Tag Archives: preschool

Growing the Attachment Strategies of Preschool Children

Important Note: The image in this post and in all the previous ones are not images of the children discussed in the posting. They are simply children whose photos I have collected throughout my travels.

I am going to offer several ways of doing this, with the understanding that I will continue to think about it and add more later.

The first option is to intervene in the school setting with the help of teachers and other school professionals. The second is consultation to the parents, for example, video feedback. The third is dyadic or family psychotherapy. The fourth is individual psychotherapy for the child; this would necessarily include meetings with the parents. These options are offered in order of increasing intensity of intervention with the idea that if parents choose an intervention of lesser intensity that proves ineffective, they may then choose a more intensive alternative.

Intervention in the school setting is predicated on the assumption that school is a safe environment; that means that the child is adequately compliant with the teachers’ directives, follows the school routine, can access the school curriculum, and can relate to peers relatively well. If the school is safe for the child, the teacher and parent can prepare him or her for appropriate behavior at pickup by breaking up the transition into manageable steps, previewing the experience, and having a teacher available to coach the child and parent through the reunion.

The parent should follow up afterwards with behavior designed to consolidate the positive reunion by encouraging the child to talk about her day and giving the child comforting feedback for difficulties and positive recognition for achievements. This is the tricky part, because the pattern that gets established when the child makes a fuss about pickup generates stress in both parent and child, so that warm, responsive communication at pickup time is usually contaminated with anxiety. Even when the pickup is successful, both parent and child are anticipating some negative experience. Also, there is an unconscious pull back into the problem pattern. That is because it is a habit, well practiced and therefore “simpler”, taking less energy in the short run, though more in the long run.

The parent can try to make declarative statements instead of direct questions that put the child on the spot – starting the comment with “I’ll bet” or “I wonder if” or “I’m thinking that”, for example, “I’ll bet that you liked the cooking activity today,” or “I wonder if it was sad for you that Martha was absent from school today.” If the child gives monosyllabic responses, just tell her that you guess she needs to rest after a long day and maybe you can talk about it later.

The thinking behind this plan is not strictly behavioral. It draws on Attachment Theory and nonlinear systems theory (odd bedfellows, actually) in that it seeks to practice more adaptive interpersonal patterns – reunion – over and over again, with the input of support (“energy”) from the teachers. If a new strategy for reunion after a separation is more successful and is practiced enough to become a stable part of the parent-child relational repertoire, it can facilitate the child’s development in a more general sense.

I will discuss the other options in subsequent posts.

The Problem of “The Little Girl with a Curl”

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A particular problem has come to my attention over the years consulting to a preschool – children behaving in controlling and sometimes aggressive ways to parents at school transitions. Teachers report that the child behaves badly with his or her parents at drop off and pick up. Often the teachers express amazement that the children who seems well behaved in school, can change dramatically when they are with their parents – boss them around, even push or hit them. Another behavior characteristic of this problem is the child running away from the parent or refusing to come with them at pick up time. It is difficult for even the most empathic teacher to avoid the suspicion that the parents are somehow allowing their child to mistreat them by not setting adequate limits for the child. Supportive evidence is sometimes found in parents restraining from disciplining their children in the school.

This situation reminds me of a Mother Goose rhyme that my parents read me when I was a young child about a “little girl with a curl”. The rhyme goes, “There was a little girl who had a little curl, right in the middle of her forehead. When she was good, she was very, very good. But when she was bad, she was horrid.” I always secretly worried that I might be that girl.

Perhaps partly for that reason, I have given this problem a good deal of thought. My conclusion is that the answer to the mystery of the “little girl with a curl” mystery is rather complicated. The reason I say this is that when I talk to the parents of these children, I get a wide variety of answers about their child’s behavior in different settings. Some children are relatively well behaved in most settings and become suddenly noncompliant and belligerent at pick up time. Other children are compliant when they are involved in activities but become disorganized and unhappy during unstructured time at home and in school. Some children are usually cooperative but have difficulty with all significant transitions – bedtime, getting up time, leaving an activity, etc. Other children are always a handful.

