A copy of the slides can be found here.
Part 2 can be found here
Transcript
partially edited - please forgive the errors from the talk to text automated script
[a bit of getting set up chatter, the talk begins about 1 minute in and some of the topics are listed by time below]
There we go! I'll start with that and then I think we can just go to the title slide and we can mention the other stuff.
00:28 Jeremy: Hey everybody! Thank you so much for joining us today my name is Jeremy Didier and I am one of the co coordinators for ADHKC. We are so excited to have our 1s. […] As you know, CHADD believes that information about publications, medications as as services and treatments should be available to members so they can make informed decisions for their families. As such, CHADD does not endorse any products, services, medications, or treatments.
01:05 I'm happy to introduce our speaker tonight, Dr Caroline Danda. Dr Danda is a clinical child psychologist in private practice and she's the coauthor of the recently released “From Surviving to Vibing filling in the gaps,” which is awesome. She specializes in working with children and adolescents who have anxiety, depression, ADHD, and other emotional or behavioral regulation problems. She has extensive training and experience with cognitive behavioral therapy and other modalities and she's just all around awesome.
01:34: Dr. Danda: Ya, you can shorten all of that. [laughs]
Thank you all for joining. I'm super excited that you guys are here and appreciate the time you're taking out of your day to come join because I know life is still super busy or it's gone back to busy since the pandemic, so I appreciate your time and the opportunity to talk to you all about emotions. One of my favorite things to do really is work with kids that have big emotions, so that's what really this is all about. It's really trying to take a lot of what I might do in the office and talk strategies and tips that I might talk with families about and kind of let you know a little bit about what I might do in my office. Strategies that you can take home and use in your sessions and so we're going to talk a little bit about, routines and strategies we're going to talk about emotions and themselves cuz we don't understand what emotions are and how they work. It's kind of hard to figure out what to do with them and then also then how can you help your child when they have big emotions.
Even though I have these nice slides that I'm going to present and you will get a copy of these slides coming back or actually they'll be emailed to you afterwards, if you guys want to take notes in between and didn't bring paper there is some paper back there if you need some paper but you will get a copy of all these slides but if you have questions all along as I'm talking about different things I'm happy to hear different examples and things like that so we can problem solve and say okay well that sounds really interesting but how would it work in this situation or tell me a little bit about this so feel free to raise your hands. Jeremy is going to be monitoring the chat for us cuz I can't see that right now but feel free to do that
03:38 So what I think about ADHD, I think ADHD is a terrible name for what actually happens. I really think it's a disorder of Regulation because it's not that you can't focus, it's just that you can't match your focus to the tasks that you need to or you may not be able to match the energy to what the task is or what the environment is and the same thing with behavior and emotion. How many of you have heard of the race car brain analogy? All right, are we getting any people on the on the zoom raising their hands? You guys can do the little reaction things. Have you guys heard of that yet? So really what it is if you think about it, it's a great analogy for thinking about ADHD because if you're a race car, you want to go fast. You don't want to drive on Mission Road. You want to drive on things that are curvy and exciting and really do things that are kind of outside the box. These race car brains with bicycle brakes, so knowing that is part of that challenge. When we think about regulating, they can go super fast. They'll be the first one to give you an idea. That'll be the first one to think outside the box. Maybe they may not be able to actually slow down when they need to change, so that's going to be part of how we talk about ADHD and why we do some of the things that we do. It's a very powerful metaphor for understanding your child that has ADHD. So what do you have to do to slow down? Anytime you've told your child to calm down or told anyone to calm down, how often has that worked? Never, right? Same thing with slowing down, but that's our job - to help create environments that help them to slow down. I kind of think about it like when you're in driver's ed. You're going to Driver's Ed, where you had the driver on the other side and they have their own set of brakes and their own set of steering wheels. That's kind of what we are as parents to our kids, we have to be over here creating an environment and supporting them when they need to develop. Kids brains are developing. I just learned it used to be like 22-23, but really they're developing up until about 25, so you also have to understand that the regulation abilities in the brain change over time. I think you said you had a four year old and a four year old versus a 13 year old, their regulation capabilities are going to be very different. Once you hit teenage years, you've got more emotions and that regulation sometimes also kind of spikes up a little bit. What ages are your kids? All right, so our goal is to help our kids slow down and I'm going to work on slowing down right now - I get so excited about these things that sometimes I get ramped up. So the first thing is thinking about transition. We think about that race car brain. One of the things is thinking about is they have a one-track mind. They've got a road map, right? This is where I'm going, this is what I want to do. They're very good at staying staying focused on what they want to do. So what happens is whenever it's time for them to stop, they're going along and all of a sudden you say “hey I need you to go get ready for dinner” and they're like, “what?” It's like you're asking them to turn left and they're in the middle of driving super fast. I'm like, “what do you mean? I didn't even know there was left, I can't turn left yet.”
