EP76: The Four Faces of an Overwhelmed Child: Avoidance, Shutdown, Emotional Reactions & Control w/ Dr. Jenna Blum

- Stores seem to be places that are very triggering for a lot of our kids, especially those kids that have sensory sensitivities. I have some clients that, honestly, when they go to large, allow lots of people, they need to wear headphones or they might need to bring like a fidget to kind of suit them. Thinking about, okay, we're first gonna show the cab, we're gonna start with some non-verbals to kind of warm you up. This is a teen who's like still living under the same roof as his parents. And she was just like that was incredible. Like he's literally never had an experience like that before. - Welcome back to another episode of The Unswoken Awards Podcast, a selective metasin podcast by The Smart Center, produced and published once again by new addition productions. This episode features Dr. Alicia Shippon Blum and Dr. Jenna Blum, director and lead clinical psychologists at The Smart Center's growing counseling and assessment department, unpacking the difficult behaviors parents see in children with selective metasin. The meltdowns, avoidance, shutdowns, and controlling moments that lead families, frustrated and confused. Dr. Ian, Dr. Jenna, explore why so many kids hold together at school and then fall apart at home. NYUis structure, consistency, routine and predictability are non-negotiables for our anxious children. Dr. Ian, Dr. Jenna also reframe each behavior as communication rather than defiance. And walk through the look, listen and learn approach. One of The Smart Center's most popular approaches, road mapping, overwhelming events, bridging down on The Smart Center's social communication bridge, sensory triggers and contributing factors like ADHD and how the feelings chart helps children put numbers to feelings they can't yet explain. If you have any questions on anything here during this episode, just head to select the meetasin.org/askdoctore. That's ASK-DRE. And make sure you're following the podcast on Instagram, on spoke-word podcasts, and on YouTube, @Un spoke-wordspotcast by Dr. E. All right, without further ado, please enjoy a last episode of the Un spoke-wordspotcast. Before we get started with the episode, you're exhausted from advocating, explaining, and hoping someone finally understands what we do. This summer, consider Communicamp for you and your family. Communicamp is the Smart Center's intensive, all-day treatment program designed to help children and teens ages three and up build social communication confidence. Over the course of one full weekend, your child or teen receives 15 plus hours of expert lead skill building while parents receive 15 plus hours of training and support. Our clinicians use Dr. E's evidence-based treatment ASK-DRE that's helped thousands of individuals find their voice. Here's what matters. Unlike other programs, your child or teen doesn't need a talk to come to camp. We meet them exactly where they are. We have three Communicamp weekends happening this summer, June 26 to 29, July 16 to 19, and August 7 to 10. Visit the link in this episode show notes to learn more. Stop waiting for your child or teen to grow out of it. Make it happen this summer. All right, enjoy the episode. [MUSIC] Hello listeners. Welcome back to another episode of unspoken words. I am here today with Dr. Jenna Blum. Hello, Dr. Jenna. Hi, how are you doing? I'm doing great. Today, we were thinking about different topics, and we get so many different questions all the time. As Dr. E, as Dr. Jenna questions. I thought today we would talk about challenging behaviors. I don't think there's a parent out there that would tell us that they don't see this from time to time. Agree? Yes, definitely. So I thought today we would talk about it because I think it's really relevant. Right now, we're doing this podcast towards the end of this school year, and often times of transition can be times where you see a child have difficult transitions and difficult behaviors. And parents don't understand what to do and why it's occurring. So I thought today we would talk about a topic called when silence feels big. Understanding difficult behaviors in children with selective mutism. So parents may say, my child isn't just quiet. They melt down. They avoid. They don't get down. They act out. And do you see this too that kids tend to act out more in situations like home with their parents more than they do in school? Although, of course, kids cannot behave your challenges in school. But what do you see? Because I see that all the time. Yeah. No, I definitely feel like, you know, we get this a lot of different times where I'll get feedback from teachers and they'll share that they don't experience this as much, but then at home, their parents will share that they experience these episodes all the time. And one of the things that I talked to parents a lot about is there's a few things. One is think about if a child has extreme social communication anxiety, like many of our kids with selective mutism. And they're so kind of inward the entire day at school, right? And they're kind of, you know, feeling more frozen or maybe they're feeling more stiff or they're feeling more stuck. Think about how much energy they need to exude when they get home, right? There's so much energy that needs to go out. And so some of that could be that our kids just need to move. They need to move around. And some of our kids aren't getting that capacity in the school environment just based on their social communication anxiety. But then other kids are also experiencing various other factors. And I know a lot of episodes we talk about, there's so many different contributing factors into the maintenance of selective mutism. And so we'd want to learn a little bit more about what are some of those factors. And maybe again, they're not coming out as much during school because we're maybe more stuck, we're feeling a little bit more frozen in that point. And then we're seeing kind of maybe more of our child's baseline in the home environment. So could we kind of both or one or the other? And also our children, anybody with anxiety, anyone, and all the adults listening and older, you know, kids, teens who may be listening, any adult listening, okay? They will tell you the more anxious they feel, the more out of control they feel. When you're out of control, you sometimes may act out as an adult, you've learned to kind of manage yourself in order to be able to function in society. But maybe at home, you may yell at your kids, you may yell at your spouse, you may freak out, you might like, you know, run off, you might hide in your room, you might act out. But when you're at work, it's your way more controlled. And we see this with our kids. And also our kids, anyone with anxiety thrives. And I'm going to repeat this throughout this episode. Structure, consistency, routine, and predictability. Yes, that was not a mistake in the audio. That is me repeating those four components to what our kids, what any individual, needs in their life to feel in control. When you're anxious, you feel out of control. School environments by nature tend to be more structured, more