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Hilber Psychological Services

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Emotions of Children on the Autism Spectrum

Emotions of children on the autism spectrum are often hard to comprehend. It is important to help children not only identify an emotion, but also connect that emotion to a specific event. According to Alice Kassotaki, speech language pathologist MSc, BSc, there are four steps to identifying emotions.

  • -Step 1: Definition of the child’s emotion: “Nick, you look scared”.
  • -Step 2: Connection of the emotion while it is being expressed: “Maybe you are scared because this is a new game”.  
  • -Step 3: Confirmation that it is normal to have such an emotion: “It makes sense to be scared when you try something new for the first time”.
  • -Step 4: Reassurance: “Let me help you. It will be easier and less scary if we do it together”.  

There are many simple games that can be played to help children identify emotions. Mirroring emotions and having children guess how you are feeling is a great way to have them practice recognizing emotions. One a child has accomplished this step, they will later learn how other people think, and then eventually be able to connect how their feeling in regard to what they are doing.


Children on the autism spectrum may have difficulties displaying empathy. However, during the transition period from early childhood to preschool age, children are able to gain some skills. For example:

  • verbal and nom-verbal characterization of the emotional expressions
  • use of emotional language to describe personal emotional experiences and to clarify others’ emotional experiences
  • development of knowledge about the rules of emotional expression and how various emotions can occur at the same time
  • gradual understanding of social emotions such as guilt

It is an important first step to understand one’s own emotions. Once this is achieved, identifying, understanding, and reacting to others’ emotions is crucial to building strong social skills. Misunderstanding social ques, such as non-verbal signs, can lead to miscommunication. A child may unknowingly misbehave because of the lack of understanding. This can often be avoided by teaching children specific emotions and reactions in the clearest way possible.

At a young age, 4 to 6, most children are able to understand the main emotions: joy, sadness, anger, and fear (think of the Disney movie, Inside Out). More complex emotions, such as pride, guilt, and shame, must be learned through the main emotions. Here are 7 ways to help children understand the complex emotions:

1.     Attention approach: some children must be taught to pay attention to social information. When you notice a child feeling a certain emotion, such as anger, state their emotion and why they are feeling that way while continuing to show nonverbal signals, such as crossed arms and stern voice.

2.     Naming the emotions: As a child begins to pay attention to social information, teach them the names of the emotions, starting with the main emotions. Using pictures of familiar faces with obvious emotions can help the child relate the name to the understanding of the emotion.

3.     Designation emotions: Once a child is able to look at a frown and identify that that person is sad, teach them how to designate each emotion. Ask questions such as “How does he feel?” to be able to designate different emotions

4.     Actions based on emotions: Now that the child is able to understand and designate each emotion, help them react based on emotions. Rather than looking at pictures, show them real life examples of emotion.

5.     Role-playing: Give the child different scenarios of receiving ice cream and feeling happy or losing a toy and feeling sad, allowing them to role-play and further identification and expression of emotions.

6.     Modeling (filming): When watching a movie or television show, point out characters’ emotions that the child will be able to relate to.

7.     Games and books: Playing board games and reading books are also great ways to help the child learn about others’ emotions in different situations. This is a way to turn learning into an interactive activity.

While this information is geared towards individuals on the autism spectrum, this same information about identifying and understanding emotions can be used to all children. 

 Contact us for more information on children on the autism spectrum, learning and expressing emotions, or for help with children who are struggling.

~Written by Allison Parker and Tanya L. Hilber, PsyD

Reference: Kassotaki, Alice. (2017). “Emotions of Children on the Autism Spectrum.” Upbility.

No Drama Discipline: The Principles, Part 5

For the past few articles, I have been exploring the three connection principles to use during discipline based on the book “No Drama Discipline” by Dr. Daniel Siegel and Dr. Tina Payne Bryson. The three principles include Turning Down the Shark Music, Chasing the Why, and Think about the How. Today, I will explore and discuss the final principle, Think About the How. To review the first two principles, please read the articles “No Drama Discipline: The Principles, Part 1,” “No Drama Discipline: The Principles, Part 2,” “No Drama Discipline: The Principles, Part 3,” and “No Drama Discipline: The Principles, Part 4.” To review the foundation of the three principles, review the articles “No Drama Discipline: The Foundation Part 1,” and “No Drama Discipline: The Foundation Part 2.”The past two principles, Turning Down the Shark Music and Chasing the Why, refer to the internal aspects of parenting. That is, these concepts explore both a parent’s and a child’s inner thoughts throughout each discipline interaction. The final principle, Think About the How, focuses more on the tone of the conversation, that is to say, how a parent expresses him or herself to the child, and less on what a parent actually says.

Let’s look at an example.

Susan has a 7yo son, Alex. It is 7pm on a Wednesday night, and Susan has asked Alex to brush his teeth before bed. The following three interactions are different ways Susan can say the same sentence, “Go brush your teeth.”

  1. With a smile on her face, a calm-looking face, and a warm tone of voice, Susan says, “Go brush your teeth.”
  2. With eyebrows turned inward, a scrunched up nose, and an angry voice, Susan says quickly, “Go brush your teeth.”
  3. With a frown on her face, narrow eyes, and clenched teeth, Susan says, “Go. Brush. Your. Teeth.”

How do you think these scenarios would vary based on Susan’s tone? How do you think Alex would react to each scenario? These examples demonstrate just how much the how matters when a parent communicates with his or her child.

