Surviving the Holidays
Written by: Dr. Joy Kolb, BCBA-D

The holiday season is upon us! This season is known for festivities and bringing people together. Even though the holidays can be filled with fun, it can also be a stressful time. Here are some general suggestions to help maximize fun, while decreasing stress. These strategies focus on preparation, structure, and predictability.

Changes In Schedule

Changes in schedule always occur during the holidays. Many times these changes can cause anxiety, frustration, and increases in negative behaviors. In order to decrease negative reactions to changes in routine, families can implement some strategies. First, caregivers can prepare their children for upcoming family gatherings, school events, special outings, and any other changes in routine. When preparing your child, be sure to discuss who will be involved in the activity, where it will be, what time and day it will take place, and other useful information.

In addition, caregivers can help structure the holiday season by using a calendar to provide a visual representation of upcoming events. Visual schedules also assist in structuring daily activities. Caregivers can select to use words, picture symbols, photographs, or small objects when creating their schedule and calendar. For example, if you believe your child will respond best to a schedule of objects, you will be able to find your schedule materials at the local craft store, dollar store, or even around the house. The scrapbook section in craft stores will have miniature objects (tooth brush and tooth paste to represent tooth brushing, clothing to represent getting dressed, etc.) that can be used to create a schedule. In addition, you can use objects around the house (toy car to represent an outing, a small Lego piece to represent play, etc.) In the craft store you can purchase a material called the "Amazing Goop - Household Adhesive." Goop is a product that will cover the objects in a protective coat. This will allow you to "laminate" objects, similar to laminating photographs or picture symbols. Once the object is covered in dried Goop, it will be ready for the object schedule. As with all toys, you will want to monitor your child as he or she uses the schedule to ensure appropriate use.

Finally, caregivers should try to be as predictable as possible. Even though your child's routine will be different during the holiday season, you can still embed predictability into that routine. For example, every evening before bed and every morning you could spend five minutes completing the preparation and structure strategies explained above. During this time, you can review the schedule and/or calendar; discuss the activities of that day, upcoming events and outings, etc. As you complete this routine on a regular basis, you will impose predictability into the holiday season.

Gatherings with Family & Friends

During the holidays, families frequently visit with family and friends. As you prepare your child for the upcoming visit, it may help to show your child pictures of who you will be visiting. This will help your child remember names and faces of people as well as prepare him or her for the visit to their home. Caregivers can also use social stories to prepare and explain to their child where and who they will be visiting and what will occur during visits to other peoples' homes.  

If your family is going to visit a family or friend and you expect your child to have challenges, you should be prepared. Sometimes children engage in negative behaviors and have difficulty during unstructured times when there is nothing to keep them engaged. Caregivers should contemplate how they can increase their child's engagement during these times. For example, consider creating a "special activities bag" for visits to friends and family. This bag should contain novel activities. Caregivers could print coloring pictures of highly preferred characters from the internet or go to the dollar store and purchase activity workbooks, small puzzles, and other toys that can be stored in the "special activities bag." When visiting family and friends, caregivers can select an activity from the bag every 15 minutes to give to their child. Remember, your child will be more likely to be captivated by and to remain engaged in activities that are novel and interesting. After 15 to 20 minutes, another activity can be selected from the bag.

Many times, family members and friends may want to interact with your child, however they may not know the best way to engage in an interaction. Give very specific directions on what your family member can say or do that your child will enjoy. Also, children and adolescents may be anxious about the social interactions that are required during gatherings. Some of this anxiety can be decreased when structured activities are included in social gatherings. Consider bringing your child's favorite board game or card game to help structure interactions with family and friends.

Finally, if you have a behavior plan you are following, be sure to continue to implement each component of the plan. Remember, when you are feeling overwhelmed and unsure of what to do, implement the strategies and recommendations your therapist has provided. The predictability of your responses is an asset you should not underestimate!

Expect some challenges during this season, but most importantly, you should remember to have fun and to enjoy this time. Here is a summary of some of the strategies you can use throughout the holidays:

1. Discuss upcoming events with your child (who, what, where, and when)
2. Use visual schedules and calendars
3. Embed predictability into routines
4. Use pictures of family/friends and social stories to prepare for social gatherings
5. Create a "special activities bag" with novel activities to keep your child engaged
6. Use board games and cards games to provide structure to social interactions
7. Give others specific instructions on how they can assist you or your child
8. Smile and enjoy the season!

