The Edmonton Educator’s Workshop Series | HANDOUTS

TABLE OF CONTENTS 1

DAY ONE Workshop #1: Proven and Effective Interventions to Enhance Executive Skills in pg. 2

Children & Adolescents | Peg Dawson, Ed.D., NCSP

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DAY TWO Workshop #2: Optimizing Self-Regulation and Managing Big pg. 11

Emotions | Caroline Buzanko, Ph.D., R. Psych

23

DAY THREE Workshop #3: Working with Highly Emotionally Dysregulated Children & Adolescence | Eboni Webb, Psy.D., HSP

pg. 100

EDUCATORS WORKSHOP SERIES - 2024

Executive Skills Questionnaire — Peg Dawson & Richard Guare Step I: Read each item below and then rate that item based on the extent to which you agree or disagree with how well it describes you. Use the rating scale below to choose the appropriate score. Then add the three scores in each section. Use the Key on page 2 to determine your executive skill strengths (2-3 highest scores) and weaknesses (2-3 lowest scores).

Strongly disagree Disagree Tend to disagree Neutral

1 2 3 4

5 6 7

Tend to agree Agree Strongly agree

Item 1. I don’t jump to conclusions 2. I think before I speak.

3. I don’t take action without having all the facts.

Your score

YOUR TOTAL SCORE:

4. I have a good memory for facts, dates, and details.

5. I am very good at remembering the things I have committed to do.

6. I seldom need reminders to complete tasks YOUR TOTAL SCORE:

7. My emotions seldom get in the way when performing on the job.

8. Little things do not affect me emotionally or distract me from the task at hand.

9. I can defer my personal feelings until after a task has been completed YOUR TOTAL SCORE:

10. No matter what the task, I believe in getting started as soon as possible.

11. Procrastination is usually not a problem for me.

12. I seldom leave tasks to the last minute YOUR TOTAL SCORE:

13. I find it easy to stay focused on my work.

14. Once I start an assignment, I work diligently until it’s completed.

15. Even when interrupted, I find it easy to get back and complete the job at hand.

YOUR TOTAL SCORE:

16. When I plan out my day, I identify priorities and stick to them 17. When I have a lot to do, I can easily focus on the most important things .

18. I typically break big tasks down into subtasks and timelines.

YOUR TOTAL SCORE:

19. I am an organized person.

20. It is natural for me to keep my work area neat and organized.

21. I am good at maintaining systems for organizing my work.

YOUR TOTAL SCORE:

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Strongly disagree Disagree Tend to disagree Neutral

1 2 3 4

5 6 7

Tend to agree Agree Strongly agree

Item 22. At the end of the day, I’ve usually finished what I set out to do.

23. I am good at estimating how long it takes to do something.

24. I am usually on time for appointments and activities.

Your score

YOUR TOTAL SCORE:

25. I take unexpected events in stride.

26. I easily adjust to changes in plans and priorities.

27. I consider myself to be flexible and adaptive to change.

YOUR TOTAL SCORE:

28. I routinely evaluate my performance and devise methods for personal improvement.

29. I am able to step back from a situation in order to make objective decisions.

30. I “read” situations well and can adjust my behavior based on the reactions of others.

YOUR TOTAL SCORE:

31. I think of myself as being driven to meet my goals.

32. I easily give up immediate pleasures to work on long-term goals.

33. I believe in setting and achieving high levels of performance.

YOUR TOTAL SCORE:

34. I enjoy working in a highly demanding, fast-paced environment.

35. A certain amount of pressure helps me to perform at my best.

36. Jobs that include a fair degree of unpredictability appeal to me.

YOUR TOTAL SCORE:

KEY Items 1-3 7-9 13 - 15 19 - 21 25 - 27 31 - 33

Executive Skill Response Inhibition Emotional Control Sustained Attention Organization Flexibility Goal-Directed Persistence

Items 4-6 10 - 12 16 - 18 22 - 24 28 - 30 34-36

Strongest Skills

Executive Skill Working Memory Task Initiation Planning/Prioritization Time Management Metacognition Stress tolerance

Weakest Skills

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Executive Skill Definitions •

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Response Inhibition: The capacity to think before you act – this ability to resist the urge to say or do something allows us the time to evaluate a situation and how our behavior might impact it. In the young child, waiting for a short period without being disruptive is an example of response inhibition while in the adolescent it would be demonstrated by accepting a referee’s call without an argument.

Working Memory: The ability to hold information in memory while performing complex tasks. It incorporates the ability to draw on past learning or experience to apply to the situation at hand or to project into the future. A young child, for example can hold in mind and follow 1-2 step directions while the middle school child can remember the expectations of multiple teachers.

Emotional Control: The ability to manage emotions in order to achieve goals, complete tasks, or control and direct behavior. A young child with this skill is able to recover from a disappointment in a short time. A teenager is able to manage the anxiety of a game or test and still perform.

Flexibility: The ability to revise plans in the face of obstacles, setbacks, new information or mistakes. It relates to an adaptability to changing conditions. A young child can adjust to a change in plans without major distress. A high school student can accept an alternative such as a different job when the first choice is not available.

Sustained Attention: The capacity to maintain attention to a situation or task in spite of distractibility, fatigue, or boredom. Completing a 5-minute chore with occasional supervision is an example of sustained attention in the younger child. The teenager is able to attend to homework, with short breaks, for one to two hours.

Task Initiation: The ability to begin projects without undue procrastination, in an efficient or timely fashion. A young child is able to start a chore or assignment right after instructions are given. A high school student does not wait until the last minute to begin a project.

Planning/Prioritization: The ability to create a roadmap to reach a goal or to complete a task. It also involves being able to make decisions about what’s important to focus on and what’s not important. A young child, with coaching, can think of options to settle a peer conflict. A teenager can formulate a plan to get a job.

Organization: The ability to create and maintain systems to keep track of information or materials. A young child can, with a reminder, put toys in a designated place. An adolescent can organize and locate sports equipment.

Time Management: The capacity to estimate how much time one has, how to allocate it, and how to stay within time limits and deadlines. It also involves a sense that time is important. A young child can complete a short job within a time limit set by an adult. A high school student can establish a schedule to meet task deadlines.

Goal-directed persistence: The capacity to have a goal, follow through to the completion of the goal, and not be put off by or distracted by competing interests. A first grader can complete a job in order to get to recess.

A teenager can earn and save money over time to buy something of importance.

Metacognition: The ability to stand back and take a birds-eye view of oneself in a situation. It is an ability to observe how you problem solve. It also includes self-monitoring and self-evaluative skills (e.g., asking yourself, “How am I doing? or How did I do?”). A young child can change behavior is response to feedback from an adult. A teenager can monitor and critique her performance and improve it by observing others who are more skilled.

Stress Tolerance: the ability to thrive in stressful situations and to cope with uncertainty, change, and performance demands. We generally reserve our discussion of this skill to adults, since it seems more relevant with this population. We find it helps people understand the kind of work environment they do best in.

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EXECUTIVE SKILLS BEHAVIORAL DESCRIPTORS 1. Brings gym clothes on days student has gym class.

2. Homework and worksheets may be placed in any number of notebooks, books, or folders.

3. Sharpens pencil, chats with classmates or takes long bathroom breaks before getting down to work on in-class math assignment.

4. Able to do classroom presentations despite fear of public speaking.

5. Wants to make the 1st string soccer team but can’t bring himself to practice ball handling skills.

6. Figures out the steps to follow to get a summer job.

7. Decides to improve math grade and increases study time for tests and quizzes.

8. Out of seat frequently during independent work time.

9. Takes notes in lecture classes and asks relevant questions.

10. Builds in extra time to complete a given task knowing there could be an interruption.

11. Struggles with creative writing assignment because can’t think of anything to write about.

12. Does work carefully and checks answers before handing in test/assignment.

13. Writes down homework but doesn’t think to check assignment book when gets home.

14. Chronically late for school.

15. Finishes an entire homework assignment before taking a break.

16. Shuts down when criticized by teacher 17. Student places documents in appropriately labeled folders on her computer.

18. Frequently makes faulty assumptions about assignment directions and doesn't check with teacher before starting the assignment.

19. Friend bails on afterschool activity; student adjusts with back-up plan.

20. Says rude or hurtful things to kids.

21. Starts homework without prompting from an adult.

22. Given 4 homework assignments on a given night, can’t figure out what to do first.

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EXECUTIVE SKILL

POSITIVE EXAMPLE

RESPONSE INHIBITION WORKING MEMORY EMOTIONAL CONTROL FLEXIBILITY SUSTAINED ATTENTION TASK INITIATION PLANNING/PRIORITIZING ORGANIZATION TIME MANAGEMENT GOAL-DIRECTED PERSISTENCE METACOGNITION

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NEGATIVE EXAMPLE

Strategies for Specific Executive Skills Executive Skill Response Inhibition

Possible Strategies Post home or classroom rules and review regularly Prompts in advance about expected behavior Arrange for in vivo practice or behavioral Visual cue on desk to remind them to work rehearsal quietly Wristband reminder (e.g., to raise hand to talk) Help student build in technology breaks rather Talking stick (cue to talk) than combining homework with technology use Sticky notes to write something down rather Sit near teacher than interrupting

Working Memory

To-do lists (paper, white board to post prominently) Colored wristbands to remind student of homework assignments Post-it reminders Laminated lists (e.g., by door at home or on inside of locker door) to remind kids what they need to take with them Songs and rhymes as memory aids Ask student what cues they think work for them (e.g., how they might use smart phone to provide cues)

Emotional Control

Help student write a script to follow Have a “cooling off” space Prepare student by asking them to predict what will happen/how they will handle it Review expectations in advance Teach students to label emotions Teach kids: “respond don’t react”

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Teach Principle of “off-loading” Off-loading: This refers to the idea that the brain doesn’t have to work as hard when you can find a way to “offload” some of the tasks we’re asking it to do. Examples: the brain doesn’t have to allot space to remembering homework assignments when we write them down. It doesn’t have to work at remembering something we have to do after school if we build an alarm into our smart phone to remind us…

Teach kids to recognize situations or early signs Teach coping strategy Rehearse the strategy repeatedly until it is internalized Teach mindfulness meditation Self-talk to plan in advance (If/Then: If this happens, then I will….)

Executive Skill Flexibility

Possible Strategies Use language to showcase flexibility “Normalize” errors (stuck/unstuck; big deal/little deal; Plan B) Preview changes in schedule Do It Later folder (for kids who have trouble Praise kids for being flexible leaving a task undone) Role play handling situations that require flexibility

Sustained Attention

Reduce distractions (seating arrangements, white noise) Modify/limit task length or demand (end in sight) Build in variety/choice Help student choose best time of day to work on effortful tasks Use fidget toys such as stress balls Movement breaks Wiggle cushions/study carrels; dead headphones; listen to iPod; quiet desk/noisy desk/standing desk; “theraband” on front two legs of chair to allow movement

Time Timer (make time visible) Sand timer (real or app) Identify distractors and figure out how to remove or work around them Have the child identify something to look forward to doing after work is done Teach to track time on task using index card or sticky note Have students set goals (how long can you go before you need a break?)

Task Initiation

Establish set time to do non-preferred tasks Teach 1-2-3-Start strategy (student lists the first 3 things they need to do in a work session and then they do them in order) Make a list and break into bite-sized chunks Use alarm on smart phone to remind student to start (If they’re not ready to start, have them hit “Snooze” rather than turning the alarm off)

Help student make a plan for doing the task and include the start time Practice getting started in isolation—start with a short, easy task and just practice starting it at the planned start time Help student figure out what’s preventing them from getting started and design an appropriate strategy (see Form in Task Initiation folder in Dropbox)

Planning

Teach to use a planning template Help student design a plan/template Start with big picture; plan backwards Help student find planning tools that work for them (calendar, agenda book, apps) Break task down with a visual (e.g., dividing reading assignment into pages per day) Put each step of a project on a separate index card or post-it and rearrange to create the right sequence

Make a road map Help student select a graphic organizer that meets the need Walk through the planning process (use a template) Have them plan a simple task and gradually prompt to do more of the planning themselves Ask questions to get student to prioritize (What do you need? What should you do first?)