What ties together all the children who fuss at pick up time and behave defiantly with their parents but not necessarily with their teachers? All these children are expressing difficulty with finding a positive strategy for reuniting with their parent. The subject of reunion strategies falls into the domain of a theory that informs much current developmental research and that has now also become popular in the vernacular – Attachment Theory. I have talked about Attachment Theory in other blog postings, because of its importance in research. The essential feature of Attachment Theory is that it presents the infant’s essential motivation as staying close to the parent in order to feel safe and secure. If the infant achieves the capacity to feel secure in his relationship to his mother, then he is free to explore the world, knowing that he can easily return to the safety of that connection.

We know that an important but primitive response to threat is running away or aggression. Remember that the “fight or flight” response of the sympathetic nervous system is one of the main “bottom up” as opposed to “top down” responses of the stress regulation system. That means that we must feel confident in our capacity to achieve security in order to use our thinking brain to tell us what we should do in a threatening situation. Transitions are inherently threatening, even small ones, because they require us to disorganize ourselves on the way to a new organization. That is, we have to stop playing in the sandbox in order to join Mother, get into the car, stay still in the car seat, etc. Playing in the sandbox is a complex organization involving a cognitive plan (building a castle), a motor rhythm (dig, pour, pat; dig, pour, pat), an affective and physiological state (contented, calm); and maybe even a compelling interpersonal experience (collaboration or competition with a peer). That is a lot to take apart in order to get into the car. And the hardest part is the disorganization in between the sandbox play and the car seat, between one organized state and the other. How do children manage that transition? It starts in infancy with the regulatory aid of the parent.

These interpersonal regulatory patterns that start in infancy gain power and stability as parent and child repeat them over and over again during the course of daily life. One pattern, that Attachment Theory would call “secure”, is demonstrated by the parent-child dyad who are able to support the child in managing all these disorganizing (and therefore threatening) experiences of – letting go his plan of building the castle, discontinuing the motor rhythm, interrupting the calm and contentment, and giving up the competition or collaboration – and maintaining adequate regulation and sense of security until the new car seat organization is established. I say “parent-child dyad” because I do not see this activity of facilitation transition as emanating exclusively from the parent. Although sophisticated advocates of Attachment Theory would probably agree with me, Attachment Theory largely tends to place the responsibility squarely on the mother, who carries attachment patterns within her even before her child is born, according to the AAI.

I will tell you how I use these thoughts about Attachment Theory in my search for answers to the “girl with a curl” problem in my next posting.

Stress Regulation: From Theory to Practice

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Stress Regulation: “From Theory to Practice”

Perry’s ideas about stress regulation are particularly important to me in my clinical work. In contrast to the negative cascade stress can cause in a sensitized child, helping a child grow his stress regulation system may initiate a healthy “cascade” effect.

In my practice, if a child gets better at calming herself, she can pay more attention to my ideas about the motivations for some of her problem behavior and consider trying more adaptive ways of behaving. For example, if a child is poorly regulated, she will not be receptive to my observations that when she starts out with “loser feelings” she cannot bear to play competitive games with her peers. She is more likely to use psychological defenses such as denial and avoidance to protect herself from the stress of acknowledging her painful feelings. If, however, we begin by my giving her a “handicap” that makes it easier for her to win, and then emphasize the rhythmic, repetitive turn taking patterns of the game with my actions and with my voice, she may be able to establish and maintain a receptive, alert position in relation to my communications and even allow me to scaffold some self reflection. In play sessions with one child, I would ask her at the beginning of the session whether it was a “bad guys in” or “bad guys out” day for her before we settled into a game of Candyland. If it had been a hard day for her, we would take all the cards that send you backwards out of the pile. If it had been a good day, we would leave them in. This small ritual allowed us to play the game together, while also helping her begin to reflect on and identify her feelings, and eventually appreciate the link between her temper tantrums and her sense of herself as a “bad girl”.

