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Replays: Using Play to Enhance Emotional and Behavioural Development for Children with Autism Spectrum Disorders
by Karen Levine Naomi CheddReplays addresses the challenging behaviors of children with autism spectrum disorders through interactive symbolic play. It shows parents and professionals how to help children access their emotions, whether the child is verbal or not, cognitively able or impaired, even-tempered or volatile. The chapters introduce and show readers how to implement Replays, and describe ways of adapting this intervention to address specific issues in different settings and circumstances. Levine and Chedd present more than just behavioral management strategies in the context of social, emotional and communication development: they have developed a technique that helps children to re-experience, play through and master the complex emotional response states that often lead to ongoing behavioral challenges. Replays is an easy and fun tool that provides numerous step-by-step examples and illustrations. It enables parents and professionals to guide children with autism spectrum disorders towards mastering, and changing, their emotional and behavioral responses.
Constipation, Withholding and Your Child: A Family Guide to Soiling and Wetting
by Anthony Cohn Les EavesConstipation, Withholding and Your Child is a positive, accessible guide to dealing with the common problems of stool withholding, soiling and wetting in young children. It gives insight into the perspectives of both children and parents, enabling a clear understanding of the issue. Using friendly and informal language, the book examines the different causes of toileting problems, including the arrival of siblings and difficulties at school, and provides practical techniques and strategies to help children overcome these problems. It emphasises the importance of diet and offers advice on how to make using the toilet less frightening, the benefits of keeping a stool diary chart, and what laxatives and medications to use in different circumstances. It provides tips on how to tackle inappropriate lavatorial behaviour sensitively and addresses the issues particular to children with special needs. This book is a reassuring, informative and non-patronising guide to help children overcome toileting problems. It is useful for parents and all professionals who work with children.
Working with Parents of Young People: Research, Policy and Practice
by Amanda Holt Cris Hoskin Debi Roker Helen Richardon Foster Helen Richardson Foster John Coleman Julie Shepherd Kerry Devitt Kevin Lowe Lester Coleman Louise Cox Nigel Sherriff Sarah Lindfield Stephanie StaceThis book provides practical guidance for a wide range of professionals working with parents and families, answering common questions such as 'How can parents facilitate their child's transition to secondary school?' and 'How can families best communicate about alcohol?'. Drawing on the findings from years of applied research projects carried out by the Trust for the Study of Adolescence, each chapter focuses on a particular area of parenting young people - from monitoring and supervision to support for foster families - and each highlights the implications of research results for policy and practice. This book presents a range of approaches to working with parents and families, and discusses the effectiveness of techniques such as parent mentoring and involving young people in parenting programmes. Working with Parents of Young People provides a strong set of evidence-based guidelines for best practice and will be a key resource for all those working to support the parents of teenagers.
The Complete Guide to Asperger's Syndrome
by Tony AttwoodThe Complete Guide to Asperger's Syndrome is the definitive handbook for anyone affected by Asperger's syndrome (AS). Now including a new introduction explaining the impact of DSM-5 on the diagnosis and approach to AS, it brings together a wealth of information on all aspects of the syndrome for children through to adults. Drawing on case studies and personal accounts from Attwood's extensive clinical experience, and from his correspondence with individuals with AS, this book is both authoritative and extremely accessible. Chapters examine: * causes and indications of the syndrome * the diagnosis and its effect on the individual * theory of mind * the perception of emotions in self and others * social interaction, including friendships * long-term relationships * teasing, bullying and mental health issues * the effect of AS on language and cognitive abilities, sensory sensitivity, movement and co-ordination skills * career development. There is also an invaluable frequently asked questions chapter and a section listing useful resources for anyone wishing to find further information on a particular aspect of AS, as well as literature and educational tools. Essential reading for families and individuals affected by AS as well as teachers, professionals and employers coming in contact with people with AS, this book should be on the bookshelf of anyone who needs to know or is interested in this complex condition. 'I usually say to the child, "Congratulations, you have Asperger's syndrome", and explain that this means he or she is not mad, bad or defective, but has a different way of thinking.' - from The Complete Guide to Asperger's Syndrome
New Developments in Autism: The Future is Today
by Carmen Nieto Vizcaino Juan Marto Perez Manuel F. Casanova Maria Llorente Comi Pedro M. Gonzalez Sally WheelwrightThis international collection provides a comprehensive overview of cutting-edge research on autism spectrum disorders (ASDs) by well-known experts in the field, stressing the importance of early diagnosis and a good working relationship between parents and professionals. The contributors cover a wide range of aspects of ASDs, from early assessment techniques, neurodevelopment and brain function to language development, executive function and genetic research. They explore how individuals with ASDs think and give evidence-based guidance on how to handle difficulties with social interaction and language development using appropriate interventions. New Developments in Autism will be of great interest to professionals, researchers, therapists, parents and people with ASDs.
