Transcript for
Working with families in neuro-affirming ways

Kate Mulheron (00:00): 

We can build the kids’ trust in themselves by showing them what they’re already doing to self-regulate a lot of the time. And once they have that idea of like, “Oh, I already know what’s going on in my body a little bit and I’m already taking action,” now we can get more specific about the actions that we might be able to take. 

Narrator (00:23): 

Welcome to the Emerging Minds podcast. 

Jacquie Lee (00:29): 

Hi, everyone. My name is Jacquie Lee, and this is the second episode in a two-part series on supporting the mental health of autistic and ADHD children. If you haven’t listened to part one yet, you can find the link in our show notes. Before we begin, I’d like to acknowledge the traditional custodians of the lands on which this podcast is being recorded, the Kaurna people of the Adelaide Plains and the Gadigal people of the Eora Nation, and pay my respects to all Aboriginal and Torres Strait Islander peoples, their ancestors, and elders past, present, and emerging. This always was and always will be Aboriginal land. 

(01:05): 

In our last episode, we looked at how a neurodivergent affirming approach to practise benefits the mental health of autistic and ADHD children. This episode builds on these understandings by looking at how you can apply a neuroaffirming lens to your work with children and their families. We’ll explore ways to build childrens’ self-regulation and advocacy skills, foster acceptance of their neurodivergent identity, and uncover the why behind their behaviour. 

(01:32): 

Once again, I’m joined by psychologist Jason Tran and Esther Fidock, Speech Therapist Kate Mulheron, and Tammie Sinclair and Jasmine Deacking from Sunny Spectrum Supports, along with Bec and Jaisen, two of our Emerging Minds family partners and parents of neurodivergent children. 

(01:49): 

A neuroaffirming approach views behaviour as a form of communication. Often, behaviours that are considered problematic are simply the child’s way of trying to communicate or meet their needs. I asked Kate and Jasmine how they work with families to uncover and understand the why behind a child’s behaviour. 

Kate Mulheron (02:08): 

I think what can be really lovely for them is to reconcile their experiences. So if you find someone who you’re working on something academic and they’re really avoidant about academics, and being able to give them that relief of having a logical feeling of, “Of course being asked to do schoolwork stresses you out. How many years have you been asked to do schoolwork without anyone knowing how hard you are working? So of course it stresses you out and I want to do it in a way that doesn’t stress you out.” 

(02:47): 

And it is teaching them that they are right and logical for avoiding their schoolwork because they’re probably thinking that it’s a bad thing to avoid schoolwork. But you can go, “No, it actually makes a lot of sense for you. Having said that, we’re not going to be stuck here forever.” I have one student who talks a lot about being shy because they’re autistic and then being able to gently challenge, “Is it just the autism or have there been people’s responses to you that have made you talk less, because it makes sense to talk less if people have been rude to you.” 

Jasmine Deakin (03:25): 

So I worked with a family of a young person where we were noticing that he would become overwhelmed with communication that was one thing after another. And I was noticing in different scenarios with different responses, whether it was he would fall to the ground, he might make a face, he might snap back and snarl back, that it was one moment where I saw him drop to the ground where it was 10 seconds. And I thought about it and I was put this pattern together and said, “Hey, let’s observe this with this lens now and see if it clicks.” And the lens was a ten-second processing window. And so it was, “Let’s just give that 10 seconds.” And since this light bulb moment, the parents have seemed to be able to identify that in different areas, and they’re now building their understanding around that need for more time to process. And we’ve acknowledged that as not a delayed processing time, there is no delay here, it’s just that he needs that time to process. 

Jacquie Lee (04:39): 

As Kate explained, validating the child’s underlying needs doesn’t necessarily mean being permissive of the behaviour itself. 

Kate Mulheron (04:46): 

I think it’s about helping them through the process of problem-solving by showing them the procedure for how to figure out what they were trying to do and helping everyone to see, “Okay, something needs to change.” But the strategy the kid was using isn’t the only strategy. So it’s not permissive to say, “I’m not angry at you for doing something that was not what would’ve been ideal.” It’s not that they’re not getting in trouble so that nothing is happening. It’s they’re not getting in trouble because they were doing their best. But if we could show them other strategies, they don’t want to do things that bother people, so they’re going to stop doing them because they’ll have better strategies. So it’s making sure, especially for people who are worried about being permissive, it’s sometimes about reframing what needs to be permitted in the first place. 

(05:41): 

So if kids aren’t particularly chatty to strangers, and then so they come in and they don’t say hi to me and then the parents are going, “You have to say hi,” and then just really reframing, “Do they have to say hi? Why? I don’t care.” So sometimes it’s about choosing your battles and reframing things so that there are less things that need to be dealt with. And then, when there are things that legitimately do need to change because they might be hurting other people or they might be not effective as a form of self-advocacy, then teaching new skills will solve that problem. 