consistent, more routine, more predictable. So therefore, as a result of that, we see our kids actually may do better in school. Because they know what, when, where, and how. And as you said, sometimes our kids are more shut down, more anxious in school. So they're holding it in. And then they come home or even in the car and they let loose. And I love what you said about like our kids needing to get up out, run, do other kids need to decompress. You and I just did an episode two weeks ago that I think went live already. If not, it will be. And by the time people hear this, absolutely will have gone on to our podcast channel. But we did an episode called Look, Listen and Learn. So many things we talk about are so, so important. I don't think there's anything that's not important that we talk about. But that episode to me is really critical. And so I would love for you just to kind of touch on that episode, just a tad, because I feel that it relates to this so much. Yeah. We talked a lot about how the look, listen and learn, kind of go hand in hand, right? So we want to look at our kids, teens or adults. And we don't mean stare at by the way. Yeah. Kind of observe. Yeah, we want to we want to look and really observe like what is going on for our child, right? What are their body, what is their body language telling us, right? Like what are they showing us, right? So I think it gave the example in the episode about how a child had gone to a family gathering and she was hidden behind her mom, right? And so rather than saying like, come on, come in front of me, take a pause and look and kind of see what is it about that scenario that's making my child maybe come behind me. And now that was a scenario that she was feeling overwhelmed. She gets a little bit more anxious with her increased expectation, like high expectation, family members. And there was also a larger group. So I think she was just feeling very overwhelmed. So she, so we talked about how when I was working with the parents, we talked about the look piece, like observe what the surroundings are. So listen to what is she or what is your child showing you in that moment, right? Like telling you what are they doing or telling you whether it's actually verbally telling you where we also talked in the episode about how sometimes even through our non-verbals, there could be many different ways that they're telling you certain things and then learned from that. So instead of saying like, oh, this was such a failure. Like now we're never going to be able to see our relatives again, take it as okay, well, we looked and we listened, right? We were able to kind of comprehend like what was going on in that moment and now we can learn from that. And then maybe the next time. we go to a family gathering, maybe we bring, you know, and this was a younger child. So maybe we bring like a bag of props for her where she can be more excited. Maybe like areas of interest. Maybe we bring a fun pole and ask all of our relatives what their favorite ice cream flavor is because it's over the summer. And again, it's a fun task that like, as Dr. he mentioned, structured consistency, routine and predictability. So having kind of more of those activities within kind of like our family gatherings, our play dates, you know, camp settings, all those things are really important too. So again, the looklessness and learn is so important and the more that we can look listen and learn, the more likely that we can try to prevent maybe some of these outbursts or some of these behavioral challenges as well because we can start to kind of pay attention maybe to what is going on, what is what is the trigger for my certain child, right, that kind of causes maybe more of these challenges. And there's so many ways that we can kind of move forward from that. And educating others, you know, when we're look listening and learning and we're dealing with challenges like these behavioral challenges, like what is this child telling us? Maybe they were dysregulated. Maybe they didn't prepare for the event. Maybe mom and dad said, get in the car and let's go without knowing on the calendar, we're going to Aunt Sally and Uncle Bill's maybe Aunt Sally and Uncle Bill are high expectation parents. So this all were, I mean, high expectation relative. So the about my child worksheet to be able to educate others on what to do and not to do. Don't go right running up to my child. If she's hiding behind you and she's acting out or she starts to cry. Listen, I remember even with Sophie when she was a little girl going to a family function, she would just get so upset and cry. And it was really a learning experience. She felt very overwhelmed. I can't get angry. You can't get upset. You can't get frustrated. You have to learn from that and go, well, you know what? She wasn't as prepared. I needed to arrive early. I needed to have a focus like you said, something she could do. Maybe stand on the outskirts. And these difficult behaviors tend to kind of go away as you start to do that. So I think it's very important that that look, listen and learn that episode is that families that may not listen to that. Listen to that as they are also, you know, going through and listening to this. So I think what you're saying is we're going to shift in perspective, right? Instead of, oh, I'm frustrated. You know, why is she doing this? Why is he acting out? Seems so oppositional. And let me tell you something. This is why some kids get diagnosed with oppositional defiant disorder because these difficult behaviors that these kids are going through are why they're being oppositional. You know what? Let's take a step back. Right. Let's shift our perspective. I've never met, you know, and I constantly do this. I constantly throw in the number of years or the years I've been doing this. But in all of my years, 30 plus, I've never seen a child oppositional behavior be like having oppositional behavior as the cause. It's a reflection. It's a result of. And so if we can see these difficult behaviors as a result of something rather than they're oppositional and looking at these behaviors, anything they do, as what they're trying to tell us, we shift our perspective and it's unbelievable how that really does shift in a great direction. So I think it's very important that we see this as, you know, when you see difficult behaviors. And let's talk about four types of difficult behaviors. One is avoidance, right? The child is so typical, right, of our kids. They avoid. They learn a way. As you said, they hide behind their parent. They don't want to go into a room. And as kids get older and older kids and teens, they learn how to avoid. I don't want to go to that party. I don't want to go with the school today. They avoid any examples you can share of some of the things you see with avoidance. I think avoidance can look like many different things. I think for a younger child, it could be, you know, a child that, like I said, hides behind their parent or, you know, just maybe is under the table. Like I actually was just talking to one of my parents and they were sharing that they were so excited because their daughter was so excited to celebrate her six birthday. And