Latest / Inside The Consulting Room - Understanding the Child Behind the Behaviour / When conditions collide. Episode 5

Transcript

When conditions collide. Episode 5 · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Hello and welcome back.
• 0:02
  SPEAKER_00: This is Kim Lee, child and adolescent psychotherapist.
• 0:05
  SPEAKER_00: This is episode five of helping the AUDHD child.
• 0:13
  SPEAKER_00: I wanted to try and help parents to look at some things that they can do, because my hope by now is that you would have a working understanding of how this condition actually is experienced and presents in children and young people.
• 0:34
  SPEAKER_00: Very often, when parents first receive the diagnosis or the formulation, the next question is almost always the same.
• 0:43
  SPEAKER_00: But what can we actually do?
• 0:46
  SPEAKER_00: Because a diagnosis is only as useful as an understanding, which then takes you to the next step.
• 0:56
  SPEAKER_00: What can you do?
• 0:57
  SPEAKER_00: You know, a diagnosis is not a kind of final statement about the child.
• 1:03
  SPEAKER_00: And the other thing that I want to reiterate is that we are talking about a whole child, not one who is defined by a diagnosis.
• 1:14
  SPEAKER_00: So I think the answer to this question is it begins with the understanding of how the brain organizes itself.
• 1:21
  SPEAKER_00: And so that gives us some clues.
• 1:24
  SPEAKER_00: One of those is about reducing cognitive load.
• 1:28
  SPEAKER_00: Executive function difficulties mean that complex instructions can easily overwhelm the system.
• 1:35
  SPEAKER_00: And very often I will talk to parents about bite-sized pieces, letting the young person or breaking down whatever the task might be for the young person into bite-sized pieces so that they can remain focused on one thing at a time.
• 1:55
  SPEAKER_00: Very often we forget this and we inadvertently overload the child and they shut down, they dysregulate, you know, what whatever.
• 2:06
  SPEAKER_00: But vigil schedules can often help as well because they reduce the amount of information the child must hold in working memory.
• 2:15
  SPEAKER_00: It reminds me some years ago working in a residential special school that I was consulting to, and one boy in particular, um, who was incredibly chaotic and who was seemingly uncontainable, uh, would often wander around the school and get himself into all sorts of difficulties.
• 2:40
  SPEAKER_00: He was an absolutely delightful child, and staff really liked him, but he was just incredibly hard to manage.
• 2:49
  SPEAKER_00: And so what we put together was a kind of containment plan.
• 2:54
  SPEAKER_00: And this meant breaking his day down into bite-sized pieces.
• 2:58
  SPEAKER_00: So, and and the staff you know produced a timetable for him so that he knew what was happening now, and he knew what was happening next.
• 3:09
  SPEAKER_00: Anything more than that wasn't relevant, just focusing on now, now we are doing, and then next we are doing.
• 3:18
  SPEAKER_00: And what they began to see was a reduction in his level of chaotic reactivity.
• 3:26
  SPEAKER_00: And so I think sometimes these little things really do help because children who have these sorts of difficulties tend to fly off into the future and become overwhelmed.
• 3:42
  SPEAKER_00: I think the other thing that people often miss, and I kind of alluded to in the last in the last episode, is the notion of working with interest.
• 3:53
  SPEAKER_00: The ADHD brain is strongly influenced by intrinsic interest.
• 3:59
  SPEAKER_00: And learning becomes easier when tasks are connected to something the child finds meaningful.
• 4:07
  SPEAKER_00: And so, in in a in a way, by utilizing that which the child is already connected with and feels safe with, can be very useful.
• 4:20
  SPEAKER_00: So what we try and do is incorporate the interest the child may have.
• 4:27
  SPEAKER_00: We recognize it and then we introduce additional things.
• 4:32
  SPEAKER_00: And essentially, what we're doing is saying, This is the something that you can do, this thing that you're very interested in.
• 4:40
  SPEAKER_00: Let's see if we can use that with this new thing, you know, whatever whatever it might be.
• 4:48
  SPEAKER_00: Now I appreciate that this is probably more in the domain of the classroom.
• 4:55
  SPEAKER_00: On the other hand, from a social skills perspective and from an emotional management perspective, we can do something similar.
• 5:04
  SPEAKER_00: It's the difference between the I can do, I can't do child.
• 5:09
  SPEAKER_00: So we say, well, you can do this and you can do it very well.
• 5:12
  SPEAKER_00: So let's see how we can help you do something that is you find a bit harder, you know, how to be with friends, how to manage when you feel overwhelmed.
• 5:26
  SPEAKER_00: Now, the other thing that I think is very helpful is movement.
• 5:33
  SPEAKER_00: When we allow short bursts of activity, sort of interspersed with physical movement, these things often work better than long periods of sitting still.
• 5:48
  SPEAKER_00: A little girl I I work with talks about having jumping beams in her head, and this is her metaphor for the psychological and the neural activity that's going on in her brain.
• 6:06
  SPEAKER_00: And so for her, having legitimate rather than reactive periods of movement is very, very important.
• 6:18
  SPEAKER_00: The other thing that I'm always alert to is this question of sensory regulation, because sensory processing, the differences are often present, and the environment the environment really matters.
• 6:33
  SPEAKER_00: So we think about what children may benefit from, they may very well need a period in a quiet space, predictable routines, structured transitions between activities.
• 6:46
  SPEAKER_00: And these adjustments aren't indulgences, they're actually neurological supports.
• 6:52
  SPEAKER_00: What you tend to find is that once that is internalized, and I come back again to this concept of internalizing, the child learns how to do it for themselves, but it's almost as if we have to guide them through those experiences.
• 7:08
  SPEAKER_00: This does take quite a lot of thinking about, and it takes planning, and it and it's a long-term task, and as listeners will know, I don't do quick fixes.
• 7:18
  SPEAKER_00: I want to just go back to Leo because towards the end of my work with him, something really interesting happened.
• 7:26
  SPEAKER_00: I'd been working alongside the teaching staff and uh gave them guidance on things that may help, and they were extraordinarily accommodating.
• 7:37
  SPEAKER_00: And they began to allow him brief movement breaks during lessons.
• 7:42
  SPEAKER_00: So instead of trying to suppress his need for movement, they incorporated it into the structure of the day.
• 7:51
  SPEAKER_00: And the change was remarkable.
• 7:53
  SPEAKER_00: You know, his in his attention improved, his frustration reduced.
• 7:58
  SPEAKER_00: So by working with his nervous system rather than against it, the environment became more manageable.
• 8:05
  SPEAKER_00: Now I I I do appreciate that there are we have to think about the context in which we're seeing this behaviour with the child.
• 8:14
  SPEAKER_00: Not all schools would would necessarily do that, but I think many are recognizing that there are there are times when the child is overloaded and they need to be in another environment that is perhaps more soothing.
• 8:33
  SPEAKER_00: Some some schools have dedicated areas, and it's really good to see that that recognition is is is being acted upon.
• 8:42
  SPEAKER_00: So in the next episode, which is the final episode in the series, we'll turn towards the future and we'll look at the strengths that often accompany these conditions and how children can grow into adults who understand their minds, use their abilities well, and develop the tools to manage differently.
• 9:07
  SPEAKER_00: Thank you for listening.