Latest / Inside The Consulting Room - Understanding the Child Behind the Behaviour / When Conditions Collide. Episode 2.

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When Conditions Collide. Episode 2. · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Hello and welcome back.
• 0:01
  SPEAKER_00: This is episode two of When Conditions Collide, and I'm Kim Lee, Child, an adolescent psychotherapist.
• 0:10
  SPEAKER_00: I want to talk about the particular internal experience that occurs from a neurological point of view when children with autism and ADHD or AUDHD, what they experience, what happens inside the brain.
• 0:31
  SPEAKER_00: Now very often parents, when they describe the daily experience of raising a child with these types of difficulties, what I'll hear most frequently are words like intensity and unpredictability.
• 0:46
  SPEAKER_00: And their day that begins calmly can suddenly become overwhelming.
• 0:51
  SPEAKER_00: So a small change in routine may trigger distress that seems completely disproportionate to the situation.
• 0:59
  SPEAKER_00: Or they may have a child who appears settled one moment and then may suddenly withdraw, shut down, or become explosively angry.
• 1:10
  SPEAKER_00: So to try and understand why this happens, we need to look beyond the behavior and into something deeper.
• 1:16
  SPEAKER_00: We need to understand how the nervous system regulates safety and threat.
• 1:22
  SPEAKER_00: Now the human nervous system is constantly scanning the environment and it's asking a simple question over and over again.
• 1:30
  SPEAKER_00: And that question is, am I safe?
• 1:32
  SPEAKER_00: Now the neuroscientist Stephen Borgis, through his work on what's called polyvagal theory, describes how the nervous system moves between different states depending upon how safe or threatened the body feels.
• 1:48
  SPEAKER_00: And when the nervous system detects safety, we enter into a state of social engagement.
• 1:54
  SPEAKER_00: And in this state, the brain is available for conversation, learning, curiosity, connection.
• 2:01
  SPEAKER_00: But when the nervous system detects danger, even subtle danger, the body moves into defensive states.
• 2:08
  SPEAKER_00: So what we then see is anxiety, hyperactivity, fight or flight responses, or withdrawal and shutdown.
• 2:18
  SPEAKER_00: Now, for children with AUDHD, the threshold at which the nervous system detects danger can sometimes be much lower and much more sensitive.
• 2:28
  SPEAKER_00: And this means the system can move very rapidly between these states.
• 2:34
  SPEAKER_00: One of the reasons this happens involves sensory processing.
• 2:39
  SPEAKER_00: Autistic nervous systems often process sensory information much more intensely.
• 2:46
  SPEAKER_00: That could be sounds, lights, textures, movement.
• 2:50
  SPEAKER_00: All of these things may register much more strongly than you would otherwise expect to see.
• 2:57
  SPEAKER_00: But at the same time, ADHD differences can make it difficult for the brain to filter and organize the incoming sensory information.
• 3:07
  SPEAKER_00: So the nervous system may be receiving more sensory input while simultaneously finding it harder to regulate attention towards it.
• 3:18
  SPEAKER_00: And the result can be that we have an overload.
• 3:22
  SPEAKER_00: Now, a child I work with who was referred to me some years ago, who I'll call Amelia, was 11 years old.
• 3:31
  SPEAKER_00: Now, her parents described her as bright, curious, and imaginative, but they were deeply concerned about what they described as her sudden emotional collapses.
• 3:43
  SPEAKER_00: At school, she sometimes appeared completely engaged and capable, yet at other times she would completely withdraw.
• 3:52
  SPEAKER_00: Teachers described her sitting silently at her desk, staring at the floor, unable to participate.
• 4:00
  SPEAKER_00: And when I first met her, she was polite but cautious.
• 4:04
  SPEAKER_00: And in the early sessions she spoke very little.
• 4:07
  SPEAKER_00: But something interesting happened over time.
• 4:11
  SPEAKER_00: As she began to feel safer, she started describing her experiences of the school environment.
• 4:18
  SPEAKER_00: She spoke about the constant noise in the classroom, the scraping of chairs, the buzz of fluorescent lights, the sudden changes when lessons ended and corridors filled with movement.
• 4:31
  SPEAKER_00: To the adults around her and other children, these were ordinary features of daily school life.
• 4:37
  SPEAKER_00: But to Amelia, they felt overwhelming.