they planned this party and they even asked her, they're like, are you sure you want to do this party? Like we could really have a smaller gathering. And she really wanted to do it. It was at this like fun kind of like playhouse area. And right around the time when it was towards the end of the party and they were about to do the cake, she hid underneath the table and didn't get out of, didn't come out of the table until the end of the birthday party. And I kind of processed that with the parents and we talked about it again. It was a lookless and learned moment because we now talked about like, well, let's think about how we can move forward to like the next birthday party and what we can do to prepare and how we can prevent some of those things. But for a younger child, I would say like that could be more of what we see is like really kind of like we're totally in that shut down mode. We're feeling so overwhelmed. We don't know how to verbalize that. So we're just completely going to like retreat, right? So she hid behind underneath the table. So my teens, I find like, I've a teen that I also work with where every single time a relative comes over, he goes into his room and he does not come out of his room. And it's been an ongoing, you know, conversation that I've had with parents about this look, listen and learn because of course you don't want to be quote unquote rude and you want to, you know, obviously greet your relatives. But for him, he is reflected with me that like it's just really uncomfortable. He knows that his relatives are always going to ask him like, what are you up to? You know, like what are you doing? And he knows he's not feeling really confident in some of the things that he's doing. So he just goes to his room. So I think avoidance can look like all of those aspects, right? For even a younger child into an older child as well. So with that older teen, what like one of the things I was going to say as I, as you were talking about the younger child, one thing was there are much more behavioral based, right? That is cognitive when they're young, even though that child can relate to a feeling and maybe next time they do like a roadmap, like what could happen at the birthday party? Let's go through what's the schedule I call the roadmap kind of like a GPS, you know, people come and you talk about some of the games. Sometimes you don't do any games at some events. You just kind of silent goal it where the parents set up the world and they take off some expectation of any sort of interaction in the beginning. Maybe they can do the waving game or they can do a high five or maybe they're doing the copy back. They say how you say hi or race to say hi. Depends on where they are on the social communication bridge. Some kids are verbal and they're doing high, high, are you good? How are you? Come on in. I mean, it depends on where they're at and that's what's really important. We're not bridging down and on verbal just to bridge down. We bridge down when we need to, but there's kids that are working on verbal initiation as soon as they're walking in. But that's a look, listen and learn. Like you said, maybe that child didn't realize they were going to be the center of attention for a birthday cake. And I know that you were sharing with me that with that particular family. They didn't share with you when you were working in your session. What was coming up? One of the things we do in our psychotherapy when we're working with families is, hey, what's going well? Let's talk about it. Let's talk about why that's going well. What didn't go so well this week? Let's talk about why that didn't go well. How could we do it different? And what's coming up? Yeah. And from what you shared, that family didn't share with you. They forgot to tell you about the birthday party. And had they told you, yes, you would have gone through that and said, hey, let's kind of do that roadmap because that's such a common thing that I find is, maybe they didn't do it that way. Maybe they didn't do, like maybe it wasn't an isolated thing. And with the teens, to bring up their cognitive, their ability to kind of change their thoughts, their behaviors, their patterns. But what have you worked specifically with this particular teen? Because they're avoiding because they're anxious and they don't like the feeling. So they learn to avoid to avoid the feeling, right? Exactly. How many what you're doing with him? I think our list has all to here too. Yeah, no. And before I get to that too, I just want to preface what you mentioned about, you know, with the younger child. This was a situation where this was actually one of my first sessions with them. But as you mentioned, like, these are all things that we navigate in our sessions, where we, like, I would have known about that birthday party ahead of time when we would have like really problem solved and like talked through it. And I think that's for something that's really important is, for those families that work with us, or if you're kind of like wanting to learn a little bit more about what we do, is a lot of our sessions are like, oh, tell me what the next month looks like. You know, how can we kind of like troubleshoot and go through things? So I think that's definitely really, really important. For the teen, yeah, I mean, we definitely bring in a lot more cognition, right, where we talk through where the, you know, where is like the, I guess, origin of this avoidance, like what's kind of causing some of that? And we have just gotten to the point where he's realizing it's honestly more so relatives than other individuals. Like he's more comfortable actually with strangers than he is with his relatives, which I think for some of our individuals, that stems from maybe having that serve an expectation. And they also don't know me as quote unquote, the individual that doesn't talk. And so especially for our teens and older children, I think the more years, right, that learn condition behavior, it also comes to the fact that they have learned, you know, that they don't communicate in these settings longer and longer, but people around them also learn that. So grandma knows, oh, you know, this, you know, my, my son, my grandson hasn't talked to me. So if he says one word to her, oh, my goodness, they're going to create like the biggest deal ever versus he can have a full conversation with his waiter and be fine. So, so I think like there's definitely dynamics there, but I would say that for an older child, like you said, it's so much more cognitive. We're really diving deeper into like, let's talk about like why this is difficult. And let's always keep coming out of his room now. Like, what happened? Is he like, is he starting? to say, all right, for the first 10 minutes, or I'm going to be busy in the kitchen or giving him like, what do you do with it? Well, I would say for him what we did was, you know, it's actually been like a process. So I would say that like, we really tried to narrow down like, what are the specific triggers? And for him, it was the fact that like his uncle and grandma and his cousin were coming at the same time. And so we actually went through like, I created a list of like, okay, who's