In psychology and psychoanalysis we refer to “respecting the child’s defenses”, something that Anna Freud talked about. That means not overwhelming a child, usually by avoiding confronting him with information he is not ready to receive. Perry’s idea of “dosing” and “spacing” adds a new dimension to the concept of “defense”. It brings the body into the equation in an important way. Thinking in these terms helps us organize our interactions with a child in time and space. It helps us put the music and dance into our clinical work. Because I study videotapes of my work with children, I see the nonverbal communication, what I call the “music and dance” of psychotherapy, both in a standard time frame and in a microprocess, second by second, time frame. In the microprocess, you can see this dosing and spacing even better than in real time. For example, in one session with a 4-yo boy, you see me introduce an idea about something scary to him; I deliver my communication in short (2 sec) vocal turns defined by short internal pauses (“dosing”) and then, right after I finish, I sit back and fold my arms across my chest. This is “spacing”. When you look at the film in slow motion, you can infer my (out of my awareness) intention of giving him space, giving him a turn.

“Dosing” adds the factor of measurement, of size, which I think is very useful to keep in mind. I remember playing with a little boy who felt the need to exert extreme control over me in the session. In order to help him grow, move him towards reciprocity, I had to stress him by interrupting him sometimes, declining to jump to comply with an order, or by adding a detail of my own to the narrative that he was spinning, any of which could make him mad. Sometimes I “dosed” my contributions by adding humor, sometimes I made them very short, and other times I acted a little confused. Slowly, using dosing in that way, he began to give me a turn now and then.

Spacing is another very helpful perspective. “Spacing” is even closer to the theory of psychological defenses than “dosing”. I was observing the need for “spacing” when I sat back and folded my arms across my chest in the previous example. Another example is my work with a child who lost a parent. When he saw me in the preschool classroom, he would “pretend” reject me by playfully pushing me away or telling me in a loud voice to go away. I would play along, sometimes moving back a few inches, but not going away until it was time for me to say goodbye. When you think about it, there is a lot of communication in our behavior. He is telling me he needs to know if his behavior can cause me to disappear forever, and I am telling him that his behavior is unrelated to when I come and go. My leaving the classroom was a dosing experience for this child. One day after many months of this daily play (“spacing”), I stood to leave, and the boy approached me sideways, without giving me a direct gaze, and leaned against me. I stroked his hair and he didn’t move.

In addition to dosing and spacing, Perry’s thoughts about “distributed caregiving” have also been helpful to me. Actually, what has happened is that my own clinical experience has been moving me further and further from thinking in terms of categorical diagnoses and “clinical” interventions. Instead, I think about children’s problems more often in dimensional terms and tend to move to support the child’s caregiving environment before immediately beginning an individual psychotherapy. Supporting the child’s caregiving environment means working with the child’s parents and teachers. One of my favorite ways of intervening is to work in the preschool. Then, I not only have a chance to offer the very capable teachers an insight now and then about a particular child. I also have the chance to “be there” for certain children when and how they need me. This is what Perry means by “distributed caregiving” – allowing a child to initiate a particular kind of interaction with each caregiver in a group available to him. This kind of thinking moves away from formulations about pathology and towards developmental goals. For example, Perry talks about how after the Waco disaster, the traumatized children seemed to identify particular caregivers for specific needs of the child – one for help with schoolwork, another for rough housing, another for snuggling. I have seen the same kind of distributed caregiving activity in the preschool classroom with healthy children.

I realize that psychotherapists and even psychoanalysts like me sometimes consult to teachers in schools by sitting down with them and listening to them talk about the children and answering their questions, and even by entering the classroom to observe certain children pointed out by the teachers. What I prefer to do is “live” in the classroom so that I can see the children in action and sometimes engage directly with them, while at the same time trying from time to time to identify what the teachers can do even better. For example, I might see a little boy who seems more fearful than average and begins tentatively to play with a toy car. I might suggest to the teacher that she encourage some gentle crashing games if the child initiates them.

In closing, I would like to emphasize the importance of rhythmic patterned activity that is repeated over and over again in helping people grow. This is very different from what I learned in psychiatric and psychoanalytic training. It is not that I have not engaged in that kind of activity in my clinical work; I have. On the other hand, now that I have integrated it into my theory, I do it more, and I do it better.

