C (11:45)
B R-I K.com the Defiant Children that I worked with and that I've seen over 33 years, they all seem to have some common characteristics. They have a lower awareness of themselves. Emotional intelligence, for example. I'll see kids, a lot of them with ADHD will come in and I'll say, joey, how are you doing in school? Dr. Jeff, I'm doing fantastic. Well, it's the second day of the second quarter, and of course, we're not even looking out of sight, out of mind of all the missing assignments and homeworks from the first quarter. So there's kind of a lack of awareness. There's coexisting conditions in a lot of the adhd. A lot of the oppositional kids that I see, ADHD leads the charge. Depression, anxiety, giftedness. And by the way, there's something that I don't know that I have on the slides, but we always need to keep our eyes out for is when there's something physical going on. There's kids that can have something called pandas. And I'm not referring to the cute, cuddly things at the zoo, animals at the zoo, but pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections. I wish I had more time with that. But it's important that we realize there could be a lot of different things that cause adhd. I'm sorry, that can create the conditions, including ADHD as one of them. For oppositional defiant disorder. These kids, over time, get conditioned to power struggles. So punishment starts to not work. They have a short fuse. They're argumentative. Many of them are highly determined, and they perceive themselves as equal or above adults. And there's a cycle, a cycle that I see play out over and over. The child is defiant. The parent lacks understanding. Not because they want to, but, you know, because they just. They're in the moment and they're struggling. And I have a sign here, and we may cover this in a slide, but I want you to keep this in mind, too. As far as understanding our children when they're struggling, it's a big question to ask ourselves. I'm hoping you can see it. Are they struggling with something at that moment, or are they choosing not? And, you know, a lot of times they're, oh, well, they're choosing not to get ready for school. They're choosing not to care about their schoolwork. They're choosing not to behave more rationally in a way that's more acceptable. But at the same time, we need to remember, especially children with ADHD have an underlying struggle. That struggle is not an excuse, but it is an explanation. And again, keep that in mind. It's not an excuse, but it is an explanation. ADHD is not an excuse, but it is an explanation. Some of the kids that I see, a lot of them, they have these cognitive distortions, if you will. Nothing is fair. Everything sucks. No one should Tell me what to do. I know better than you. Nobody even cares. It's your fault. I hate you. You're ruining my life. I see a lot of kids that say these types of things and they share this with me. I think with these kids with defiance, one of the most striking things I see is a limited ability for them to soothe themselves. And I always say life comes down to two skills. And sometimes with the kids in my office, I'll get kind of playful, like, you know, I have a 9 year old sitting across from me with his parents. And I'll say, well, what do you think the two most important skills are? To have a good life. And they'll look at me, of course, their parents are leaning forward, like, what are they? You know, And I well, you know, math skills are important and, you know, computer skills are important and speaking skills are important. Reading all these things. I'll go down the list and I'll say, you know, the two most important skills for life, in my opinion, are, are the ability to calm yourself down and solve problems. Calm down, solve problems every day. 13 miles away from where I'm sitting right now is something called Chester County Prison. There's a lot of guys there that may not be that different than me who probably wish they could go back and have a redo at one critical moment of their life. Maybe some of them were even diagnosed or not diagnosed with adhd. Perhaps, perhaps. But regardless, and wish that at that moment of their life, they had taken a little more time, 15 more seconds, 10 more seconds, 30 to work on calming down or problem solving. It's that big a deal. They struggle to problem solve when they're upset. We all do. But with, with defiant children, they really get very wound up. They have problematic interactions with their parents, with teachers, and there's a belief that they're not understood. And that's why it's so important that we take that time and that we lean into empathy when we're trying to connect with our adult, I'm sorry, defiant children, whatever age they are, all the way through adulthood. A lot of the teenagers I work with, they'll feel that their peers understand them almost like a second family more than their parents. And these cognitive distortions really rev up when these children are emotionally dysregulated when they're upset. So when you use this calm, firm, non controlling way of interacting, which I gave in my story about my son Sam, it's really keeping in mind that no one likes to be told what to do, especially a kid who has a lot of defiance. This way of relating helps bypass emotional reactivity. Let me give you another example. A confirm non controlling statement could be something like I understand from talking to your teacher that your comment to Ben was seen as a threat. Help me understand what you were thinking, what was your view so we can better understand each other. And again, please don't look at any of like there's handouts that are coming along with today. Don't look at any of it as a script, but it's a mindset and that mindset is you