Youth Justice and Child Protection
by Andrew Lockyer Fred Stone Malcolm HillThis book is an examination of recent developments in the areas of youth justice and child protection. It investigates how well young people and the societies in which they live are served by judicial and service systems. Consideration is given to those in care - in young offenders' institutions, foster families and residential homes - as well as those living with their families. A broad range of international experts discuss the largely segregated youth justice and children's legal and service systems in England and Wales, other parts of Western Europe and the US, and compare these with Scotland's integrated system. The implications of these arrangements are considered for the rights of children and parents on the one hand and society on the other. The contributors also provide insights into the rationale for current and proposed policies, as well as the efficacy of different systems. This book will be an important reference for policy-makers, social workers, lawyers, magistrates and equivalent decision makers, health professionals, carers, and all those working in youth justice and child protection. It is highly relevant for academics and students interested in children, citizenship, youth crime, child welfare and state-family relations.
Different Like Me: My Book of Autism Heroes
by Jennifer Elder Marc ThomasDifferent Like Me introduces children aged 8 to 12 years to famous, inspirational figures from the world of science, art, math, literature, philosophy and comedy. Eight-year-old Quinn, a young boy with Asperger's Syndrome, tells young readers about the achievements and characteristics of his autism heroes, from Albert Einstein, Dian Fossey and Wassily Kandinsky to Lewis Carroll, Benjamin Banneker and Julia Bowman Robinson, among others. All excel in different fields, but are united by the fact that they often found it difficult to fit in-just like Quinn. Fully illustrated in colour and written in child-friendly language, this book will be a wonderful resource for children, particularly children with autism, their parents, teachers, carers and siblings.
Bringing Up A Challenging Child At Home: When Love Is Not Enough (PDF)
by Jane GregoryChrissy is Jane Gregory's oldest child, an attractive girl with a tremendous sense of fun. She also exhibits behaviour which other people find challenging - screaming fits, stripping off her clothes, violent outbursts and self-mutilation. It was apparent from an early age that Chrissy had a learning disability, and subsequently as an adult she was diagnosed with a rare chromosome disorder and autism. In Bringing Up a Challenging Child at Home, Jane Gregory describes her life with Chrissy candidly and pragmatically. She relates her struggles to cope with Chrissy's difficult behaviour, the effects on the rest of the family, and her attempts to understand the reasons behind it. Offering practical advice for other parents, she explains how she got the right support and effective treatment. Her story provides professionals as well as parents with a unique insight into what it is like to bring up a complex and challenging child.
The Autism Spectrum and Depression (PDF)
by Nick Dubin Tony AttwoodFor people with Autism Spectrum Disorder (ASD), the stresses of coping with a world that often seems alien to them can frequently lead to depression. Written specifically for adults with ASD, this ground-breaking book offers accessible and sensitive advice on how to manage depression and make positive steps towards recovery. Nick Dubin shares his own experiences of depression including how he has dealt with it, and everything from initial feelings of anger and frustration to medication, cognitive behavioural therapy and overcoming 'the dark night of the soul'. It explores the aspects of everyday life that can cause people with ASD to feel low, explains how this can escalate and looks at ways in which depression can be prevented. With a chapter on suicide and interviews with his parents, the book provides real, practical solutions to a problem that is often overlooked.
