Practical Behavior Strategies For Neurodiverse Kids And Stressed Parents

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Transcript

Welcome And Meet Katrina

SPEAKER_00 0:01

Hey everyone, welcome to uh Living a Full Life podcast. We've got a great guest this week talking about the stuff we're passionate about, kids, and helping them move forward. Thanks for joining us, Katrina. She's from Beyond the Individual.

SPEAKER_01 0:13

Thank you so much for having me.

SPEAKER_00 0:15

Yeah, tell us a little bit about what we're gonna dive into, you know, helping our kids. In um, I always teach my patients the dimensions of stress, and they come from physical, chemical, emotional, and mental. And I think you really help with the emotional and mental part with these children. Um, yeah, tell me a little bit about how you got into helping kids and what you do and and why you do it.

SPEAKER_01 0:37

Yeah, so I uh went to college planning to be a medical doctor, quickly realized that's not where my heart was, and fell into a few uh jobs doing behavioral interventions with um kids with emotional behavioral disorders and uh autism, and ended up going into grad school, completing my PhD in clinical psychology,

From Med School Plans To Kids

SPEAKER_01 0:59

thought I wanted to do research and work at R1 Research University. Quickly found out after having my own child uh in the midst of my PhD program that maybe a different path may be better for me as well, and ended up uh working in the clinical realm. Nice. Where I where I ended up is uh director of a not-for-profit first, doing more behavioral-based interventions, and quickly realized that a lot of our systems were inadequate for helping the kids that uh I was being expected to help, which could be a little bit frustrating at times, and at the same time um started to see some behavioral and neurodevelopmental differences for my own, uh my eldest, and decided to go out on my own and found beyond the individual, really to try to shift how we provide these services so they're a lot more effective and feasible for families.

SPEAKER_00 1:55

That's what I love about it. More, you know, more directed, uh, accessible for these for these parents and and the kids for sure as well. So behavior, I mean, that's that's where we're at here. I'm an 80s kid. I grew up, you know, really young in the 80s, probably meaningful years was the 90s, graduated, you know, 2000 from high school. And then um, so those years, we didn't have this, you know, not that we didn't have the issues, we had the issues, we didn't have the resources, and so a lot of parents like myself who have young children are growing up and uh uh don't know where to start, don't know what to do. But because there's so many resources out there, I find that our generation is hyper-aware as parents to know that we have to do something or we should do something for our kids, where our parents, you know, we're like, suck it up, buttercup. Um, so yeah, so that's so how does that dynamic change our jobs, you and I, as providers helping children?

SPEAKER_01 2:52

Yeah, I will say that I am right with you. Even uh in my career, I graduated from with my PhD in 2014. And even since then, the way that we approach and think about parenting has changed as a society quite a bit.

Behavior Support Beyond Compliance

SPEAKER_01 3:07

One of the things that can be a challenge in my work is really trying to help people understand that behavior analysis isn't necessarily about compliance and making kids do certain things or fit a certain mold. It really is all about helping our kids be their best versions and build skills to choose the environments where they get to go exist rather than getting stuck in an environment that is more restrictive because they don't have the skills to be outside of it. And there are some parenting practices that um, when people think about what we do, they're like, oh, you're you're just turning kids into robots, you're treating them like puppies, you know, we're training them. And I was like, no, really, what we really focus on are relationships and systems and environment modification to help kids be successful.

SPEAKER_00 4:02

That's awesome. Yeah, I mean, the dynamic, but you know, as things change with our world and everything that's changing, I mean, the dynamic changes as well. And but what the thing that hasn't changed is the classroom. We still put a diverse population structurally and how they interact with the environment, which the environment is digital now, let's be honest with it, which it wasn't for us. And we still put them in a in a a brick, in a brick environment, sitting down. And that that environment doesn't work for every child, unfortunately. We're putting them into a mold. So I was just kind of counteracting your answer to that with parents thinking that we're doing robotics. We're not we're not doing any of that. What we're trying to do is help the child adapt to the environment as best as possible. That that all environments, the house environment, the school environment. So, what are some strategies that you help parents with? Or first off, before we dive into the strategies, what should parents be looking for and how do they know to see to search for you? Or where do they start with all that? What would be something that is pro proliferating in the child in the child that makes them say, hey, maybe I should go seek some help? And then they cross your path.

SPEAKER_01 5:09

Yeah, so I

When To Seek Help

SPEAKER_01 5:11

often take this the focus away from what is the child doing? And I want to look at is that child um having success or failure in those environments? And so where families might want to see someone like us out is when their child is maybe they're working really hard, they're trying their best, they've implemented all of the parenting techniques or the teaching techniques at school, and their kid is still not coming into contact with the success that they want to see. Um that's that's a good time for us to be called in because there can be a lot of pieces to these interventions that uh work for 80, 90% of individuals, but then we need just a little tweak for that other 10 to 20% of kids. And it can even sometimes be a really small tweak in that intervention that really accelerates the progress we can see.