want to shift to having observer's mind. If you have to get up on the ceiling and look down at the interactions, see yourself as an emotion regulation coach. It slows you down, you switch lanes. You don't take it also personally when your kid is trying to get you into a power struggle and it helps you avoid those fruitless power struggles. It's very important to check your ego at the door and be willing to let go of any of your desired rehearsed responses and really listen. I think I saw it was M. Scott Peck in a famous book from years ago, the Road Less Traveled. And he was talking about, there was a quote, something like if we would listen to our children with the same level of attention that we would give to a great lecturer. What a gift. And think of how many times today that we're, you know, we're pulled in so many these things, you know, we're pulled in these phones, we're pulled in so many directions and our kids are too those that have them. So listening. Oh my gosh, it's such a precious resource, really listening. It's really important to not fall into the trap of negative labels. I can't tell you how many parents come in and they're frustrated. I get it. Again, keep in mind that a lot of the children that come to me with oppositional defiant related issues, a lot of them have the ADHD diagnosis or they turn out to have it. Lazy versus a more adaptive right, not all encompassing label of motivationally blocked underachiever versus not working up to their potential troublemaker versus they're troubled within. They don't care versus they're missing a sense of purpose. They have no remorse versus they're not feeling safe or they're just not sensitive as I gave, you know, in that example, they're not, they're, you know, they're not showing remorse, they don't care. Well, maybe their defenses are up right now and that's in the way. So we need to be able to give our kids within reason, the benefit of the doubt. It's hard to imagine that any child, teen, adult, child, that's struggling wakes up in the morning and says, how can I deliberately sabotage my life just a little more and create more pain just because that's what my life's mission is? When you put it in that context, we come back to this sign of, you know, struggle with versus choose not. It really kind of puts it in perspective when you ask yourself that question. Okay, so there's a lot of anger that goes on. It's a misunderstood emotion. My mother got me a book. My mom and dad got me a book back in 1978 by Carol Tavris. It was called Anger the Misunderstood Emotion. It's just as is misunderstood today. It's not a bad emotion necessarily. I mean, it's probably responsible for the TSA having checkpoints and stoplights on roads and stop signs and keep us safe. Someone was angry and they were constructive. But we tend to look at anger as this problematic emotion without understanding that it's a signal and that we need to look below the surface and see if angers are surface emotion or what's underneath it. Sadness, shame, frustration, anxiety, to name a few. A lot of times when kids come in my office, what I'll do to help them understand what we're working on in terms of anger is I'll draw two firecrackers, two rectangles on a sheet of paper, vertical, and then I'll put a fuse on each one. And I have a short fuse and a longer fuse. And I'll try to give them this conceptual, pictorial, if you will, representation that we're trying to get a longer fuse, you're still going to have things that bother you. But if you can have a longer fuse and learn how to think, and one way parents can influence that is by being calm, firm and non controlling. Some techniques that are helpful. I wish I had a lot more time to go through these in detail, but kind of coming up with a safe word or phrase. I've had kids say grapefruit banana when they're frustrated, understanding that compromising is a win too. I see so many kids that come in, they're playing a game on the playground at school. I had one just the other day playing in a Gaga ball pit. And just he was so reactive and he was so angry that the ball didn't hit him, even though his peers said they did. And so this whole idea of winning and fairness is a big one. And really having conversations and helping them see how compromising is A form of winning. It's a way of connecting with others. Shrink the fireball again. One of your handouts today has about 57 different strategies that I found help over the years. I have kids look at these and give me feedback. You know, you imagine that you have a fireball in your hand. You close your eyes and you imagine a fireball of anger. And you imagine that you're shrinking it down and it helps with calming down. There's another one. I don't know if I have it on this sheet or not. Yeah, it's down at the bottom of Squeeze a Lemon. I like that one too. In fact, I had a kid just a few weeks ago because I said, well, you know, you have to use your imagination. Where are you going to get the lemons? You know? And he said, I'll go to Lemon Land. So you go to Lemon Land, you grab a lemon and you squeeze the lemon. You imagine that you have a hole in the bottom of the lemon and you squeeze out the juice and you let it go. And then you talk about how when your hand gets tight and tense, your wrist follows, your arm follows, your whole body follows. And when you learn to tighten and then you learn to relax, it's a way of being able to identify those different states. And it helps kids have more awareness. When we can engage them physically and make them more mindful, that mind body connection really helps. Diaphragmatic breathing, very important. I can't tell you how many times I have kids come in and we'll do the diaphragmatic breathing and I say, show me how you take