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Hidden Harm, After-School Meltdowns · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: And welcome back to episode three of Hidden Harm.
• 0:04
  SPEAKER_00: In this episode, I want to talk about why it might be a child looks fine when at school, but something entirely different happens when they are at home.
• 0:19
  SPEAKER_00: This is very concerning because in my work, when I'm providing guidance for parents, I very often include schools.
• 0:29
  SPEAKER_00: And what this does is to give me a multidimensional view of the child's presentation.
• 0:37
  SPEAKER_00: There are occasions which demonstrate that the child's presentation in one environment, namely school, is in stark contrast to how they are when they're at home.
• 0:51
  SPEAKER_00: And sometimes schools will say, Well, there's no problem here, so either there's no problem, or the problem remains, or the problem resides in the home environment.
• 1:06
  SPEAKER_00: And this is a very narrow view because it doesn't understand the concept of situational presentation, which is something that we as clinicians are very alert to.
• 1:19
  SPEAKER_00: There are times when, in fact, almost always, when I encounter this, I will have to explain in fine detail why such differing presentations occur.
• 1:30
  SPEAKER_00: And my task is to enable schools to understand that just because they are not seeing a problem doesn't mean that one doesn't exist.
• 1:40
  SPEAKER_00: Now, with respect to my colleagues in education, they're not necessarily trained in this kind of understanding.
• 1:47
  SPEAKER_00: Nonetheless, the underpinning principle is just because you can't see something doesn't mean it's not there.
• 1:53
  SPEAKER_00: And therefore, we have to continually ask the question, what can't we see?
• 1:59
  SPEAKER_00: Particularly when we see a lack of congruence in presentations.
• 2:04
  SPEAKER_00: And so the child who looks fine at school is holding themselves together all day.
• 2:13
  SPEAKER_00: They manage the classroom, they follow instructions, they meet expectations.
• 2:17
  SPEAKER_00: They're described as settled, engaged, and doing well.
• 2:21
  SPEAKER_00: And then they come home and they completely unravel.
• 2:25
  SPEAKER_00: The child who was calm becomes overwhelmed.
• 2:29
  SPEAKER_00: The one who was cooperative becomes oppositional, and this supposedly fine child no longer is.
• 2:39
  SPEAKER_00: And at that moment a question emerges.
• 2:42
  SPEAKER_00: How can this be happening if everything is fine at school?
• 2:48
  SPEAKER_00: The question I ask is why is this child under the radar?
• 2:52
  SPEAKER_00: What's happening?
• 2:54
  SPEAKER_00: Now, one of the most common and most misunderstood dynamics in childhood is what we call situational presentation.
• 3:02
  SPEAKER_00: The same child appearing in profoundly different ways, depending upon the environment they're in.
• 3:09
  SPEAKER_00: At school, contained, cooperative, functioning, at home, dregulated, reactive, and overwhelmed.
• 3:19
  SPEAKER_00: Now this can feel confusing, but sometimes assumptions are made on the basis of this difference.
• 3:27
  SPEAKER_00: And those assumptions are never helpful.
• 3:30
  SPEAKER_00: It is confusing, it seems contradictory, and it leads to questions like: are we seeing the same child?
• 3:39
  SPEAKER_00: Is this behavior being exaggerated at home?
• 3:44
  SPEAKER_00: And why is it only happening there?
• 3:47
  SPEAKER_00: Well, there are some very intelligent answers to these questions, because there is this isn't about inconsistency and it's not about manipulation and it's not about the fault of parents.
• 4:03
  SPEAKER_00: It's about psycho-emotional organization.
• 4:08
  SPEAKER_00: And we have to understand this, we need to think about the difference between performance and safety.
• 4:15
  SPEAKER_00: School, by its very nature, is a performance environment.
• 4:19
  SPEAKER_00: There are expectations, structures, rules, and the child is required to regulate behavior, follow instruction, maintain composure, and adapt.
• 4:32
  SPEAKER_00: And many children are able to do this even when it costs them an enormous amount.
• 4:39
  SPEAKER_00: Because within that environment, the child is organized around what is required of me here.
• 4:47
  SPEAKER_00: I should also just add to this that children who are on the autistic spectrum disorder, and indeed those with ADHD, will very often have to work incredibly hard at masking their symptoms in order to adapt.
• 5:03
  SPEAKER_00: This is we know we know about masking.