• 4:41
  SPEAKER_00: So what appeared to teachers as disengagement was actually a nervous system that had reached the limit that it could process.
• 4:49
  SPEAKER_00: So her withdrawal wasn't defiance, it was protection.
• 4:54
  SPEAKER_00: Now another important part of this story involves the way children learn to regulate emotions.
• 5:00
  SPEAKER_00: And the psychiatrist Daniel Siegel describes the mind as developing through relationships, as do many other theoreticians.
• 5:09
  SPEAKER_00: In early life, the child's nervous system relies heavily on the presence of a regulating adult.
• 5:16
  SPEAKER_00: And when distress arises, it's the adult's calm presence that helps bring the nervous system back into balance.
• 5:23
  SPEAKER_00: And over time, the child generally internalizes these experiences.
• 5:29
  SPEAKER_00: And this is how emotional regulation develops.
• 5:32
  SPEAKER_00: But when a child's nervous system becomes overwhelmed more easily, the need for consistent co-regulation becomes even greater.
• 5:43
  SPEAKER_00: One afternoon, Amelia arrived at her session unusually agitated.
• 5:48
  SPEAKER_00: She was moving quickly around the room, touching objects and just unable to settle.
• 5:53
  SPEAKER_00: Her mother explained that the school day had been chaotic and there'd been unexpected timetable changes and several substitute teachers.
• 6:03
  SPEAKER_00: So the structure that Amelia had relied upon had disappeared.
• 6:07
  SPEAKER_00: And in that moment, the goal was not to correct her behavior, the goal was to help her nervous system to settle.
• 6:17
  SPEAKER_00: So I dimmed the lights slightly, and we slowed the pace of conversation, and gradually, and with a little help, her breathing slowed.
• 6:29
  SPEAKER_00: After a while, she was able to sit down and begin drawing.
• 6:34
  SPEAKER_00: And that small shift was the nervous system returning to a state where thinking could return and happen again.
• 6:44
  SPEAKER_00: For many children, the behavior that appears disruptive may simply reflect a nervous system overload.
• 6:52
  SPEAKER_00: And the child isn't choosing to escalate.
• 6:55
  SPEAKER_00: The system is attempting to manage more stimulation than it can comfortably process.
• 7:00
  SPEAKER_00: And when we begin to understand behavior in this way, our responses change.
• 7:07
  SPEAKER_00: We become less focused on control and correction and more focused on regulation.
• 7:15
  SPEAKER_00: I think what I would like to encourage parents to do is to imagine the idea of psychologically and emotionally standing still.
• 7:28
  SPEAKER_00: When the child is dysregulated in this way, intervening actually can overstimulate.
• 7:37
  SPEAKER_00: Sometimes parents understandably use too many words.
• 7:42
  SPEAKER_00: We don't need that many when we're trying to help a child regulate.
• 7:47
  SPEAKER_00: The soothing comes through our intention and our own internal calmness.
• 7:54
  SPEAKER_00: Standing still is a metaphor for being alongside, being unfazed, and being gently observing and reassuring.
• 8:08
  SPEAKER_00: We don't need too many words to do that, but questions will not help.
• 8:12
  SPEAKER_00: We're already talking about a system that's overloaded.
• 8:17
  SPEAKER_00: One of the things that Amelia and I did frequently was to engage in a kind of joint therapeutic activity where we would sit side by side and she would draw something and then I would draw something.
• 8:54
  SPEAKER_00: Sometimes there wouldn't be very much talking, but what she would do is when she'd finished hers, she'd look across at mine, and then she would pass me hers and take mine.
• 9:06
  SPEAKER_00: And this kind of became a symbol of exchange.
• 9:10
  SPEAKER_00: And I would comment on what I not what I thought of her her drawing, but what I what I saw in it.
• 9:20
  SPEAKER_00: And little by little she began to talk about that that she was producing.
• 9:27
  SPEAKER_00: The question of the child's internal world and how it can be expressed through play, music, art is a really big topic which I can't cover in this series, but we'll do at another time.
• 9:48
  SPEAKER_00: So in the next episode, we'll look at something many parents recognize, and that's the sense that the child seems to be pulled in two neurological directions at once.
• 10:01
  SPEAKER_00: We'll explore the internal conflict that explains and often exists within AUDHD, and it's a tension between the ADH drive for stimulation and the autistic need for predictability.
• 10:17
  SPEAKER_00: Thank you for listening.