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Executive Skill Time Management

Possible Strategies Create a color-coded chart showing student their Write each task on a post-it and place it on a weekly schedule and where the discretionary time is large dry erase calendar so that it can be moved (school; sports or extracurricular activities; travel to as needed. and from school; chores or family obligations; study Use a dry erase board for planning with columns time) for Task, This Month, This Week, Today, Done.

Practice estimating how long it takes to do Have student move post-its from left to right. something.

Goal-Directed Persistence

Make sure the goal or benchmark is in sight—post it visually (e.g., a picture of the reward they’re working for) Help them set “Personal Best” goals (i.e., incremental improvement) and teach them about Outcome Goals (“Last week I got a 75 on my math quiz. This week I’ll shoot for a 78.”) and Process Goals (“Last week I studied 20 minutes for my math quiz. This week I’ll study for 30 minutes.”) Talk about the advantage of focusing on Process Goals.

For students who are resistant to goal setting: Define a goal as something that people want to get better at or to change.

Start with helping them set a goal for something they want to do outside of school.

Skip the word “goal” and talk with them about making a plan (starting with one thing they want to do before the next coaching session)

Metacognition

Help student create sample to match or error monitoring checklist Embed metacognitive questions into instruction/conversations Help student decide on how performance will be evaluated Have the student evaluate their own performance Model thinking aloud to solve problems

Use different strategies—ask kids to evaluate which worked best Use Problem Solving Template Teach students to ask questions o What’s my problem? o What’s my plan? o Am I following I my plan? o How did I do?

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Optimizing Self-Regulation & Managing Big Emotions Dr. Caroline Buzanko, R. Psych. caroline@korupsychology.ca drcarolinebuzanko.com

Self-regulation is Important for:

LEARNING

POSITIVE SOCIAL INTERACTIONS

LONG-TERM HEALTH AND WELL-BEING

OVERALL SUCCESS IN ALL DOMAINS

Understanding Self-regulation Affects:

ATTENTION

BEHAVIOURS

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SOCIAL INTERACTIONS

PERSISTENCE

MOOD

Self-Regulation Foundational for Overall Success • • • • • • • •

Adaptive functioning Learning Emotion regulation Communication Social functioning Long-term health and well-being Vocational success Managing self without others

Independence

Understanding Self-Regulation The ability to process and manage thoughts, feelings, impulses, and behaviours.

Self-Regulation: Managing Self to Attain a Goal

Any action students direct themselves to

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Create change in their behaviour

Change the likelihood of future consequence/ attain goal

To adjust, we need to be aware of:

• Changes in our environment • How we are feeling • How we are behaving • How to respond adaptively when upset • How to be flexible and adapt to a situation • How to resist an emotional outburst

Self-regulation

Range of skills that help students to adapt to a situation or meet a certain goal (flexibility key!)

Self-regulation Building Blocks Behaviour

Sensory Processing

Emotion development

Attention

Executive functions

Planning and sequencing

Receptive language

Social skills

Working memory

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Self-Regulation Interconnected Domains Biological Physiological response to stimuli.

Largely automatic, but can be influenced by factors such as hunger, fatigue, and illness.

Emotion

Cognitive

Social

Prosocial

Affective responses such as anxiety, sadness, or frustration.

Focus, planning, and problemsolving abilities.

Social interaction and understanding the subtleties of human relationships.

Empathy, kindness, and connection with others.

Emerges at 2 months

Rudimentary selfsoothing

2 months

Self-regulation Starts Early & Develops Over Time into Adulthood

Aware of expectations By 18 months Change behaviour with direction – adults still nearby

2 years

Follow established rules even with no adults

3 years

Act how they think others would want them to

Self-regulation

Is voluntary and effortful/intentional response

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Remember rules + anticipate consequences… …to manage thoughts and emotions…

Effortful

…to guide behaviour and make positive choices about what to do next

Prerequisites!

Internal self-talk to guide behaviour

Think before acting, remember rules and consider consequences

Look backward or forward Mentally manipulate/visualize events Imitate complex behaviours

Effortful coping Use internal resources to manage effectively

Managing energy levels

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Self-regulation Difficulties • Low CONFIDENCE to regulate emotions • Limited knowledge and clarity about emotions • Poor goal-directed behaviour when upset ***Stress becomes too overwhelming

Energy Depletion

Get dressed Eat breakfast Be nice to your sister Pack your backpack Brush your teeth

Drains already limited resource pool: Toxic Effects

If you don’t get done, no iPad after school

Example Stressors Depleting Energy Biological

Emotion

Cognitive

Social

Prosocial

Loud noises, sensory overload

Changes in routine, transitions

Put on the spot

Bullying

Empathy overload Moral dilemmas

Leaving parents

Uninterested in a topic

Social media pressures

Pain or discomfort

Injustice to self or others

Over-excitement

Information overload

Peer pressure

Inadequate or irregular sleep

Distractions

Friendship fires

Fast pace, time pressures

Family conflicts

Feeling undervalued or unappreciated

Lack of clear instructions

Social anxiety or shyness

Feeling unsupported

Language barriers

Miscommunications

Negative self-talk

Complex problem solving under pressure

Disagreeing with what someone is saying

Memory demands

Conflict between personal values and societal expectations Being undervalued or unappreciated

Lack of physical activity Sitting too long Screens Poor diet

Fear of making a mistake Trauma

Dehydration

Anxiety, sadness, anger, frustration

Too hot or cold

Guilt or shame

Allergies or intolerances

Clutter

Being in a social setting alone

Feeling overwhelmed with work Inability to express emotions

Unfamiliar or new environments Inconsistent routines

Sharing ideas as part of a group plan Missing friends

Lack of exposure to natural light

Feeling powerless Uncertainty

Lack of feedback on performance

Navigating complex social hierarchies

Discomfort in clothes

Loneliness

Concentrating for long

GI problems

Trouble making friends

Social exclusion

Homework

Overexertion

Pressure to perform

Making choices

Cultural assimilation challenges

Medication side effects

Relationship conflicts

Being a minority

Lack of natural light

Busy schedule

Feeling unloved or unsupported

Disorganization

Lack of empathy

Frequent task switching

Managing social commitments

Illness Poor air quality – classrooms!

Stress from life changes

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EF challenges

Navigating societal norms and rules

Observing or learning about widespread suffering Witnessing distress without being able to help

Self-regulation Difficulties • • • • • • • • • • • • • • • • •

Subjective reactions to events Difficulty covertly emoting and motivating Difficulty with delayed gratification Difficulty with perseverance Sensory sensitivities Day dreaming Tired easily Poor attention and easily distracted Poor motor skills Poor sleep Picky eater Hygiene tasks distressing Seek movement/pressure Poor social communication Rigidities Immature & social difficulties Emotional roller coaster

They need help!

If stress is too overwhelming, students can’t self-regulate on their own.

Reserve and replenish their resources as much as possible!

Consider Brain Differences! (Makes self-regulation even harder) Sensory Processing

• Sensory overload • Unable to modulate emotional responses to sensory stimuli • Can interfere with self-soothing capacity

Sensory Accommodations

Language

• Difficulties expressing emotions • Miscommunication • Limited emotional vocabulary, which impedes recognizing and regulating feelings

Communication Supports

Executive Functioning

• Poor impulse control • Poor planning and organization that can lead to procrastination and last-minute stress • Working memory essential for self-regulation • Limited flexibility

Coaching and Supports

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Examples Sensory Processing

Language

Executive Functioning

• Sensory-friendly environment • Sensory breaks • Visual schedules (to prepare for sensory-rich activities or transitions) • Sensory tools and accommodations

• Effective communication • Visual supports and cues, prompting • Simplified language • Repetition and clarification • Alternative communication (AAC) devices

• Visual organization • Time management techniques • Break tasks down • EF coaching • Routines and predictability

 Can’t learn  Can’t remember  Brain seeks pleasure (stop trying/putting in effort)  Reactive response (fight/flight/freeze)

When stressed, self-regulation is near impossible

 Intense emotions  Behavioural and emotional outbursts  Impulsivity  Rigidity  No self-reflection  Unable to take perspectives  Disengagement 24

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• Aware of behaviour and rules • Within their capacity to act differently

None of these capacities: Behaviours serve to protect

Social disconnection and loneliness

Identity and body Issues

Lack of downtime

Helplessness and hopelessness

Peer pressures

Parents

School

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Multiple pressures and high expectations

Social media

Stress

Local and world news

Self-esteem • False messages to avoid rejection • So happy!

• So beautiful!

• “Likes” worsens self-esteem Others won’t like the “real” them.

As social media time Increases

Perceived exclusion and social isolation also increases

Massive-Scale Emotional contagion • We begin to experience the same emotions as others without our awareness • Long-lasting moods (e.g., depression) can be transferred through social networks

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FOMO

Most important relationship for bonding and overall development

Family Connection

No longer turning to parents to debrief day and hurts

Discovering: • Self • Values • Pe r s o n a l i t y • World

Screens are replacing parents and disrupting family development

Technostress • Hard to detach = chronic stress • Shame & stigma If not connected

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Bullying doesn’t happen privately anymore

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Sending unsolicited and/or threatening e-mail.

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Encouraging others to send e-mail or to overwhelm the victim



Posting/spreading rumours.

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Making defamatory comments online

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Sending negative messages

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Sexual remarks

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Posting the victim’s personal information

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Hate speech

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Impersonating the victim online

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Harassing the victim

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Leaving abusive messages online, including social media sites

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Sending the victim pornography or other graphic material that is knowingly offensive Creating online content that depicts the victim in negative ways

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Trolling

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Cyberstalking

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Hate raids

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Digital Immigrants vs.

Digital Natives No issue big enough to risk being disconnected 35

Loneliness Poor School performance

Self-esteem

Depression

Screen time

Disordered eating

Withdrawal

Anxiety

Suicidal planning

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Suicidal ideation

Numerous factors influence our ability to cope

Child • Coping & Self-regulation • Self-confidence • Social Skills

Numerous factors Community influence our ability to cope Society Family

• Parenting • Relationships • Connections

Public policies

Neighbourhood School Mass media

Communication Peers

Social values

Services

Tech

Models Child

Sibling SES Factors

Attachment

• Connections with peers • Educational settings • Healthy risk-taking opportunities

• Policies • Values • Legislation

Infra-structures Community Cohesion

Caregiver Co-Regulation

Caregiver Co-Regulation

Caregiver Co-Regulation

Co-Regulation

Caregiver Co-Regulation

Regulation

Cultural norms & values

Preschool

Childhood

Adolescence

Young Adult

If not filled, affects emotional, cognitive, and behavioural outcomes

Infant/Toddler

Optimal Functioning through Co-regulation Nurturing & maintaining emotional balance

Scaffolding support

Coaching and modelling

Effective adult role to help kids understand and adjust their thoughts, feelings, and behaviours. Help maintain balance.

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Individual factors

Self-regulation Pyramid

Opportunities Social connection

Supportive environment

Supportive Supportiveadult adult relationship relationship

GREATEST SUCCESS: CHANGE THE WORLD (Multiple systems)

Connection •

Fundamental priority

•

Physiologically constantly seeking connection

•

Critical for self-regulation

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Optimize Self-Regulation Through Relationship Down-regulate “negative” emotions • Being • Tolerating • Validating

Adult self-regulation

•Avoid passing own stress on to kids!!!

