Closing the gap between trauma and disability

October 27, 2019 / / No Comments

I’ve been away from my blog for a while, busy with family and work and all the things that life throws at you, but I have been itching to write about this topic, and this week gave me the push I needed to put my fingers to the keyboard.

Earlier this week, I attended a training day about strategies for managing aggressive and violent behaviour in traumatised children and youth. The focus was on understanding the impact of developmental trauma on the developing brain, and being aware that when a child who has experienced trauma is being aggressive or violent, it is usually a fight or flight response and the child is actually terrified. The strategies were all designed to keep the child and yourself safe and to stay connected to help them de-escalate without the use of restraint.

While much of the information about trauma was not new to me, the techniques regarding safety and connection were a breath of fresh air – they were respectful, logical, and focussed on relationships. I could also see how relevant they were to many of the children I support who go into fight or flight for other reasons and may become aggressive as a result (sensory or cognitive overload, severe anxiety, etc.) – not just those who have experienced trauma.

As I listened to the speaker talk about the needs of these young people, what struck me most about it was the stark contrast between the world of trauma and the world of disability. When a child has experienced trauma, there is acknowledgement of neurological and physiological changes as a result of the child’s adverse experiences, that mean they can’t control their emotional reactions and need love and support to heal and become better able to regulate their emotions and behaviour. When a child is Autistic or has another developmental disability, there is an assumption that the child with neurological and physiological difference as a result of their genetics is choosing to act in inappropriate ways when emotionally triggered and needs to be trained to behave differently.

How is it that we can view behaviour that is driven by the same nervous system response to threat in such starkly different ways? And why are disability and trauma so often viewed as separate, when having a disability makes an individual more susceptible to adverse experiences and trauma than those in the general population?

It concerns me greatly that Autistic children in particular continue to be exposed to ABA based interventions and restraining techniques to manage their aggressive behaviour, when what they need is love, support, understanding and guidance. Now I do recognize that there are extreme situations in which restraint is the only means to keep a child and others safe, but it should be a last resort to put a hand on a child – not the first port of call.

While it feels like there is a long way to go before we see the necessary changes to thinking and practice, there is hope. Clinicians and researchers are starting to recognise and talk about neurology, physiology and child development in ways that acknowledge a child’s need to feel safe, secure and loved, and that challenging behaviour can be an indication that these needs are not being met. There is also increasing awareness that it is not only ongoing abuse or neglect, or experiencing a single traumatic event, that can have an impact on a child’s development – adverse childhood experiences (ACEs) and toxic stress can also have a significant and lasting impact on any child.

Ultimately, what we need to remember is that all children, regardless of their neurology, genetics or circumstances, deserve to be acknowledged, nurtured, understood and supported, and what works for one may not be right for another.

When we can see a child for who they are and take the time to be curious about where a behaviour is coming from, rather than making judgements and assumptions, we can support them to grow and develop the skills they need to flourish.

The Danger of “One-Size-Fits-All” Behaviour Management Programs

October 22, 2018 / / No Comments

Recent discussions with several of my families about behavior management has prompted me to write about something I am becoming increasingly concerned about: The ‘one-size-fits-all’ behavior management program.

There are any number of programs around at the moment, often manualized and with research behind them, that are being sold to families as guaranteed solutions to their child’s behavior problems. How can any program guarantee success? Unfortunately, these programs often blame parents for their inability to follow the program correctly if a child’s behavior does not improve, rather than questioning the suitability of the program to the individual child.

While behavior programs themselves can be helpful, and there are some common elements that are important in any intervention created to change a child’s behavior, the notion that any one program will be effective for all children is outdated and misguided, and unfortunately can cause a child and family unnecessary stress.

This is particularly evident in the world of Autism Spectrum Disorders. Autistic children often demonstrate challenging behavior, sometimes including meltdowns and aggression, and families are desperate to find something that will help them support their children to behave more appropriately and manage their emotions more effectively. So when a program promises results, parents are understandably eager to sign up and see improvement in their child. But what they are promised is often not what they get, not because the program is necessarily ineffective, but because it does not work for their child.