SPEAKER_00 6:09

Makes sense.

SPEAKER_01 6:11

Yeah.

SPEAKER_00 6:12

What uh what are we looking for in success or failure as parents?

SPEAKER_01 6:16

That's another great question. I this is where I'll I'll say some of this comes from my own values about what is success. Uh I will say I I myself am a very type A, high achieving person, and definitely also have some attention difficulties, executive function difficulties, and and such. So success and failure isn't necessarily achievement. It can be how is your kid feeling at the end of the day? So if I have a kid coming home in tears almost every day after school, that tells me that something's not working for them. Um or if I have a child who doesn't want to go to school, right? That tells me something's not working. Uh also I look at the other consequences of the system. So if I have parents who at the end of the day, they're like, I just don't know what I'm doing. I don't know if this is normal or not normal, or what is normal sometimes is the question they have. Or they're like, I am doing everything I know, and my kid is still having, you know, hour and a half meltdowns daily. Those would be some signs of maybe we're not meeting the success that we want to have. So I want people when they come to see us, you know, move away from things like achievement. Uh, there's there's some nuances with that, right? So if a kid is struggling to learn to read, I'm less worried about their reading grade. I'm more worried about their reading ability and being able to access uh all of the opportunities that being able to read effectively gives you.

SPEAKER_00 7:53

Yeah, that's great. That's great. Um, so parents, and typically it's a last resort, isn't it? Usually it's when the fire is burning and they're like, man, we got to do something, the behavior's out of control, or the emotional regulation is really out of control, uh, where they start to panic as a parent. And that panic translates into the family dynamic as well when you're searching for help. So I want to touch that a little bit. When we're when we're truly wanting to help children, uh, as parents, the toughest part is kind of stepping out of the way to allow it to help. Let's touch on that a little bit. What are some uh tools that parents can use or uh mindsets that they can come into with helping their children seek proper help?

SPEAKER_01 8:37

Yeah, so I love that you said that emotion regulation, because we often see for families with neurodiversity, right? Um, it's not just you have a neurodiverse

Parent Regulation And Values

SPEAKER_01 8:47

child, you actually have a neurodiverse family system oftentimes as well. And with that can come some of the same difficulties. Uh, and so when we are actually approaching therapy, we actually really focus more of our work a lot of times on the adults that are working with children because they are the ones that have to implement these interventions, they're the ones that have to keep cool when hey, the kid maybe is not, because we can either add fuel to the fire or we can snuff it out. So I generally uh practice with a lot of the parents that I work with an acceptance commitment uh therapy approach. And the first thing we do is we first of all identify what are our values, what are our values surrounding not just ourselves and our actions, but our values around parenting. Because that is something that you can fall back on when in the moment your behavior, when everyone's heightened, uh behavior can be very automatic. So I need to learn how to lean back and think about my values and take a moment. From there, uh, we start using those values to drive some of the strategies to help us. So as a parent, uh most parents don't say compliance is my number one parenting value. I want my kid to do what I want them to do every time, right? Uh a more common value I'll see with parents is I want my child to be successful. I want my child to grow to be a functioning adult. And I would say, okay, so these are these are the values that we have. In this moment, how do I do that? Because every decision is moment by moment. We do teach the first strategy, like you said, is taking a break. Now, sometimes our kids don't always let us, they'll chase after us and just be like, no, I need you, I want you, I want you to go toe-to-toe with me. Uh, but it's how do you take a break? How do you, even if your kid's not physically letting you take your moment and stay calm. Some other strategies are we know that stress and other things happening outside of that moment and that parenting interaction also affect our ability to stay regulated ourselves. So I think about even myself as a parent. If work's really stressful, I know it's gonna be harder for me to stay regulated for my kids. So I might need to take a minute in the car and just listen to a song before I go in and start the chaos of the evening. And so it's taking some of those moments as well for regulation. Um, and then some of those more uh acceptance, commitment, mindfulness uh strategies. So, how do I stay in the moment? How do I focus on what's going on right now? How do I recognize thoughts as thoughts and actions as actions to help stay regulated in the moment?