Safe environment

Criticizing

Supports

Minimizing

Validates

Punishing

Perspective taking

Own emotion dysregulation

Own emotion regulation

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Child emotion dysregulation

Adaptive child emotion outcomes

Adult Emotion-Related Behaviours

• What is going on for me?

Stress is Contagious

• Am I being patient? Warm?

Responsive?

• CO-REGULATION critical!!!

Need to Choice manage our own stress, perceptions Context & responses to build relationship Connection and provide:

Choice • No control = fight/flight • Choice is empowering & stimulates inner security and wisdom (Show trust in their own expertise and internal resources)     

Offer choices in interactions Lots of opportunities to establish control Choice through eliciting their inner wisdom Get meta!

Get mindful (noticing now) & follow that

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Context Builds Safety Nervous system always on alert • Are we safe?

• Is it safe to engage?

• Do I need to run away? Or shut down?

Reframe Thoughts about the child and their behaviours

Ability to Self-Regulate is Related to Identity • Identity and self-concept are co-created!

• Self-evaluation is based on their experiences and others’ appraisals • What are the consistent, repeated cues they receive over time?

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Consider feedback loops

Fail & Avoid

Fail & Avoid

Fail & Avoid

Fail & Avoid

Fail & Avoid

No such thing as bad kids.

What are behaviours?

Manifestations of what is happening in their nervous system

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Emotions Lead to Behavioural Responses

Anger

Assert, defend

Shame

Avoid

Fear

Sadness

Fight, Flee, freeze

Joy

Support, withdrawal

Excitement

Connect, engage

Attend, explore

Function of Emotions Disappointed

Lonely

Sad

Anger Guilty

Hurt

Worried

Embarrassed 56

Behaviours often adaptive for them

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• To get love, a need met, or support … because they don’t know how to get it any other way • To protect themselves from perceived lack of safety (emotional or physical)

Greatest predictor of ODD: Adult stress + negative perceptions of the child

Remember!

• Strong emotions limit flexibility and perspective taking • Emotions guide behaviours that seem most helpful in the moment • To hit the peer who bumped into them • To avoid something that could make us vulnerable

Perceive Students for Their FULL Potential

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Success

Success

Success

Success

Success

Lots of Rejection in the World

Our job is to create a sense of belonging and connection.

This is the basis of every strategy we use in any context.

The only real behaviour management you need….

Strong Relationship

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Relationship Major Protector Factor Positive physical and mental health Motivation Academic outcomes Academic self-efficacy Reduces risk outcomes • Violent behaviour, School failure, Substance abuse, Depression and other mental health challenges, Suicidal ideation, Unwanted pregnancy Major predictor of long-term happiness

Teacher Relationship • Promotes emotional well-being • Reduces problem behaviours • Improves school liking and engagement • Provides a sense of belonging

• Critical difference in outcomes for kids with behaviour difficulties • Greatly supports self-regulation • Greatest predictor of long-term happiness

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Safe, nurturing relationships…

Multiple adults at home, school, and community part of their fan club Mr. A

Mom

Bullied

Mrs. B

Coach Tim

Ms. W

Mr. Mr. K A

Math

Writing

Uncle Chris

Mrs. D

Relationship: How do you show up?

One small change in your interactions can be a gamechanger.

You have less than 6 minutes • Students need to feel liked and respected • What can you DO to strengthen your relationship with your students every day?

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Greet Every Day! •Stand just inside or outside the door or go around the room •Greet each student by name •Have a short positive interaction •Follow student’s lead Handshake, fist bump, high five, pinkie shake • Direct them to the first activity

What I need from you

Emotion Coach

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Always remember

• Focus on connection • Connect before correct!

Connection: Stay present Big emotions disrupts their ability to stay present and connected • We must create the space to do this • Our presence alone is often better than words

Give space for regulation

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What do you need from others when dysregulated?

We all need different things when we’re distressed

No matter what, they MUST believe:

We are on your side!

Even if they challenge, we still have to work hard

RESPECTFUL

POSITIVE

NONAGGRESSIVE

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ASSERTIVE

CARING

Open Supportive Communication = Connection Feel heard

Feel seen

Feel valued

My thoughts and feelings are worthwhile

Trust

Accepted/ Nonjudgmental

Positive energy in the relationship

Connection to Action

Listening

Demonstrating understanding

Valuing their perspective & what’s important to them

Responding consistently

Demonstrating warmth and positive regard

Meet THEIR needs

Effective Communication

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Adults don’t tend to understand children’s experiences and needs.

Our best intentions can work against us  We minimize or negate their feelings  We excuse away their feelings  Kids may believe we don’t want to hear how they feel  We might send the message we know best  The benefit from our hindsight is lost  We disrupt our connection with kids when we share advice or opinions

Effective Communication:

Become a Master Listener

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• Talk less listen more

Effective Communication

Disarm

Key to Success: Validation!

Validation Helps Disarm

They need to feel heard without judgment or criticism!

• Acknowledge the truth of their experience • Recognize and accept their thoughts and feelings (even if they don’t make sense or seem absurd!)

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Full attention/no distraction Show Lean in & nonverbals Interest Stay calm Paraphrase Reflect Clarify content Ensure you understand their perspective

Validation

Be hesitant!

Reflect Acknowledge nonverbals feelings Ensure you understand how they feel Validate Makes sense, given this situation the situation No wonder you feel this way!

Let me see if I got that. You said…

Did I get it?

Be prepared!

Is there more?

That makes sense…

Effective Communication What to Avoid!

• Talking too much • Emotional escalation • Nagging, lecturing, fixing, yeah butting • Power struggles • Jumping in with our agenda • Taking things personally • Negativity • Judgment • Becoming dysregulated ourselves

90

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Effective Communication

Unhelpful Communication

Actively listen Acknowledge their feelings Acknowledge their perspective Respectful and caring attitude Respect their autonomy Ensure they feel heard Self-regulate own emotions

Ignore their feelings Ignore their perspective Disrespectful and uncaring attitude Talk too much Emotional escalation Lecture, teach, or fix the situation Nagging, yeah butting Power struggles Jump in with our agenda Negative Judgment Dysregulated ourselves

How we talk is important

Replace negativity with curiosity

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Effectively expressing thoughts, feelings, and needs Verbal anger not directed to anyone

Helpful to remember!

Verbal aggression towards others Physical aggression towards objects Physical aggression towards others

When we have a strong relationship & know how to respond effectively WE CAN C O - R E G U L AT E

Self-regulation looks like:

Early Childhood (2-5) • Brief attention.

• Use rules and strategies to guide behaviour.

• Delay gratification for longer.

• Perspective taking and empathy.

• Language begins to control emotional responses.

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Adult relationship • Key for effective emotion regulation Teach

Early Childhood Co-regulation Considerations

• Expressing emotions & problem solving through direct instruction, modelling, and coaching Identify & Label • Observed emotions Model • Appropriate emotion management (e.g., self-talk) Prompt & reinforce • To follow the same process.

• Self-regulation supported through external consequences.

Role of Language Receptive and expressive skills related to executive functions & impulse control • Parent verbal skills also predictive of impulse control Language also important in learning strategies for self-regulation • Explain rules and talk through problems • Learn rationale for behaviours • Interpersonal communication • Negotiate adult demands and peer conflict • Verbal self-instruction to internal speech and later thoughts • Label emotions helps appraise their experience and how to react

Early Childhood Co-regulation to Self-regulation • Guided choices to promote a sense of control • Establish consistent daily routines to provide a sense of security and predictability.

• Use stories or play to discuss feelings and appropriate responses to different situations.

• Engage children in play activities that require turn-taking and sharing to naturally teach selfregulation in a social context.

• Encourage them to solve minor problems on their own with verbal guidance, fostering early decision-making skills.

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Early Childhood Co-regulation to Self-regulation Ideas for in the classroom • Visual and verbal cues to signal transitions between activities, helping children prepare for changes and reducing anxiety.

• Provide structured choices during activities to promote autonomy while ensuring the choices align with educational goals.

• Model appropriate social and emotional responses. Use role-play to practice these skills in a controlled setting, providing immediate feedback.

Self-regulation looks like:

Middle Childhood (6-12) • Not a lot of growth • Still an important time for skill development

• Internal speech to guide behaviour • Reflecting on one’s own thinking (to modify as needed) • Increased self-awareness of behaviour • Attention, flexibility, controlling impulses and emotions

• Understand and respond to others appropriately.

• Social problem-solving

• Self-regulation becoming more independent • Co-regulation still needed to manage difficult feelings, problem-solve social situations, and learn executive skills • More space to make decisions and self-monitor within structure and consequences

Adult relationship Teach problem-solving.

Middle Model conflict resolution.

Childhood Co-regulation Provide time and space to manage emotions.

Considerations Model, prompt, and reinforce developing skills.

Encourage independence in task completion with external consequences as needed.

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Middle Childhood Co-regulation to Self-regulation • Explicit teaching of specific strategies -

Managing emotions, managing time, monitoring work and behaviour, focusing attention, and being more independent through the day.

• Scaffolding for complex tasks: step-by-step guidance, gradually reducing support as their skills improve.

• Positive reinforcement for desired behaviours that promote self-regulation.

• Collaboratively problem-solve -

Encourage them to generate potential solutions, consider different options and consequences

Middle Childhood Co-regulation to Self-regulation Ideas for in the classroom • Implement classroom management strategies that encourage self-regulation, such as a place to reset their battery or a point system for self-monitoring behaviour.

• Use group projects to teach cooperative skills, turn-taking, and conflict resolution, requiring children to regulate their behaviour in social contexts.

• Teach skills directly • E.g., organization - how to keep a tidy desk or use an assignment notebook, providing regular check-ins and support as needed.

Adolescence (13-18+)

Self• Increased focus, selfand task regulation monitoring, completion. looks like: • Strategies to manage distress.

• Reward-seeking.

• Poor decisions in the moment.

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More reactive to stress

Adolescence Co-regulation Considerations

• Increase in reward sensitivity and sensation seeking • Stronger than cognitive regulation • Low impulse control • Peer context increases risky behaviours • Reduced avoidance behaviour • Experimentation and novelty seeking = Self-regulation is out of balance

More vulnerable to anxiety, depression, and risk behaviours

Adolescence

Adolescence

Co-regulation to Self-regulation

• Relationship • Effective communication - always supportive so they feel safe to express and manage their emotion • Invitations and seeds of guidance on coping mechanisms.

• Coach • EF skills & healthy stress management • Collaboratively problem solve • Encourage decision-making when regulated • Set and review goals • Set limits to reduce reward-seeking behaviours • Monitor task completion

Adolescence Co-regulation to Self-regulation • Encourage projects that require planning, research, and execution over longer periods.

• Teach and model effective time management strategies.

• Work with them to set personal goals related to selfregulation and actionable steps to achieve these goals.

• Gradually increase their autonomy over daily choices and responsibilities, providing guidance as needed while encouraging independent problem-solving.

• Foster an environment for open discussions about emotions and struggles without judgment, emphasizing collaborative solutions.

• Encourage self-reflection about their beliefs, values, and goals for identity development.

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Adolescence Co-regulation to Self-regulation

Ideas for in the classroom • Provide opportunities for students to assess their own work and set personal learning goals.

• Offer project-based learning opportunities that require independent research, planning, and execution, with the teacher acting as a facilitator rather than a director.

• Incorporate lessons on stress management, mindfulness, and coping strategies to help students manage academic pressures and personal challenges.

• Relationship and safety • Explicit and consistent expectations • Positively reinforce desired behaviours Focus on effort and improvements • Mindfulness

Tips for All Ages • Relationship and safety • Explicit and consistent expectations • Positively reinforce desired behaviours Focus on effort and improvements • Mindfulness • Monitoring their capacity and coregulating as needed

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Self-Regulation Battery Example Signs for Billy’s energy level

Still need support!!