Welcome Nandita Joshi, M.D.
Board Certified Child, Adolescent and Adult Psychiatrist

After graduating medical school, Dr. Joshi completed her residency in Adult Psychiatry at Columbia University's St. Luke's-Roosevelt Hospital Center in New York City.  She then completed her fellowship in Child and Adolescent Psychiatry at The Johns Hopkins University, School of Medicine in Baltimore, Maryland, followed by additional fellowship training in Consultation-Liaison Psychiatry at Memorial Sloan-Kettering Cancer Center in New York City.

Before moving to Jacksonville, she worked as the Director of the Adolescent Psychiatric Inpatient Unit at Focus By The Sea Hospital in St. Simon's Island, Georgia. 

Dr. Joshi is double boarded - in Adult as well as Child and Adolescent Psychiatry.  She offers comprehensive outpatient care including diagnostic evaluations, second opinions, medication management, and patient and family education.  She also engages in medical research at Clinical Neuroscience Solutions, Inc. in Jacksonville, Florida.

Integrating her strong academic background, clinical experience and findings from latest research, she provides the highest quality of care to her patients.  

Dr. Joshi will be accepting clients beginning Monday, January 11, 2010.  Please call the clinic for an appointment.

Welcome Rinita Laud, Ph.D.
Licensed Clinical Psychologist

Dr. Laud currently works with MHMRA in Houston, Texas.  Dr. Laud received her Ph.D. in Clinical Psychology from Louisiana State University in 2006.  She also completed her pre-doctoral internship and post doctoral fellowship at the Kennedy Krieger Institute and Johns Hopkins School of Medicine.  Dr. Laud most recently served as a faculty member at the Kennedy Krieger Institute for two years, where she specialized in the assessment and treatment of pediatric feeding disorders.  Dr. Laud has provided behavioral services to individuals, families, and residential staff over the last ten years in addition to having published various journal articles and books in the area of developmental disabilities.

Dr. Laud will be completing feeding assessments on Saturday, January 23, 2010.  Please call to schedule your appointment.

Welcome Paige DeMasters & Kara Bozeman
Front Desk Staff

Meet-N-Greet Our Doctors!
January 6, 2010

On the first Wednesday of every month from 5:00-6:00 p.m., you will have an opportunity to meet and greet with all the doctors at Keystone Behavioral Pediatrics. This is a wonderful opportunity to get to know Dr. Katie Falwell, Dr. Adrienne DeSantis, Dr. Joy Kolb, and Dr. Paras Nabizadeh. Please bring any questions you may have about our practice.

The next Meet-N-Greet will be held on Wednesday, January 6, 2010.

Keystone Kids
December 2009

This month we are featuring a family who will share with you some of their thoughts and feelings, ranging from emotional stories to the funny side of life.  We'd like to introduce Jenny W. and her two beautiful boys. KBP Staff was honored to talk with her to find out how she manages to organize her life!

KBP: How are you able to deal with having one child on the GF/CF diet and another on a diet with no restrictions?
JENNY: I always have all kinds of food choices while in the car, so there is never an opportunity to give the wrong things. Both of my boys were told what they can and cannot eat, and over time, they have both respected what their limitations were. I explained to each boy what it meant. Now, my child who is on the GF/CF diet knows if certain foods are OK, and if he is unsure, he'll ask if he can have it.
KBP: How has your child changed since coming to Keystone?
JENNY: My child has changed leaps and bounds. He is not contained to a stroller anymore and can stay in the cart in the grocery store. Instead of reacting to certain situations, he is now processing each scenario.
KBP: What is your favorite GF/CF recipe?
JENNY: We love Cookie Momsters cookies.
KBP: Describe your perfect day.
JENNY: My perfect day would be horseback riding on the beach and searching for sea glass. This is what relaxes me the most.
KBP: What is your favorite characteristic about your boys?
JENNY: I love their silliness, their laugh, and how much they enjoy hanging out with me.

Walk Now for Autism Speaks
Inaugural Jacksonville Walk Now for Autism Speaks

On Sunday, November 8th, Keystone Staff participated in the Inaugural Jacksonville Walk Now for Autism Speaks. We made many new friends that day, and had the opportunity to share with families the behavioral and psychological services we provide. To date, the North Florida communities have raised over $53,000 in support of Autism Speaks. Autism Speaks funds numerous research projects that explore what causes autism, and further develops more insight into the treatments, preventions, and eventual cure. We look forward to partnering with Autism Speaks again in 2010.