We have to think about building time. I mean there's rules for slowing down, like when you take the driver's test. I can't remember if it's like 500 ft or whatever. You have to have a car's length in between. We have to build in time for them to transition. One of my favorite phrases to use is stopping point. How many of you tried to do warnings? “You’ve got 2 minutes.” Not so much because a kids notoriously are not great purveyors of time, especially if you have ADHD. A lot of times your timeline too, you get lost in your task. You get lost in the things, and so stopping can be really difficult, especially if it's a preferred activity to a non-preferred activity, like brushing your teeth. So what you want to do is build in five or 10 minutes out the door at the same time. So you say “hey it's time to wrap up and find your stopping point” and then you want to think about like what's a good stopping point. You might say how long is the video game? You want to think about or you want to say, “do you want to finish to step number five: or “how about you do five more red pieces” or “finish up coloring the pedal and the flower.” You want to be very concrete versus time-based because that gives them something to kind of latch onto that they can actually monitor.
Offer equally valid choices. This is the proverbial, “hey do you want to go three more times on the slide or four more times?” Give him a couple of choices. They're both equally valid and here's the deal, though they can totally agree on a stopping point, they don't stop. I'm sorry to say you might agree on the stopping point, but you might still have to supervise the stopping point, because again, if they've got something preferred in front of them, it's kind of like you put a bowel of potato chips - especially the video games - and you say okay, I'm only going to have just one more. How successful are we if right in front of us is the temptation? Not super successful. So sometimes we still need to supervise the stopping point, especially with video games.
One of the things we can do to help our kids is actually engage by commenting, like you're a little bit of a sports announcer, not annoying but you might be like “oh I see what you're doing here,” “oh you're building the red ones,” “you're putting the red ones on the yellow ones,” and “I see you're building a car.” You might start to engage with them. “You look like you're having so much fun right now.” So you start to engage with them and it can help them sometimes get outside of their own world. Okay, I see you shaking your head a little bit. Are you saying like this will never work with my child? Okay I want to hear about that and I’ll get back to that.
We also reinforced the stopping point and sometimes you need to let them know when they can get back to it. Sometimes they're like, I don't want to stop cuz I don't know when I'll have a chance to do it again. Sometimes that can be helpful and the other thing is is sometimes you want to make sure that they get stopped before you give them what to do next. If you say, “I need you to stop playing on your iPad to go brush your teeth,” that's like saying, “stop eating M&Ms so you can eat brussel sprouts.” Sometimes you don't want to give them the actual task that needs to happen because it's can't compare to what they're doing in the moment.
I want to hear more about what you're thinking. Okay, so I get a 12 year old, they might be a little bit more, you know, cuz I haven't learned this kind of moving up so it's 12 year old's going to be a little more like that, but I think you can still use some of that to at least tell them to try to find what they're stopping point is. Then sometimes I'll have to come in and say “hey okay, it's done.” I'll still supervise it, I might not comment as much while I'm doing it. You have to limit. Again you can't be overly effusive sometimes cuz that they don't they feel like it's fake, but like you can still say, “all right, good job! Let's go,” so you don't make a big deal of the praise itself . So yes, for a teenager you're going to truncate this a little bit, but you still have to supervise it.
I should also say I'm not only a clinical psychologist but I also in the mother to three teenage boys. All have ADHD and some … because they're not the same though. It’s like - how is it that I have three boys that do have ADHD but they all have different facets of it? I can't even parent them the same either, so I get all these things are great but you have to figure out what parts… apply it to my kid what parts of it will work. It's a little bit of a trial and error parenting. Any more questions about that?