Optimal participation  Communicates needs  Easily transitions  Engaging  Smiles  Follows requests easily  Follows rules

Self-regulation support • Adults monitoring his energy levels & providing support as needed • First-then for less preferred activities • Regular breaks to do energy restoring activities

Signs for Billy’s energy level

Self-regulation Plan/supports for Billy

OK Participation  Seeks attention/connection  Can choose and engage in tasks with frequent check-ins  Responds to strategies offered  OK with following rules  Transitions with support  Negotiates-can come to agreement

Self-regulation support  First-then  Visual schedule  Choices  Hands-on activities out and available to use  Social acknowledgment when requested  Frequent breaks with energy restoring activities  Regularly monitoring signs of stress

Signs for Billy’s energy level

Need more support!!

Self-regulation Plan/supports for Billy

Struggling to participate  Echolalia  Grabs  Less agreeable Little patience/hard to wait  Impulsive  Says he is “bored”  Stomps feet  Moves away from group  May not eat when needed/hungry  Self-Initiating breaks  1:1 support to do activities  1:1 support to transition  Rigid negotiations  Anxiety

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Self-regulation Plan/supports for Billy Co-regulation support

 First-then  Modify expectations  Following his lead about calming activities  Physical activities  1:1 quiet time  Self-regulation supports Into routines  Connect before direct  Reduce stressors draining energy  Energy boosting activity

Need a lot of support!!

Signs for Billy’s energy level

Self-regulation Plan/supports for Billy

Struggling to participate  Unresponsive  Does not following prompts connected to routines  Pinching self  Runs away from group  Hyper, giggly, silly, highpitched squeal  Arguing  Noncompliant  Rigid  Trying to get control of the situation  Throwing things  Anxious

Calming co-regulation support:  Calm tone of voice  Listen vs. talk  Focus on connection  Reduce stressors draining energy  Acknowledge emotions  Say there for support  Provide low energy options for expectations  Cuddles

Signs for Billy’s energy level Very Challenging Behaviours  Physical aggression  Verbal aggression  Running away  Screaming  Hitting  Face turning red  Crying

Self-regulation Plan/supports for Billy Emphasizing cues of safety  Position body lower than his  Minimal talking  Let him know you are there with him/there to help him If needed  Give time and follow his lead for space or connection  Keep him safe

Individual factors

Self-regulation Pyramid Supportive Supportive environment environment

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Opportunities Social connection Supportive adult relationship

Especially with Dysregulated Students

• Struggling students are often in an environment that is mismatched with their interests and abilities

When things are going good = certain conditions are met to support their success

Environment to bring out their inner strengths Accommodations a great way to start Any changes in the physical or social environment, task modifications, and altering adult interactions to support EF skills.

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Never take away recess. Give more!

• Movement increases blood flow to the brain.

• Improves performance, creativity, attention, and focus.

Helpful

Engaging (interests) Immediate consequences Frequent feedback Personally important or relevant Early Supervised 1:1 Structured Clear expectations and jobs Close to needed materials Quiet/low arousal Choices

Not so helpful

Boring tasks Delayed consequences Infrequent feedback Low importance tasks Late in the day Unsupervised settings Group situations Unstructured activities Uncertainty Need to search for materials Loud/high arousal environments Excessive multitasking requirements Overloaded sensory stimuli without a relevant educational focus Sudden changes in schedule or expectations without preparation Overemphasis on competition rather than cooperation Poor relationships with peers Poor relationships with teachers

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Important to match expectations to what they can do

Start the day off right

Self-control, willpower, & motivation don’t work

What is more important are the student’s circumstances

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Structure the environment for success

8 Forces of Motivation Gregariousness

Inquisitiveness

Power

Affiliation

• Need to belong

• Need to know

• Need for control

• Need to associate & belong

Autonomy

Aggression

Recognition

• Need for independence

• Need to assert

• Need for acknowledgement

Consider Their Love Languages

Clear and consistent based on what the CHILD needs to blossom.

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Conduct a Praise Assessment!

• How do you like receiving praise? How do you hate receiving praise?

• Create a developmentally appropriate assessment form with a menu of lots of feasible options • Praise students based on their preferences Reflect and adjust!

Effective Teaching

Consider basic demands put on some students NOTICE HOW YOU F EEL WITH TH E F OLLOW ING AC T IVITIE S...

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You’re only limited by your own creativity!

PASS THE BALL – child with ball tosses ball to another child who is the next one to answer a question from the teacher

TEAM PLAY – Make an academic activity a friendly competition

Get them curious!

• Curiosity piques interest and learning Our brains hunger for information Reward value in the brain for learning Itchy need to know!

• Interest starts to deplete into deprivation around the 7 min. mark for most students Even shorter for kids with self-regulation challenges.

MUST get interest piqued right away.

Effective Teaching • Intentional, explicit, and transparent Kids need to know: • What they are learning • Why it is important to learn it • What strategies help strengthen learning/success

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Effective Teaching

Strengths based

• Incorporates student interests and preferences • Allows student choice • Multimodal instruction and demonstration of knowledge • Students help design assessment criteria • Accelerated content • Passion projects • Real life • Success hour •Balance the day with opportunities for kids to complete tasks they can do already

Self-regulation Pyramid Opportunities

Individual factors

Opportunities Social connection

Supportive environment

Focus on getting them TRYING and experiencin g SUCCESS

Supportive adult relationship

Success Success

Success

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Success

Success

Individual Factors Opportunities Social connection Supportive environment

Exercise!!!

• Strengthens the brain • Chemicals calm brain during stress • Stress chemicals released to help stressed out system recover efficiently Promotes attention and other key skills

140

Sleep!!!

• Critical for learning: glue for remembering Need good night sleep before exam Need good sleep after studying for exam!

• Helps manage stress • Helps eat better

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More sleep = • Better grades & standardized scores • Less depression • Increased attendance • Less car crashes • Less impulsivity • More control over emotions • Less aggression • Fewer symptoms and illnesses 4/18/2024

Hydration!

Important Considerations

Healthy diet

Collections

Appropriate Physical recreation pursuits leisure activities Creative Nature

Developing Self-Regulation Continuous development Affected by: • Environmental expectations • Teaching • Experience

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Self-Regulation Often unaware they are off task/engaging in problematic behaviours That is why explicit teaching is critical

Interconnected domains Physical

Prosocial

Cognitive

Social

Emotional

Behavioural

Emotional

Cognitive

• Awareness & understanding of feelings.

• Tolerate & manage uncomfortable feelings effectively.

• Attention, executive functions, perspective taking, problem solving, decision -making

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Cognitive  Plan  Prioritize  Time management  Break tasks down  Remember goal (vs. going to friend’s house)  Knowing what to do when  Knowing what strategies work best  Knowing how one learns best

Emotion  Manage stress  Stay calm to focus  Manage disappointment or self-criticism Affects attention and motivation

Using the Emotional Brain

Emotional brain

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• Emotion is a stronger motivator than reason • When it wins: • Connections stronger • Dopamine increased • Increases likelihood will win again

How to manage the experience of emotions 151

Emotion regulation

Awareness, understanding, and acceptance of feelings • Modulate emotional arousal • Act in expected ways regardless of emotions

Emotion Dysregulation

Inability to cope with elevated emotions (positive or negative)

Emotion Regulation It’s not about avoiding, ignoring, or supressing emotions

It’s about being aware of them, acknowledging them, co-existing, and responding in helpful ways

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Core skills

Mindful emotion awareness

Cognitive flexibility

Identifying and modifying problematic emotional behaviours

Integration of above skills through emotion exposure to master adaptive responses

Increasing awareness and tolerance of physical sensations

Curiosity is a key response to emotional experiences Becoming an Emotion Detective 155

Physiological

Understand Emotion & What it does….

Motivational (response)

Emotion

Cognitive

Body language 156

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How do emotions show up?

157

Thoughts Physical sensations

Behaviours

Emotions

(And they only last 90 seconds!)

Emotional Literacy Students with strong expressive abilities are best able to self-regulate.

• Express feelings adaptively • Comfortable talking about feelings • Know/figure out what to do next Emotion coaching to support these skills

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Emotional Literacy Name it to tame it • Builds confidence • Helps with staying present

160

Saying it out loud gives us more power  To expose  To use coping strategies

161

Anger • Alerts us to threats or injustices • Protect our well-being

Emotions are OK and Adaptive!

Tell us something about reality

Fear • Alerts us to danger • Protects us from harm Joy • Positive reinforcement for doing things that promote our wellbeing and survival Shame • Prompts self-reflection, processing, and change • Maintains social harmony Sadness • Alerts us to loss, separation, or unmet needs and allows us to process the event • Promotes personal growth and deeper social connections Excitement • Propels resilience and growth • Fosters curiosity, creativity, learning, and adaptability 162

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Emotions Help Us Navigate Situations

Keep us safe or move us towards goals

No Anger

Picked on

No Disgust

No Fear

Get eaten

No sadness

Eat pooh

Unable to process loss

Externalize You are not your emotions (Sneaky trickster trying to make you think there is something wrong…)

Externalize

They are not their behaviour Things to watch for: Mind robbers Brain drainers Freaking out Fran Mean Jean Explosive Bob Worry Wanda Distracting Dan Yelling McGee

Get on offense and make a plan together – you’re on the same team!

• When does it show up?

• How does it show up?

• What can you do?

• What support do you need?

165

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Expose it Remind how emotions works  Yep, there’s Bob, that’s what it does.  Wow, it is really working hard to make me freak outtoday!  Yeah, we knew it’d show up now. It doesn’t want me to write the test.  It wants me to avoid new things.  It really knows how to try to stress people out.

166

Emotions Manifest Physically

MUST have physical reactions to alert us to what is happening (Cannot change reactions without this understanding) • Most powerful • Usually shows up first • Triggers emotional response before we even realize it • Helps us to prepare to react to the situation 167

Our brain doesn’t care if its hazardous or not Our brain will respond based on what we need to survive in the immediate moment

168

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•

When the alarm goes off, the body gets ready to fight or run

Even when it is a false alarm!

The brain (and body) cannot tell the difference.

Physical Symptoms are a Problem

Physical feelings: -> Can reinforce there is a problem -> Can be distressing, which they will do anything to stop

Become reactive Misinterpret, which increases sensations…

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Feel more but can’t interpret what the feelings mean Do whatever they can to get rid of them…

172

Physical Sensations are Subject to Distortion • Wrong context • Need to learn to correctly interpret interoceptive signals

173

Core skill Mindful Awareness of Emotion: What it feels like in the body!

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…What it feels like…

Model, Validate & Normalize Feelings

That makes sense!

No wonder - your adrenal glands have sent out all that yucky stuff.

176

Dizzy

Shivers

Racing

Increased heart rate Weak legs

Tension Achy Sore Hot Cold Tingly Numb Sharp

Identify& describe TWO places anxiety shows up.

Stronger on left or right?

Ringing ears Blurred vision Muscle tension Shaking Trembling Chest pain Headaches

Breathless

Burning skin/sweating

Shivering

Blushing

Sweating

Changes in breathing

Trouble swallowing

Stomach-ache/ Nausea

Tired

Relaxed

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177

When we label the different parts of emotions and our experiences, we: • Change our interpretation of them • Change how our body responds • Dampen amygdala’s false alarm • Turn on prefrontal cortex • Make adaptive decisions • Learn that we have control over our responses I know what you are & I know how to handle you

• Avoid getting sucked in – it’s just a piece of information 178

Nonjudgmental Awareness of the NOW is Foundational • Must develop mindful awareness of emotions • Otherwise, can’t work on strengthening more adaptive responses • Therefore, need LOTS of practice and experiences

Focus on Physical Sensations • • • • •

Be with it Observe it vs. think about it Breathe into it Expand it Allow it to be there

• Sensations might change but they might not. It doesn’t matter!