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Aggression in Early Childhood

Aggression is a good thing. It motivates initiatives – including learning, athletic effort, and healthy competition. Yet, good outcomes depend on the capacity to regulate aggression, and that is always a challenge. Self-regulation, as we have said many times in this blog, is a developmental competency that we keep working on throughout our lives. Self-regulation is a special challenge in early childhood, when it is just getting established, but it is a challenge at any age when we are under stress.

How do young children express aggression? They express it by running joyfully with their friends through the playground, by throwing a basketball or riding a tricycle fast, by shouting out the words of a song when cued, by laughing at a clown or shrieking with excitement at a magician. They also express it by pushing another child, by screaming, biting, or hitting, or by grabbing a toy away from a friend. What is the difference between these two ways of being aggressive? The difference is that the first way is adequately regulated; the aggression is under control. The second way is poorly regulated and out of control.

If children do not have adequate self-regulatory capacity to manage their aggression, they may express it with aggressive outbursts such as noted, but they also may express it by holding themselves tight – holding their bodies tight and holding on tightly to their emotions. That frightened, too-tight holding-on is intended to guard against an unwanted aggressive outburst and can manifest as excessive shyness or fear of speaking, or even as bodily problems such food pickiness or constipation. The reason that children fear the loss of control of aggression so much is that they are afraid of the destructive force of their aggression. Even if it is completely unrealistic that a small child could hurt an adult with an aggressive attack, children (out of their awareness) fear that this could happen. That can lead to nightmares of bad things happening to them or to their parents, whom they love and depend on. I want to stress that it is not the aggression that is bad, but it is the fear of losing control of it and harming someone that is bad for the child.

Why do some children have more difficulty managing aggression than others? Some children are temperamentally more sensitive, more active, or more intense. Some children have developmental difficulties that make it hard for them to “get it altogether” – from the point of view of regulation in various domains – motor, emotional, cognitive. Imagine how hard it would be to feel relaxed and confident if your body “didn’t listen to your mind”- that is what I sometimes say to impulsive children. Other children come from high conflict families in which overt or covert aggression presents a chronic threat. Still other children have histories of trauma – either directed at them or at a parent or even grandparent. Finally, some children have more than one of these reasons to have difficulty with aggression.

How can we help children develop the crucial competency? We can help them in three ways. First, we can create a safe situation in which both child and caregiver are not afraid. That usually means adequate and predictable adult supervision, predictable routines, and secure boundaries. Second, we can communicate tolerance of aggression and model constructive forms of aggression. For example, teachers who play basketball or tag with the children are helping the child experience the high arousal state of aggressive activity without the fear of losing control. At home, a parent’s skillful rough housing with a child can offer the same experience. Third, we can make it possible for children to practice aggressive activities without getting hurt or hurting others. Children cutting play dough with a wooden knife, crashing small cars into magnet tile constructions, and engaging in active playground activities are just a few ways I observed today at the preschool.

Our society has a strange and highly ambivalent relationship to aggression. Some parents in our culture prohibit pretend play with toy guns and soldiers, while others teach their children to shoot real guns. American television, video games, and movies are full of aggression. That puts parents in a difficult position, having to negotiate a reasonable balance between under and over controlling both their children’s aggressive behavior and the aggressive displays they are exposed to. There is no simple solution, but the guidelines as mentioned above are – demonstrate to your children a healthy attitude towards aggression; offer them a safe opportunity to take risks with their aggression and to practice using it; and give extra support to children with special sensitivities and needs so that they too can try out their emotions and test their bodies with exuberance.

Read this blog in Spanish.

Transition to Preschool

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September is a turbulent time of year for young children. Recently, a mother of a preschool boy contacted me to ask me what to do. She asked me about a problem with her son’s sleep and also with an exacerbation of temper tantrums. I will call him Andrew. Three-year old Andrew has always had trouble with sleep, but just before the start of school he began waking up at night and insisting on sleeping in his parents’ room. The temper outbursts seemed random and were shocking to the adults present. For example, recently when his beloved grandmother came for a visit, he ran up to her and punched her. Then he refused to apologize. Andrew’s worried parents were exhausted by his frequent waking during the night and felt helpless to deal with his temper outbursts. Time outs had never really worked for Andrew. His mother asked me for suggestions.