The problem is that lumping all Autistic children together, and expecting them all to respond to the same intervention strategies, ignores the individual characteristics that make any child unique and the underlying reasons for the behavior. Factors such as personality, cognitive functioning, adaptive skills, sensory sensitivities and anxiety, can all impact on how a child responds to intervention, and parents are the most qualified people to figure out what intervention is going to suit their child best.

This has been illustrated most recently by the difficulties faced by parents of children with Pathological Demand Avoidance (PDA), a subtype of Autism Spectrum Disorder characterized by severe anxiety, when they are trying to advocate for the fact that their children require a behavior management approach that is different to that usually recommended for children with ‘typical’ presentations of Autism.

Children with PDA experience anxiety at such a high level that even simple, everyday demands are met with defiance due to the child needing to be in control to feel safe. Many parents of children with PDA report undergoing years of being blamed for not being consistent enough, not being hard enough, and not setting clear enough limits, because they were being told to use strategies that usually work for Autistic children, and they were just not working.

Thankfully, a group of parents were able to make themselves heard and found professionals that would listen, leading to the development of strategies that are more likely to assist their children and be effective in supporting them to manage their behavior, as well as gaining recognition for the PDA profile.

This example is important for a number of reasons. Firstly, it shows that parents know their children better than anyone else, and secondly, it illustrates that behavior management strategies need to be tailored to the individual child to be most effective.

When considering a behavior management intervention for any child, it is important to consider a number of factors including how a child communicates, their cognitive level, their skills in regulating their own behavior and emotions, their sensory sensitivities, what they are motivated by, and most importantly, the reason for their behavior. With this information, a plan that is suited to a child’s individual needs can be chosen or created.

It is important to remember that some children will respond well to firm rules and a reward system to reinforce appropriate behavior, while others will benefit from a more flexible approach that involves negotiation and collaborative problem solving. Finding the right approach may involve trial and error, but taking the time to find a system that works best for a child and their family will ultimately be most effective.

So parents, please do not be afraid to speak up if you feel that the strategies you are given to support your child don’t seem to be working; and professionals, don’t forget to listen to parents and work with them to find the best way to support them and their children.

Nothing in life is as simple as ‘one-size-fits-all’, especially when it comes to children, so if you are looking for support for a child’s behavior, please consider the individual and what strategies will best suit them, rather than trying to make the child fit the program.

How to Help Your Child Overcome Social Isolation

October 16, 2017 / / No Comments

As parents, we all want our children to have friends and fit in, but that can be challenging for some children, especially when they have difficulties with social skills.

Social skills allow us to have positive interactions with others, understand the feelings and behaviour of ourselves and those around us, and change our behaviour depending on where we are and who we are with. When a child’s social skills are delayed, it can be difficult for them to interact meaningfully with peers and make friends, leading to them becoming socially isolated either through being excluded by others or by isolating themselves due to being repeatedly unsuccessful in their attempts to join in.

The most concerning impact of social isolation is the negative effect it can have on a child’s wellbeing including reduced self-confidence and self-worth, loneliness, and the development of more serious mental health concerns such as anxiety and depression.

Thankfully, there are things we can do to help children develop the skills they need to be successful in their social interactions and find a sense of belonging at school or kinder.

 Identify Gaps in Your Child’s Social Development

The term ‘Social skills’ represents a wide range of abilities from recognising feelings in others through to navigating relationships, and everything inbetween. To be able to support your child to build their social skills, you first need to know where the gaps are. Ask yourself – What aspects of social interaction does my child find difficult? Do they have trouble reading the emotions of their peers, or engaging in the back and forth of conversation? Do they struggle to understand jokes or find it hard to join in? Knowing where the gaps are will help you to know where to focus intervention to help your child continue to develop their skills.

Teach and Practice Skills Needed for Social Interaction and Friendships

Once you know what areas your child needs support in, you can focus on teaching them the skills they need to be more successful in social interactions. For many children, explicit teaching of social concepts or rules will be necessary. Teaching can be done in many ways including reading story books, watching videos, role-playing and discussion of real situations. Once they understand a concept, provide opportunities to practice skills with parents and siblings to help them increase confidence in their abilities. Then encourage them to practice their skills with their peers, and assist them to reflect on their successes and their challenges.