180

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Teach: Physiological awareness Know what stress vs. calm feels like Pair a cue word with a relaxed body

Mood Induction Practice • Observe reactions, whatever comes up physiologically, in an objective and nonjudgmental way Third party reporter Focus on the PRESENT MOMENT • Grounding techniques • Debrief at the end about all the reactions that happened, in an objective and nonjudgmental way

182

Teach process to keep cortex working Even when their amygdala gets frustrated and wants to take over with the stress response.

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Name it

Teach process to keep cortex working

Where is it in the body?

How does it feel?

Left or right?

What’s next?

How Emotions Manifest: Thoughts • Negativity bias Primes them to (non-existent) danger Uncertainty misinterpreted See events as threats Becomes ingrained

185

The brain cannot tell the difference between what it actually sees and what it imagines

& will react as truth 186

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Mindful Awareness & Acceptance of Thoughts • Infinite amount of thoughts (4.617 x 10^61 potential thoughts= four hundred sixty-one duodecillion and seven hundred decillion)

187

• Constant stream • Unaware of most of them  Even when they affect how we feel

• Easy to get stuck on one • If sensitive, the bizarre ones will always stand out

Success at controlling obsessions _________________________________ 1

10

Effort in trying to control obsessions _________________________________ 1 10 Back & forth battle where obsessions typically always win…

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We can't control our thoughts – only our response to them Be aware and accept it for what it is: A random thought 190

Sit with, accept, & acknowledge worries

Focus on raising awareness to thoughts Recognizing them

Acknowledging them

Disentangling from them

Accepting them

vs. trying to change thoughts

Mindfulness

Not about relaxing or getting rid of physical symptoms

Not about changing thoughts 192

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Mindfulness

IT’S ABOUT NOT FIGHTING THEM

193

Active process

Mindfulness

Paying attention to the present moment in a non-judgmental way Being detectives

Emotions Likes to Keep us Stuck!

Negatively influences affect, thoughts, behaviours

Thoughts of Past or Future

Keeping thinking of past or future

Negatively influences affect, thoughts, behaviours

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At the expense of valuable information now

195

• Need to stay here and attend to the current context To keep prefrontal cortex online • To attend to corrective information • To learn!

Mindfulness

Versus getting sucked into worries, which intensifies the emotional experience and keeps us stuck

Acceptance • Confront emotions • Sit with emotions NOT resist, control, or eliminate emotions.

To Accept, Understand • Emotions are a normal part of being human • Physical feelings and thoughts are temporary • Thoughts are not fact

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Emotion Dial

Acceptance Dial

0

100

Defusion

0

100

•Noticing thoughts vs. getting caught in thoughts

Create a Bingo Card of Strategies Past/Present/Future

Distancing

Train, balloons, bubbles clouds, or leaves on the river

Thank them

War of the Worlds

Objectify

Name that Story

Repetition

Humour

Paradox

Body Scan

Literalization 201

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Did you know?

Fear and excitement feel the same in the body?

BUT HOW WE THINK ABOUT IT MAKES ALL THE DIFFERENCE IN THE W O R L D… .

Core Skill: Cognitive Flexibility

Our thoughts are not always trustworthy!

204

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Knowledge Influences Sensory Information (e.g., all faces are always convex)

• Our knowledge/ experience misleads us into seeing the mask as convex Bottom-up sensory information is overridden by top-down knowledge

205

• Information from our senses are only loosely connected to what we experience  Fragmented  Ambiguous  Lots of effort

206

Illusion of Emotions (and all that accompanies it)

207

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She’s criticizing me

ANTS

Someone said a lie I am in trouble

Teacher looks at me I failed She’s calling home

The first draft These are only guesses!!

Wrong 99% of the time

209

Creating Distance from Thoughts DISMISS

DEMAND MORE

Roll my eyes

You’re so boring!

Is that all you got?

Is that the best you can come up with?

Big deal

So what?

Don’t you have something scarier?

Can’t you give me more?

210

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Possibility 1

Possibility 4

Possibility 2

Situation

Possibility 3

She needs to tell me something important

ANTS I am in trouble

Teacher looks at me

Got an A on my test

She needs my help She’s not looking at me

Mixing up the day

Be Creative!

Find three ways to learn about a topic

Find three ways to show what you know about a topic

Stop and Switch (e.g., dribble, switch to math, back to ball activity)

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Practice Flexibility: Getting Unstuck • Looks like the amygdala is trying to get you stuck • What little change can help?

• How can you try something different?

Brainstorm to build flexible problem solving.

Build Awareness!

Externalize & Get Meta • When does Stuck Stan show up?

What is easy to get stuck on? What is easy about it?

What is easy to avoid getting stuck? What is easy about it?

What helps you get unstuck? What worked before?

What do you say to yourself to get unstuck?

• Identify obstacles to getting unstuck • Collaboratively develop strategies to overcome them

Unexpected event/mistake of the day & how you handled it 216

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The Importance of Mistakes  Talk about your own mistakes  Talk about others’ experiences

Embrace mistakes Have a “Mistake of the day” to share: • A mistake or challenge they faced • How they fixed/handled it • What they learned

Mistake of the day/ Honourary Mistake Wall

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Embracing mistakes What was this experience like?

What did you learn today?

What mistake did you make that taught you something?

What did you try hard at today?

What can you learn from this?

What will you do the next time you are in this situation?

What advice can you tell others based on this?

Important!

It is not what they did wrong that counts, but what they do next.

Forging ahead Get Unstuck No need to ask why, lecture, or explain the problem: Have them think of hows  How will they get unstuck  How will they fix this mistake?  How will they move on?  How will they handle (the situation)?

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• Never, always, no matter what, nothing can change, no one likes me

All-ornothing

Break it up • Good and not so good • This part is hard • I will focus on one step at a time

All or nothing: I can’t do anything Some things are easy

I can’t write

I can brainstorm

I can follow a template

I can edit

Scaling questions

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Coming up with ideas on my own is hard (But I can with a storywheel)

Math: Easy

Reading: Easy

Gym: easy

Difficulty scale Easy

Hard 9

What is easy that makes it 9 (and not 10)?

What can I already do?

What can I do to bring this down to 7 or 8?

Want to scale Hate it

3

What do you like that makes it 3 (and not 1)?

What can I do to bring this up to 4? 7 or 8?

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Love it

Core skills Identifying and modifying unhelpful emotion-driven behaviours

What it looks like • Our body communicates how we are feeling • How would others know when I am feeling anxious by looking at me?

230

When Freaking out Fran shows up:

What I feel

My body feels

How FF wants me to do & interact

Disappointed

Chest pain, headache

Get in their face, swear, punch, yell, blame

Disconnected

Nausea

Avoid talking about what is going on, retreat

Unloved

Heart burn

Say hurtful things, yell, cry, and throw things

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Emotional Discomfort

Important!

MUST understand how their behaviours are maintaining, or even worsening, their emotional discomfort  The behaviour is reinforced in the moment, increasing the likelihood of using this strategy again in the future

Brain is rewarded

Behaviour

Feel better in the moment 232

Remember! Short- and long-term outcomes of maladaptive vs. adaptive coping strategies

Maladaptive Coping

Feel better in the moment

Worsens discomfort in the long run

Ingrains emotional pathways

Adaptive Coping

Feel distressin g in the moment

Tolerate & manage emotions in the long run

Create new healthy pathways

233

Emotional Behaviours Function: To reduce the intensity of the emotion Goal: To tolerate the intensity of the emotion

234

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90% of what kids learn is from what they experience

235

Resilience Ability to adapt well to adversity, trauma, tragedy, threats, or even significant sources of stress.

Resilient kids Effectively respond to and cope with everyday challenges - This is where we are going!

drcarolinebuzanko.com

When students avoid or miss out on situations that make them uncomfortable, they lose the chance to practice and grow

We rob them of important opportunities Get out of Traps This alone can make all the difference in the world

Saying “Don’t worry” doesn’t work

Get stuck in constant need for reassurance No skills developed Minimizing 240

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Enabling A C C O M M O D AT I O N S

Accommodation Behaviours Participation

• Assist in checking behaviours • Assist in avoidance • Reassure

Modification

• Prevent triggering situations 242

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Create Opportunities: Stress Inoculation • Need students to practice managing stressors and emotions effectively • Exposure with a focus on success – within tolerance window at first

Outcomes directly relates to their willingness to feel big emotions

245

Emotion Dial

0

Willingness Dial

100

drcarolinebuzanko.com

0

100

Core skills Integration of all the skills through emotion exposure to MASTER ADAPTIVE RESPONSES

Integrate Skills through Emotion Exposure Integrate skills to master adaptive responses

• Talking not enough to change the brain!

Doing makes stronger memories Doing gives us experience Quicker progress • Provoke STRONG EMOTIONS - MUST show up for learning to happen

Practice to build awareness of emotions Not being first in line Losing a game Meeting a cute puppy iPad unavailable Someone cheats at soccer Making a mistake

drcarolinebuzanko.com

Students get stuck in negative patterns when emotions show up

HELPFUL

Avoid real danger

Becomes a problematic learned behaviour that’s hard to break

Excessive & incongruent with the context Gets in the way of what’s important to us Based on short-term gratification vs. long-term consequences

UNHELPFUL

Never learn anything new

That things weren’t as we expected That feelings pass That we can cope

Remember!!!

Ensure they see the long-term consequences No one understands me

Refuse to participate

Social isolation

They hate me and always criticize me

Swear when given feedback, throw things

People will stop trying to help me

I can’t do anything right.

Rip work up, run out of class & slam doors

I will never get better

I have to fight back or they’ll walk all over me.

Threaten or beat up

Might be a friendship there

If I’m in control, I can’t be hurt.

Dominate interactions, no compromise

No friends

They’re going to punish me anyway, so why bother?

Break rules

Might not be in trouble (just making it harder for myself)

drcarolinebuzanko.com

Otherwise, you get resistance

253

Daily Practice!

Focus on awareness • Objectively observe whatever comes up in the present moment  Physical sensations  Thoughts  Behavioural urges

254

Hypothesis Testing Lots of experiments and experiences needed!

• What do you think will happen?

• How sure? (1-10)?

• Was the hypothesis right?

• What did you learn?

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Goal:

Willingness Action Plan

Big why:

The steps I need to take are:

The discomfort I am willing to have to achieve this goal:

I will take the first step on (date) at (time)

Thoughts Feelings Sensations Urges I can remind myself that:

Create Many Opportunities to Focus on Emotions & Work on it Every day!

Speak in front of a small group

Make small talk with someone new

Practice losing a game to someone who cheats

Use pictures, videos, or live encounters with feared bugs

Simulate test-taking conditions with practice exams or timed quizzes.

Role-play scenarios where express their concerns or assert themselves in a safe setting.

Create situations where they can safely express anger and practice coping strategies.

Tolerating not knowing what’s happening today.

Engage in activities they've been avoiding due to emotional discomfort.

Experience and tolerate physical sensations like increased heart rate through exercises.

Watch sad video

Kindie running away with the soccer ball in the middle of a game

drcarolinebuzanko.com

Opportunities for managing the Unknown & Risk-Taking

Capitalize on current challenges!

• Challenges are part of life & dealing with them is part of learning.

• Optimize teachable moments Let them try.

Let them fail (but don’t set them up for failure) Work through next steps and how to fix things

Create challenges!  Challenge of the day, week, or month Work through things on their own Might get frustrated in the moment but the intrinsic reward once solved is far greater than if helped

drcarolinebuzanko.com

Hard

Working on It

https://parentsoftheyear. com

Caroline Buzanko, PhD, R. Psych.