So, thinking about directions and change too. We want to think about how do we get our kids to listen to directions and follow directions and things like that. One of the things is that sometimes kids are non-compliant because actually they didn't process the information. They didn't actually hear the direction. That might seem like they're kind of listening, or they're like, “yeah, yeah,” but they're not really processing. So hearing and processing are two different things. Listening means we hear it and we process it. So one of the things that I say is you want to listen with your eyes. Has anybody heard that before? The ears process the words but your eyes - if I'm looking at you - it says hey I my brain tells your brain. I need to think about what I'm actually what you're saying and think about it and so but you don't want to say, “Give Me Your Eyes Give Me Your Eyes Give Me Your Eyes” cuz that will not work. What I do is sometimes I'll use their name, I'll say Sam, and then I'll pause. I might have to touch them. I might have to touch them on their shoulder or whatever, and then I pause and I wait for their eyes. As soon as I get their eyes I'm like okay, and then I give them the instruction. I might even say, “oh there's your eyes, aren't you ready to listen?” Probably not with your 12 year old, right? But I would not talk till they give you the eyes, and that way at least you know that you have some sort of attention going.
Then the other thing is kids don't … how many of your kids like change? Another thing that I find is change is really hard, cuz again they're this race car. They're on their road, they like their road, so changing and shifting can sometimes be difficult - even for things that they like to do. It's like, even if like my kid loves to go to baseball but, like then stopping… he's at home and getting him to actually go to baseball is sometimes difficult. He loves it when he's there, but that transition can sometimes be kind of hard. Or if there's a change so one of the things I sometimes do is sometimes we preview the change. Say like, “hey, we've got a little bit of a mixed up moment. Something's changed. I'm not sure you're going to like it, but I want you to hear me out.” And then you … again you're giving him that lead, and so it's not like “no you can't do this” or “this is the change” so it gives them time to process a little bit. If you can't always do it, but if you can preview the change, that sometimes will help. You might even say, “hey I know this is really important to you so I want to talk about what we can do so we can kind of figure out what we can do next” or “another time we can do it” so you can kind of start to kind of the process of the problem solving before you even tell them the changes.
I also say avoid … so is she doing it as a whole class, like everybody needs to change? So I may come in with him sooner and do the stopping point. I think him finding a stopping point is helpful cuz he might just feel the need like I need to finish what I'm doing, and he might be able to. Do some of that with him.
This is a question about a preschool and a Montessori and the teachers having trouble with them transitioning. I think I think doing that is having a stopping point is probably going to be helpful. I also would say avoid the immediate “no” cuz how many times your kids are asked for a lot of stuff right they're like “I want I want I want.” As a parent a lot of times you're like, “no we can't do that” That's kind of what the immediate thing that comes to our mind, but when “no” is a trigger word, we don't want to hear.
And a lot of times here's the thing about kids and adults. I don't know for all of us a lot of times it's not that what they want is terrible or unreachable or something that they can't have, a lot of times the timing is wrong. I want to have my friend over. I want to have ice cream. I want to play video games. I want to do all these different things. I want to you know I want an Xbox. It's not like they're always crazy ideas about what they want, but it's not they can't get. What I tell him is they can't get what they want, when they want. That's kind of what we talk about. A lot of times if you can avoid the immediate no and paraphrase and repeat back the request, then they know you've actually understood and hear them. If they ask for a play date, you might be like “hey I really I know you love to play with Susie. Susie is a really good friend and you really like it whenever she comes over. I think that's a great idea to have a play date,” and then, “oh man it's kind of a bummer, but I don't think today's going to work, but I think we can find another time.” Again, you've given them that lead in without actually just saying no.
I also teach my kids the power of timing. When I walk in the door, please don't ask me anything cuz the answer will be “no.” So it's also helping your kids understand timing and that's a skill that they can … I think you could just explain that, right? Give me 5 minutes before I get in the door and you're more likely to get a yes response or you're more likely to get a response you might like. It might not be yes, but it won't be an automatic no. With the younger kids you can start to phase that in.
I also like to practice mix it up moments. Sometimes we'll do musical chairs at the dinner table. We're going to have a mix it up moment. We're going to do musical chairs. It sounds really weird but you're going to practice having change. You might practice like, “okay we're going to have a mix it up moment” and then you give him the language. So when a mix it up moment happens outside of your practice, they're like, “oh it's one of the mix it up moments” and they have practice realizing when it's a mix of that moment it doesn't mean it's bad. This is another way you can also preview change. I might do that I might like say “oh we're going to have a little bit of a mix it up moment, we're going to each one take turns like changing a rule on a game, or what I'm going to have a mixed up moment I am going to color my dog purple” or something like that. You can be really playful about it.