SPEAKER_00 11:38

Great. I love it. I love the whole approach. Uh there's the missing piece, I think, is the parents. It is because all neurodevelopment, um, behavioral uh psychology, therapy, all those things focus on the child. Of course, they're the patient, they're the ones that uh that need the help, but the parents, it's it's a very different dynamic than an adult seeking help. They are self-aware, they can make their own choices, they can go and do it one-on-one. But as a parent, you're part of the whole process. And your uh prior uh knowledge is not behavioral therapy, it's not, it may not be psychology, it may not be anything in the health field at all. So coming in as a parent, you need to be a little bit aware that, oh, maybe my approach as to how I have been trying to navigate neurodiversity or behavioral diversity in the household is also playing a huge part in the overall outcome of this whole thing. In a good or bad way, it doesn't matter, both ways. It's neither negative or positive, it just is. And uh, so that that's the great part. I think that helps parents seek out proper, proper help and be part of the help as well.

SPEAKER_01 12:41

Yeah, absolutely.

SPEAKER_00 12:42

Yeah, that's great. Um, you know, what what are some of the cases that you find have the best outcomes? And what are the steps that the parents took or the families took to get that result?

SPEAKER_01 12:55

Yeah, so where I've seen the best outcomes is when one is when we're able to access the necessary resources. So this can often be a struggle and it's not always in our hands, even as a provider, where let's say I have a family who they need some help in home, right? Because

What Drives The Best Outcomes

SPEAKER_01 13:17

you know what, I have my kid, I've gone through all of the you know, PCIT parent-child interaction therapy, and we are using all the strategies, they're not quite working, but I also have three other small children running around my legs, and I'm trying to use these strategies, so it's it's not working. So, one of those things is looking at resources because that's something you know, we have to, even looking at our best interventions, there might need to be some support. So if I have a child who really needs some one-on-one attention, I need to find a way to make that happen. Now, there's a lot of different ways. Um, within our practice, we might do additional skills training one-on-one with that child. And maybe can we look in is there a way that we can um bring in another care uh provider? Is grandma available? Um, is there some way we can pull kids from school like 30 minutes early, even to get some of that one-on-one time? And so we start looking at what are some of the resources. At times those resources aren't there, and we need to work within those systems. It just makes it a little bit harder. So being well resourced is definitely one of those things that we that we look at at in terms of success. And what are the other systems that we can tap into that might help with that? Another one is we call it fidelity. So, fidelity is that we implement the way things are supposed to be implemented. And this is one of those things where a lot of the interventions we focus on say, hey, we need to reinforce the skills we want to see. We start where the child is going to be successful and can demonstrate that behavior pretty reliably, but we also have to use something called extinction. So this is where we no longer reinforce behaviors that have been reinforced in the past that are maladaptive. And where I see things can fall apart is, and this is where it comes to parents being regulated, when your child is engaging in maladaptive behavior and the function is something like attention, or at least partially attention, a lot of things we say are socially mediated. So it's you need the attention to get the other things. Um withholding that attention for the behavior, not from the child completely, can be really hard. And so where we see things work really well is if parents can get to that place where they're able to enact those um strategies reliably and consistently. We do see that um families that can align their values with some of this. Sometimes I do have a family who comes in and says, No, my family value is I am the parent, my child will do what I tell them to do, or maybe uh achievement is that value. In those cases, I'll be honest, our practice may not always be the best fit for some of those families because we also see like focusing on some of those values can cause a lot of things like anxiety and stress that actually further inflame uh some of these behaviors. And then the last thing is really, yeah, just that parent regulation and support.

SPEAKER_00 16:33

Yeah. No, absolutely. Um you nailed it. You you took my next question out there. I mean, it's this isn't an attack on parents from my perspective. You know, they might be listening and be like, man, take it easy on me. I'm sure I'm doing my best. But we just need to be aware. I think that's all it really is, is just awareness on that band. Oh, yeah, you know, I have my parenting style, I have my beliefs, I might be imposing my type A personality onto my child on top of what they're going through and learning about the world. So that makes sense too. So that's great. I love how you approach that. And you actually have a system that incorporates the parents into it. I think that's the biggest piece that's lacking in in both virtual and in-person uh therapy around there. But all of you do such a wonderful job for these kids too, because it's it's exactly what they they need is just to learn the skills to uh regulate, which is amazing stuff there too. So that's great too. Um, so successes. What are the toughest cases? And don't you know pick anybody by name, but what are the toughest cases that you get? And you're gonna surprise the parents listening right now because it's not gonna be the toughest cases on the children. What are the toughest cases that you're getting to work with? And why do you feel like that those things happen in a therapy?