your most comfortable relative to your least comfortable? And he was most comfortable with his cousin who's actually a little bit younger than him. And then he was least comfortable with his uncle. So we talked about how, okay, well like it's great that you're having family gatherings. Obviously we can't always avoid that because it's important, right? But maybe we could talk with mom and dad about like maybe having get together with your cousin who's a little bit younger, who you guys have a lot of similar interests to. So that's been really effective where now he's also learning like, I don't have to avoid when I see my relatives. So he's almost like restructuring in his mind that he's not avoiding his relatives. It's more the dynamic of all of them together. So we actually recently, he had just had his cousin come over and it was just the two of them. And it was so effective and his mom actually reached out after because this is a teen who's like still living under the same roof as his parents. So I think it's just showing that like, we can be flexible. We can try to figure out like what are small games that we can win from that because I think sometimes it can feel so scary. It's kind of like if you think about a hierarchy, right? From like zero to 10, 10 being like the most like avoidable, right? And zero being like, I can do it. We're not going to start with the most avoidable things, right? We're going to maybe think about like what could like a five or six look like? And for him, a four to five was like bringing his cousin over versus like all of his relatives was like a 10. So he was learning like, oh, I'm really only avoiding it when it's like, all these things together. So now we're like kind of breaking it up. So when they come over, is he like, is he like now? Because eventually aunt, uncle and grandparents are going to come over. One of the things that I've done with some of my kids is we have them come at different times. I have them be busy with something like maybe like, for example, I'm working with a teenage girl and similar like this is so common with relatives. Like you said, they often do better with strangers. So practicing in the real world, building up those skills actually carries over, but also educating them not to ask a lot of questions. But my, the girl I'm working with that she's about 15. She helps mom in the kitchen. Yeah. You know, it's not the most ideal that she's, you know, in the kitchen when they come, but she could eventually greet or be part of it. But it's okay. So she's cooking something she loves. So she's focusing on that. And when they start to engage, they may say, what are you cooking? So we did the common questions. What could they ask you? Yeah. Like an action plan. You're in the kitchen. So that really work for this one girl Rebecca. She just thrived. She's like, you know what? I feel good there. That's where I'm myself. Yeah. Like I love it. And I'm so proud of my baking abilities. Like that's my favorite thing to do. So when they come over, that's what she's doing. Plus when she goes to their house now, she brings it in instead of high how are you? She's handing over something in the beginning. Okay. So we bridge down. And I'm just trying to make sure that the listeners don't understand that if you, if your child is not speaking, it's not a fail. Of course, they're going to become more confident social verbal communicators. But it's a process listeners. And sometimes you bridge down for comfort. And then you bridge up and by bridging down, you're actually helping them feel safe and secure, which allows them the fuel to progress more. So as the gathering goes on, but let's go on to, because we can talk just about that. But another is the shutdown. And I don't know about you, but the typical shutdown occurs much more common in younger kids because of that kind of neurological reaction, whereas older kids like tend to be more avoid and they don't look as anxious. But that shutdown is usually a result of being loud, large lots of people overwhelmed and not prepared. Like, yes, I would say, you know, I would definitely say preparation is probably the biggest thing that I see with, with the shutdown. I would also say this is actually one where, you know, I mean, all of them are important to understand the contributing factors into the maintenance of SM. But to me, I see a lot of shutdown with individuals that have a lot of sensory sensitivities because if they're in large loud lots of people environments, as I know you always say, right? And they're in like a large loud restaurant, right? That's very classic for them to actually just, you know, maybe from actually even like a neurological standpoint, like their body just literally shuts down. Like they are so overwhelmed. They're so overstimulated in many ways. So there's different, I see kind of both. I would say for like a classic younger child that shuts down and kind of freezes as you're saying, preparation is so important. I just had a client actually who she was eight and she every single time her mom would have her family friend come over. She wouldn't actually avoid. So she wouldn't like hide, you know, behind mom, but she would just almost like freeze. And she's a little bit more cognitive. Like eight's a little bit more cognitive. We're like, I actually talked with her about that. And she would say to me how she actually really injured like it was like her favorite day of the week. Like her family friend would come like almost every Saturday. But her mom would be like, I don't understand though. She's so stuck like she's frozen. It's like she literally can't get her words out, but I could feel like she wants to. But just the subtlety of like preparation made such a world difference. We talked about how she just got a new cat and she we kind of like walked through the entire get together. And I said, okay, the road map, like I would be like, what would you want to do first? And she really wanted to show her family friend her new cat. And we talked about it. I was like, well, let's think about the social communication bridge. Again, she's a little bit more cognitive. I was like, right now we're at stage zero, right? We're like frozen. How can we think of like growing across the bridge? At stage three, like using our words, feel so, so scary and very unrealistic right now. What could be other things we can do? And she was like, well, I guess I can always like, you know, maybe like show her my cat and kind of like, you know, nonverbaly, like kind of move the cat towards her. I guess I can also like show her some of my cat toys that I just bought by handing it to her. I can also we talked about like using mom as a verbal intermediary where mom could ask her one or two questions about the cat. So we like mapped out this whole thing and again, it was such a successful experience where just that preparation of knowing she freezes, right? Thinking about, okay, we're first going to show the cat. We're going to start with some nonverbals to kind of warm you up. And then they have the great idea again, she's super motivated where mom was going to question both family friend and her and she really wanted to do she wanted to do cat