Koru Family Psychology caroline@korupsychology.ca drcarolinebuzanko.com

drcarolinebuzanko.com

Success!

https://bit.ly/overpoweringemotionspodc ast

5/1/24

M ay 2 0 24

Wor k Emot ing with i High Dysr onally ly e Adol gulated C esce hildr nts en & Eboni

Webb

, P syD

, HSP

Schedule Time

Topic

8:00a-10:30a

Parenting and Attachment

10:30a-10:45a

Break

10:45a-11:45a

DBT & the Biosocial Model

11:45a-12:45p

Lunch

12:45p-2:15p

Key Childhood & Adolescent Disorders and Interventions

2:15p-2:30p

Break

2:30p-3:30p

Building Resource Toolkits

2

Rudyard Kipling “Often and often afterwards, the beloved Aunt would ask me why I had never told anyone how I was being treated. Children tell little more than animals, for what comes to them they accept as eternally established.”

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Today’s Objectives 1. Understand the biosocial model of pervasive emotional dysregulation disorders found in innately sensitive children.

2. Apply behavior modification strategies at the earliest stage of dysregulation.

3. Recognize the significance of structure in skills training and home environments, and demonstrate methods to teach parents or caregivers to implement these strategies effectively.

4. Adapt each skills module to reflect the language of the child, fostering better communication and understanding.

5. Define the roles of educators, caregivers, and parents in re-establishing a safe and supportive structure that enables the child to learn and generalize skills effectively.

Sit and breathe • Wait for any sense of discomfort (e.g. restlessness, an itch) • Note the desire to move and resist it • Notice thoughts that arise. These thoughts are just thoughts. So gently bring your attention back to your breath and bodily sensations. Note the changing position, shape and quality of the discomfort over time. Be interested in feeling it as precisely as you can. Notice how the shape and intensity changes with the cycle of the breath.

• Is it stronger during the in breath or during the out breath?

Steps to Adaptation: learning how to fit in your family system Intersubjectivity (Trevathen, 1980) Wounding

Intention

Attunement

Communication

Action

Repair

Trauma Mirror Neurons (Gallese, 2007)

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Attachment goal secure and authoritative parenting produces autonomous and interdependent adults

Attachment Rule Attachment is not fixed or absolute. Growth and change are driven by one’s season of life.

Affect Regulation Definition: Attachment “An in-born system in the brain that evolves in ways that influence and organize motivational, emotional and memory processes with respect to significant caregiving figures.” (Bowlby)

Behavioral Regulation Cognition Self-Concept

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How do we live and thrive as humans? (Bowlby to Ainsworth)

Secure Base

Safe Harbor

Proximity Maintenance

Seeking, m onitoring, and attem pting to

Fleeing to an attachm ent figure w hen in

Attunem ent, presence, accountability,

m aintain connection to a protective

situations of danger or alarm

direction, protection, correction, and

attachm ent figure.

connection.

Neighborhoods, churches, com m unity centers, schools, service providers (e.g. health, legal, m ental health), governm ent

• Safe Harbor

• Secure Base Parents, Grandparents, Extended relatives, m entors, teachers, leaders

• Proximity Maintenance

Attunem ent, presence, accountability, direction, protection, correction, and connection.

How do we embody this as therapists?

Safe Harbor

Proximity Maintenance

Attuned therapists that are skilled

O ffice safety and security, inform ed

Tolerate, M odulate, and C om m unicate

listeners, attuned, present, and activated

Secure Base

consent, confidentiality, com m unity

D ifficult Em otions, Feelings, and

towards change and challenge

safety planning and protection

Sensations as they arise in session.

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Understanding Attachment Styles

THE STRANGE SITUATION SECURE ATTACHMENT oReunion behaviors are more insightful than separation behaviors. oImmediate reassurance from the return of their secure base (distress is natural and expected at separation). oReconnection prompts return to independent exploration and play. oChild Behaviors: Flexibility and resilience oSecure Parent = Sensitivity, attunement, acceptance, cooperation and emotional availability

THE STRANGE SITUATION AVOIDANT ATTACHMENT oReunion behaviors are more insightful than separation behaviors. oApparent lack of distress should not be mistaken for calm. Superficial indifference is a trauma defense. oReconnection displays active rejection of bids for connection by parent resulting in limp physical connection. oParent Behaviors: W ithdraw and Rebuff oAvoidant Parent = Inhibited emotionality, aversion to physical contact, and brusqueness

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THE STRANGE SITUATION AMBIVALENT ATTACHMENT oReunion behaviors are more insightful than separation behaviors. Looking for their absent parent even when the parent is present. oTwo presentations: Angry or Passive oReconnection displays overt bids for connection and expressions of rejection (e.g. full-blown tantrums, leaning away, etc.) to implicit bids for solace displayed in helplessness and misery. Lack of exploration.

Parent Behaviors: Unpredictable and Intermittently available oAmbivalent Parent = Insensitive signaling, neither verbal or physically rejecting while discouraging autonomy

Equity vs. Equality

Parenting with authoritative and connected strategies

Understanding Your Parenting Style

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Parenting Styles Authoritative

Authoritarian/Abusing High expectations, and control Low communication and nurturance

High nurturance, expectations, and control Moderate communication

Power Assertive

Democratic Attachment Parentastic.org.

Parenting Styles Neglecting

Permissive High nurturance, moderate communication, low expectations, and control

Low nurturance, expectations, control and communication

Indulgent

Uninvolved Parentastic.org.

PARENTING STYLES Typ e s

D e fin in g F e a tu re

N u rtu ra n c e

C o m m u n ic a tio n

E x p e c ta tio n s

C o n tro l

A u th o rita ria n

P o w e r-A sse rtiv e

Lo w

Lo w

H ig h

H ig h

A b u siv e

V io le n c e

Lo w

Lo w

Lo w

H ig h

A u th o rita tiv e

R e c ip ro c a l

H ig h

M o d e ra te

H ig h

H ig h

D e m o c ra tic

A tta c h m e n t P a re n tin g

H ig h

H ig h

H ig h

M o d e ra te

N e g le c tin g

U n in v o lv e d

Lo w

Lo w

Lo w

Lo w

P e rm issiv e

In d u lg e n t

H ig h

M o d e ra te

Lo w

Lo w

http://parentastic.org/parenting/parenting-styles/

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PARENT ATTACHMENT STYLE & ADOPTION % of Low-Risk Adoption

% of Troubled Adoptions (e.g. trauma, abuse, illness)

Avoidant

20%

42%

Entangled

Ambivalent

20%

42%

Unresolved

Disorganized

Childhood Attachment Type

American Population %

Autonomous/Free

Secure

15%

Dismissing

Parent Attachment Style

1-2%

TCU Institute of Child Developm ent . (Producer). (n.d.). Attachm ent Dance [DVD]. Available from TCU.

Family Dialectical Dilemmas Excessive Leniency Fostering Dependence

Pathologizing Normal Behaviors

Limits Presence Forcing Autonomy

Normalizing Problem Behaviors

Authoritarian Control

DBT Theory: The Biosocial Model Understanding the impact of developmental and environmental trauma

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Five Movements Mindfulness

25

Overview • Children can suffer from emotional vulnerabilities • Emotional vulnerabilities can come from many sources (e.g., attachment issues, loss, trauma), but is often assumed to be biological • Chronic and consistent invalidation exacerbates emotional vulnerabilities • An ongoing, reciprocal relationship exists between emotional vulnerabilities and environments

Common Types of Invalidation ╺

╺ ╺ ╺ ╺ ╺

Abuse and neglect Being ignored Open rejection of thoughts, feelings, and behaviors Making “normal” responses “abnormal” Failing to communicate how experience “makes sense” Expecting behaviors that one cannot perform (e.g., due to developmental level, emotionality, or behavioral deficits

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• Divorce • Prolonged separation from parents and/or siblings • Frequent moves • School transitions • Bullying (Cyber, physical, etc.)

• In utero assaults • Delivery difficulties • Health of both parents during conception • Mental Illness • Abandonment via adoption • Learning difficulties

• Identity disturbances • Racial issues • Inside threats • Sexual assaults • Accidents (falls, vehicle, etc.)

Stress & Cortisol

t h is y is ?

Wh in g pen hap

Our Survival Hormone

W hat can I lear n from this ?

How do I fix th is ?

Prefrontal Cortex Observing Thinking Decision-Making Mid Brain Emotional Center

W il lI su rv iv t h is e ?

Memory

Lower Brain Survival defenses Automatic processes

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Excessive Cortisol Effects • Neurotoxicity to Hypothalamus • Neuron Death • Clogging of the corpus callosum connecting the left and right hemispheres • Suppression of the immune system

The Powerful Amygdala Key Features • Reactionary • Triggers Sensory System (Smell and Touch are the most direct pathways) • Controls autonomic responses

Safe

Danger!

Life Threat

33

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What Happens During A Stress/Trauma Response?

Acute Response to Threat Study Hyperaroused Continuum

Rest (M ale Child)

Vigilance (crying)

Resistance (Freeze)

Defiance (posturing)

Aggression (hitting, spitting,etc)

Dissociative Continuum

Rest (Female Child)

Avoidance (Crying)

Compliance (Freeze)

Dissociation (Numbing)

Fainting (checking out, mini-psychosis)

Primary Brain Areas

Neocortex

Subcortex

Limbic

Midbrain

Brainstem

Cognition

Abstract

Concrete

Emotional

Reactive

Reflexive

Mental State

Calm

Arousal

Alarm

Fear

Terror

“In the brains of people who have been abused, the genes responsible for clearing cortisol were 40% less active” (Morse &Wiley, 2012) Acute Response to Threat; (Perry, Pollard, Blakely, Baker & Vigilante, 1995). Adapted from study results for teaching.

HYPERAROUSAL

Window of Tolerance Sensorimotor Psychotherapy Institute®/Sensorimotor Psychotherapy founder, “Pat Ogden

HYPOAROUSAL

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From Dysregulation to Self-Soothe The Purpose of Co-Regulation

39

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Child Dialectical Dilemmas Increasing Choices Acceptance of Change

Supervising Connected Authoritative

Giving Permission

Validating Stability

Keeping their world small

The Teenage Brain

The Adolescent Brain (Adapted from Brainstorm by Daniel J. Siegel, MD) • • • • • • • • • • • •

Ages 12-24 Heightene d experience of bore dom Impulsivity Hyperrationality Gist thinking Intense social engagem ent Seeking new experiences despite the strangeness of the situation Enables leaving the nest Risk-taking Exploration Curiosity Identity

•

•

• •

Increase in the developm ent of pleasure an d reward centers in the brain Lower baseline of dopam ine levels until a new experience occurs w hich flushes the brain w ith heightene d dopam ine Neural fiber integration Neural pruning

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Teenagers Change the World

The Little Rock Nine 1957

Stress Management Our Body’s Natural Defense

Hormonal Counter to Cortisol=Oxytocin

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Hormonal Counter to Cortisol=Oxytocin • Responsive • Activated through birth • Increases sense of safety and connection • Must act in order for it to be released • Can accumulate through repeated activities.

Problematic Auto-Regulation is Learned

Cortisol

Oxytocin

SelfSoothe

Stress

Behavior

Now Doesn’t This Get Some Oxytocin Flowing?

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Treatment Targets to Increase Oxytocin Without Problem Behaviors

• Hugs • Sing in a choir • Give a back rub/foot rub • Hold a baby • Stroke a dog or cat • Perform a generous act • Pray

• Make positive eye contact • Breath work • Listen without judgment • Positive touch • Proximity • Laugh/Dance

“

The curious paradox is that when I accept myself just as I am, then I can change.