Aspies on Mental Health: Speaking for Ourselves (PDF)
by Alexandra Brown Anne Henderson Anthony Sclafani Chris Mitchell Chris Smedley Christopher Wilson Dean Worton Debbie Allan E Veronica Bliss Janet Christmas Luke Beardon Lynette Marshall Melanie Smith Natasha Goldthorpe Neil Shepherd Stephen Jarvis Stephen William Cornwell Wendy LimPeople with Asperger Syndrome (AS) can be particularly at risk of developing mental health difficulties such as anxiety and depression. Here, adults with Asperger Syndrome speak out about their own experiences of mental health issues, offering sound advice for other Aspies and providing valuable insights for family, friends and also for mental health professionals. Touching on everything from difficulties at work and college to coping with low self-confidence, self-harm, alcohol, misdiagnosis, sectioning, counselling, medication and battles with mental health services, the book provides a window into how people with AS experience mental health issues, and what can be done to help. The individual accounts describe innovative coping strategies and methods for maintaining emotional and psychological wellbeing as well as practical advice on things like how to stay positive and deal with day-to-day stress and meltdowns. This is essential reading for adults with Asperger Syndrome, and their families and friends, and will be a useful resource for psychologists, psychiatrists, mental health service providers and other professionals who support adults with Asperger Syndrome.
Aspergirls: Empowering Females with Asperger Syndrome (PDF)
by Rudy Simone*Gold Medal Winner in the Sexuality / Relationships Category of the 2011 IPPY Awards* * Honorary Mention in the 2010 BOTYA Awards Women's Issues Category * Girls with Asperger's Syndrome are less frequently diagnosed than boys, and even once symptoms have been recognised, help is often not readily available. The image of coping well presented by AS females of any age can often mask difficulties, deficits, challenges, and loneliness. This is a must-have handbook written by an Aspergirl for Aspergirls, young and old. Rudy Simone guides you through every aspect of both personal and professional life, from early recollections of blame, guilt, and savant skills, to friendships, romance and marriage. Employment, career, rituals and routines are also covered, along with depression, meltdowns and being misunderstood. Including the reflections of over thirty-five women diagnosed as on the spectrum, as well as some partners and parents, Rudy identifies recurring struggles and areas where Aspergirls need validation, information and advice. As they recount their stories, anecdotes, and wisdom, she highlights how differences between males and females on the spectrum are mostly a matter of perception, rejecting negative views of Aspergirls and empowering them to lead happy and fulfilled lives. This book will be essential reading for females of any age diagnosed with AS, and those who think they might be on the spectrum. It will also be of interest to partners and loved ones of Aspergirls, and anybody interested either professionally or academically in Asperger's Syndrome.
How Everyone on the Autism Spectrum, Young and Old, can...: become Resilient, be more Optimistic, enjoy Humor, be Kind, and increase Self-Efficacy - A Positive Psychology Approach
by Ayelet Kantor Cooper R. Woodard June Groden Lewis LipsittEncouraging people on the autism spectrum to foster positive emotions and character traits can dramatically improve their lives in every way, and help to strengthen their ability to cope with everyday challenges and setbacks. Drawing on the key concepts of positive psychology, this book looks in detail at five positive character traits - resilience, optimism, humor, kindness, and self-efficacy - and offer tried and tested strategies for bolstering each strength in individuals with ASD. The authors provide rich and varied lesson plans which contain a multitude of activities designed to build on the five areas identified, and which can be easily implemented at home, at school, or in the community. This complete "toolkit" provides parents, educators and other professionals with everything they need to know to use positive psychology strategies to support people of all ages and abilities on the autism spectrum.
Adopting after Infertility: Messages from Practice, Research and Personal Experience (PDF)
by Anthea Hendryknight Gayle Letherby Gill Haworth Jan Way Jenny Gwilt Julia Feast Lone Schmidt Lorraine Culley Marilyn Crawshaw Nicola Hudson Olga Van den Akker Penny Netherwood Peter Selman Petra Thorn Rachel Balen Sally BaffourAround three quarters of people who turn to adoption do so because of infertility and those working in this field need information, guidance and support to assist them in the process of adoption to support the adopters and to deal with any issues that may result from infertility. Adopting after Infertility is an accessible and informative interdisciplinary book that addresses the issues that professionals working with adopters and the adopters themselves face when going through the adoption process and the impact of infertility on their experiences. The book includes chapters on the effects of infertility, why people may choose adoption and the assessment and preparation process. It also covers what an Adoption Panel needs to know about the prospective parents, the experiences of those coming to adoption from minority communities or when living with health conditions and post-adoption support needs. Personal accounts by people who have experienced adopting after infertility are included throughout the book. This book will be essential reading for professionals and academics from a range of disciplines including social work, psychology, health, mental health and counselling. It will also be invaluable to students studying for post-qualifying awards.