trivia. So we came up with three really great questions about cats. And it was good for me because I don't know much about cats. It was really fun for me to learn. You're a dog person. Yeah, I'm a dog person. But, you know, I don't just discriminate. But anyway, it was such a successful experience. But again, it kind of went from that frozen look of like she literally would just her body would shut down to now where every single time that we meet, we're thinking of other ways that we can really get her more engaged. And then maybe that can carry out to other people that she's kind of quote unquote frozen with and shut down. So I would say that like frozen is a little bit similar to the avoidance piece, but again, a lot of it stemming from like almost like our body shuts down. And from the sensory piece too, I always say that's a huge piece of like how can we create almost these coping skills, right? Like I have some clients that honestly when they go to large, loud lots of people, they need to wear headphones or they might need to bring like a fidget to kind of sue them or they might need to have a client who brings like a weighted blanket with her because she just gets really overwhelmed and almost needs like a little bit of that like comfort for her. Also preparing like not going to large loud lots of people environments. So I have some clients that like we'll talk about that. And I'll say like I know that cheesecake factories, your favorite restaurant, but this smaller cafe, you might be seeing way more success and you might not see yourself as frozen. And the more that you practice there, we might start to notice that we can win towards more of those like larger louder places. So I'm going to bring it off hours to look at it's funny. I brought up cheesecake factory. We have one somewhat near the smart center and this particular family will go like right after our session. So we tend to have a session around one o'clock. So go around two. So if they come in later and they go at five, that's really overwhelming. So they go before the crowds and they always sit in a booth away, even if they wait because they feel safer. We'll get back to the episode in a second. If you have a child or teen with social communication challenges, listen up for more than 20 years, the smart center has helped over 6000 individuals overcome select and meet. Now we're bringing our expertise to you in a new way with our six week virtual social skill series over six sessions. Your child or teen will learn through activities, role plays and real life practice by learning conversation starters, developing friendships and managing social anxiety in a safe and supportive space. Our train clinicians meet every child and teen where they are, whether nonverbal, finding their voice or already verbal. We run new groups every few months. Visit the link in this episode show notes to register your child or teen today. All right, let's get back to the episode. So interesting, the shutdown, when we do the prepare, I think about being on the lookout, this is a really interesting concept. What causes that shutdown, that neurological reaction, right? Like the amygdala, the shutdown, the fear response. If you can work with the brain, the cortex, I learned this really early on. I was always interested in neurology and how the brain works. If we can get them, I know, well, the apple doesn't fall. The apple doesn't fall far from the tree. But if you can get someone to think, it's hard to shut down. So one of the things that we do for some of the kids that shut down is one, the silent goals arrive early, prepare the whole thing in a fun way. It doesn't have to be prepared in a rigid way. Oh, we're going to hear like this could happen. Like we're going to see this person in. I wonder if this happens. I get an upbeat, positive way, prepare. And sometimes it's creating the visuals, which could be game-like for young children or go like. So, and then how the parents bring the child or the teen into social communication or something. But they're on the lookout. You know, I do it the eye spy. You can see how many people like you're going to a family function. Let's see how many people ask me about what I'm doing this summer. So you're on the lookout. Yeah. You know, you're looking out like I wonder if Aunt Sally is going to wear a dresser pants today because she kind of says pretty funky. And so you look out, you're on the lookout. You're on the lookout for common questions. You're on the lookout for fun things. You're on the lookout for is she wearing funny earrings or whatever. And by doing that, you're preventing the shutdown because you're using your cognition. That's why these games that you play, like you said with the cat trivia questions. It's a focus on something. Also, one question could someone ask about a cat? Yeah. I mean, we also name what kind of cat? Yeah. We also talk a lot about like real world goals and games and activities like that because real world is very predictable, right? If you go to restaurants or stores, you might, those families that work with us or if you look at our literature, a lot of times we'll talk about home, real world, and school because most of the time we're spending, we're going out and about in the real world. And so the exact same thing, if there's families in here that we haven't worked with yet, one recommendation I have, especially if you've a younger child, is being on the lookout when you're going into stores because stores seem to be places that are very triggering for a lot of our kids, especially those kids that have sensory sensitivities. So for example, we always say this at community camp, right? So where we live in many areas within the nation, but depending on who's listening to this, they might not know. There is a store called Target and it's a very wide-known store. And what's really nice about Target is they, all the workers wear red shirts. And so that actually is something that we talk a lot about at community camp that even though Target can be a little large, a lot of people, like Dr. Remenschen obviously going off hours is helpful. But one of the things that I find a lot of my kids love is I'll say, okay, you have a task. When you go to Target, you're going to be on the lookout. You have to look for someone with a red shirt, right? And that kind of starts the process too. So that's definitely something to kind of get yourself moving and kind of just getting yourself more excited rather than that shut down frozen look in a store. Yeah, I know that's a great idea. Another is the emotional reactions. And as you said, we have a lot of kids, a lot of teens with sensory challenges, sensory processing difficulties and what goes along with that is emotional dysregulation. So if you have a child that gets very irritable, frustrated, cries a lot, just kind of just like upset a lot, I would say, are they a sensory kid? And what is, you know, what is causing that? You know, why are they dysregulated like that? And those kids, again, structure, consistency, routine predictability in their home helps. But what are those triggers? Yeah. It's tired, overstimulated, understimulated, you know, not knowing what's happening and sudden changes