Throughout parental-child interactions, it is important to give the child a choice rather than focus solely on the consequence.

For example, a mother, Mary, is trying to get her 7yo daughter, Veronica, to bed. Veronica enjoys story time every night, which may be a good reward, or incentive, for getting to bed on time. Veronica decides she does not want to go to bed. Mary can state her message in one of two ways:

  1. “Get into bed or you won’t get to read a story tonight.”
  2. “If you get into bed now, we will have time to read a story. If not, we will run out of time and we will not be able to read a story tonight.”

In the first message, Mary stated a consequence. In the second message, Mary was able to give her child a choice, allowing the child to make a decision for herself. When it comes to parenting, giving children a choice allows the parent and child the opportunity to connect while simultaneously giving the child control over his or her choices. In this manner, a parent is teaching his or her child the reward or consequence that accompanies a given choice. This, in turn, will help the child navigate the world as an adult.

The how in No Drama Discipline may be a reflection about how the child feels about him or herself as well as how the child feels about the parent. Children learn how to treat others by observing how the parent treats others and modeling those behaviors. Children tend to be more cooperative when they feel connected to a parent. Futhermore, according to authors Daniel Siegel and Tina Payne Bryson, discipline becomes more effective when the how is calm, playful, and respectful.

If you would like to learn more about parenting techniques and receive individualized treatment to address specific problems in your home, therapy can be a great place to do so. Please contact us at Hilber Psychological Services to explore therapy options. If you have any general questions, please visit our FAQ

Be sure to come back soon to read about more topics in the field of psychology and mental health.

How do you start therapy? What is it like?
Deep breathing

Ever wondered how to start therapy? How does it work? What is it like behind the closed doors? What happens in the beginning? Every therapist is different in their personality, orientation and type of therapy, and style of conversation in therapy. To be brief, there are a few types or orientations to psychotherapy that include humanistic, cognitive-behavioral, behavioral, psychodynamic, and psychoanalytic. Some therapists focus on one type and others may integrate a few of these. Some therapists may ask more questions and others may allow space for clients to fill. Hilber Psychological Services therapists provide therapy mostly from a Cognitive-Behavioral therapy orientation or CBT. Since all personalities and office procedures are different, this will give you a good idea of what it's like to start your work together with us at Hilber Psychological Services.

Before the Appointment Before setting up an appointment at Hilber Psychological Services, there will be a short conversation via phone or email to verify important details. These details include whether there are custody issues and if both parents are supportive of treatment and your insurance carrier if you choose to use your insurance plan.

After you have discussed these details, an appointment is set up. If you consent to an email, you will receive a confirmation email with the office address, your appointment time, and the paperwork for you to fill out in the privacy of your own home. You may bring that paperwork with you to the first appointment.

First Appointment or "Intake" At the first session, there will be a brief review of the paperwork you signed. The rest of the session is then focused on getting to know you and your situation. This is the time to bring up your concerns and presenting issues you want help with, as well as any questions you may have for us. At the end of the first session you may make a follow up appointment if you felt like the appointment and therapist was a good fit with you.

Second Appointment For adults and teens, typically the second appointment is to get to know each other better, talk about any topics that you feel are important but haven't mentioned yet, and move forward to discuss the steps recommended and continue with your treatment.

For children, the second appointment is about meeting the child, getting to know each other, discussing emotions and "wild card" coping skills of deep breathing and muscle relaxation. Typically the last part of the session is saved for playing a game to build the relationship, reward the child for working so hard, and practice the skills they have just learned. Finally, during the last few minutes, the parent is brought into the room and given a brief overview of the topics discussed and skills introduced.

Now you are ready for the following appointments. These are more dependent on the situations and individuals, but you may find that you are comfortable in session.

For detailed questions, please contact us via Hilber Psychological Services or at drhilber@hilberpsychsandiego.com to set up an appointment. For more common questions about therapy, see FAQ at HPS.

Adult ADHD: How is it different than childhood ADHD?

As mentioned in a previous news post by Dr. Filizetti, Attention Deficit/Hyperactivity Disorder (ADHD) may "look" different in adults when compared to children. We know that ADHD persists into adulthood; however, it tends to affect adults differently than children. When we think of childhood ADHD, we often picture the hyperactive child that cannot sit still and struggles to focus in class. However, hyperactivity remits in adulthood, and is apt to interfere with ones performance in different ways. For example, adults with ADHD may be at higher risk for driving difficulties or speeding through traffic.  Adults may also struggle with reading comprehension or sustained attention while reading.

As required for a diagnosis of childhood ADHD, symptoms must be evident in multiple settings, and interfere with the person’s ability to succeed in a variety of areas. In children, ADHD interferes with  performance at school, home, and sports. However, adult ADHD may impact relationships, college  coursework, and/or ones ability to succeed in the workplace.

Adult ADHD: Assessment and Treatment

As with childhood ADHD, adult ADHD is evaluated and diagnosed by a psychologist. When you meet with the psychologist they will likely ask you about your personal history, observe you behaviorally, and administer a variety of tests to assess whether or not you meet criteria for ADHD. Upon completing an ADHD evaluation, the evaluator will recommend various types of treatments that best fit your individual needs. Treatment for adult ADHD includes: Neurofeedback, Biofeedback, Cognitive-Behavioral Therapy and/or medication management.

For more information about assessment or treatment of ADHD, feel free to contact Dr. Filizetti. Written by Dr. Kirstin Filizetti.