Wednesday, June 20, 2012

How to Set Limits Without Losing Your Mind: Behavior Strategies That Make Life Easier

I have a continuing saga of Autism One posts, as I need to go through my notes in the hopes that I remember some of what I learned.  Bonus for you (ok, in my head I think it’s a bonus, so let’s hope it truly is) is that I put my notes online in a post so that at least this way I can find them easily – and search them, too.  There were so many sessions I attended that are applicable for all children, and this was definitely one of them.  Nicole Beurkens, PhD gave a great talk about behavior and not just how we can stop what we don’t want but a lot of discussion about why it occurs in the first place.

There are many many reasons for behavior issues from: poor processing skills, poor problem solving skills, lack of (quality) sleep, overwhelmed/anxious/stressed, poor communication (understanding and speaking), illness/pain/physical issues, lack of motivation, bad mood, testing to see what will happen, and more....

Poor processing skills - these are individuals with processing problems.  The brain isn't able to make sense of the information as quickly or accurately as others.  It can be a host of issues, visual, auditory, etc.  When your brain is slower in processing this, you get overwhelmed.

Poor problem solving skills - lacking the ability to think through “how I would solve this issue.”  When plan a doesn't work, they lack the ability to think through what the next options may be.

Lack of quality sleep - There are a lot of individuals who are not getting good quality restorative sleep at night. They can't get focused or process well this way.

Overwhelmed/stressed - the more we feel this way, the more we will respond in ways that are not ideal.

Poor communication skills – whether it is receptive or expressive issues, this leads to behavior challenges.

Pain/illness/etc - This tends to be really overlooked in this population.  Once they have a diagnosis of autism, everything gets locked into this box.  “Oh, this is because of autism” where they have underlying medical issues.

Motivation - we have to look long and hard about what our kid are spending time doing.  If they are engaged in repetitive and meaningless programs (to them), then they shut down.  If there is not something to work for, that can certainly lead to frustration and behavior challenges.

Bad mood - Just like the rest of us, these kids are entitled to bad mood days.

Testing to see what happens - Of course they're going to do this.

The first step in really addressing behavior challenges is understanding the underlying reasons for this individual.  You hear a lot of functional behavior analysis, etc.  They can be good processes but don't go far enough.  a lot of times, people will say people are just doing this for attention or because they're resisting something.  We often have to look at some of these other issues first before we can rule them out and move to those reasons.

Some of the biggest mistakes that parents make. 
One of the biggest is becoming emotional.  I'll tell you that when we as the adult begin to become emotional about the behavior, it almost becomes the kiss of death because we become involved in this spiral of death.

Taking things personally - one of the saddest initial consultations, a child who had extreme underlying medical and health issues and severe self injuries and acting out behavior.  The child is very disregulated and overwhelmed with life.  The dad said "she just hates me" - it was important to acknowledge that he felt that way, and it gives the opportunity to talk about the challenges they have are not personal attacks against us as parents, though it can feel that way at times.

Inconsistent expectations - Sometimes parents and staff will expect a lot from a child in one environment and not in another.  The bar is sometimes held at one level one day and another another day.  This creates confusion in the child over what the expectation is.  She is a very firm believer in high expectations for every child in every situation.  Every child can be a little bit better tomorrow and the next day - with support to reach those.  "Better" looks different for every child.

Inconsistent responses - One day things are ok, and the next day we clamp down on it.  This often comes up with dads who are a laid back guy and things are going ok and it doesn't bother them and then they lose it.  You go from no response to lowering the hammer.  By consistently responding to inappropriate or challenging behaviors, this helps the child respond to what is not appropriate and also helps children keep themselves regulated.

Ineffective communication - talking abut more effective communication strategies to get through the child.  Not every child will understand reasoning and not in every situation.  Once they go past a certain point, even the most even-tempered child can’t understand what you’re saying when they’re in the midst of that meltdown.  Getting the right communication that is effective for your child is key.