and scheduling. These things can be really, really difficult for a lot of our kids. And so when these things occur, we want to understand some of those triggers for emotional dysregulation and, you know, try to address them. And these are things we see a lot in a lot of our kids, as I said, with sensory challenges. Anything you want to add to that? Yeah, definitely. So two things that I wanted to add. One is definitely this was a great opportunity to dive deeper into like what are those contributing factors? Because I would say that as you're mentioning, many kids with sensory challenges also experience a lot of emotion regulation challenges. Also actually a lot of individuals that have ADHD really have a lot of struggles with emotion regulation challenges. Some individuals on the spectrum have challenges with emotion regulation. So there's many different variety of diagnoses and other contributing factors that are definitely important to kind of pay attention to. And so if you're not sure about maybe some of those underlying contributing factors and again, we have so many other podcasts where we talk about additional diagnoses and how we really try to monitor all of those things. We definitely recommend to listen to some of those podcasts. But I definitely would say that's important because as Dr. E mentioned, one of the main things we do is yeah, we do we track the triggers. So we have a parent trigger sheet where we really try to pay attention to like like all the things she just mentioned, like when are we noticing that they're overwhelmed, that they're overstimulated, that they're hungry, that they're tired, that you know, maybe they're feeling jealous of their sibling or you know, whatever it might be, right? There's so many variety of of triggers. And so I think that that's really important. It was interesting because I worked with a family where I worked with them for a while and it was interesting because the child, she was seven, she always got dysregulated after school. Always she would come home every single 330 meltdown and parents tripped like they tracked it. We did the lookless and learn where we were really trying to like understand it more and turns out, you know, I mean, this was later on in treatment, but turns out she actually had ADHD. She had underlying ADHD and we learned more about that as we were talking about some of her underlying academic challenges, how she really had a lot of hard time, you know, she was very inattentive and definitely very hyperactive and couldn't like I said, she was very stuck in school so she would have those alphas. Just the subtlety of shifting her evening routine where parents initially they were like, we have to get all the work sheets done before dinner because she also had a younger sibling and so like we had to like get everything done. The parents were very rigid and structured and which again, structure helps, but we learned that just the subtlety of giving her 30 minutes of run around time has made a tremendous shift in her motion regulation. So just shifting by like instead of starting with the work sheets where she's been literally stuck all day at school, she needs to just move around. She really just like needed to move and so that made a huge difference. And so what I would say is as you're listening is thinking about like what is it that again triggers my child and also remember for children, they don't have the verbal language to share maybe what's causing their shutdown, right? So I always say this and I say this a lot of community camp like for those kids that have emotion regulation challenges, they're telling us something, they might not use the words but their actions are telling us that like there's something that's not feeling right, that's why they're getting reactive. So as adults, we've learned to be communicative and we might share like, hey, I'm feeling a little anxious right now like or I really just need to like have a minute to myself, I need to decompress. Kids don't necessarily have that language, they also might not have that cognitive ability at that point to think through those things. So one that's where like a treatment provider can come in and we can help with that but the other component is really kind of understanding that too that they're not trying to be disruptive, they're not trying to become dysregulated but there's unfortunately reasons for that. So the hope is that all the things that we're sharing hopefully can be can be helpful in kind of trying to decrease some of those challenges. No, I think that that's just really important to know and for our listeners that these dysregulated behaviors, there's so many reasons for it and rather than what you do as a parent because I get it, I'm a parent too, is you get frustrated and part of the frustrations, you don't know why it's happening and what to do about it. But it is a sign and we need to kind of step back and one of the things you said which I was really glad you brought up is we as parents have our own agenda. Yeah. Right? We have our own agenda. We're going to do this then we're going to do that then we're going to do this and we're going to go there. As an adult, you can make and decide if you're going to change your plans. Oh God, I'm tired. You know what? I'm not going to do the laundry today. I'm going to do it tomorrow. I don't feel like dealing with it. I don't want to go to the store today. I know I needed to go to the card store and get birthday cards. I'm just going to go tomorrow. I'm just beat. Well, I'm frustrated. You know, I had a tough day at work. But when you're a child or a teen and your parent kind of is like kind of, I don't want to say we're dictating, but kind of like, you know, that's the plan. We're going to go here. We're going to do this then we're going to go get there. We're going to get shoes. We're going to get our haircut. We're going to do this as a child. You're going to react behaviorally, right? And so sometimes we have to say, hey, maybe my child's too tired today to work on her goals or games. You know, like what's going on? And then if they're old enough, you can say, hey, you know, you seem a little tired. Maybe we do it after dinner or you know what, we do it twice tomorrow. You have to have flexibility when you're working with anyone. When you have a child that has anxiety at just a child in general, you've got to be flexible, you know, authoritative and parenting, not authoritarian. And we work with a lot of parents that go, wow, I didn't even think of that. You know what? I was supposed to go to a cocktail party last Friday with my husband. I was just beat, but I just said, go without me. I'm tired. Well, with our kids, we're taking them to the store. We're going here. We're going there and sometimes I just want our listeners to say, hey, you know, this makes sense. Maybe this is like you said Coming home from school sitting in school all day being kind of pent up. Maybe they need time to run around. Maybe they need a snack Maybe they need well in school. Maybe you know what I mean? Maybe they're having a sugar low So I think it's really you know important with that you know flexibility When you see a child being very controlling wanting