliance is to set a good example yourself. Consider using an app like "Moment" or "Checky" to monitor your own screen time.

Autism: Early Intervention Makes a BIG Difference

With up to one in 68 children now being diagnosed with autism, a public debate rages: Is the actual incidence of autism rising at what some say are epidemic proportions, or is our high awareness of this once rare childhood neurological condition leading to more vigilance and better diagnosis? While the larger debate is likely to continue for some time, plenty of proof suggests that more awareness is at least part of the reason we see so many kids diagnosed with an autism spectrum disorder now compared to a generation ago.



Recognizing more children with autism means more opportunity for intervention and a greater chance of a better future for these children. In fact, while typically considered a lifelong challenge, the possibility exists that some children improve not only emotional, behavioral and learning skills, but might even outgrow autism itself. Yet studies also tell us that the best chance for optimum results is to catch it early and initiate a comprehensive, targeted intervention specific to their needs.



'Outgrowing' Autism



Decades of research encompassing hundreds of studies validate a particular type of intervention called applied behavior therapy (ABA) for autism. Behavioral intervention, supported by speech language therapy, produces significant and meaningful improvements regarding social, play and communication abilities. This includes documented cases in which children reach the "optimal outcome" of no longer meeting criteria for autism.



Most importantly, a study recently published in the Journal of Developmental and Behavioral Pediatrics found that 83 percent of autistic children who reached optimal outcome started therapy prior to age 3. The rest obtained intervention by the start of kindergarten. Children diagnosed even with high-functioning autism (suggesting milder impairments) who missed out on services in early childhood did not reach an optimal outcome as often as more impaired peers. Yet in the real world, children with high functioning autism often receive minimal services instead of ongoing, autism-specific supports.



Watching and waiting is not the way to go, since early diagnosis and early intervention matter profoundly. Children with developmental delays are at much greater risk than infants and toddlers who meet all their milestones. And thankfully, since developmental interventions are educational they have little downside when done appropriately.



It's understandable that a parent may hesitate and want to give children time to mature, and a huge range does exist for typical development. Yet as scary as it may seem, it is better to get an evaluation done and, if necessary, to start services. If your child displays any of these possible symptoms, contact your pediatrician and seek evaluation by a developmental specialist:



• Language delays, such as no babbling as an infant or no words spoken by age 15 - 16 months. While most children with language delays turn out only to have language delays, an evaluation rules out other causes.



• Lack of gesturing to communicate or finger pointing by age 1.



• Lack of back-and-forth interaction. This includes experiences such as a child who does not respond to his name by age one, or lack of interest in (and initiation of) back and forth play as an infant (such as peek-a-boo).



• Lack of imaginative play as a toddler or in an older child.



• Loss of developmental skills at any time.

Rest Easy, Parents and Children: Healthy Sleep for Every Family

At 7:30 p.m. you hand-hold your preschooler to bed, give a kiss, turn down the light, and crack the door just enough to alleviate his aloneness. But how long before he's at your knees begging he cannot sleep or wants a drink of water for what seems like the ten thousandth night in a row? You blow him another kiss and wish him a good night's sleep -- for his sake, you say to yourself, but in reality also for your own.



Most every parent has experienced the claustrophobic dread that takes over the room while trying to convince a child to lie down, close his eyes, and stay still long enough to fall asleep. We console and cajole, we beg and plead, but he is not at all compelled hearing about the importance of good sleep for his health and happiness tomorrow.



Evidence tells us that the impact of disrupted sleep can be extensive and follow a child through life. It can have deleterious effects on cognitive development, mood, and the ability to pay attention and behave. Studies show it may even impact parental health and well-being, as an infant or toddler who cannot sleep through the night is a potential cause of maternal depression.



There's no doubt about it: Bedtime epitomizes all the demands and challenges inherent to parenting. We (hopefully) remain calm on the outside, churn on the inside and muster all of our resources only to discover, when nightfall calls, that once again we cannot control everything after all.



And yet, evidence also tells us that getting our little ones -- even infants -- to fall asleep by themselves and rest through the night is more than wishful thinking. We can actually influence the odds our children sleep well. It spite of concerns sometimes raised, sleep training itself has been shown to be not only safe for children's emotional development but effective. It requires only two parental disciplines: Establishing a set routine and implementing it consistently



Researchers reporting in the journal Pediatric Sleep came to this conclusion after reviewing 52 studies involving various sleep-time approaches on more than 2,500 children from infancy to age 5. They found that virtually all pediatrician-sanctioned approaches should work, even after just a few days. The one consistent finding was... consistency! As long as parents stick with a plan, no matter how challenging, most children develop healthy sleep habits.