breaths. And of course they'll, you know, we really want to instead have those belly breaths. So because when we expand our diaphragm, as I understand it, we stimulate our vagus nerve located down by the spine, and it sends a signal to help reboot our reactive brain. Counting to 10 works really well because again, we're bringing in a kind of computational task and it slows things down. Stretching. Can I have a whole sheet of. With all these types of interventions, walk away. I try to help kids. We'll do an exercise called Unhelpful and Helpful Thoughts where we work on getting rid of those shoulds and nevers and rigid thinking patterns, or at least trying to contain them. So what goes along with defiant behavior? Anxiety. It's often denied by kids that come in less today. But I still get a lot of kids swimming in that big river in Egypt called denial that they have anxiety. But I think there's been so many efforts to Kind of get mental health out of the closet and into the public talking about it. So that's. I think it's still there, but we need more to do more work on kind of letting people know it's okay to have anxiety. It's how we manage it. Depression can be overshadowed sometimes by aggression. ADHD learning differences lead to that struggle with versus choose not gifted kids. I've seen often it's hard to be super smart, maybe even smarter than some of the adults around you and not get reactive. Imagine that it's very, very hard. Parenting, family dynamics and peer issues, all these can lead to go along with defiant behavior. With ADHD, up to 40% of defiant children by some estimates have defiant behavior. For these kids, it's hard to live in their own skin. It disrupts those two most important skills which in my opinion for life, the ability to self soothe or calm down and problem solve. And it's very important where you can to get schools outside when you can. When you have the resources to get psychoanalytals, neuropsychs. With adhd, neurology becomes psychology. A colleague of mine, Ari Tuckman, I don't know if that was his original quote. I've certainly heard him say it. It may be, but that's a very important quote to keep in mind that again, it leads to this idea that for a lot of these children, they really have a bona fide struggle. Again, I want to keep this image alive for you. Struggle with versus choose not. Because that really helps with the empathy. Okay. Anxiety is a very common problem. It seems. It's ubiquitous these days. It affects 13% of children. And I have more and more kids naming it for me. I think the movies Inside out and Inside out, two wonderful movies, I think, have, you know, getting that message out that it's okay to have feelings, even problematic feelings. And the more that we bring them along for the ride versus thinking we have to extinguish them. It's part of life and learning to live with and manage. But anxiety is a really big driver of defiant behavior. I've seen kids lash out and do things with peers, with their parents, and then later talk to me about how scared they were, how shamed they were, how, how they felt so backed into a corner and their fears overtook them. Depression. I've seen a lot of kids with depression that have kind of an agitated form of depression. They're irritable, they have attitude. And a lot of times that's what's driving that defiant behavior. It can occur too. It's very Important to keep in mind that, you know, we tend to think of, oh, this child has depression, this one has anxiety, this teen has depression or anxiety. There's an intermingling, there's comorbidities that can be very merged. And it's very often a child has a couple different things going, plus life stressors. Things may be going on at home or with peer groups. I've had so many children these days, the preteens and the teens seeing on Instagram or Snapchat things where they're not included, parties they weren't invited to. Used to be there would just be a rumor of something that happened. But now that feeling left out, negative comparison of self to others. By seeing all these teens living their best lives, being their best selves, I see so much of this and I see the number it's doing. So I'm throwing this into the mix as another part of the stew, if you will, that is simmering and boils up into defiant behavior. A lot of kids that I see are, in my opinion, overbooked. They're over scheduled. I see. I mean, as a child psychologist, I'm competing. I'll use that word when I go to schedule kids with soccer practices, drum lessons, piano lessons, scouts, religious activities, you name it. I think it's really good for kids to have structure. But I'm seeing a lot of kids that are very overscheduled. I think when the pandemic occurred, one of the problems was that a lot of kids were socially cut off and they lost a lot of their ability to socialize at the same time. For a lot of kids, it slowed their lives down. So it's sort of a mixed bag. We all know that there's a lot of ripple effects from the pandemic on mental health. But now that we've been out of it for a while, I'm seeing again so many kids spread very thin in different directions and a lot of very tired parents, too. I think defiant children have a hard time prioritizing the demands of their responsibilities, particularly if they do have adhd. We know that executive function happening is really problematic. And I like the metaphor, especially with the academic challenges with kids who have defiance. ADHD of the distant elephant. You know, if you envision an elephant right now that's like, you know, 100 yards away, a football field away, it's not going to nearly be as big. But when it's lumbering toward you, think book report, think presentation, and you haven't really prepared, and now all of a sudden