things to be a certain way resisting transitions again That's a challenging behavior and often all of these things that we're talking about controlling behaviors emotional dysregulation shutting down avoidance There's signs of discomfort. They're telling us something. Yeah, and we talked about the wise We talked about the social communication anxiety not knowing what went and where which is such a big Thing and this is why so much of what we do with our CBT based as cat is viewing the whole person and helping them know what went and where through our action plans Sandwich questions the high-by game the common questions the guests who the interviews the I am and I just statements There's so many games and goals that we work on to help the kids know what went and where and to be ready for Conversations and to respect their stages on the bridge You mentioned a lot about the wise with sensory issues noise Visual overwhelm crowded spaces physical, you know, we didn't talk a lot about like clothes and you know I'm thinking about my little granddaughter. Yes, everyone. I'm a grandma But I remember for her naming she was wearing a dress that was just not comfortable and it was itchy And she just was like irritable and we weren't used to her being that way Well, she couldn't say this dress is itching me so she reacted behaviorally she cried That was so unlike her to be crying like the way she was and as soon as we realized whoa She's just uncomfortable in that dress We changed her she was as happy as can be now. Of course. She wore a onesie to our baby naming because we didn't have another dress But and you remember this Little Ellie was just really irritable from the dress But many of our sensory kids don't do well with closed tags, you know hair brushing Again, they're not being difficult. It's they're reacting to a feeling. Yeah Yeah, they're reacting to a feeling and we talked about emotional dysregulation and How this internal anxiety could spill over they may appear calm and then suddenly melt down Difficulty labeling and expressing feelings. I mean you want to talk about that because like you said a lot of our kids even our Older kids our teens a big part of what we do is we help them understand feelings It's such a big part of what we do and rate and grade their feelings and respect what they feel Yeah, I mean, I would say that like again There's a variety of reasons for why maybe emotions are really hard to identify So that's again where like those contributing factors are really important to understand into the maintenance because there's certain Individuals for example like there's some individuals on the spectrum where just labeling emotions can feel really really challenging Right and so being aware of like well, what is causing maybe some of these challenges? But what I would also say is you know sometimes even like our speech and language chat like Challenge children Or teens and young adults like even that expression piece of so open-ended can feel really overwhelming right because they might have an expressive language challenge So there's so many variety reasons, but we use you know many different types of interventions one of the interventions that we use is something called a feelings chart Which I feel like we've talked about in here before But you know for younger kids we've read it from like a zero to three older kids at zero to five But it's the same thing. It's just more about you know having more complexity with your feelings as you get older So zero to three for younger kids being like three being the most scary right zero to five five being the most anxiety Provoking the most difficult and as the numbers go down into a zero It's like most comfortable or for a younger child. I always say it's like super happy right super comfortable So many times we just start with that we try to label our feelings like how did it feel when we came into the session today? You know to that feel pretty younger child super scary medium scary like medium happy or super happy right for an older teen Like let's talk about it like what did that feel like did it feel like a five which was like super super uncomfortable really anxiety Provoking was it more like a four which is like a little bit less than a five, but it's still pretty anxiety Provoking three is kind of like in the middle right two is like a little bit less One's obviously a little bit less than zero is like where we feel really really comfortable And so we'll really identify like each aspect so for some teens like I will literally differentiate between like what is a one feel like comparatively to a two comparatively to a three and like we'll talk about all those different things and what's interesting is some individuals have challenges where things are either a three or there is zero And there's a lot of the in between that's really hard to differentiate so that's where a lot of times that Education could come in like I just had a child I worked with yesterday and she does really well with her feelings chart she's six but she kept saying everything was a three or a zero and I said Well, so so when we started doing sounds in the session Because that was a really great strategy for her we do sounds into words and so she was trying to make some sounds and She'd rated that a zero and I said I was like well, you know I didn't notice that we did it so I created definitely not feel like maybe a two or three but I'm wondering did it feel like super super comfortable or do you think that like it was a little bit harder than when you were giving me some thumbs up You know just because we were starting to kind of make some sounds and so she was able to identify it was like a one for her so sometimes it's kind of us Either as the educators or you as parents kind of like helping them now we're not forcing a war like I'm not saying to her It has to be a one you know, I'm still giving her the autonomy But I'm trying to like help her differentiate sometimes like when things can feel a little scarier Versus not but I would say the feelings chart and we talk about this all the time It's a huge way when especially individuals difficulty labeling their feelings um to really start that process So a couple things you said so much great information there I have worked with a lot of parents over time where You'll hear the parent in session correct the child and what they feel well that shouldn't feel scary like You know her you've known her all your life that shouldn't feel scary or Why aren't you doing that why aren't you just asking the store clerk this question that shouldn't be hard And so without realizing they're dismissing the child's feelings yeah and what we've learned as we go through treatment with families Because so much of our work which is why we do all day parent education and support and work through Scenarios and role play and coach at communica and for 15 hours Is because you as a parent are the most critical component to the success of your child Your children don't come with a guidebook everywhere they go saying do this do this do this you are the facilitator So we have to work with you we have to train you We have to help you we have to support you It's such an important concept