Thursday, October 23, 2014

Dr. Jonine Biesman: Avoiding Crises Through Respectful Parenting

Photo of Dr. Biesman from theAAPN.org
[Image description: Woman w/beige skin,
long curly dark hair, & brown eyes,
smiling widely, directly at the camera.]
Dr. Jonine Biesman specializes in working with neurodiverse children and adolescents, as well as with their parents and larger family system. She is a training leader and interventionist in DIR/Floortime.

We talked with Dr. Biesman about best practices for parents who need help understanding and parenting kids with aggressive or self-injurious behaviors, about presuming competence in children who need communication support, and about the potentially dangerous costs of parent-enforced compliance. Here's what she had to say:

[Best practices] doesn’t just apply to autism. With any child, whatever age, whatever person, who’s having a hard time, the first step really is understanding. What is that behavior really representing, what is it a manifestation of, and what’s really being communicated. As soon as anyone’s needs are better met, then the function of such strong behavior isn’t needed.

I think that if parents are having a hard time understanding what’s behind a behavior, therapeutic help can be valuable — because somebody can sit down with parents, help regulate the parents, and go over reasons why [the child] may be having that reaction. It could be any number of reasons — sometimes people are simply sleep deprived, and prone to being more irritable and on-edge. Sometimes they are feeling very overloaded by the sensory environment. It could be something that’s accumulating, something that’s happening at school, for example a peer conflict or a mismatch between a teacher and the student.

Oftentimes, people will internalize their feelings until they escalate and get more intense. And sometimes children, adolescents, or young adults don’t themselves have a sense of why they’re feeling overwhelmed. And once someone’s angry and out of control, it’s hard for any of us to bring them out of that extreme of an episode. So the best work we can do is on the front end: really trying to read cues, and read signs.

If our children are trying to communicate something, there’s value in stopping and listening, rather than jumping in all the time with “that wasn’t right,” and going to a place of “well that broke a rule, and there needs to be consequences.” Instead, stop and listen, ask “what’s on your mind?” and ask “what can I help you with?” Say “I’m listening and I want to hear what you have to say,” and then just say nothing. Sometimes the fewer words from the parents, the better.

I get that not everyone on the spectrum has access to that kind of language, but whatever kind of communication system is in place, it's important to give the time for the person who's upset to share. A good resource in this area is Dan Siegel’s new book No Drama Discipline. It has a lot of what I think what parents really need, which are hands-on tools. In the back of the book there are 20 things maybe not to do when your child is misbehaving, and alternatives.

I think when you’re working through the relationship, you always want to be thinking about ways you can help. There are ways you can choose your words that won’t escalate a situation further. A lot of people get angrier when consequences are put forth, or when you’re trying to preach versus just explain something in a calm way. And when our children are very agitated or irritated, or aren’t able to access their cognitive capacities to problem solve, we want to be very calm.

We can choose our words carefully, and not overwhelm with too many words. Whenever you have something you want to impart to your child, there’s always a way to say it positively. For example, when a child has a hard time transitioning and shifting, and moving on to the next thing, you can always move into that kind of situation in the role of a helper.

It’s about saying “yes” with conditions, rather than always saying “no.” Framing in a way that is not threatening to a child, finding a way to let them know they’re going to get what they want, but first they might have to do X,Y, and Z -- and then they’ll be able to get back to what’s really important to them.

Crisis situations are tough, especially when a kid is self-injurious or is in the midst of an aggressive episode. You always want to try to understand the function of a behavior; if a child is self-injuring it may be because they are in a great amount of pain, to the point where they feel numb, dissociated, and disconnected, and self-injury makes them actually feel something. There’s always a function. But do we want someone to continue to injure themselves, to bang their head against a wall? No. You can always say, “I want to help you, and a pillow might feel better. If you really need to feel something right now, let’s try this.”

When it comes to something like sibling interactions, or a parent and child dyad, and there is violence in that dyad — you can always start from day one, impressing on your child what your family values are, letting them know “we are not an aggressive family.” They need to know they have other options. Engage the child, have them come up with ideas for some of those other options. Make sure they’re part of that problem-solving process. You can also talk about another value in your family being forgiveness.

And model for your child! We’re always going to have reactions that we regret. We’re going to have times when we’ve overreacted, or didn’t take a moment to listen, or we thought to ourselves afterwards, “wow, I could have handled that better.” We can take those moments, and we can talk about those moments, and we can repair. We can say, “I’m sorry that I used a loud voice, I never want to be scary,” or “I love you guys so much, I don’t want to yell at you guys, that’s not what I want to do.”

Then it’s about having family meetings about how you all want to be interacting with each other. And it’s always OK to go back when you aren’t so heated, and sit down with your kid, and say “You know, I’ve been thinking about this, and I could have done this, and let’s do it this way.” You can go back on ultimatums. Because parents will say irrational things in the heat of the moment. So you have to be aware that a multitude of such things piling up can create harm, can create a break in the relationship. You always have to be working on the parent-child relationship, like any relationship.

You have to nurture relationships. You have to give them time. You have to make sure there are plenty of loving, bonding, connected moments. When you have that as a foundation, there’s more room for mistakes to be made on the child’s part and the parent’s part, and you can get past “transgressions.”

Children with communication challenges often understand more than people think they can, of course. And certainly someone can pick up on a softer tone of voice versus a harsh tone of voice. Human understanding and touch and hugs and rubs on the back — we’re pretty innately wired for reading those cues. I would venture to say that any kid with autism would be able to pick up on some of those subtle human kinds of feelings, and distinguish between something scary and something pleasant.

What’s so amazing about the work that Siegel does, is he asks parents address the ghosts in their own closets first, and understand why they’re making their parenting choices. Because we all have our own histories, and our own exposure to our own parents. Examining that, in terms of the choices that we’re making, is really important. Looking inside ourselves first.

As a developmental interventionist, I’m not a huge fan of the term ‘compliance.’ Realistically, compliance is a necessary part of life in some ways. We need to listen to our parents, we need to be cooperative. But ‘cooperation’ has a very different tone than ‘compliance.’ If we try to force our kids into compliance, it’s almost like we’re trying to make them trained animals, in a zoo. And they’re human beings.

So instead of compliance, why don’t we think about how we can work cooperatively, together, and absolutely listen to not only your child’s cues, and what your child is saying. It’s really important, because sometimes your child is not only giving very strong messages, but is trying very hard to tell their parents what’s going to work for them and what’s not going to work for them -- and ignoring those cues can have some very dire consequences.

You need to listen to your kids, you need to listen to yourself, and you need to ask yourself why compliance is so important to you. Or is there another way to look at the situation, or think about it.