Anybody know what a feedback sandwiche is? So positive, negative, positive. For example cuz here's the deal is that especially with kids with ADHD because sometimes they have trouble staying on task they have real difficulty actually completing a task all the way. What happens is a lot of times they get deep and they don't get credit for the parts that they have done, which then they feel like “man I'm always getting in trouble they're always getting on me” and and they feel like, “what's the point?” Then they start tuning you out more and more. But for example, when they're getting dressed, you might be, “oh it looks like you've got your shirt on, you got your pants on, it looks like you're just missing your shoes. I know you know where those are.” “It's great - I see you're at the table. You've got your homework there, so that's that's great. You're in the right place,:” so even though they're not starting their homework, you're at least giving them credit for being at the table or moving into where they need to be. It's giving them credit for any movement towards what you want to see. Even just paying attention and commenting on it without that formal praise gives them some momentum to keep moving forward.
Any questions about any of that we have? Some questions from the text box or the chat box - yeah…
21:00 You can try to make it in the chat I don't know apparently we're having some difficulty with getting to unmute the participants in the zoom, so we'll work on it.
All right. Well let's talk about emotions.
How many of your kiddos have emotions? Think about it- they're quick to react. We know that's a regulation issue because they're not processing all the information at once and they jump to conclusions. They're kind of their impulsive- they have race car emotions too, right? So there is true … kids do with ADHD. I don't understand why emotional regulation is actually not one of the core diagnostic criteria for ADHD, but it's not, I mean again, I know it's probably not in some kids, it's a little less so, but in many many kids especially the ones that have like a combined presentation and more of a hyperactive impulsive, you're going to see the emotional problems. So let's talk about emotions cuz we all need them. We don't always like them. We don't always want them. But they're all there to do a job. So one of the things to think about is when your kids are melting down and they're having emotions, they're trying to communicate something. Honestly, they don't like how they feel. I don't. They don't want to melt down anymore than you want to see them melting down, so one of the things to think about is not “my kid’s being a brat.”
You want to, if you can step back and say “it's my kid having trouble, something is not working for my child,” then that helps you be able to address it a little bit better, even though it seems like sometimes … they're struggling with something. So one of the questions is what messages are emotions telling us? The first one we have is Happy. Who knows what happy is trying to tell us? Anybody can shout out or put in the chat. Yes, they like what's going on. Did anybody come up with a chat? Okay. All right, so yeah, it's “I like what's going on, I like what's happening.” Why is that important to recognize the happy? Because if we know that I like what's happening, I'm more likely to do it more often, or if I'm not feeling in a great state, then I can recognize that and I can think about the things that do fill my bucket and create some happiness. So that's actually real, and again, there's different variations of happy.
How about Mad for any of you who didn't read what I put up? Mad is actually one of my favorite emotions because I think it's so so useful. I don't like to feel it, but it's so useful once we understand what Mad tells us. Essentially: I have a problem. Something's not going my way. So much to think about your kids when they're melting down and they're angry and they're mad. How often is it? Can you say it's they have a problem, something's not going my way? That is beautiful. That's good information to have. We can start at that. It's not great because the challenges we can recognize that they have a problem, for a parent we can recognize something's not going my kids way, and they're having a problem, but but we also understand if you stay in the mad, then it's actually hard to solve that problem.
What about anxiety or worry? What does that tell us? All right, Stacy, all right. You answered something, you get a book, you can pick it up at the end if you want.
Yes, anxiety means “yikes!” It's feeling danger or sometimes it's kind of related to mad. It's a big problem, not just any problem, but it's like telling us danger again. Danger could be I'm not in, maybe I'm not going to get what I want, but or it could be like I don't feel safe. You're leaving. I have to go talk to somebody and it makes me uncomfortable cuz I don't know what to expect. Yikes, what if they reject me? What if I don't do well on this test? What if I don't get all my work done? That combines with the overwhelmed of ADHD - oh I didn't put overwhelm on there, but that's a really good one too. We know what overwhelm means anxiety is exactly it's alerting and so it's letting us know we need to pay attention that there could be danger. A lot of times are we interpret it because it goes so big we interpret it more as dangerous here right and so it's it's bigger than what we need it and overall is a lot of times kind of part of that over when you have so much going on and you can't process it. It feels too big and so you get anxious when you also feel overwhelmed.