Rule 1 - Stay calm
If you are not emotional and behaviorally regulated, then your child will not be either.  Keep a calm but firm voice and presence.  Stay in the here and now.  Speak and move slowly to give yourself time to think.  Many of these are very simple strategies, and nothing you haven't heard before.  Just because something is simple doesn't mean it's easy to do.  Stay calm definitely fits there.  If adults can't master staying calm in the face of a child's disregulation, nothing else is going to be effective.  Part of that is because we provide a model to the child in those moments.  It shows what needs to happen in that moment.  If they get worked up and we get worked up right along with them, no one is steering the ship and showing how to stay calm and regulated.

Some tools to help do this:  Keep a very calm voice and presence.  It's almost like the more loud and frantic a child is getting, the more you do the opposite.  The more you get quiet and soft and slow because competing with the loud child is not going to provide an environment for the child to calm down.  It is important to be firm, as this is not just wimping out.

It's also important to stay in the here and now. Parents say that it goes through their heads like "what if they're 18 and still doing this" and suddenly in that moment you are living 20 or 30 years down the pike, and that's getting you even more worked up because now the situation with a 3 or 7 year old has taken you to a place a fear and anxiety.  It's important to stay in the here and now and focus on what's going on in front of you and not allowing your mind to skyrocket into the future and have the heart rate go up, panicking in the what if mode.

Speak and move slowly to give yourself to think.  One thing she sees happen, the more upset the child gets, the more frantic the parent gets.  They feel like they have to do something immediately which puts us into a fight or flight mode, so we can't think abut how to deal with the situation best.  We need to slow down that sets a tone of safety and allowing some time and space to work through this.  It brings the tenor of the emotional situation down a few notches.  When parents and teachers and everyone can master this, it changes the picture of those interactions around negative behaviors.

Rule 2 - Communicate Clearly
Make statements - don't ask questions.  Say what you need to say and nothing more.  Don't lecture; don't try to rationalize.  Don't respond to everything that comes from your child mouth.

Make more statements instead of asking questions. When things start to unravel for your child, we try to get information from our child to get an idea what's going on.  We ask what's wrong, what do you need, etc.  We have a child who is already overwhelmed and having difficulty keeping it together.  Now there is all this complex language that they have to process and respond to.  And now - I've asked a questions, you need to respond to it.  It's much more effective to make statements instead of asking questions.  Instead of what's the problem, state "wow, something is not working well" or "wow, you look really upset."  It puts a more supportive spin on things and lets the child know you aren't going to put more pressure on the child to respond.

Say what you need to say and then know when to stop talking.  This is a hard one.  Because processing systems get overwhelmed so quickly, we are talking more than what they can make sense of, so we overwhelm them more.  We need to learn to be comfortable with stopping and not doing any more talking. Silence and processing time is ok.  Things start to take a real negative turn when we feel like "This is a moment to teach a lesson."  Don't lecture.  When we start in with this lecture, it adds fuel to the fire, as they are already in a state of fight or flight, and this only exacerbates the situation.  Their brain is not functioning optimally.  It starts to say "red alert, shut down nonessential areas for functioning."  One of the first areas to shut down is the thinking and rationalizing part of our brain in the frontal cortex.  In the heat of the moment is not the time to have this discussion because their brain is not engaged in a way they can make sense of it in the moment.  This is not to suggest that you should not talk to them after the fact about what happened and what they should and should not do.

Sometimes as adults, we feel compelled to respond to every thing that comes from our child's mouth.  When children are trying to keep themselves in check, they are like the stereotypical teenager who says things that don't require a response where we end up on a hamster wheel going around and around and back and forth.  It helps no one.  Sometimes it may be a series of questions that they already know or repetitive questions or it may be some really mean and nasty things.  Just don't respond.  What majority of parents discover is that responding only perpetuates the cycle and makes things worse.  In the heat of the moment and even across the board, know that you don't have to respond to everything that comes out of your child's mouth.  You do want to avoid getting on the hamster wheel.

Use language your child can understand.  The more stressful situations may mean that language they can understand in normal situations is something they can't process.  The more stressed they are, the less they are making sense of the communication coming at them.  The more stressful the situation, the more we have to reduce the complexity of our communication.  Focus on using more nonverbal communication instead, especially in the heat of the moment.  Often a verbal directive or attempt to redirect them will fluster and get them upset where using a nonverbal gesture works better.  A child who doesn't want to do homework, you start with "ok, let's do problems 1-5" gets things wound up again.  Instead, point at a problem or put the paper back in front of them.  Kids who get really flustered about getting backpack ready to leave in the morning, point to the backpack.  Just taking the verbal piece out of it reduces the complexity of what they have to process and also gives them a firm idea of what needs to happen. 