Before giving her mother any suggestions, I visited Andrew at school. This was Andrew’s second year at school, and he was in a different classroom with a larger number of children and more activities. In the classroom, Andrew’s behavior showed that he was excited and proud to be such a big boy. There was a little swagger in his walk as he rushed over to meet his returning classmates with a friendly and confident greeting. However, Andrew’s confident behavior was an over reach. On several occasions his old friends, who were having their own difficulties accommodating to the beginning of school, were unable to reciprocate his exuberant greeting and clung to their parents or held back in preoccupied silence. When this happened, Andrew’s confidence instantly melted. His face fell, his shoulders sagged, and he slouched away from the other child. It was easy to imagine his inner picture of being Big Man on Campus and how catastrophically it collapsed when the reality of his friends being only 3-yo (as of course so was he) interfered with their ability to play their role in his grandiose fantasy.

Andrew had a similar reaction to a mild correction by a teacher. He had readily and apparently magnanimously given up a toy car to another child who requested a turn, but as it turned out, he hadn’t really had a chance to think it through. He had been playing a wonderful game of collecting pebbles and sticks from the playground for one of his new teachers. His enthusiasm had recruited another classmate in the activity, and they had been happily wheeling around the playground. After a while, his attention strayed and he left the car, which was then claimed by the second child. At this point, Andrew looked around at the other child whizzing off in the car, and his disappointment was obvious. “Now what can I do?” he muttered under his breath. After grumpily refusing multiple alternatives from another teacher, he settled on a smaller vehicle and began pushing it across the playground surface. His friend from the previous activity joined him in this fast-paced game, and his good mood seemed recovered. Then, suddenly a third teacher announced – in a perfectly friendly manner – that children must sit on the seat; pushing the vehicle was not allowed. Again, Andrew’s face and body were transformed into a thundercloud. This time he fell to the ground and hid his face in his hands.

You can see how exhausting a morning it was for Andrew, and it was only 9:30! Insight into the mind of a child like Andrew can guide his parents in their decisions about to handle his sleep problems and his tantrums. After considering what is in Andrew’s mind, his parents might tell him, “You are working so hard to be a big boy, and we are so proud of you. But sometimes you get tired out and can’t act like a big boy any more.” They might then comfort him and assure him that they believed he could “be a big boy again tomorrow”.

They decided to let him sleep in their room for a couple of weeks while he managed the transition to school, with a planned, graded, return to his own bed facilitated by rewards. This approach had the advantage of offering him the support he currently needed with an additional built-in transition-practicing exercise. (By this I mean that the planned return to his bed was another chance to practice making transitions.) In addition, a procedure like this reinforces the link between his inner experience (distress about transitions) and his behavior.

With regard to the assault on his grandmother, they concluded that an apology was too much to expect at the moment. If another such incident occurred, they agreed that they would take his hand and apologize to his grandmother for him (after giving him a chance first) and explain to the grandmother that he was having a hard time recently with starting school, and sometimes his body just bursts out with a mad behavior like the punching (another chance to link the inner experience with the behavior, modeling for him self reflection) and you know he is very sorry about it even if he can’t say it right now. Then, later, they would give him the chance to do something nice for her in reparation.

Read this blog in Spanish.

Bullying in Preschool?

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First of all, it is important to define what you mean by bullying. One definition found on the internet that allows the observer to immediately identify bullying behavior is “chronic, frequent behavior that has at its core the intention to harm or intimidate”. However, as is usually the case, things are not that simple, as I will explain.

I will first address what to do in concrete terms if you think your child is being bullied. Then I will discuss the roots of bullying behavior, because understanding these is the best way to really stop bullying. Finally, I will consider a more comprehensive approach to prevent bullying – teaching friendship.

First of all, how do you know if your child is being bullied? It is not obvious. Preschool children are learning how to behave in groups of peers, and this requires learning how to communicate their desires and needs to other young children and learning how to make sense of the communications they receive from their peers. Children are learning how to share, how to play together, and how to compete. All of these activities involve exercising initiative and assertiveness, and this engages aggression. Aggression is not all bad. However, when you are just learning how to do these things in a group of peers, it is also not always smooth, and other kids are often intruding into your territory in one way or another. Your impulse control is not yet great, and you may push or pinch to get someone out of your space. When you want something that someone else has, it may be too hard for you to wait, and you may grab it away or “be mean” in some other way. This is not bullying. It is typical preschool behavior.

