drmargaret

There’s a basic sequence and order of training behaviors. Children get to learn these things by the time they are four years old. Dogs learn these same things by the time they are two years old. It is necessary to train these in order. Some children, and some dogs, pick up the behaviors on their own with no training. Here is the order:

1. Look at me
2. Sit
3. Leave it
4. Sit and stay there
5. Stay in a place
6. Come here
7. Stay with me (heel)
8. Go get something and bring it back (fetch)
9. Down
10. Be quiet

Some people teach Down after Sit. Some people teach Fetch sooner because they want something to do with the dog. Some people never teach be quiet as a command at all, just ask my neighbor’s dogs, Shut up Molly and Shut up Libby.

Now some people get resentful when I explain that the above things are basic commands taught to dogs that used to be taught in the exact same manner to children. They were taught in preschool. People don’t do this anymore for the most part. On television, several nights a week, people can tune into one of several Nanny programs and watch behavior specialists show parents how to do these commands with older children. A few shows have Barbara Woodhouse or Uncle Matty showing how to do these basic commands with dogs. They are the same commands. I had a discussion with Uncle Matty who says it’s different training children than training dogs, and I think he may be correct, dogs may be easier. In both cases you have to train the owner or the parents.

Behavior work involves identifying behavior. Behavior is what you can observe. People make things up about motives and feelings. Behavior is what you can see. Behavior is about what happens.

Everyday I have at least one parent who tells me their child can’t sit still. Most people confuse sitting with sitting and staying in one place. They confuse number 2 with number 4 in the above list. So the first thing I do is to see if they are correct. I ask the child to sit. Almost all the time the child is able to sit. They can’t stay in a sit. So I observe for the parent that their child can indeed sit. They can’t stay seated. For the few children that indeed can’t sit, I train the child to sit. It takes a few seconds. I then have the parent do the command. I tell the parent they will have to practice the command several times a day. The children who make no eye contact have more of a problem and need to work on that first, prior to working on a sit.

The basic things that get taught by behavior specialists, whether at Petco or PetSmart or some private behavior specialist for a dog, or through school, the Regional Center, some Nanny, or a private behavior specialist for a child are technique and timing of interventions. Now I have two dogs and my timing is horrible. My two dogs can both reasonably get through all 10 of the above list. Baxter does them easily. Cinnamon does them when she is good and ready. Some will say Cinnamon isn’t well trained, but she does all the list and there are no problems. I think if some 4 year old child can get through the list with no problems then things are fairly fine. Timing doesn’t have to be perfect, dogs and kids will adapt to less than perfect. The better you are in training, the easier it will be for the dog or the kid to figure out what you want. It’s important to be consistent. It’s important to have a schedule. It’s important to have the same trainer. It’s important to use the same commands. Those all help. It’s important to set up the environmnet to make it as distraction free as possible for training to take place. All those things are important. But children and dogs adapt to less than optimal conditions. If there’s some problems, work on getting more optimal. In behavior work the problems belong to the trainer to work around. If you are having problems with you child or your dog get a professional behavior specialist to help as soon as the problems start. If a dog isn’t looking at you as a puppy it’s a big problem. If a child isn’t making eye contact at 6 months it’s a big problem. Get an evaluation. Big problems get bigger. If your two year old dog isn’t housebroken or your four year old isn’t potty trained and isn’t using utensils get an evaluation. If your dog is growling and biting or your child is, it’s a big problem. It’s not going to go away, it will get worse with time. Training can fix it and make things more livable at your house.

I took several pictures of my dogs recently and, let’s face it, they are fat. When I first got the dogs I walked them twice a day. I considered it an obligation of being a dog owner. So, rain or shine, I walked them twice a day. It kept them less fat.

When Cinnamon was a puppy she was skinny. She had parasites. As soon as the parasites were gone she continued to eat as if she still had them. She runs all over the yard so she keeps her weight down. She’s muscular. She’s big and she just looks big. She doesn’t look really fat unless she’s around some skinny dog like a greyhound, or some thin dalmation.

Baxter is fat. He’s always been fat. He eats everything. He likes food. He wants to savor his food. If he had the opportunity, he would eat slowly. If he ate slowly, Cinnamon would shove him out of the way and eat all his food, so he eats fast. He moves slowly. He doesn’t run all over the yard. He saunters. So he is fat. I’ve cut back on the dog food, the treats, the little extras, all that and he remains fat. He needs to be walked.

Dalmations were bred to run alongside a carriage. Baxter needs to be running alongside a carriage. The guy down the street has a couple of dalmations. He takes them on a good 3 to 4 mile walk every day. One of them hadn’t been walked by her prior owner and she got fat too. She seemed unhappy. Now she seems happy and she has slimmed down. She’s also with another dalmation.

Baxter doesn’t seem unhappy. Neither does Cinnamon. I take them on short walks when I can manage it. I’m out with them outside in the garden, and they are running all over out there. Both are getting older and both seem to have some arthritis. I get them out the front of the house for a walk some times. They get out back several times a day. Still Baxter remains fat while Cinnamon stays thinner.