To Sleep, Perchance to Sleep



Establishing consistent routines makes parenting easier. Any habit established in early childhood is likely to persist into adolescence and beyond. It is far easier to teach your toddler how to calm down and fall asleep than to convince a media-addled, sleep-deprived teen to turn it all off and get under the covers.



Establishing habits in children as early as possible is a parenting benchmark and a cornerstone of adult self-care. When children push nighttime boundaries, parents become chronically over-tired. That makes them less likely to maintain the necessary routines in the first place, which sets up a vicious cycle. He cries and pleads and we're too tired to wait for it to stop. But "just tonight" does not mean much to a child, and joining you in bed or acting like a "jack-in-the-box" for two hours takes on a life its own.



Here are some guidelines for establishing a bedtime routine. As you will see, it all comes down to new habits and consistency.



• You decide when bedtime starts. We all fall asleep easiest when our internal clock (our circadian rhythm) readies us for sleep. For a child put to bed too early, falling asleep is a challenge. Too late, though, and children pass their 'sleep window' and become restless again. An appropriate bedtime aims for head on the pillow (not starting bedtime itself) as the body slows. A consistent bedtime in and of itself has been correlated with cognitive performance.



• Start an hour before 'lights out.' Determine when you think your child should be asleep and start bedtime around an hour earlier. If that timing is unclear, monitor it by observing for when your child starts to slow down a little. Whatever you decide, set a reminder alarm if you tend to lose track of the time yourself.



• Establish an environment of calm. Children need guidance on ways to ratchet down from the day's activities. The idea of "sleep hygiene" means a habitual plan that quiets children, including activities such as showering or bathing, quiet games and reading. In spite of a common misperception screen time actually wakes the brain; studies suggest a need for electronics free time before falling sleep so keep it out of the routine. Avoid horsing around or other activities that rev-up the body. Offering a choice between reading and sleeping is one great way to encourage a lifetime habit. Bedtime is 8 p.m., but you can read until 8:30 p.m. It's one of the healthiest nighttime choices children can make.



• Encourage sustainable "sleep associations." Children seek reassurance when falling asleep and several times each night while cycling through light sleep. They consciously or unconsciously check for a comfort object or a parent. If it is you they have learned to seek, they may wake when you are not there, so avoid making yourself a sleep association. Instead, create a space in which your child feels safe and comfortable, and encourage a sleep association with stuffed animals, soft toys, pictures, or whatever else soothes.



• Ease yourself out. If you have become part of what your child needs to fall asleep, gradually reduce your presence. To move a child out of your bed or to get yourself out of their bedroom, pick a start date. Anticipate several weeks of disruption whenever you change the rules. Fade out your physical presence, perhaps sitting near their bed, then moving towards the door gradually over several weeks. Or fade the time between checking in on your child, returning after five minutes, then 10 after a couple of nights, and adding on from there.



• If a child wakes and gets out of bed, place him back in his bed without discussion. Avoid letting bedtime become a source of attention. If your child needs something, provide it with minimal conversation. If he needs nothing except to avoid going to sleep, direct him dispassionately but firmly to lie down again.



• Monitor for anxiety. If fearfulness or anxiety undermines sleep, discuss with your pediatrician or another health care professional ways for managing these challenging emotions.



• Consider tying the bedtime routine to a reward program. Offer stickers or points towards a long-term goal for each night successfully following your guidelines.

Time for the Straight Talk on Time Outs

With such an overload of information out there on the Internet, there's been a lot of controversy over the years about how trustworthy websites really are, especially when it comes to dispensing parenting advice. Because the Internet is often the go-to source for helping parents solve behavioral issues, a research group set out to see just how reliable it is for implementing the very effective discipline we all know as a time out.



The findings, recently published in the Journal of Developmental and Behavioral Pediatrics, found the web is not dependable at all. According to the authors, the odds of finding "complete and accurate information" were "near zero." Thirty percent of searches falsely suggested time outs might be harmful. Inaccuracies, omissions and inconsistencies were found in all 102 websites explored. This may lead parents to feel time outs ineffective and lead them to less useful, potentially harmful techniques such as yelling or spanking.



That's a shame, because time outs are a proven parenting tool -- when implemented correctly. They are one of the few disciplinary strategies recommended by the American Academy of Pediatrics to reduce problem behaviors including non-compliance, oppositional actions, verbal and physical aggression, destruction of property and temper tantrums. So here are the go-to guidelines for implementing time outs, according to the latest research:





Time-outs work best when they are part of a parenting style that focuses on affection and rewards.

A high ratio of positive to negative feedback by parents provides a contrast that makes time outs most effective. This may be the most important message of all from the research.



Time out should be served in a boring environment.