that so many parents are like well, I just need you to work with my child Ain't gonna work we work with your child But we learn and then we train you how to Facilitate how to help your child and what we have learned through treatment because I see the evolution as I work with the family And it doesn't take long you see the child open up more to their own parent when they feel safe and to be able to express their feelings without worry of dismissal Or without worry of invalidating them because it's so important our kids Don't feel comfortable in situations you can't fight them on it and children need that ability to reflect and Feelings journals, you know, there's so many even like on Etsy You know writing their feelings being able to get in tune to what they feel to be able to rate and grade and because Kids can't express themselves as well and there's lots of ways music therapy art therapy equine therapy All of these things are wonderful adjuncts to a treatment program But they're not the cure all and end all to be able to just support a child all the way through their social communication anxiety they need the skills they need the The strategies the interventions, but they're wonderful adjuncts that I can't say enough of To work with our kids to help them Identify to feelings and lower their anxiety and give them confidence and strength and courage It's amazing how these adjunctive therapies and that would be a wonderful podcast topic too But as they're working through this using numerical values as you said zero to three zero to five some kids will go Four and a half or four point three five and they get really into the nitty gritty of their feelings It gives them a way through the numerical value to label a feeling rather than explain a feeling. Yeah, it's very universal that Explaining why something happens why I feel that way is hard, but if they can relate to a number, you know, then it You know, it helps them relate to what they're going through so We often as you said zero or three we will say well wait a three is when Or a five is when you're really shut down like you said that when uncle Sally Sorry uncle Bill and aunt Sally were coming over you felt so scared and that was like a hundred Right it felt like a hundred so it so It you're now able to be able to high five uncle Bill that what does that feel like a hundred or is that feeling like You know, maybe a little lower so you got to give them words for their feelings sometimes you correct them So if they say it's really easy but it's not, you could say, well, really easy is when you're home with mom and dad and the words are coming out really easy. When you're at a restaurant, maybe it's a one or two. And one of the things that I love in session is they redo feeling charts all the time. Yeah. And they start to see that their comfort has increased. And they're feeling better about some of the games and goals they're doing and they went, wow. When I first started, it felt like this. Now it's feeling like much lower. And that's confidence booster. Yeah. And I will say to kind of like as a wrap up because I feel like this was kind of a good summary to kind of like finish up a lot of the things that we're talking about is believe it or not, the feelings chart can actually be an incredible way to minimize some of the emotion regulation challenges because sometimes when I do feelings charts with individuals, you don't realize how much you avoidance or the shutdown, right? Or some of the, I mean, emotion reactions or the controlling behavior stem from the fact that they don't have words for their feelings. And so that's where the feelings chart can come in and believe it or not, sometimes I'll have individuals rate how they're feeling before they do an exposure and after. And some of the avoidance could stem from the fact that they're not rating their feelings before they do something. So I was just working with a young adult the other day. And she comes in every time. She always tells me like how she felt when she does an exposure. And then I had a moment where I looked at her and I was like, well, wait a minute, we've talked about this before 'cause we were trying to add a new exposure and she was a little bit resistant. And I said to her, I was like, how do we feel sometimes like thinking about this before and she didn't know? And I said, I was like, I'm wondering, are we unsure how we're gonna feel because we've never really rated feelings before? Like we only rate feelings after. And she said, yes. And I was like, well, let's add that in. Like let's rate our feelings before and after because one, I wanted her to start seeing that there's something called anticipation anxiety. And so many times our anxiety is a lot higher before we do something than afterwards. And then also that could end up actually reducing shut down and avoidance because the more that we do things and we realize, wait a minute, that wasn't so bad. The easier it is for us to not avoid and to actually go forward and kind of engage in new scenario. So feelings charts can be very effective and just identifying how we're feeling but can also be really effective in helping us navigate some of these goals and interventions as well. - No, that's really helpful. I would like to do a part two on this about some additional strategies kind of sum up what we did. So perhaps the next time we meet, we're gonna finish this up for part two of basically big feelings, understanding difficult behaviors in children with SM. So we'll give you more as I call a meat and potatoes to this very, very relevant topic. So thank you listeners for a wonderful opportunity to share with you different aspects of SM, which is so much more than not speaking. And it's interesting the name of this podcast, unspoken words, so much of what our kids say without having to say it helps us understand them. And so if you have questions listeners, please write to us. Let us know your questions. Let us know what you're thinking. We love hearing topics you wanna hear about. You could write to smart center at selectivemutismcenter.org. Please in the subject line, forward to Dr. E. And they'll forward it directly to me. We're gonna answer these questions during podcasts, blogs, please read blogs. By the way, I don't talk about it enough, but so many wonderful blog articles or topics that are so relevant to this population, relevant for parents, for teachers, for professionals, for researchers, for older kids and teens, please go to the blogs. And again, it's summer coming up, end of school year, so much is happening. Thank you listeners. - Thank you. - Bye bye. Thank you for listening to unspoken words, a selected mutism podcast hosted by me. Dr. E. and the smart center. This episode and all episodes of unspoken words is produced by new edition productions. Don't forget to submit any questions you have from today's episode using our Ask Dr. E. form on our website. Just head to selectivemutismcenter.org/askdrere. I'd love to answer your question in a future episode or blog post. Remember, for the best of this episode in every episode of unspoken words, please follow the podcast on Instagram and YouTube. 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