you look up, it's overwhelming. And I think that's often the life of a lot of kids with ADHD and defiant behavior. We are so focused on pathology, so positive reinforcement, in my opinion, it's just so important. We need to not just think in terms of this. Anxiety disorder, depression, adhd, they're wonderful labels. They help us conceptualize when medications are used. They're helpful. They're helpful in coming up with treatment plans. Totally on board. But what about positive psychology? Where is that in the mix? Are we really helping our children and teens identify their character strengths enough? Think of it this way. If you go out today and buy a blue Toyota Camry, I hope I won't get in trouble for mentioning a brand. I don't even own one. But I'm just using this as an example. Any kind of, you know, model, like a blue Toyota Camry. What are you going to see on the roads tomorrow? A blue Toyota Camry, right. Or, or a Nissan Sentra will, will spread it out. Blue one. You know, whatever your car is, make and model, the next few days, you're going to see your newly acquired car. You're going to see other people driving. Why? Because it's top of mind. And in homes where children have a lot of defiant behavior and reactivity, I think everybody's so beat up and worn down that we start to look at only the negatives, the problems, we start to anticipate them. And the more that we can help our children and teens see the positive exceptions to the rule, like Sam, you know, in that example I gave at the beginning, my son, you know, he, he was able to downshift and apologize to his sister. And by the way, later in that weekend, his younger sister came up to him and was provoking him. And he cocked a fist and I said, sam, please. And he let it go. That was a win. And I was looking for wins. And the more we look for wins and we let our children know through that accountability mirror, not only for what they need to do better, but also praise them for what they do well. Concrete, specific feedback, it starts to crowd out the negative behaviors. So we want to give them rewards within reason. Verbal praise, by the way, I think is one of the best rewards. We want to speak through our hearts, from our hearts, and we want to let these strengths build on ourselves. It's so important. I think we're in a world of a lot of pathology and again, learned optimism, character, strengths, grit. When our kids show grit, that bounce back, ability, we want to let them know so they can identify it. When kids get into flow states, preferably not just with a video game, but drawing a picture, reading, throwing a ball, playing a board game where we lose that sense of time. We want to talk about how, what a great coping strategy that is. Okay. And with a lot of the kids that come in, particularly like age 10 and down, I'll have the parents do what I call a positive catchbook. And I'm listing them here. Right. The quick second bullet, quick recoveries. Use their words. They were more flexible. They let it go. Think of Elsa, right? Frozen. They didn't take the bait. They made requests in a calmer way. They resisted hooks like screens. They asked for help. So we really want to take this opportunity that when we want to look for it, write it down, especially for younger children, go over it with them a few times a week, perhaps when they're lying down to sleep and they're more receptive and you have a captive audience. As far as some of my work, one of my books, I have these cooperation games and I want to briefly mention these as I wrap up for today. There's I believe 17 cooperation games in my latest book on defiant children. And one is put yourself in each other's shoes. This actually goes way back to one of my first sessions when I was really anxious. This big tall father with a commanding presence who was a very pragmatic engineer and his kid had ADHD and oppositional defiant and they just kept locking horns. His nine year old was really giving him a run for his money. And in this session I literally had them take off their shoes. So the boy has got his feet lost in his father's size 13 shoes and they actually role played each other. And by doing that and stating each other's perspective, I mean the father broke down and started crying. It was so moving because he got to hear what he sounded like and he was frustrated. So I mean it doesn't always have to be emotionally laden, but it's a way of changing up perspectives, putting the past behind you. So get up to a wall, do a wall, sit and crouch and share issues that you both overcome, maybe that, you know, you've seen each other overcome. You coach your child a little bit to help you with that or get them to focus on their own. Doesn't really matter. The idea is that we're focusing on positives and then handfuls of gratitude. I can't say enough about gratitude. I try to practice it. It's my drug of choice. You can never OD on it. Gratitude is a wonderful way. It's hard to be grateful and be miserable at the same time. So. So in this particular game, standing on one leg, secure yourself with a wall. I don't want anybody coming after me. And state what you're grateful for with each finger in the air and then make a fist and you're not using your fist to punch each other. So on that note, I believe we've gone through the slides. I want to end with that. It's very important to lead with empathy. As I've tried to stress be when you feel in the lane, locked in the lane and stuck in the traffic jam of frustrated parents, switch over to be the emotion regulation coach. Stay calm, firm and non controlling. Again, the handouts. There's a handout that talks about, that gives a lot of good prompts and ways to practice, infuse encouragement, keep innovating and build on those successes.