SPEAKER_01 17:42

Yeah, so the toughest cases that um I tend to face are those where we really are focusing on a system uh and the issues are in a different system. So, for example, if I have a kid coming and working on skills, but the behavior is occurring at school and our therapies are

Why School Cases Get Hard

SPEAKER_01 17:59

occurring outside of school. Those are really tough because we see that we can teach skills, but getting generalization or having helping those skills be demonstrated in the setting where they need to be is really hard, especially for children who have uh neurodiversity, because they're responding to what's going on in that environment in the moment. And that goes both ways because uh we do work uh contract with schools directly, and sometimes we need to have intervention that spans across both systems. And getting those systems to agree and work together can sometimes be challenging, especially when they're looking at what are the values of each of those systems, and if those values of the individuals in each of those systems are different or the viewpoints, that makes it a very difficult uh job. So it's we can make progress, but a lot of times our progress will plateau if we can't get those systems to work together.

SPEAKER_00 19:03

Makes sense. Now you help virtually you can help um families in all virtually every state across the country. So you say you help find the resources. So it doesn't matter where they contact you from, if we have a home issue or a school issue or wherever it may be, you help the parents and the families find the resources locally at theirs at either their school or in their town to help facilitate therapy. Is that correct?

SPEAKER_01 19:30

Yeah, so we what we tend to do is we do a lot of consultation. Uh, and so that can look like oh and excuse me, that can look a lot of different ways. So that might be for us to do record review, look at the information and say, hey, this is where we recommend your intervention point be. Um then from there, uh we can work with families to help what are the resources in their state. Now, one of the things that um

Finding Resources Across States

SPEAKER_01 19:56

is kind of frustrating for this type of work is those systems vary greatly state by state. We've even found like here, we're we're based in the Kansas-Missouri area in Kansas City, just district to district can look a lot different in how those systems operate. And so we say, hey, here's where we recommend that intervention point, here's what you can do, or the multiple intervention points you have. And then it's like, what are the ways you can access that? So that might be also discussing can you get insurance coverage for some of these therapies? Uh, that also varies by state, like here in Kansas, if you have an autism diagnosis, you can get some of these behavioral therapies covered. If you don't, you can't. And uh it's an upward battle, even if you need those services. Um, other states, I think Colorado, for example, is a little bit, they actually provide this for a more uh broad neurodevelopmental base. And so it's kind of working with what are the policies, who do you ask for, and then helping families get into those systems as well. Sometimes it requires a diagnosis to get those systems. So we might tell families it's like, hey, you know what? It sounds like you got some stuff going on that there could be a diagnosis. And I'm a person where the diagnosis is less important when it comes to a treatment standpoint. It's like, what's everything going on, what's functional. But the reality is labels get us services. And sometimes we recommend, hey, we can do an evaluation uh for families that live close enough, they can come to us, we can do that evaluation for them. But sometimes we're gonna say, like, hey, let's look and see what are the systems, what are some of the pros and cons. So, for example, going to a large university hospital system, your wait list is gonna be two years. Whereas if you can find the cash to do private pay, you might be able to get in somewhere within two weeks. And so it's kind of talking through what is that resource management as well for families.

SPEAKER_00 21:52

Love it. Yeah. So you are truly guiding the parents, even though it would be virtu it'd be impossible for you to know district via district across the whole country on how. That's there, but you can guide them in the right direction. And then they can minimize their research into some focal points and be like, hey, maybe we should look into some different insurance, or maybe we should. Yeah, that's great. I love that. That's that's a big hurdle for parents too, because they want to help their kids. But then there's all these hurdles and obstacles in the way, being like, Oh, our insurance doesn't cover it. Oh, there's nothing in our district that does that. Oh, our school's not collaborative in that type of program. Or so that's great. I'm glad you do that because that can be that can be tough. Uh awesome. So we can find uh people can find you going to your website, of course. That's the easiest way, and services, and you can book on there. And I'm sure you're responsive to communication as well if parents have any um comments or questions that they may have, right? So they can reach out to you and your handles. Uh, anything that we missed on here that you find is really important for parents to hear in this

Don’t Despair And Next Steps

SPEAKER_00 22:48

day and age.

SPEAKER_01 22:49

I think the main thing is focus on what are we doing now to help them in the future, right? It's because you're gonna have those days, they're gonna be really hard. They're going to, you're like, I don't know what I'm doing. Know that there are resources and systems out there to help support families with all different kinds of needs. The biggest challenge is sometimes tapping into those. And so I always tell families like, don't despair. Uh and really, it's reach out for help when you need it. You don't have to do it alone, and you don't have to be ashamed if you need some help as well.

SPEAKER_00 23:24

Love it. Perfect. Uh, beyond the individual.com, you made it easy for everyone. Go out there, and then she's got all of her handles. I have it in the podcast brief as well. Thanks for joining us. I really appreciate this. Thanks for being on the team of helping families and kids with uh this part of life. Keep doing what you're doing.

SPEAKER_01 23:42

All right, thank you.

SPEAKER_00 23:43

See ya.