Rule 3 - Stop the Action
Sometimes the best action to take in the heat of the moment is no action at all

One of the keys to really effectively managing highly stressful situations, think tantrums or overwhelmed, we feel like we have to do something right away to make it stop.  Sometimes the best action we can take is to stop and wait.  Give them time to process and some space.  It gives the child a chance to calm down and start processing what's going on.  This is with the  caveat that when there is a safety issues, this is not applicable - common sense.  Very often, these kinds of behavior issues don't involve an immediate safety issue.  This is incredibly important in schools where they need to let things try to resolve themselves.

It's about finding the space between forcing and a free for all.  There are two opposing options in most people's heads, but this isn't the case.  “You are going to do X,” a force mentality.  Many of use know that this is just going to exacerbate the situation.  When we try to force a child to do something, at best is a surface level compliance.  What we don't get is any thoughtful understanding of what's going on in the situation so things don't get better over time.  The other end is the free for all - every time we try to do this, he gets upset so we're just not going to do that.  When we just allow the kid to do what they're going to do anyway, there is no learning that comes from this.  There is a great middle ground, which is where the stop and wait comes in.

What does this look like?  Don't let the child get away.  Don't try to force the child to do anything. Maintain a close physical zone of connection if needed. Don't walk away while they have a tantrum, just wait expectantly with them.  It teaches the child to come back on their own.

Rule 4 - Be consistent
Inconsistency make things much more difficult.  If you say something is going to happen, then follow through - but know when to fold.  Figure out what is going to work for you in terms of expectations and consequences, and then stick with it.

Being consistent is so important.  This is not like keeping everything the same in a complete routine.  This is about having one set of expectations day in and day out.  This is especially the case when we tell the child that something is going to happen when they make a choice.  Frequently, a family will say that something is going to happen and then they don't consistently follow through with it.  This is about the telling one time what's going to happen and then enforce it.  Don't give warning after warning or what you do means nothing.  You have to follow through, but know when to fold.  You will all at some point have a threat or consequence flies out before you think about it and you wish you hadn't said it.  You need to know when to say "you know what, I need to take a minute to think because I just said something and didn't mean it."  That teaches our kids that sometimes we say and do things without thinking and it models how they should behave when they do it, too.  In general, when you say something is or is not going to happen, that is exactly what is or isn't going to happen.  You need to have that kind of relationship with your children, too.

You need to figure out what works for you.  Every family is different and there are different things that work or don't work for you.  Figure it out an then stick with it.

Rule 5 - Focus on the positive
This seems so simple, but we forget about it.  If you have a child who is spending a lot of time acting out or being criticized, it gives your child the knowledge that you do appreciate them when you focus on the positive.  It helps balance out the negative that has to be focused on sometimes.  It also allows the parents to focus on the positive sometimes because we are so often thinking about the negative.  When we're in that place, that keeps us from positively engaging with our children and from staying calm.  It's important for us to stop and remember that there are positive things that happen, no matter what.  You can find something in the course of a day where you can say, wow I was so impressed that you just did that. 

Positive reinforcement works best.  Focus on the positive of "sure you can have this once you do x."  Form things in a positive way of what can happen once we do something else.

Remind yourself of the good things your child does, and make time to have fun together and enjoy each other.  When you do this, it makes a world of difference in terms of your ability to stay calm when your child does have challenges.

Nicole Beurkens, PhD
Free resources on the web -

Yes, a lot of it is common sense, but putting it all together really makes a big difference.  I’m one of the talkers when the wee ones are upset, and I know I need to chill more there, and I’m working on it.  I also love the reminder that when we accidentally come out with a major consequence (no going to the pool for the rest of the month if you X), we can back up if needed and it’s not a bad thing – provided we’re not doing it all the time.  What are some of the behavior lessons that most stick with you?


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