60 Social Situations and Discussion Starters to Help Teens on the Autism Spectrum Deal with Friendships, Feelings, Conflict and More: Seeing the Big Picture
by Lisa TimmsTeenagers and older children on the autistic spectrum are, like the rest of us, surrounded by complex social codes and rules that govern everyday interaction. Interpreting these and reading social cues such as sarcasm, idioms and body language often presents a real challenge, but this book of realistic and thought-provoking stories can help. Designed with both parent and child in mind, every story outlines a real-life situation that young people on the spectrum are likely to encounter. Each of these is followed with questions such as 'what else might he have done?', 'how do you think she felt?' and 'why do you think they were upset?', along with practical tips for parents on how to facilitate constructive discussions. As children consider these questions with adults, they begin to put themselves into someone else's shoes and are encouraged to think about how their actions and behaviour may affect those around them, gaining invaluable skills and understanding that will be transferable to everyday life situations. Packed with 60 stories exploring real-life situations, this book will be an essential tool for parents, caregivers, teachers, and anyone else wishing to enable young people on the autistic spectrum to improve their social skills.
The Adolescent and Adult Neuro-diversity Handbook: Asperger Syndrome, ADHD, Dyslexia, Dyspraxia and Related Conditions (PDF)
by Claire Salter Sarah HendrickxIncreasing numbers of adults are realising that they have been living with an undiagnosed developmental condition, yet most information and support focuses on children. This leaves many adults confused and in the dark. The Adolescent and Adult Neuro-Diversity Handbook is a handy first-reference point guide to the full range of developmental conditions as they affect adolescents and adults. Each chapter focuses on a different condition, describing its history, causes and characteristics, its implications for the individual, diagnosis and assessment, treatments and approaches, and strategies for providing support and self-support. A wide range of conditions are covered, including Autistic Spectrum Disorders, Dyslexia, Dyspraxia, ADHD, OCD, Tourette's and Anxiety Disorders. The Adolescent and Adult Neuro-Diversity Handbook is an invaluable resource for health and social care practitioners, as well as for individuals who feel that they may be living with an undiagnosed developmental condition.
An A-Z of Genetic Factors in Autism: A Handbook for Parents and Carers (PDF)
by Kenneth AitkenThe concept of a single condition known as 'autism' is quickly becoming outdated, and is now understood to be an umbrella term for a variety of predominantly genetic conditions. This can be confusing for parents of children who have been diagnosed as having an 'autism spectrum disorder'. An A-Z of Genetic Factors in Autism provides parents with a complete overview of the main genetic disorders associated with autism, including those linked to growth differences, cardiovascular issues, neurodevelopmental problems, immune dysfunction, gastrointestinal disturbances and epilepsy. Kenneth Aitken demystifies the umbrella term 'autism' by alphabetically listing these conditions along with information about how common they are, their causes, signs, and symptoms, and for many, appropriate methods of treatment and management. Information on support groups and sources of further information are also included to help parents obtain any additional support they need, and keep up to date with new developments in research and practice. This is a must-have book for any parent or carer who feels confused by their child's diagnosis, or who seeks a better understanding of the many genetic conditions linked to autism.
Vulnerable Children and the Law: International Evidence for Improving Child Welfare, Child Protection and Children's Rights
by Cathy Humphreys Chaitali Das Christine Beddoe Deena Haydon Gill Thomson Gladis Molina Goos Cardol Greg Kelly Helen Rhoades Helen Richardon Foster Jackie Turton James Reid Jason Squire Linda Moore Lisa Young Meredith Kiraly Nicky Stanley Pam Miller Patrick O'Leary Rawiri Taonui Robert H. George Rosemary Sheehan Shelly Whitman Suzanne Oliver Terri Libesman Una ConveryGlobal support for improving child welfare and upholding the rights of children is strong, but in practice often fails to recognise the emerging gap between traditional child welfare practices and the evolving nature of child vulnerability. This book takes an international perspective on child welfare, examining how global and national frameworks can be adapted to address the rights and best interests of children. Synthesising the latest international research, experts redefine the concept of a 'child in need' in a world where global movement is common and children are frequently involved in the law. The book considers children as citizens, as refugees, victims of trafficking, soldiers, or members of indigenous groups and identifies the political and cultural changes that need to take place in order to deliver rights for these children. Focusing in particular on child protection systems across nations, it identifies areas of child welfare and family law which systematically fail to look after the best interests of children, often through prejudice, outdated practice, or even the failure of agencies to work together. Exploring the nexus between children's rights and the law across the globe, this book makes essential reading for policymakers, social workers, lawyers, researchers and professionals involved in protecting vulnerable children.