The effectiveness of the time out is impacted by the amount of activity and interest available to a child. The more stuff there is -- TV, computer, cell phone, toys, even a coloring book and crayons -- the less effective the time out.



Use one warning only.

Making one brief unemotional warning such as, If you do not do as I say, you will be going to time out, has been found to reduce the number of time outs a child will ever go through. By contrast, parents who repeat the warning decrease the effectiveness of the punishment. Immediacy is equally important -- Go now! The delay between the inappropriate behavior and the initiation of the time out should be as short as possible to reinforce your message.



Stick to a reasonable length for time outs.

Time outs of "moderate length" are more effective than shorter ones and may be as effective as longer ones. A general recommendation for time outs is one minute per year of age. However, some research suggests that 4-5 minute time outs are enough regardless of a child's age.



But don't just rely on a timer.

Waiting to release a child from time out until they are quiet and calm (even if the timer went off) is more effective in reducing disruptive behavior than allowing a child to leave when they are still kicking and screaming.



Be consistent.

Pick a few behaviors to target and give the child time out every time they engage in one of those behaviors. Giving a time out only sometimes for the same misbehavior confuses children and makes learning the rules really hard.



Always follow through.

Children should not be allowed to escape time out by agreeing to obey after you have told them to go to time out. This reinforces the inappropriate behavior. Once you've stated a time out will happen, it happens.



Make it known who is in charge.

And that's you. Evidence suggests that a time out is significantly less effective when a child determines when the punishment ends -- when you are ready to leave -- compared to when an adult determines when the time out is over -- when I say it's OK. If your child leaves time out before you say it is OK, you need to return them quickly to time out (without talking to them) or provide a back-up consequence, such as no TV until they finish the time out.



Get the behavior right in the end.

Kids end up in time out for doing something wrong or not doing what they're told. Don't let them off the hook. When the time out is complete, return to the scene of the crime -- now go back and pick up your toys. If you don't make closure, the same incident is more likely to be repeated.

When Will We Ever Learn: Dissecting the Common Core State Standards With Dr. Louisa Moats

Dr. Louisa Moats, the nationally-renowned teacher, psychologist, researcher and author, was one of the contributing writers of the Common Core State Standards (CCSS). The CCSS initiative is an attempt to deal with inconsistent academic expectations from state-to-state and an increasing number of inadequately prepared high school graduates by setting high, consistent standards for grades K-12 in English language arts and math. To date, 45 states have adopted the standards. I recently had the opportunity to discuss the implementation of the CCSS with Dr. Moats.



Dr. Bertin: What was your involvement in the development of the common core state standards (CCSS)?



Dr. Moats: Marilyn Adams and I were the team of writers, recruited in 2009 by David Coleman and Sue Pimentel, who drafted the Foundational Reading Skills section of the CCSS and closely reviewed the whole ELA section for K-5. We drafted sections on Language and Writing Foundations that were not incorporated into the document as originally drafted. I am the author of the Reading Foundational Skills section of Appendix A.



Dr. Bertin:What did you see as potential benefits of establishing the CCSS when you first became involved?



Dr. Moats: I saw the confusing inconsistencies among states' standards, the lowering of standards overall, and the poor results for our high school kids in international comparisons. I also believed that the solid consensus in reading intervention research could be reflected in standards and that we could use the CCSS to promote better instruction for kids at risk.



Dr. Bertin: What has actually happened in its implementation?



Dr. Moats: I never imagined when we were drafting standards in 2010 that major financial support would be funneled immediately into the development of standards-related tests. How naïve I was. The CCSS represent lofty aspirational goals for students aiming for four year, highly selective colleges. Realistically, at least half, if not the majority, of students are not going to meet those standards as written, although the students deserve to be well prepared for career and work through meaningful and rigorous education.



Our lofty standards are appropriate for the most academically able, but what are we going to do for the huge numbers of kids that are going to "fail" the PARCC (Partnership for Assessment of Readiness for College and Careers) test? We need to create a wide range of educational choices and pathways to high school graduation, employment and citizenship. The Europeans got this right a long time ago.



If I could take all the money going to the testing companies and reinvest it, I'd focus on the teaching profession -- recruitment, pay, work conditions, rigorous and on-going training. Many of our teachers are not qualified or prepared to teach the standards we have written. It doesn't make sense to ask kids to achieve standards that their teachers have not achieved!



Dr. Bertin: What differences might there be for younger students versus older students encountering it for the first time?



Dr. Moats: What is good for older students (e.g., the emphasis on text complexity, comprehension of difficult text, written composition, use of internet resources) is not necessarily good for younger students who need to acquire the basic skills of reading, writing, listening and speaking. Novice readers (typically through grade three) need a stronger emphasis on the foundational skills of reading, language and writing than on the "higher level" academic activities that depend on those foundations, until they are fluent readers.