Lists of “warning signs” that your child is being bullied can be problematic because they include behaviors that are not at all specific to being bullied, such as suddenly being scared to go to school, or acting clingy and whiny. Even coming home with unexplained injuries or talking about one particular child doing mean things to him does not necessarily mean that your child is being bullied. This ambiguity should not present a particular problem, however, since if your child displays any of these behaviors it is a signal that something is going on that you will want to address, and the first step in doing that is to understand your child’s mind. Whether it turns out that your child is being bullied or having a big reaction to the birth of a sibling, you will want to know about it.

In the case of bullying, finding out whether or not bullying is really going on presents an important complication in itself. If the parent has some reason for believing the child is being bullied, then the parent’s questioning of the child may generate in the child the same belief. Children are very suggestible, especially to the words of adults in authority. This is not only a problem in terms of misidentifying a bullying situation and perhaps falsely accusing another child – which is bad enough. It is also a problem because in making these suggestions (often in the form of repeated questioning), the parent unwittingly usurps the agency of the child, overwhelms his mind, so to speak, and this works against the child developing a mind of his own.

In the next posting, I will discuss what to do if you decide your child is being bullied.

Read this blog in Spanish.

Preschool, Day Care: Attachment and Separation

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I have promised to discuss interventions for childhood constipation and soiling, but I received a great comment that I would like to address first.

A reader of the blog commented:

As the director of a Montessori school in Colorado, I have a few questions:
1) What are your thoughts about early child care and its effects on attachment? I am aware of Belsky’s study and the NIHCD studies. Do you believe that early child care (before 3) undermines security of attachment? Do you believe this is irrespective of the type or quality of care? Is there other research on this issue that you would recommend?

2) I know there have been a lot of studies (some even specific to child care) which show that infants/young children separated from their parents show abnormally high cortisol levels and lower growth hormone levels. Given these studies, do you have a recommendation as to an optimal way to transition a young child into a child care setting (to minimize their distress)? Is there an optimal way for children to separate from their parents each day (we have tried many things over the years- parents walking their child into the school, children leaving their parents in a car line- a teacher comes out to get the child, etc)? If a child appeared to be highly stressed (how would you quantify this?), what would you recommend? Is there any research as to how specific practices might increase or decrease a child’s experience of separation?

In response to this important comment, I contacted recent graduates of the Infant Parent Mental Health course in Boston and Napa, of which I am on the faculty – https://www.umb.edu/academics/cla/psychology/professional_development/infant-parent-mental-health. I value the knowledge and expertise of this group of clinicians and wanted to start a discussion about the issues of childcare, security of attachment, and separation from parents. I will also request comments from another group of valued colleagues – preschool teachers.

My first response came from an IPMH graduate who also has extensive experience directing and administrating early child care programs, Alayne Stieglitz. Here is her thoughtful response:

When I read these questions I thought of Ed Tronick on the first day of the IPMH Program introducing us to the caregiving practices of several cultures around the world: The village in the Andes where infants are bundled in blankets and strapped upside down on their mothers backs for the first year of their lives and the tribal group in Africa where children have an average of seven caregivers before their first birthday. These are not what we would consider ” best practices” but the children there are reaching their developmental milestones, forming healthy, robust attachments, and thriving in their societies. He said, “Different patterns of care taking and parenting may violate norms we hold as vital, yet children are still developing and learning. Those differences work for their culture. The point is to raise a child who can be competent and successful in the culture they live in.”

In this day and age, the culture that an increasing number of families are living in includes childcare. Single parent households and households where both parents work in order to provide what’s needed for their family do not have the option of whether or not to put their children in someone else’s care. There are many choices; in home care by a relative, in home care by a nanny, small family day care, and center based care. I think the question to ask is not, “Which type of care is best?” But, “Which type of care will be best for my child and my family?” And, of course, “Which is the highest quality of care that I can afford?” This last question limits the options for many families. Continue reading →