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Two Systems, One Child. When Conditions Collide. Episode 3. · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:01
  SPEAKER_00: Hello and welcome back.
• 0:03
  SPEAKER_00: This is Kim Lee, child and adolescent psychotherapist.
• 0:07
  SPEAKER_00: And before I commence episode three in the series when conditions collide, I just want to make reference to the last series, which was about facing psychological reality.
• 0:24
  SPEAKER_00: Somebody very helpfully let me know that episodes eight and nine had an irritating metronome noise accompanying my voice.
• 0:37
  SPEAKER_00: And I didn't realise that was the case.
• 0:39
  SPEAKER_00: It is absolutely right.
• 0:40
  SPEAKER_00: So those have been unpublished and will be republished as soon as they've been re-recorded.
• 0:49
  SPEAKER_00: So if anybody's looking for them, they will be back soon.
• 0:52
  SPEAKER_00: And for those of you who have downloaded and listened to them, please accept my apologies.
• 0:58
  SPEAKER_00: In this episode, episode three of When Conditions Collide, I want to talk about something called the double bind.
• 1:09
  SPEAKER_00: And that is two competing sets of needs.
• 1:13
  SPEAKER_00: Now, one of the most confusing aspects of this condition for parents is what appears to be a single contradiction.
• 1:23
  SPEAKER_00: A child may insist on rigid routines one day, yet the next they seem restless, impulsive, and easily bored.
• 1:31
  SPEAKER_00: And sometimes you'll get these variations within the same day, maybe more than once or twice.
• 1:39
  SPEAKER_00: So parents often ask, well, which one is it?
• 1:42
  SPEAKER_00: But the answer is that both patterns can be present because we're talking about two systems.
• 1:48
  SPEAKER_00: The ADHD system seeks stimulation and it's drawn towards novelty, excitement, and rapid engagement.
• 1:56
  SPEAKER_00: Whereas the autistic system, by contrast, seeks predictability and it relies upon routine and structure to maintain that stability.
• 2:10
  SPEAKER_00: So when both systems operate together, the child may and probably will feel internally divided.
• 2:22
  SPEAKER_00: Now I also want to stress at this point that this isn't a decision.
• 2:29
  SPEAKER_00: This is neurobiological activity.
• 2:32
  SPEAKER_00: We're talking about different parts of the brain coexisting but in a disharmonious manner.
• 2:41
  SPEAKER_00: And the symptomatic expressions of these are puzzling, they're confusing.
• 2:49
  SPEAKER_00: But I want to talk about a case in particular, a boy who I'm going to call Thomas, who was ten, when he came to see me.
• 3:00
  SPEAKER_00: Now he had an extraordinary fascination with trains, and he could recite entire railway routes from memory.
• 3:10
  SPEAKER_00: He spent hours drawing intricate track systems.
• 3:15
  SPEAKER_00: He was completely able to recall incredible amounts of information and describe the information that he'd retained in a way which was both compelling and impressive.
• 3:33
  SPEAKER_00: Not a particularly rare feature with ASD children.
• 3:39
  SPEAKER_00: But when he wasn't engaged in this interest, he became restless, agitated, and impulsive.
• 3:48
  SPEAKER_00: And teachers would describe him leaving his seat repeatedly, interrupting lessons, calling out, struggling to remain focused, heightened distractability.
• 4:02
  SPEAKER_00: During one of his sessions, Thomas said something that captured the experience perfectly.
• 4:11
  SPEAKER_00: He said, It's like my brain wants everything to stay the same, but it also gets bored when it does.
• 4:20
  SPEAKER_00: So in that moment, he described the internal tension of AUDHD more clearly, in my view, than any textbook.
• 4:32
  SPEAKER_00: Here he was battling with the desire for continuity and calming stability, yet not knowing how to contend with the impulse-driven, fragmented part of the brain that was operating at the same time.
• 4:52
  SPEAKER_00: Now, another important aspect of this condition involves social communication.
• 4:58
  SPEAKER_00: There's a researcher, Damian Milton, who introduced a concept of the double empathy problem.
• 5:06
  SPEAKER_00: And this idea suggests that difficulties in communication between autistic and non-autistic people arise not simply because autistic individuals lack social understanding.
• 5:21
  SPEAKER_00: Rather, both groups interpret the world differently.
• 5:25
  SPEAKER_00: So misunderstanding occurs in both directions.
• 5:30
  SPEAKER_00: It's even more complicated with AUDHD because this can become an impulsivity-associated situation.
• 5:42
  SPEAKER_00: Because with ADHD, we see that the child will very often speak quickly, interrupt, be unable to retain the information that is being passed to them.
• 5:55
  SPEAKER_00: Whereas meanwhile, autistic communication differences may make it difficult to interpret social cues.
• 6:04
  SPEAKER_00: So the result can be social experiences that feel confusing and exhausting.
• 6:11
  SPEAKER_00: Sometimes I've had patients say that their experience of trying to or attending a social situation was such hard work that they've needed considerable time afterwards to recover.
• 6:28
  SPEAKER_00: It costs a lot, and it's an invisible cost, but it's nonetheless true.
• 6:36
  SPEAKER_00: I was asked to see a 13-year-old girl, and she she described her experiences of what conversations were like.
• 6:47
  SPEAKER_00: She said that by the time she'd worked out what someone meant, the conversation had already moved on.
• 6:56
  SPEAKER_00: Her mind was processing information carefully and literally, but the speed of social interaction made it difficult to keep up.
• 7:06
  SPEAKER_00: At the same time, her ADHD impulsivity sometimes led her to speak before she had fully organized her thoughts.
• 7:15
  SPEAKER_00: And the result was that she often felt embarrassed and self-conscious afterwards.
• 7:22
  SPEAKER_00: She described leaving social situations feeling as though she'd made mistakes that she couldn't explain to herself or anyone else.
• 7:32
  SPEAKER_00: Now, understanding this internal experience helped the adults around her respond with greater patience.
• 7:43
  SPEAKER_00: And I I think I think there's a bit more to it than that.
• 8:04
  SPEAKER_00: We're going to come back to that in a future episode.
• 8:08
  SPEAKER_00: But in the next episode, what I want to do is to move more into the child's subjective experience and how repeated misunderstandings can shape the way a child begins to think about themselves.
• 8:25
  SPEAKER_00: So I will be back shortly with that one, and I will re record and re upload the episodes eight and nine of Facing Psychological Reality.
• 8:39
  SPEAKER_00: But in the meantime, thank you for listening, and I'll be back soon.