Child Well-Being: Understanding Children's Lives
by Anne-Marie Brooks Asher Ben-Arieh Colette Mcauley J Aldgate John Rowland John Rowlands Johnathan Bradshaw Jonathan Bradshaw Markell Harrison-Jackson Pamela Munn Pat Dolan Peter Pecora Roger Morgan Sinead Hanafin Sylda Langford Wendy RoseChild well-being, which covers everything from family relationships to their material well-being, is now increasingly being talked about in policy and practice nationally and internationally. However, a lack of clarity remains about what the idea really means and how it can help children. This book brings together contributions from international experts in order to define child well-being and to further understand how it can improve children's lives. Issues covered include how the idea is being used in government policy and practice in the UK and USA, how children can contribute to the understanding of child well-being, recent advances in the exploration of indicators and measures of well-being, and the importance of context in making comparisons. A concluding chapter explores whether child well-being is a useful concept in understanding children's lives, whether it positively contributes to policy and practice, and the value of international comparisons. This edited collection is essential reading for all those involved in understanding children's lives and who have responsibility for improving them, including practitioners, policymakers, students and academics.
Adopting after Infertility: Messages from Practice, Research and Personal Experience
by Anthea Hendryknight Gayle Letherby Gill Haworth Jan Way Jenny Gwilt Julia Feast Lone Schmidt Lorraine Culley Marilyn Crawshaw Nicola Hudson Olga Van den Akker Penny Netherwood Peter Selman Petra Thorn Rachel Balen Sally BaffourAround three quarters of people who turn to adoption do so because of infertility and those working in this field need information, guidance and support to assist them in the process of adoption to support the adopters and to deal with any issues that may result from infertility. Adopting after Infertility is an accessible and informative interdisciplinary book that addresses the issues that professionals working with adopters and the adopters themselves face when going through the adoption process and the impact of infertility on their experiences. The book includes chapters on the effects of infertility, why people may choose adoption and the assessment and preparation process. It also covers what an Adoption Panel needs to know about the prospective parents, the experiences of those coming to adoption from minority communities or when living with health conditions and post-adoption support needs. Personal accounts by people who have experienced adopting after infertility are included throughout the book. This book will be essential reading for professionals and academics from a range of disciplines including social work, psychology, health, mental health and counselling. It will also be invaluable to students studying for post-qualifying awards.
How Does Foster Care Work?: International Evidence on Outcomes
by Anders Hjern Anne-Dorthe Hestbaeck Bo Vinnerljung Catherine Roller White E. Christopher Lloyd Elaine Farmer Elizabeth Fernandez Eva Franzen Fiona Daly Frank Lindblad Fred Wulczyn Harriet Ward Ian Sinclair Irving Hwang James K Whittaker Jorge Fernandez del Valle June Thoburn Kirk O'Brien Lajla Knudsen Lee Ann Murdock Lijun Chen Marie-Pierre Paquet Mónica López Nancy Sampson Paul Delfabbro Peter Pecora Piet Strijker Richard Barth Robbie Gilligan Robert Flynn Robyn Marquis Ronald Kessler Tine EgelundHow Does Foster Care Work? is an international collection of empirical studies on the outcomes of children in foster care. Drawing on research and perspectives from leading international figures in children's services across the developed world, the book provides an evidence base for programme planning, policy and practice. This volume establishes a platform for comparison of international systems, trends and outcomes in foster care today. Each contributor provides a commentary on one other chapter to highlight the global significance of issues affecting children and young people in care. Each chapter offers new ideas about how foster care could be financed, delivered or studied in order to become more effective. This book is important reading for anyone involved in delivering child welfare services, such as administrators, practitioners, researchers, policy makers, children's advocates, academics and students.