It’s not until I see the photos that I realize just how fat the dogs are. It’s what almost everyone says when they see the “puppies.” Some people couch it in politically correct terms. They say the dogs are “well loved.” Meaning I feed them too much. So for the past month I’ve been very careful in watching exactly what they are eating. I did cut down on Baxter’s food. I cut it in half. Unless they are binging out on the weekends, on Friday and Saturday, they are not remotely eating too much. So this is not enough exercise. They have lost a bit of weight in the past month. Baxter dropped a pound. Cinnamon stayed the same. Gradually with some work Baxter should lose some more.

Weight loss is hard work for everybody. It’s hard even for dogs. It takes a two pronged approach. A medical evaluation to ensure there are no medical obstructions to weight loss. My dogs have a clean vet bill of health. Then it takes a good diet and a weight loss plan and food control and an exercise plan. If you go from exercising twice a day for a mile to a little bit of running around the yard then you are likely to put on weight, just like my dogs have. So they have to cut calories and increase exercise. The occasional rat, bird, and cat in the yard just isn’t enough of an exercise plan for them.

People used to have to do a lot of things. They had to move around a lot to get things done. Now things are done by automation. Few things have to be done physically. People get bigger. We used to be able to burn off the calories we ate. Now we don’t. Our diets got much higher in convience foods and sugars. It’s helpful to limit these. Just like I have to limit how much dogs can have treats. They are not for all the time.

People have different perceptions of pain. The point at which pain can be perceived is someone’s pain threshold. Some people have a high threshold. They notice pain at very low levels. In the fable the Princess and the Pea the Princess could perceive the pea under 40 matresses. This is a very high pain threshold. She can notice very insignificant levels of pain for most people. In contrast was a man who had become very sick. He had no awareness of how sick he was. This is a low pain threshold. I reviewed his history. I specifically wanted to hear how often he had broken bones. He had broken bones quite a few times. It was no big deal to him. He had driven himself to the hospital most of the times, with cracked ribs, a broken arm, and with a broken leg. He didn’t notice he was in pain. So when he started developing diabetes it wasn’t caught until it was very late in the course of his illness. When he caught a bacterial infection, he had already developed septicemia and the infection was well into his blood stream before he felt the first twinge of pain.

Pain works to help people recognize something is wrong. Too soon with too high a pain threshold and there is no sign of the underlying disease process. I see the MD about two weeks prior to the lab tests showing something abnormal. I notice pain early, prior to anything showing up as wrong. Wait a couple weeks and then there are signs of the infection. It’s a running joke at the medical office, that on my tombstone it will say “But her labs were normal.”

The second thing about pain is tolerance. A low pain tolerance means that pain can’t be tolerated well. A high pain tolerance means that pain is tolerated better than average.

Pain threshold and pain tolerance work together. They are based in part on how many pain receptors the body has in a particular area and on how someone deals psychologically with pain. The man I talked about appears to physiologically have few pain receptors. He doesn’t notice pain. He has a high tolerance for pain and a low pain threshold. He may become seriously ill and take no notice. To combat this he needs to be seen regularly and have routine labs drawn to ensure he isn’t medically ill since he has no awareness of pain.

I have an acute awareness of pain but a high tolerance of pain. So although I notice pain at very low levels I can tolerate fairly high levels of pain. The problem with this is that I notice pain prior to medicine picking up what is wrong.

There are people who have an acute awareness of pain and a low pain tolerance. These people experience lots of pain. They complain about pain from minor injuries, from bumps and bruises, from little scratches. These people just experience a lot of pain. When something big happens that causes most people pain, they are doubled over screaming.

Doctors use a 10 point scale to have people describe pain. That really doesn’t do justice to pain. It gives them an idea of how bad this pain is in relation to their other pain in their life but it doesn’t tell them how pain is. I prefer to anchor the scale better on both ends. When I ask about someone’s pain I ask about what their worst pain was like and what they remember about that experience. Were they doubled over? Were they vomiting continuously? Were they blacking out during the episode? Were they in a hospital? Did they break a bone, lose consciousness, need an operation, give birth? Now that’s the worst kinds of pain. So that would be the 10.

Now the least kinds of pain are little things like a scratch, a little bruise you didn’t even notice you had a couple of days after you got it, a minor ache, something so small you wouldn’t seek treatment for. That’s the 1. And less than that would be no pain at all, nothing. That’s the 0. Then I have them rate their current pain and describe the symptoms.

So my appendicitis was an 8, even though I went shopping an hour before I went to the hospital. The guy I saw was a 9, even though he described his pain as a twinge, a pressure in his chest, it was worse than when he broke his leg. He was in the hospital for 4 months, intubated, in septic shock.