Carl Rogers

Attachment Style: Adolescent (Chara, 2005) Characteristics

Secure

Avoidant-Insecure

Ambivalent Resistant Insecure

Disorganized Insecure

Predominant Emotions

Optimism; mature emotionality

Detachment; callousness

Anxiety, anger

Fear, doubt

Desires trust; but mistrustful of others

Desires, but wary of, trust, suspicious of others

Ability to Trust

Desires trust; finds it Indifferent toward trust easy to trust mistrustful of others

Ability to be Intimate (mutual self-disclosure)

Desires intimacy; able to be intimate

Avoids intimacy; difficulty being genuinely intimate

Desires intimacy, but doubtful intimacy is sincere; difficulty being intimate

Intimacy desires mixed with fear and doubt; difficulty being intimate

Fear of Abandonment

Low; finds security in relationships

Low; indifference born of self-reliance

High; fears being rejected

High; strong fears of rejection

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Adolescent DBT Dialectical Dilemmas Skill Enhancement

Trust

Transparency Empathic Relational

Suspicion

Privacy Self Acceptance

Secure (60%)

Avoidant/Dismissive (20%)

Disorganized (varies)

Feels that parent is an “emotional desert” Learns to get needs met by acting like they don't have needs. Becomes disconnected from emotions and presents with developmentally inappropriate selfreliance.

Feels frightened or terrified by their parent, experiencing fear without solution or resolution. Feels that their parents are unsafe despite the urge to seek security from them. Unpredictable and erratic behaviors marked with emotional turmoil.

Anxious/Preoccupied (20%)

Child Experiences and Behaviors

Feels “safe, soothed, seen, and secure” Child will be flexible, curious, and connected. Able to participate in relational ruptures and maintain a sense of connection even in disagreements

Caretaker Behaviors

Intermittently available or Creates a compassionate environment, rewarding and then will shift to able to regulate their own emotions and being unavailable and behaviors. Sees child as a separate misattuned. Might person. Moderately attuned (30%) to unintentionally look to their child child’s needs. Able to empathize and stay to meet their emotional needs. present with the child. Able to repair Turns to child to feel good about ruptures. self.

Adult Attachment Style (Working model of relationships based upon childhood)

Can trust others to be there for them as needed. Able to maintain their own unique identity while remaining connected to others. More satisfied in relationships. Marked with honesty, openness, and equal, and interdependent.

Feels “confused and frustrated.”

Child might be clingy, desperate and anxious.

Has difficulty trusting others will there for them when needed.

Maintains clingy and insecure behaviors. Seeks rescue versus establishing a real loving and trusting relationship. Frequently will test and sabotage relationships.

Provides basic and instrumental needs for the child but will have trouble responding to the child on an emotional level.

Struggles with intimacy and has a hard time being vulnerable or showing any dependence on others. Often wards off partners attempts to be close, experiencing them as “needy.” May have difficulty remembering much from their childhood, and they may see early experience as having no impact on who they are as an adult. Tendency to lead more inward lives, turning off their emotions and can easily detach when threatened.

Engages in terrifying behaviors and unable to meet their child’s emotional, psychological, and relational needs. Not attuned to others

Learns that relationships are dangerous and will hurt you, but they desperately need others. They may be desperate or clingy when someone pulls away then aloof and withdrawn when someone comes toward them. Their behavior is often erratic and scary for their partners.

What Does Earned Security Look Like?

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S afe

SECURE BASE

C onsistent

Safe Space

Care Providers

Lim its, R ules

Loving Well

PROXIMITY MAINTENANCE

SAFE HARBOR

School

Flexibility

Counselors

A ttunem ent

Body

HOLISTIC INTERVENTIONS

Home

Mind

The Biosocial Model ╺

Emotional vulnerabilities are characterized by: -

Emotional sensitivity

-

Emotional reactivity

Slow return to emotional baseline Over time emotions get sensitized, leading to a “kindling” effect This emotionality (and associated invalidation) is associated

-

╺

╺

with many problems (disorders) Emotionality leads to escape and avoidance that leads to chronicity

Coping-Avoidance Escape Behaviors Emotional Arousal

╺

Heightened Reactivity Innate Sensitivity

Time

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Biosocial Theory Coherently Guides Treatment Targets and Strategies ╺

Validation is a primary intervention to: ╶

Reduce acute emotionality

╶

Provide gentle exposure to emotions

╶

Provide a corrective validating environment (and new learning)

╶

Create a bridge to learning self-validation

Open the client up to change interventions Emotion regulation is taught to:

╶ ╺

-

Understand how emotion happen

-

Reduce vulnerability to intense emotions

-

Increase opportunities for positive emotions

-

Assist in stepping out of ineffective mood-congruent behaviors

Biosocial Theory Coherently Guides Treatment Targets and Strategies ╺

Mindfulness (non-judgment and acceptance) is taught to: ╶

Reduce amplifying emotions

╶

Reduce escape and avoidance of emotions

╶

-

╺

Create qualitatively different and effective experience of emotions Distress Tolerance is taught to:

╺

Provide healthy ways of coping with emotions when

needed Use the theory to conceptualize the purpose of the interventions used

What to Look For SelfInvalidation

• Self-hate/criticism • People-pleasing • Perfectionism

Emotional Vulnerability

• Anger, Bitterness Towards Others • Fragility, Vulnerability

Inhibited Experiencing

• Active avoidance • Passive avoidance, dissociation

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How to Help Self-Invalidation • Modeling failure • Communicating validation

Emotional Vulnerability

Inhibited Experiencing

• Model self-care • Create a safe home environment

• Model Emotions • Display authentic reactions without exaggeration

What to Look For Unrelenting Crises Active Passivity Apparent Competence

• Uncontrollable Events • Crisis-Generating Behavior

• Willfulness, Demandingness • Helplessness

• Disconnect between verbal and non-verbal behavior • Contextual Competence (mood/situational)

How to Help Unrelenting Crises

Active Passivity

• Control the Controllable in the Home • Practice/Model Delayed Gratification

• Cheerlead • Encourage problemsolving • Set Personal Limits

Apparent Competence • Highlight effective behaviors observed • Lose the assumption of how the loved one “should” behave in all contexts based upon one.

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Key Childhood to Adolescent Disorders

STATISTICAL PREVALENCE OF CHILDHOOD DISORDERS Disorder

Prevalence

W ith Severe Im pairm ent or Distress

M edian Age of Onset

Anxiety

31.9%

8.3%

6 years of age

Behavior

19.1%

9.6%

11 years of age

M ood

14.3%

11.2%

13 years of age

Substance Use

11.4%

Not analyzed

15 years of age

Dual Diagnosis

40%

Not analyzed

Not analyzed

Merikangas, K.R., He, J-P, Burstein, M., Swanson, S.A., Avenevoli, S., Cui, L., et al. (2010). Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49,(10), 980-989. DOI: 10.1016 /j.jaac.2010.05.017

STATISTICAL PREVALENCE OF CHILDHOOD DISORDERS BASED UPON MULTICULTURAL FACTORS • • • •

Black Youth are significantly under-represented in m ental health and treatm ent-oriented services and overrepresented in containm ent-focused facilities.[17] First Nations youth die by suicide about 5 to 6 tim es m ore often than non-Aboriginal youth.[18] LG BTQ youth face approxim ately 14 tim es the risk of suicide and substance abuse than heterosexual peers.[19] Youth living in the lowest-incom e neighborhoods had the highest rates of suicide, em ergency departm ent visits for deliberate self-harm , acute care m ental health service use, treated prevalence of schizophrenia.[20]

[17] G harabaghi, K ., Trocm é, N . and N ew m an, D . (2016). Because Young People M atter: Report of the Residential Services Review Panel.

[18] C entre for A ddiction and M ental H ealth. M ental Illness and A ddictions: Facts and Statistics.

W ebpage: w w w .cam h.ca/en/hospital/about_cam h/new sroom /for_reporters/Pages/addictionm entalhealthstatistics.aspx [19] C anadian M ental H ealth A ssociation - O ntario. Lesbian, G ay, Bisexual, Trans & Q ueer identified People and M ental H ealth.

W ebpage: w w w .ontario.cm ha.ca/m ental-health/lesbian-gay-bisexual-trans-people-and-m ental-health/ [20] M H A SEF Research Team . (2015) The M ental H ealth of C hildren and Youth in O ntario: A Baseline Scorecard. Institute for C linical Evaluative Sciences.

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Anxiety • Anxiety is an adaptive response to threat (and the traumatized client expects threat) • Validate the feelings and sensations as real and experientially work with the somatic experience that the feelings are intolerable • Balance mindful acceptance of anxiety with relaxation and grounding skills(e.g., breathing, muscle relaxation, positive self-talk, self-soothing skills) • Realign therapeutic environment that threatens to dysregulate your client.

Attention-Deficit/Hyperactivity Disorder • Assess for history of Traumatic Brain Injury as recent studies indicate a correlation between trauma and ADHD (McIntosh, 2015) • Hypervigilance resembles hyperactivity and might be easily misinterpreted (Littman, 2009) • Focus on nutritional management strategies-hydration, omega-3 fatty acids, targeted amino acid therapy (TAAT) (Purvis et al, 2007) • Assess for compromised parenting as impulsivity and compromised executive functioning inhibits proximity maintenance and structuring the environment appropriately (e.g. safe harbor) • Target in-session activities that activate the observing mind and a restful mind state

OPPOSITIONAL DEFIANT CONDUCT DISORDER • Multifamily therapy only • Bring a family Teacher on the team and open up multifamily skills training to all supporting family members • Contingency management of all expectations (e.g. diary card, skills group homework) • Keep child’s world small and predictable with immediate consequences

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Family Dialectical Dilemmas Excessive Leniency Fostering Dependence

Pathologizing Normal Behaviors

Limits Presence Forcing Autonomy

Normalizing Problem Behaviors

Authoritarian Control

BEHAVIORAL PRINCIPLES You must become a behavioral specialist.

• Positive Reinforcement: behavior is followed by a reward, increasing the b’s frequency • Negative Reinforcement (think avoidance learning): behavior is followed by removal of something aversive, increasing the b’s frequency • Positive Punishment: behavior is followed by something aversive, decreasing the b’s frequency • Negative Punishment (think response cost): behavior is followed by removal of something, decreasing the b’s frequency • Extinction: removal of any consequence for a behavior, leading to a decline in the behavior

BEHAVIORAL PRINCIPLES You must become a behavioral specialist.

• Shaping: reinforcing approximations to a desired behavior • Avoidance Learning: behavior results in the cessation of an aversive stimulus (falls under negative reinforcement) • Non-contingent Reinforcement: providing reinforcement regardless of behavior you want to decrease (but in absence of that behavior). The b then decreases as it is no longer necessary to receive the reinforcement • Generalization: performing desired behavior outside of treatment setting

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BEHAVIORAL CONTINGENCIES • The consequences of behavior influence what we learn • A temporally close relationship between behavior and consequence influences what will happen the next time we are in a similar situation with similar context • Highlighting contingencies (e.g., structure, expectations, safety, immediate feedback, etc..) helps Students learn and be more effective

Best Behavioral Methods to Create Change Make Reinforce

Make a high probability behavior contingent on a low probability behavior (i.e., Premack Principle)

Reinforce anything and everything that is not a problem behavior (clients emit positive behaviors nearly continuously)

Train

Train a new behavior (skill) to reinforce

Cue

Put a problem behavior on “cue” (i.e., bring it under stimulus control)

Understand

Understand the motivation for the behavior and use it to leverage change

BEHAVIORAL PRINCIPLES: WHAT TO CONSIDER • Are effective behaviors reinforced? On what schedule?

Be careful to maintain desired behaviors!

• How are ineffective behaviors reinforced (maintained)?

• How can I shape effective behaviors while extinguishing ineffective behaviors?