Facilitate Playdates

Arranging play-dates with children from school can support children to feel included not just by helping them connect outside of school times, but also by increasing the likelihood they will have someone to play with in the school playground. To facilitate a successful play-date, you may need to teach the rules associated with having a friend to play, such as letting a guest choose what to play, or not deserting a guest to go and play something else on their own. It can also be useful to plan out the activities that are available and schedule in a snack or two to reduce the demands on the child to think of ideas and also reduce anxiety about what will happen and whether it will be successful. Regular play-dates help children make stronger connections with individual peers that can assist them in at school, as well as providing them with opportunities to practice their skills in a safe and familiar environment.

Help Your Child Use Their Strengths to Make Connections

While it is important to know what areas your child needs help with, it is also important to know what your child does well. Do they have a great sense of humour? Can they talk about dinosaurs for hours? Are they good at sport or computers? Do they have an amazing memory? Your child’s strengths can be used as a way for them to connect with others, particularly those with similar skills or interests. Joining a sporting club, cubs or scouts, a dance class or a gaming club may provide an opportunity for your child to practice their skills with like-minded peers who already have a common interest, making connecting a little easier.

Get Kinder or School Involved

Given the amount of time that children spend at kinder or school, it makes sense to get them involved in supporting your child’s social development. This can be done in a number of ways. For example, lunchtime clubs around a specific activity such as Lego or gardening can be a great way of supporting children that struggle with the unstructured time out in the playground. It gives children an opportunity to interact with peers around a common activity, with an adult there for support if needed. Other initiatives schools or kinders can employ include buddy systems, peer mentoring and small group classroom activities or games. The best way to get school or kinder involved is to talk to your child’s teachers about your concerns regarding your child’s social development, and work with them to create opportunities for positive social interaction.

With support and guidance, all children can develop the skills they need to develop positive peer relationships and have social success in the classroom and playground, allowing them to find the meaningful connections and sense of belonging that every child deserves.

Helping your child make a smooth start to the new school year

October 8, 2017 / / No Comments

There seems to be a lot of information available for parents about the big transitions that children face at the start of the school year, such as starting Primary or Secondary school. But for many children already at school, starting the new school year in a new grade with a new teacher is an equally big event, and one that we can help to prepare them for.

With the end of the school year fast approaching, it is a good time to think about how to help your child get ready for the changes that come with moving up a grade in school.

Get familiar with the rooms and teachers.

While it is unlikely that the school will know exactly who your child will have as a teacher and what room they will be in before the very end of the school year, most schools have classrooms dedicated to specific year levels and regular teachers that teach those grades. Ask your child’s current teacher to provide opportunities for your child to visit higher grades in informal ways, such as running errands or participating in joint class activities, so they have a chance to get to know the classrooms and teachers and will hopefully feel more familiar with the staff and surroundings when it’s time to move up a grade.

Talk to your child about changes that are going to occur in their new grade and reassure them that there will be a lot of similarities to their current year level.

Talk about what to expect.

Many teachers start to talk to their classes about expectations for the year ahead to try and motivate children to work harder or behave better. However, this can result in increased anxiety and unrealistic expectations of the workload. Statements like “you will be in Grade 6 next year, so you need to start setting an example for the younger students,’ or ‘the work is going to be harder in Grade 3 so you need to pay attention,” can make going up a year level feel like a huge jump in responsibility and work that many children don’t feel ready for. Talk to your child about changes that are going to occur in their new grade and reassure them that there will be a lot of similarities to their current year level. For example, teachers are not going to give students really hard work at the beginning of a new grade, they will start where their students finished the year before and slowly build on their skills and knowledge. This will help your child have a more realistic and less scary picture of what the year ahead will look like.

Help your child learn to embrace change.

It is usual for children to be uncertain about the changes that moving up a grade will bring. Concerns about whether they will have friends in their class, or if their teacher will be nice, are common, and may lead to anxiety and a reluctance to attend school or challenging behavior at home. To help reduce their uncertainty, encourage your child to think about the good things that moving up a grade will bring, and support them to reflect on situations where they have experienced change in a positive way (e.g. new clothes, birthdays, holidays, etc.). It is also important to let your child know that it is normal to be a bit nervous or uncertain about change, but you will be there to help them work things out and they will be alright.

Preparing your child for their transition to a new grade will help to make the move a more positive one not just for your child, but for your family as a whole.