Our CCSS guidelines, conferences, publishers' materials and books have turned away from critical, research-based methodologies on how to develop the basic underlying skills of literacy. Systematic, cumulative skill development and code-emphasis instruction is getting short shrift all around, even though we have consensus reports from the 1920's onward that show it is more effective than comprehension-focused instruction.



I'm listening, but I don't hear the words "research based" as often as I did a decade ago -- and when CCSS proponents use the words, they're usually referring to the research showing that high school kids who can't read complex text don't do as well in college. Basic findings of reading and literacy research, information about individual differences in reading and language ability, and explicit teaching procedures are really being lost in this shuffle.



Dr. Bertin: What benefits have you seen or heard about so far as the CCSS has been put in place, and what difficulties?



Dr. Moats: The standards may drive the adoption or use of more challenging and complex texts for kids to read and a wider sampling of genres. If handled right, there could be a resurgence of meaty curriculum of the "core knowledge" variety. There may be more emphasis on purposeful, teacher-directed writing. But we were making great inroads into beginning reading assessment and instruction practices between 2000-2008 that now are being cast aside in favor of "reading aloud from complex text" -- which is not the same as teaching kids how to read on their own, accurately and fluently.



Dr. Bertin: What has the impact been on classroom teachers?



Dr. Moats: Classroom teachers are confused, lacking in training and skills to implement the standards, overstressed and the victims of misinformed directives from administrators who are not well grounded in reading research. I'm beginning to get messages from very frustrated educators who threw out what was working in favor of a new "CCSS aligned" program, and now find that they don't have the tools to teach kids how to read and write. Teachers are told to use "grade level" texts, for example; if half the kids are below grade level by definition, what does the teacher do? She has to decide whether to teach "the standard" or teach the kids.



Dr. Bertin: You've raised concerns elsewhere that CCSS represents a compromise that does not emphasize educational research. How do the CCSS reflect, or fail to reflect, research in reading instruction?



Dr. Moats: The standards obscure the critical causal relationships among components, chiefly the foundational skills and the higher level skills of comprehension that depend on fluent, accurate reading. Foundations should be first! The categories of the standards obscure the interdependence of decoding, spelling, and knowledge of language. The standards contain no explicit information about foundational writing skills, which are hidden in sections other than "writing", but which are critical for competence in composition.



The standards treat the foundational language, reading and writing skills as if they should take minimal time to teach and as if they are relatively easy to teach and to learn. They are not. The standards call for raising the difficulty of text, but many students cannot read at or above grade level, and therefore may not receive enough practice at levels that will build their fluency gradually over time.



Dr. Bertin: How about recommendations for writing?



Dr. Moats: We need a foundational writing skills section in the CCSS, with a much more detailed progression. We should not be requiring third graders to compose on the computer. Writing in response to reading is a valuable activity, but teachers need a lot of assistance knowing what to assign, how to support writing and how to give corrective feedback that is constructive. Very few know how to teach kids to write a sentence, for example.



Dr. Bertin: In an article for the International Dyslexia Association, you said "raising standards and expectations, without sufficient attention to known cause and remedies for reading and academic failure, and without a substantial influx of new resources to educate and support teachers, is not likely to benefit students with mild, moderate, or severe learning difficulties." You also mention that 34 percent of the population as a whole is behind academically in fourth grade, and in high poverty areas 70-80 percent of students are at risk for reading failure.



How does the CCSS impact children who turn out to need additional academic supports for learning disabilities, ADHD or other educational concerns?



Dr. Moats: I have not yet seen a well-informed policy directive that addresses the needs of these populations. There are absurd directives about "universal design for learning" and endless accommodations, like reading a test aloud, to kids with learning disabilities. Why would we want to do that? The test itself is inappropriate for many kids.



Dr. Bertin: How does it relate to concerns you have about teacher training in general?



Dr. Moats: What little time there is for professional development is being taken up by poorly designed workshops on teaching comprehension of difficult text or getting kids to compose arguments and essays. This will not be good for the kids who need a systematic, explicit form of instruction to reach basic levels of academic competence.



I've been around a long time, and this feels like 1987 all over again, with different words attached to the same problems. When will we ever learn?



* * *

In addition to the LETRS professional development series, Dr. Moats' books include Speech to Print: Language Essentials for Teachers (Brookes Publishing); Spelling: Development, Disability, and Instruction (Pro-Ed); Straight Talk About Reading (with Susan Hall, Contemporary Books), and Basic Facts about Dyslexia. Dr. Moats' awards include the prestigious Samuel T. and June L. Orton award, in 2013, from the International Dyslexia Association, for outstanding contributions to the field.