One of the things I like to do with overwhelm … the way I see overwhelm is there's too much in my head, which is true. I think about race car brain. You got a lot going on and so that's very easy to do to kind of get all of that stuff going on. For teenagers and adults, some for a younger kids, I sometimes will do a brain go. Whenever I feel the overwhelmed because if there's too much in your head, what do you want to do you need to get it out of your head and if you can see it on paper then you can kind of start to sort out what it is right. Some kids love this, they're like I'll tell you, you know I'll be your secretary you just tell me everything that's on your head and I'm going to write it down. They love it when you're their secretary. They like that and then you're not evaluating it, you're not fixing it, you're not doing anything with it, you're just saying well let's take a look at everything going on and then then you can start to help them sort it out.
Sad. So sad just means I'm missing out or there's a lot.
Emotions are super helpful and I think it's helpful as a parent to understand where your kids coming from what these emotions are. I think it also helps you understand and relate to them and help them feel understood.
Let's talk about what happens in the brain when we have emotions.
I'm going to see if this animation all works. I'm going to divide the brain into two parts. The upstairs brain, which is our kind of thinking wizard brain, basically all the things that happen in the upstairs brain are all the executive functioning things which we know we're delayed. Kids that have ADHD and also developing up until you're 25, so that also already puts our kids at a disadvantage. Our adults too, actually for that matter, but it's really like it's problem solving. It's Focus. It's attention. It's logic. It's facts. It's decision making. It's impulse control. All those things that we need to function well as a human. It's the human part of the brain. Other animals don't have this.
If we've got the upstairs brain, we're going to have the downstairs brain, which I call the lizard brain because it's the part of the brain that we share with the Animal Kingdom. It's the emergency response system. It's automatic, which also means that that's where our feelings are. If you think about it, do we tell ourselves, “okay I'm eating sushi, I love sushi?” If I'm getting Sushi, I don't go, “oh you're eating sushi, I'm happy now.” The happy just shows up, just like the magic shows up. Just like when our kids are melting down, they're not going “I'm going to be mad and throw a tantrum.”
A lot of times those emotions come very quickly, even though they may know better. A lot of times it comes from the body and from that back brain and they go into that fight or flight and they get all the physical sensations that go with the fight, fight, freeze. They're melting down and they're in that back brain. Then you've got the amygdala, which is your on/off switch. And your hippocampus. The hippocampus is like your memory center. A lot of times they get together and they're good friends but not great - they're not kind of toxic sometimes. The hippocampus will go, “remember when that was terrible when that happened” and so then it triggers the amygdala to go “yikes!” Then that's no good. A lot of times that's where you see they have repeated issues with some of the same things. They've had a negative experience and then they keep wanting to have that. So what happens is when your bottom, your lizard brain, gets triggered- what happens to that thinking brain? It is offline, which is great if you're an emergency. If you're about to be hit by a car, absolutely you don't want to use thinking right now. It's going fast, it might hit me, maybe I need to get out of the way. It's not going to work very well and here's the challenge: our kids that have this emotional regulation and especially with they tend to go to that downstairs brain very quickly, they're intense and they're quick and they're big.
This part is Dan Siegel stuff. He talks about your hand brain. This is your bottom brain, this is your top brain. When they get into those meltdowns, they flip their lid. Think that means sometimes you're normally logical child cannot hear logic. They also can't hear the solution.
“But I wanted the blue cup.” “Here it is.” “No, no,” it's still not right, even if they get what they want because the processing and the thinking brain. You can't ask them why because that's like an essay question, they can't access that up here. A lot of times they don't have the words to actually be able to identify and express what's going on.
The other thing is is what happens if you go to consequence when they're in that back brain: trying to recognize it's a consequence but understanding here's the consequence, therefore I need to change my behavior. It's logical, right, so most of the time it just makes them mad. It doesn't always help them settle and it doesn't always change their behavior. I'm not saying that we can't give consequences or have solutions or do any of those things, but when they're in that back brain your first job is to get him back upstairs.