• 5:07
  SPEAKER_00: Unfortunately, I think more and more people are receptive to the concept.
• 5:11
  SPEAKER_00: But of course, with masking, there is a considerable cost, and that cost is almost always likely to find expression at home.
• 5:21
  SPEAKER_00: And home is different because home is where the child isn't required to perform, and it's why where they return to this environment that everything they've been holding just spills out the size.
• 5:37
  SPEAKER_00: So something very important happens here because the child who has contained themselves all day can no longer maintain that containment.
• 5:47
  SPEAKER_00: So for some children, getting through the school day is an act of sustained regulation.
• 5:53
  SPEAKER_00: They're managing sensory input, social demands, academic expectations, and internal emotional states that may be incredibly hard to manage.
• 6:06
  SPEAKER_00: And what they're doing is without necessarily having the space to process what they feel, is manage.
• 6:14
  SPEAKER_00: But that manage that managing costs to them.
• 6:17
  SPEAKER_00: This requires significant effort.
• 6:20
  SPEAKER_00: And although the child may appear calm and functional, internally they're working incredibly hard.
• 6:29
  SPEAKER_00: They're monitoring themselves, suppressing reactions, adapting continuously.
• 6:35
  SPEAKER_00: And this is what we refer to when we use the term masking.
• 6:39
  SPEAKER_00: It's not deception, it's not manipulation, it's adaptation.
• 6:46
  SPEAKER_00: And the other thing is the child doesn't know they're doing it.
• 6:50
  SPEAKER_00: When the child returns home, the system shifts.
• 6:53
  SPEAKER_00: They're no longer required to hold everything together, they're no longer performing for an external environment.
• 6:59
  SPEAKER_00: And so the regulation gives way.
• 7:02
  SPEAKER_00: And what emerges is not new behavior, it's the release of what has been contained.
• 7:10
  SPEAKER_00: This can look like irritability, emotional outbursts, anger, withdrawal, opposition, and ways in which the child has to give expression to that which they've been managing.
• 7:25
  SPEAKER_00: And this is often the point where parents feel most uncertain because the message they receive from outside the home doesn't match what they're living in.
• 7:35
  SPEAKER_00: But here is the reframe, and this is important: home is not the problem.
• 7:42
  SPEAKER_00: Home is the place where the child feels sufficiently safe to stop holding it all in.
• 7:48
  SPEAKER_00: Now I realize that doesn't make it easy and it doesn't make the behaviors automatically manageable, but it changes what it means.
• 7:57
  SPEAKER_00: Because instead of asking, why is my child like this at home, we begin to ask, what has my child been holding all day?
• 8:08
  SPEAKER_00: It's also important to acknowledge this.
• 8:12
  SPEAKER_00: This dynamic can be deeply exhausting for parents, to be the place where everything is released and can feel relentless.
• 8:21
  SPEAKER_00: And at times it can just feel unfair, particularly when the external narrative is they're doing fine, which can also be interpreted as you're an oversensitive parent and you're overreacting.
• 8:32
  SPEAKER_00: Nothing could be further from the truth.
• 8:36
  SPEAKER_00: But what you may be holding isn't the difficult version of your child, you're holding the uncontained version, which is explicable and that matters.
• 8:48
  SPEAKER_00: So what helps is not trying to eliminate the difference, it's in the understanding of it, creating the correct kind of space for decompression.
• 9:00
  SPEAKER_00: And recognizing that after school, your child might need less demand, less questioning, more quiet presence, and gradually helping them to build the capacity not just to perform externally but to process internally.
• 9:15
  SPEAKER_00: Because the goal isn't simply to become a child who copes at school, it is a child and who copes at home.
• 9:23
  SPEAKER_00: It's a child who can exist more freely across environments.
• 9:28
  SPEAKER_00: Now, in terms of harm, whilst the harm that whilst there is a harm connotation, it's subtle.
• 9:44
  SPEAKER_00: However, children who have these kinds of emotional and psychological states eventually reach a point where breakdown is a possibility.
• 9:56
  SPEAKER_00: And breakdown is as the child gets older, you start to see what we call comorbid expressions of this incongruence of functioning.
• 10:09
  SPEAKER_00: And children of this kind very often feel like they are failing.
• 10:14
  SPEAKER_00: Because what often happens is that although they're managing at school, that over time will start to break down because the child becomes overwhelmed.