I meet people who complain of severe pain all the time. Some people have debilitating pain. Some people have pain complaints that exceed anything realistic. Some people use pain complaints to get pain medication. Pain medication is psychologically and physiologically addictive. The psychological part can be more problematic than the physiological part. For chronic conditions the idea is to control the pain on the least amount of medication possible. Often controling inflammation, depression and anxiety are also helpful.

I love psychological testing. It’s the majority of my professional job and it’s what hooked me in graduate school. I spend 7 hours a day, five to six days a week doing psychological evaluations.

Lots of people dislike the process of being evaluated. I can sympathize with that. I’ve been evaluated. In order to perform the tests I have to take them. I like some of the tests better than others. I think some of them have clearer items. I think some of the items are more challenging. I think some of the items are too simple or not engaging enough. I think some are too hard to see. What people dislike about the process of being tested, especially for SSDI, is the lack of feedback. I can’t tell someone if they got an answer right or wrong. I can’t tell them if they are doing as well as most people. So there is a lot of ambiguity in the process. Ambiguity makes people feel anxious.

Psychological testing gives me lots of data. I start collecting data from the moment I see the person. I might see the person in the parking lot or elevator or in the waiting room. I might not see them until I get their initial paperwork and call them in to be evaluated. I have a four page intake form. It is mainly check off boxes with brief answers for some history. I review the form with the person. An average person with a high school education can complete the form in 15 minutes.

Most people don’t realize that from that limited interaction of seeing someone walk down a hallway and having them complete a form made up of check off boxes I already have an approximate IQ score. I have an idea about what is wrong with them and what they are applying for. I have some idea about their ability to remember basic information.

After that I get to talk with them. My questions are to confirm or reject the hypotheses I am attempting to develop. Psychological testing has gradiations on how I can score responses. Some responses can get a score of 0. The response isn’t close enough to the answer to merit a number. Some responses get a 1. It’s closer, but it isn’t quite it. The person knows what I’m talking about but hasn’t articulated it or put it together enough. Some responses get a 2. The person knows what it is and can articulate it. There isn’t a test I know of that asks someone to describe a banana. So I can use it freely to describe it as an item. A zero would be a yellow thing. You keep asking the person to go further and tell you more but they can’t go beyond yellow. As far as you can tell it’s a yellow beach ball. A one is something you eat or it has a peel or you cut it up for corn flakes. They clearly know what it is. A two goes beyond that to a classification to a fruit. They may go further to a tropical fruit. Tropical fruit tells me they are smarter than the person who just says fruit. Now there are debates about people who use common use versus abstraction. You have to get the person to abstract before you score the response and you get around the debate. The tropical fruit person is going to keep me longer on the test and we are going to go through more items.

There is also speed. People who work quickly get more points than people who work slowly. Speed on tasks stays fairly constant. If it declines over time then the decline is steady. So if someone finishes the forms in 15 minutes then I expect an average perfomance on all the timed tasks. If they suddenly slow down when the timing starts it gets kind of obvious. It’s like they say to themselves “Oh, she brought out her stopwatch, let me slow down by 80% now.”

Then there is memory. People have lots of misinformation about memory functioning. Memory involves lots of parts to it. It involves paying attention long enough to put information into memory storage. Concentration to hold information in memory. Storage in memory in the immediate memory range. Transfer from immediate memory to intermediate memory. Then eventual transfer into long term memory and ultimately retrieval of information from memory. People will tell me they have “no memory.” That almost never happens. In addition they tell me that after completing 4 pages of historical information. Concentration problems are what people usually mean when they report memory problems. Occasionally there are some people who can’t remember. Vascular problems are the most common causes of memory difficulties. Depression is the next cause and is reversible. Finally there are actual problems with the brain. Accidents and diseases impacting the cortex can cause memory problems. People try to fake memory problems about 2-10% of the time. There are tests to evaluate faking. It’s sad that people think they have to exaggerate their real problems or fabricate problems to try to get a check for benefits. It complicates the lives of the people who have problems. It makes a lot of work for all of us in the field.

When everything lines up correctly, psychological testing makes the evaluation process easy. The person comes in with complaints. The complaints match everything the peron says. The complaints match all the data. The complaints match all the history. The complaints match all the statements from all the treating providers. The complaints match the objective psychological test data. There is a report to that effect. The analyst for the person makes a decision which is then comparatively easy. The person either gets benefits or they don’t.

The worst thing someone can do is to try to fake data or exaggerate their illness or problems. When they do that then they are considered suspect. Then everything has to be looked at with suspicion. So the person comes in and says “I don’t know what a banana is I’ve never eaten one. I don’t eat fruit.” That’s not a 0. That’s a 2. But the person is being a jerk. They clearly know the thing is a fruit. If they do that throughout the testing the test will not be able to be scored. They can be classified as above average but problematic. Lot’s of people are problematic. They don’t like testing and are resistant. I end up describing the resistance. I classify them. Resistance doesn’t help them. It hurts their case.

I ask lots of questions.