As a parent we're currently creating the space for them to do that
Any questions? …
So we're going to talk about kind of some emotion coaching.
So your goal is not to get rid of the feeling. The goal is to interrupt it and allow it to reset. Here's the deal about emotions: they get turned on really quickly and they can get intense really quickly, but they don't just turn off. They tend to turn off slowly. I think that's important.
All feelings are valid. Whether you agree with how much they're reacting or you don't think it's a big deal. If they're reacting, it's a big deal to them. So we need to get their nervous system calm and get them back upstairs so that we can get them back to a point where they can function.
It's Connection before Direction. That's the brief thing which is kind of hard sometimes, right, because you're trying to get out the door and you're like, “I just need you to get your shoes on,” but sometimes the more you push them to get the thing done, you're still taking time. You're like, “I don't have time for this.” Well, you're going to use time, whether it's your kids melted down, the time issue is just moot. You’re going to lose time either way but you want to think about how can you be proactive in using the time to help them learn calming skills rather than just escalating the situation.
So these are the steps in the emotion coaching and I'm going to go through all of those different steps. I'll let you take a look at that real quick.
I will say one of the things that happens is that we end up in steps number at 1 2 3 4 5 and 6, brainstorming, problem solving, set limits, and consequences. The instinct is to go there first, but notice where they are. They're at the very last part, and as I go through and explain what this is, I hope that it doesn't take you as long to do this in practice as it does for me to explain it to you. So what what does it look like? Naming it: you give them the words for what's happening and going on.
Even if you don't know the specifics, you probably have a pretty good idea in general what's happening. “You're frustrated because something didn't go your way.” “That was a mix it up moment. “You're frustrated that wasn't expected.” If you start to use that language then all of a sudden that will be something that they will start to learn. “Oh, I get upset when something changes or when something doesn't go my way.” They'll start to learn how to explain that you're disappointed because you were having so much fun you're angry cuz your sister took something and they're a statement. We're not going to ask why. We're not trying to ask a lot of questions because again, thinking brain is not really online and so it gives a springboard. If you say “oh you were so you were upset because you were playing with that and your sister grabbed it.” All of a sudden you're you're giving them words, which is a thinking part. It's connecting to that back brain which is the emotional part. You’re connecting and saying “I get where you're coming from” and they start to feel like you get it.
That's empathy, which again, we want our kids to have. A lot of times we think our kids just never think about anybody else, right? This is modeling for them. Then we're going to paraphrase and reflect, so if they say “yes cuz I was going to build this Tower and she took my toy,” and then you're like, “oh okay, so yeah you had a really big idea and I know you are so creative you had a really big idea when your sister took that toy.” It slows everybody down, cuz how often when your kid melts down you're like throwing the kitchen sink at it trying to get them to stop, but it's not really what it's affected. It also avoids misunderstandings. It gives everybody time to process and it's actually just a good communication skill. It works so much better than asking questions. If your kid comes home and says, “so and so called me a name.” Like, “oh man, that must have felt really bad when they called you a name.” They'll probably tell you more about it then, instead of going, “what happened? Why did they do that?” But you might say like “oh yeah, you were having fun playing” or “you wanted to do it yourself” or “all right I get it this is not something you expected” or “you really hate unloading the dishwasher.” I get that in my house. Why do I have to understand, right? I have said that to my child before and then we have to talk about why it's not his job today, but but here's the thing, a lot of times when our kids are melting down they know better than to hit, to yell I hate you, you're the worst, it's the worst day ever.
That's what I call emotional vomiting. They're vomiting emotion and they will throw out everything that will also try to push your buttons. If you go you can't talk to me like that, that's not okay. You know what happens. All the sudden the issue you were talking about has moved over here and now you're talking about how you can't talk to me like that and that's not okay. It's escalated more. So while I'm not saying it's okay to hit or to use that language addressing it, at this time is not helpful. So what we talk about is you don't repeat the negativity. If they say “I hate you,” you don't go “oh you hate me,” you might say “wow I can hear how frustrated you are. You're really mad.” You give them the right words to say and that can help them learn that they're not going to say “oh yeah you're right, Mom,” right? So you are feeling really down that … for some kids don't like to be corrected.