• 10:23
  SPEAKER_00: And then what we start to see are these comorbid or additional expressions of the distress that the child is experiencing.
• 10:33
  SPEAKER_00: Those take many forms.
• 10:36
  SPEAKER_00: And I think for that reason, what we have to do is alongside asking the question, because something's clearly happening, we have to quantify it.
• 10:47
  SPEAKER_00: We have to say, okay, how do we understand this?
• 10:52
  SPEAKER_00: And for children who are having this kind of experience, clinical intervention is almost always what's indicated.
• 10:59
  SPEAKER_00: Because what we're doing is we're we're we're we're needing to objectively and clinically understand why this difference is finding expression.
• 11:12
  SPEAKER_00: It could be undiagnosed ASD or ADHD, it could be a number of things.
• 11:18
  SPEAKER_00: But in any event, it needs to be quantified and qualified so that the right kind of intervention can occur.
• 11:27
  SPEAKER_00: Children who don't do well in any environment experience that in a way which influences their self-esteem.
• 11:39
  SPEAKER_00: It influences their perception of themselves.
• 11:44
  SPEAKER_00: I can't remember how many parents have said to me, My child has said I just shouldn't be here.
• 11:52
  SPEAKER_00: I just make everything difficult at home.
• 11:54
  SPEAKER_00: There's no point in me living.
• 11:56
  SPEAKER_00: It would be easier for everyone if I was gone.
• 12:01
  SPEAKER_00: And yet the same child at school looks fine.
• 12:06
  SPEAKER_00: That's a risk factor.
• 12:08
  SPEAKER_00: Because even though we understand such expressions as being underpinned by desperation, when we translate that into early and mid-adolescence, it can look quite different.
• 12:22
  SPEAKER_00: And so then there is a possibility of depression, self-soothing through medication.
• 12:29
  SPEAKER_00: But the medication I'm talking about isn't legal.
• 12:32
  SPEAKER_00: So we're paying attention to something that's asking to be understood.
• 12:39
  SPEAKER_00: And our responsibility when we encounter things like this is to focus on what it is that's driving this difference, this situational presentation.
• 12:53
  SPEAKER_00: And for parents, this can be incredibly hard because inevitably they begin to think it must be us.
• 13:01
  SPEAKER_00: Well, actually, no, it's not, very probably.
• 13:04
  SPEAKER_00: Yes, there are times when that is the case, and certainly presentations that are situational and different can also be signaling something else.
• 13:17
  SPEAKER_00: And sometimes schools will pick this up and they will ask further questions.
• 13:23
  SPEAKER_00: But normally that only happens when there's something that occurs within the school environment that is concerning, then they will ask the questions.
• 13:32
  SPEAKER_00: So I think as parents, what is required is to is to seek guidance.
• 13:42
  SPEAKER_00: It's very important.
• 13:43
  SPEAKER_00: Your child may have an undiagnosed disorder, your child may benefit from medication.
• 13:49
  SPEAKER_00: If it is the case that an undiagnosis, an undiagnosed disorder is present, that changes the landscape consistently.
• 14:00
  SPEAKER_00: It helps educationalists understand the nature of this and they can be involved in appropriate interventions.
• 14:11
  SPEAKER_00: So really the purpose of this is to illuminate the fact that hidden harm is something which finds expression in a multitude of ways.
• 14:26
  SPEAKER_00: I suppose, okay, because I do this for a living, I'm always alert to different forms of presentation.
• 14:36
  SPEAKER_00: But I think for parents, the message is when you see something that is different, the child isn't going to grow out of it, they're going to grow into it very probably.
• 14:47
  SPEAKER_00: Ask questions, don't ask the child questions, but do ask the right people the right questions.
• 14:54
  SPEAKER_00: In my series, no, it's not a series, the compendium of parental guidance, which is available on my website, there are a whole number of topics which include this that will be hopefully helpful to you.
• 15:11
  SPEAKER_00: And so if you go to the children'sconsultancy.com website, you can download the free parental guidance compendium, which covers a whole host of topics.
• 15:23
  SPEAKER_00: And whilst these things give an overview of specific things, what you'll find is that they may just signpost you in ways that you might find helpful.
• 15:36
  SPEAKER_00: Thank you for listening, and I'll be back with episode four shortly.