Posts tagged: attention


Business Logo for Psychological and Neuropsychological IssuesThe October issue of the Monitor on Psychology offered seven strategies to improve parenting.  These strategies are culled from a century of research in child psychology.  This effort is especially gratifying to the author, as the bulk of important psychological research goes unnoticed and unheeded.  Please view these suggestions as ways to improve parenting, rather than a critique on the status of parenting in America.

Few activities are as bound to one’s self-worth as parenting.  Some parents will assume they employ all these techniques perfectly.  Some parents will dispel them as psychological nonsense.  Perhaps it is true that good parents often worry about their parenting skills, and poor parents believe their parenting skills are axiomatically above reproach.  This is reminiscent of how peak performers in any field tend to function.  They systematically review and analyze their performance, whereas the losers tend to blame anything but themselves.  It is hoped the parental reader will keep an open mind.

Please also keep in mind that consistency is the linchpin of any behavioral intervention.  It is probably better, most times, to employ a bad behavioral intervention consistently, than a good intervention inconsistently.  Interventions that are inconsistent leave the child confused and liable to act out in unpredictable ways.  Consistency between the caretakers must occur before the parents can employ behavioral interventions in an effective fashion.  If the parents are not in agreement about the intervention, the intervention is doomed to failure.  The child will receive a different message from each parent; again causing confusion and unpredictable acting out.  Additionally, if the child is getting what they want by pitting one parent against the other, what they are being taught is how to use deceit in order to manipulate people towards their own ends.

That being said, the first strategy is to embrace praise, but the praise should not be indiscriminate.  Dr. Eyberg named this type of positive feedback as “labeled praise.”  The praise should be specific to the situation, realistic, and followed with a smile or gentle touch.  False praise for poor performance robs the child of the “learning that comes from failure.”  The second strategy is to ignore minor behavioral problems that do not result in physical or emotional injury.  Ignoring screaming pleas and only responding to prosocial ways of attracting attention teaches the child there are easier and more reliable methods to receive a parent’s attention.  Third, read up on child development.  New parents are often surprised by behaviors that are normal for the child’s developmental stage.  This helps to lower the parents anxiety through increasingly realistic expectations.  Fourth, use time-out in a brief and immediate fashion.  Time-outs will not work if the parents give positive reinforcement for antisocial behaviors.  The child will not stay in the corner if their aggression is rewarded at other times.  The fifth strategy is to prevent misbehavior by planning and structuring activities.  Teaching children to cope with situational demands and stay busy will help combat boredom and the disruptive behaviors that ensue.  Sixth, the parent must take care of themselves first and foremost.  There is a strong link between parental and child stress, as well as how the child will learn to cope with stress in their adult life.  Lastly, psychologists advise making time for your children.  This is not a suggestion to give up your work to sit and stare at your child.  About an hour a week, divided or whole, appears to be sufficient to satisfy the needs of most children that have been researched.  The parent should not be teaching or correcting during this time, but simply sharing an activity.

Please note that these strategies are not only effective with “normal” children, but are employed with good effect in child clinical populations.  The main difference is that these strategies are utilized in a much more rapid and rigid format.  The rules remain the same.  The primary task is to model and reward behaviors that will serve the child well in adulthood, while coping with the extraordinary responsibility and stresses of being a parent.  No one is a perfect parent, as no one is perfect at anything.  Perfection is an idealistic goal that is never attained.  It is the process of working towards this ideal that generates excellence.  So, if your worried about your performance as a parent-you’re probably a pretty good parent already.

Delirium Generis

Business Logo for Psychological and Neuropsychological IssuesDelirium is a term that has gained acceptance within the medical community.  Twenty years ago, a clinician could be maligned for using the term in a clinical setting.  Many providers consider it a popsy, imprecise, if not inappropriate term.  Delirium is actually a precise clinical term that may have profound consequences for the afflicted.  It is a cognitive state in which the person is unable to focus their immediate attention.

Schizophrenics are often incorrectly labelled as being in a delirium.  Their stream of thought is bizarre and often not pertinent to the immediate situation.  While their attention is reduced by the automatic thoughts, schizophrenics are rarely delirious.  Similarly, people who suffer with mania or are highly anxious may be labelled with a delirium, but this is also a rare situation.  While automatic and unwanted thoughts decrease their attention, these unfortunate individuals are still able to focus their attention at a reduced level.

Individuals suffering with a delirium have an impairment of immediate attention.  The attentional deficit far surpasses that observed in people with an Attention-deficit Disorder, which is typically a disorder of sustained attention-not immediate attention.  It is not a dream world, since this presupposes the sustained attention to be consistently unrealistic.  It is an acute condition that is typically caused by a metabolic or an infectious process.  Delirium is more a sign of medical illness than psychological distress.  A person immersed in a delirium may incur increasing organic damage the longer they remain in this state.  Urinary infections, severe dehydration, head injury, stroke and an elevated intracranial pressure may produce a state of delirium.  Psychoactive drug use and allergic reactions may also produce a state of delirium.  Alcohol and tranquilizer withdrawal are two of the more common causes of delirium.

A simple test for delirium is to ask the person to repeat numbers of increasing length.  The ability to repeat five digits accurately generally indicates functional immediate attention.  A limit of four digits is borderline functional, and these individuals often manifest problems with independent living.  A person suffering with a delirium is usually unable to repeat more than two digits before their attention shifts.  Commonly, the examiner will be unable to teach the simple rules for the digit repetition task.  The delirium renders the assessment of higher order cognitive functions impossible, since the person is unable to focus on the task instructions sufficiently.

Managing a person suffering with a delirium is best accomplished with a smile.  Since their attention is too impoverished to comprehend well, the patient will tend to focus on the examiner’s facial expression.  Gentle physical guidance is almost always required, secondary to the poor aural comprehension.  The main task of the caregiver is to protect the person from accidental harm until medical services can intervene.  It is not suggested to wait for the delirium to pass, since there may be increasing organic damage without the appropriate treatment for the underlying condition.  Even if the caregiver knows that severe dehydration if causing the delirium, convincing the person to drink voluntarily is nearly impossible.  If a person was able to understand the caregiver’s concern and act accordingly, this would be proof enough that the person is not in a state of delirium.

No matter how skilled the caregiver, delirium presents an emergency that requires coordinated medical care.  A highly skilled caregiver is apt to know their limitations and seek timely medical intervention.  Less skilled caregivers may wait for the condition to pass.  Even worse, the caregiver may perceive the patient’s delirium as a personal commentary on their skill as a caregiver.  Be a skilled caregiver and seek medical intervention as soon as possible.

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