An A-Z of Genetic Factors in Autism: A Handbook for Parents and Carers
by Kenneth AitkenThe concept of a single condition known as 'autism' is quickly becoming outdated, and is now understood to be an umbrella term for a variety of predominantly genetic conditions. This can be confusing for parents of children who have been diagnosed as having an 'autism spectrum disorder'. An A-Z of Genetic Factors in Autism provides parents with a complete overview of the main genetic disorders associated with autism, including those linked to growth differences, cardiovascular issues, neurodevelopmental problems, immune dysfunction, gastrointestinal disturbances and epilepsy. Kenneth Aitken demystifies the umbrella term 'autism' by alphabetically listing these conditions along with information about how common they are, their causes, signs, and symptoms, and for many, appropriate methods of treatment and management. Information on support groups and sources of further information are also included to help parents obtain any additional support they need, and keep up to date with new developments in research and practice. This is a must-have book for any parent or carer who feels confused by their child's diagnosis, or who seeks a better understanding of the many genetic conditions linked to autism.
A Practical Guide to Caring for Children and Teenagers with Attachment Difficulties
by Chris TaylorThis book guides childcare professionals through attachment theory and provides techniques for caring for children with attachment difficulties. It explains what attachment is, what different patterns of attachment look like in children and young people, how early attachment experiences affect their lives, and how this understanding can help childcare workers to develop therapeutic ways of caring. By understanding these issues, childcare workers are better equipped to help and support the troubled children they care for. This book shows how to promote recovery through secure base experiences in a therapeutic environment and provides solutions and methods to tackle challenging and problem behaviour, anger and the effects of trauma in children with attachment problems. This essential book will be invaluable to professionals such as residential carers, social workers and foster carers who work in a therapeutic environment with vulnerable and troubled children and young people.
Successful School Change and Transition for the Child with Asperger Syndrome: A Guide for Parents
by Clare LawrenceMoving to a new school can be a daunting prospect for the child with Asperger syndrome, and parents are often left feeling powerless to help prevent the anxiety and loss of confidence which may ensue. Clare Lawrence's new book provides parents of children with Asperger syndrome with practical advice on how to prepare their child for moving to a new school, and how to help make the transition as smooth as possible. A wide range of material is covered, including useful guidance on choosing the right school, supporting the child during the period prior to the move, and identifying and practising the different social rules and expectations of the new school. The strategies in the book can be adapted for children of all ages and include working out a transition time-line, identifying a named adult and 'safe haven' at the school, and effective communication between parents, teachers and support staff. This clear and accessible book will be an invaluable resource for parents of children with AS who are moving to a new school, and will also be of interest to the teachers and education professionals who work with them.
Focusing and Calming Games for Children: Mindfulness Strategies and Activities to Help Children to Relax, Concentrate and Take Control
by Deborah PlummerHaving the ability to focus, relax and concentrate is key to enabling children and young people to achieve emotional well-being, and is also important for a child's development of skills and abilities. This book uses a model of 'mindfulness play' to help children to achieve well-being, an approach designed by the author which encourages children to build awareness of their inner and outer worlds. Part One covers the theoretical and practical background, setting out how to facilitate play using the mindfulness play model, including consideration of the emotional environment. Part Two includes a wealth of games and activities, from 'Body focus' and 'Fidget flop' to 'Musical drawings' and 'Pass a smile'. The activities are suitable for use with groups and individual children aged 5–12, and can be adapted for children with specific attention and concentration difficulties, such as ADHD, and for older children. This is an ideal resource for teachers, counsellors, social workers, occupational therapists, speech and language therapists, youth workers, parents, and carers.
Happy Families: A Parents' Guide to the Non-Violent Resistance Approach
by Carmelite Avraham-Krehwinkel David AldridgeParenting a severely disruptive child can be exhausting and demoralizing to the point where breaking the cycle of bad behaviour seems an impossible task. Happy Families offers a realistic, step-by-step, practical approach to tackling destructive behaviour that helps parents regain control and establish harmony within the family. Using hands-on techniques based on the principles of non-violent resistance, each chapter deals with a different stage of the process - from communicating to the child an unwavering determination that the situation will change and enlisting the support of family and friends, to taking positive action in a way that avoids escalation. General advice such as how to respond constructively and consistently to provocation is included throughout, and morale-boosting tips encourage flagging parents to persevere with the approach. Happy Families will empower despairing parents and caregivers who seek to contain, counter and positively re-direct the aggression they face from children in distress, resulting in deep-felt and lasting change.