• Consider relevant behavioral principals when analyzing

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BEHAVIORAL CHANGE

Aim For Behaviors That Push But Do Not Exceed Student’s Capabilities

Attachment Disorders • Stability first! Child must have skills to tolerate distress and remain in the window (e.g., work on grounding skills, distress tolerance, and emotion regulation) • Incorporate emotion regulation strategies that hyper or hypoarousal patterns(e.g. aggressive connection or dissociated drifting to strangers) • Develop healthy connective strategies through somatic exercises

• Teach boundaries and learning how to sense the body for child and parent

Need

Age of Development

Healthy Development

Unhealthy Development

Survival

0-2

Emotions

Threat Response

Key Emotions Impacted

Security

2-3

Pleasure

0-3

Body-Self Development

Body Shame

Shame, Disgust, Envy, Love, Guilt

Affection

4-5

Capacity for love, sense of love and belonging, worthiness

Inhibition from autonomous connection

Love, Anger, Envy, Jealousy

Esteem

5-6

Recognition, Acknowledgement, Self-Acceptance

Lack of trust in self

Sadness, Shame, Guilt

Control

3-7

Choice

Compulsion, Impulsivity

Jealousy, Anger, Fear

Power

7+

Intention

Invulnerability

Envy, Guilt, Fear

Fear, Happy, Anger Fear, Jealousy, Self in Relationship Diffuse Boundaries Love

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PTSD AND TRAUMA • Stability first! Student must have skills to tolerate distress (e.g., work on grounding skills, distress tolerance, and emotion regulation • Linehan promotes exposure techniques • Consider other ways to handle trauma (e.g., mindfulness and presentcentered approaches) • Incorporate Connected Child (Purvis, et.al, 2007) work into DBT work

EATING DISORDERS • Often center on issues of identity and acceptability. Intense emotions

result from self-loathing (food the focus of attention). Dialectics focus on urge indulgence vs. inhibition, helplessness vs. self-control, and acceptability of the individual to self and society.

• Validate experience-increase radical genuiness • And develop positive identity and healthy controls (externalize disorder)

Em otion

Function

Action Urge

Anger

Boundary, Identity, Injustice

Attack, Define a boundary

Disgust

Protect from contamination/influence

Reject, Separate

Envy

Obtain something not currently possessed

Obsess, Aspire

Fear

Survival, Life Threat

Survival Defenses To make amends or apologize

Guilt

To signal a threat to personal morality

Happy

Connect with pleasure

Maintain

Jealousy

To signal a threat to an important relationship

Possess, Posture, Protect

Love

Connect relationally

Connect, Sustain

Sadness

To signal a loss (relationship or expectation)

Isolate, W ithdraw

Shame

To signal a threat to social standards/expectations

Hide, Conform

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EATING DISORDERS

• Increase distress tolerance • Increase emotion regulation • Increase sensory input through mindfulness (again externalizing) • Mindful eating followed by distraction or urge surfing helpful

MINDFULNESS/ACCEPTANCE INTERVENTIONS • Apply Core Mindfulness Skills • Have Student “sit with” emotion longer than he/she desires (i.e., exposure or desensitization) • Have Student change relationship to emotions and thoughts (not right/wrong or good/bad, but a different awareness based on acceptance and meaning making)

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DEPRESSION • Depression happens when desires are frustrated, making hope difficult and leading to greater passivity.

• Validate the mood, especially given lack of positive experiences (reduces secondary guilt and shame).

• Challenge the ineffective strategies used to deal with the mood.

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DEPRESSION • Increase positive behaviors (coaching, prompting, contracting, etc..)

• Decrease mindfulness of negative experiences • Build in self-care and emotion regulation skills • Take dialectic approach to cognitions (explained more later)

SUBSTANCE ABUSE/DEPENDENCE • Validate needs and challenge means of meeting those needs • Increase mindfulness of urges and then shift to external focus • Decrease environmental triggers • Increase distress tolerance and emotion regulation to deal with withdrawal and urges

STARTING OUT: COMMITMENT STRATEGIES • Evaluate pros and cons of therapy • Play the devilʼs advocate • Foot in the door techniques • Door in the face techniques • Connect to prior commitments • Highlight the freedom to choose (especially in the absence of alternatives) • Shape stronger commitment (as therapy progresses) • Coach and cheerlead

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YELLOW “Inhaling I sense my body” BLUE “Holding I am here” GREEN “Exhaling I relax my body.”

PINK “Holding this is the perfect moment.”

SQUARE BREATHING MINDFULNESS

SQUARE BREATHING MINDFULNESS

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SKILLS STREAMING THE NEST DBT Family Skills Format

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DIALECTICAL FAMILY SYNTHESIS (ADAPTED FROM FR. RICHARD ROHR’S “EMOTIONAL SOBRIETY” DVD)

Self Responsible

Under Responsible

Overly Responsible

Copyright © 2016 by Dr. Eboni Webb, PsyD, HSP. All rights reserved. This slideshow or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the author.

Dialectics FINDING THE MIDDLE PATH

• Acceptance and change • Validation and challenge • Emotion and reason (Wise Mind) • Doing oneʼs best and needing to do better • Active Student and active Teacher • Goals of therapy (and/or program) and goals of Student • Integrating research and practice (per EBP)

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Dialectics in Action Others-focus Self-Efficacy

Problem-Solving

Student Teacher Help-Seeking

Sitting With

Self-Focus

DIALECTICAL DILEMMAS EMOTIONAL VULNERABILITIES

ACTIVE PASSIVITY

UNRELENTING CRISIS BIOLOGICAL SOCIAL

APPARENT COMPETENCE

INHIBITED EXPERIENCING SELFINVALIDATION

Dialectics in Action Availability

Intervene

Class Process Teacher Student

Skills Training

Consult Limits

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WAYS STUDENTS CAN PRACTICE DIALECTICS • Balance of “old” self with “new” self • Balance of “want-toʼs” with “have-toʼs” • Balance of your wants/needs with othersʼ wants/needs • Activating Wise Mind • Considering alternative viewpoints and opinions • Weighing pros and cons • Choosing “middle path” behaviors • Engaging willingness to shift from “stuck”

Experiential Identify and write down one (1) dialectical dilemma you deal with in your practice or in relationships and share with the colleague next to you.

Building the Resource Toolkit

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Resource Domains (Ogden & Fisher, 2015) Somatic

Psychological

Spiritual

Relational

Artistic/Creative

Nature

Emotional

Intellectual

100

BODY CENTERED AND GROUNDED

101

Somatic ▫

Internal

▫

External

102

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Relational Internal ▫ Sense of “love and belonging” (Brown) ▫ Ability to reach out and experience connection ▫ Establishing healthy boundaries

External ▫ Friends ▫ Family ▫ Mentors ▫ Spouses/Partners ▫ Pets

103

EMOTIONALLY REGULATED

104

Emotional Internal ▫ Access to the full range of emotions, expressions, and sensations ▫ Ability to modulate high to low arousal ▫ Ability to tolerate intensity of emotionality

External ▫ Relationships to give and receive emotional support ▫ “Sister or Brother”-circles ▫ Activities that elicit high and low emotional arousal

105

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How the Brain Organizes Our Experiences

Sensations

Thoughts

Emotions

Urges

Movements

106

Intellectual Internal ▫ Creative thinking ▫ Dreaming ▫ Imagination ▫ Learning

External ▫ School ▫ Classes ▫ Study groups ▫ Puzzles ▫ Books

107

Artistic/Creative Internal ▫ Capacity to access creative processes ▫ Imagination ▫ Vision

External ▫ Art materials ▫ Creative writing groups ▫ Cooking classes ▫ Music (e.g. cds/access to music) ▫ Museums

108

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Material Internal ▫ Ability to rest ▫ To enjoy the comforts of life ▫ Experiencing pleasure

External ▫ Home ▫ Comfortable bedding ▫ Life hacks

109

RESET SURVIVAL DEFENSES

110

RAGE

GROUP CHAOS

TERROR

POSSESIVE JEALOUSY

PANIC

HYPERAROUSAL

FEAR SADNESS SHAME

Window of Tolerance Sensorimotor Psychotherapy Institute®/Sensorimotor Psychotherapy founder, “Pat Ogden

ANGER

HYPOAROUSAL

JEALOUSY

111

FEIGNED COMPLIANCE

DISSOCIATION PSYCHOTIC BEHAVIOR

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Psychological Internal ▫ Strong sense of self ▫ Self-awareness ▫ Esteem ▫ Compassion ▫ Nonjudgmental ▫ Resiliency

External ▫ Access to a therapist ▫ Workbooks ▫ Manuals ▫ Support groups

112

Spiritual Internal ▫ Ability to develop connection with a Someone or Something greater than one’s self ▫ Capacity to connect with one’s own spiritual essence

External ▫ Meditation ▫ Contemplative Prayer ▫ Shabbat ▫ Spiritual mentors

113

Nature Internal ▫ Utilizing your senses to take in the world around you ▫ Sensory bathing

External ▫ Gardens ▫ Parks ▫ Hiking ▫ Plants in the home

114

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Critical Interventions: Building the Therapist’s Resource Toolkit

Validation The Keys to the Kingdom 116

Validation: The Keys to the Kingdom • Validation is the non-judgmental acknowledgement of the child’s experience • Validation creates the conditions of acceptance that usually precede change • As a rule, start with validating the child, and return to validation when the child is “stuck” (remembering that rules have exceptions)

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Validation as an Exposure Technique • Regulates emotions by decreasing their intensity • Provides gentle, informal exposure to emotions with a sense of self-efficacy • Allows for a more complete expression of emotions, cueing a fuller adaptive response

Balance of Validation and Change • Validation opens kids to change: - Lets kidsknow you understand the nature of their issues and pain - Exposure to painful emotions create a qualitative difference in relating to emotions (decreasing ineffective escape and avoidance behaviors) - Exposure to painful emotions can create motivation to invest in change

Slowing Down and Pacing • Validation is NOT a means to an end • Validation requires time to be processed • Moving too quickly sends unintended messages about emotions and distress • Children will typically let you know if too much time is spent on validation

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Levels of Validation (Linehan, 1997) • Being acutely attentive (V1) • Reflecting verbal communication (V2) • Describing non-verbal communication (V3) • Expressing how experience makes sense given history or biology (V4) • Expressing how experience makes sense in the present moment and context (V5) • Being in genuine, human contact (V6)

Prosodic Communication

• Pitch • Intonation • Rhythm • Loudness • Tempo • Stress

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The Therapeutic Space Authoritative Therapy: Creating a Safe Haven

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In Summary • Change does not happen overnight.

• Assume that you and your children are doing the best you can.

• Validation are the keys to the kingdom.

• Validation precedes change and challenge.

• Attachment endures throughout the lifespan. No attachment is fixed.

• The areas of the brain that are compromised in early attachment trauma are the most neuroplastic.

• Commit to keeping your child’s brain at rest.

Questions?

The impulse to heal is real and powerful and lies within the client. Our job is to evoke that healing power, to meet its tests and needs and to support it in its expression and development. We are not the healers.

We are the context in which healing is inspired.

Ron Kurtz

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ADDITIONAL RESOURCES • Behavioral Tech, LLC-Marsha Linehan’s website: http://behavioraltech.org/index.cfm?CFID=54493378&CFTOKE N=48711039 • TCU Institute of Child Development: http://www.child.tcu.edu/default.asp • Parenting a Child Who Has Intense Emotions-Dialectical Behavior Therapy Skills to Help Your Child Regulate Emotional Outbursts & Aggressive Behaviors-Pat Harvey & Jeannine Penzo (2009) • Loving Someone with Borderline Personality Disorder: How to Keep Out-of-Control Emotions from Destroying Your Relationship-Shari Manning (2011)

Thank-You • Eboni Webb PsyD, HSP ewebb@ webbjamconsulting.com 615-589-1018

The Village of Kairos 1451 Elm Hill Pike, Suite 250 Nashville, TN 37210 367 Riverside Drive, Suite 104 Franklin, TN 37064

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