Jacquie Lee (06:25): 

Esther and Bec discussed why an understanding of the whole family’s context is essential to these conversations. 

Esther Fidock (06:32): 

So I think a really important part of working with families is always getting a good picture of the full family unit individually as well as all together. So I think for me, I would always try and work to understand each person’s perspective of what they’re finding tricky, what kind of things they’re finding really easy or enjoyable for example, and to do this I often target particular times of day. So often, I would say something like, “Tell me the hardest time of day for you.” And if someone says, “Every part of every day,” then we have to get a little bit more specific. 

(07:03): 

So often in those younger age ranges, it’s early in the morning or late at night, so we might kind of pick that getting ready for school, preschool for example, and target specifically a time of day. So then, we can approach I guess the supports and the understandings of how to make that a little bit easier. And then, what happens when you support a family to make a certain time easier is they see the value in understanding further psychoeducation, further strategies, understanding how to work with each other, manage each other’s sensory needs. All of that kind of thing becomes a little bit easier, because often we see people who are just so overwhelmed they don’t know where to start. So if we can help them from the get-go to get a little win to make a little time of their day easier, then I think it just flows on from there. 

Bec (07:51): 

If they can understand enough of who we are and what we’re about in our family and they’re willing to join us in how we support our kids already, offer some new strategies within what can work for us. Because sometimes strategies are suggested and they just feel too hard for our circumstances, and that’s when you go, “Yeah, we can’t have this person advising us and our family on how to do this because that’s not going to work in our family.” 

(08:25): 

Sometimes it’s just got to be really small little things or options or that recognition that sometimes you’re not going to be able to do all your homework, you’re not going to be able to do all the things. You can give them a go. And I think that’s what I have appreciated in practitioners that give you a selection of things that you might be able to try. And maybe none of them will work or maybe a few of them will work or maybe they’ll work for a week and then they don’t. 

Jacquie Lee (08:54): 

Meltdowns are a common presenting concern for autistic and ADHD children. I asked Jason, Kate, Tammie, and Jasmine to share their reflections. 

Jason Tran (09:04): 

So I guess when I’m working with a young person that has troubles with meltdowns and I guess behavioural challenges as well is again understanding that the ABCs, the triggers that led up to it, the behaviour itself, and also the consequence of how it’s been responded. And what’s also very important is understanding what I call vulnerability factors, so factors that make that young person, I guess, more likely to have emotional distress or more likely to go into a meltdown. It could be things like lack of sleep, for example, sudden changes of routine, increased expectations on the child as well. So really try and understand, and helping the parents or families to understand the triggers or the vulnerability factors that might lead to a meltdown or challenging behaviour and then how we can probably reduce that or prevent that in the future as well. 

Kate Mulheron (09:54): 

Pattern finding is something that I encourage. The more you can learn the patterns, the more you can predict what’s going to happen. Because if they’re seeing everything as isolated incidents, then that’s really hard to deal with. And asking the kid, “What was that like for you?” 

Tammie Sinclair (10:14): 

Meltdowns happen when someone is in a prolonged state of distress or when there’s just an immediate trigger. It could be a buildup of stuff that leads to this meltdown. The most important thing is when that happens, you need to remember that the child isn’t making a decision to do that. Your body’s in fight or flight. It’s happening. We just need to ride it out, but we need to support recovery and we need to reduce shame. And we need to remember that it was not a sign of that child’s personality even, because logical reasoning and personality are in the same space. 

(10:47): 

In that moment, when they come down from it, they’re either going to forget it or they’re going to feel really, really bad. And what we need is to hear, “I still love you. It’s okay. I know that made sense to you.” And often things make sense and that’s why we have this meltdown because no one’s hearing you. So validating and understanding their experience and then using the experience as a learning opportunity later when they’ve recovered from that meltdown. We do not need to feel shame for having a meltdown. It’s a normal response to a distressing situation. 

Jasmine Deakin (11:24): 

I think one key part that can be tricky but is also quite impactful is understanding when it’s best to ride it out. And whilst that might be uncomfortable, because meltdowns are distressing and exhausting, they’ve got to come down sometime. And there can be a sense of relief or release perhaps that comes from a meltdown, and it can be a way to assert that autonomy and to get that out. 

Jacquie Lee (11:58): 

As the parent of three neurodivergent children, I was interested to hear Jaisen’s perspective. 

Jaisen (12:03): 

It’s really hard because you’re thinking, “Okay, what’s triggered them? What can I do to reduce the trigger or get them calm?” So for example, your child might need pressure like a hug or something or coming up to them and just giving them that high pressure feeling so that they’re feeling safe or getting them out of that situation, so if it’s bright light or if it’s too noisy, things like that. 

(12:36): 

It’s for me, regulating myself is really hard because I have some challenges myself. And so, it comes down to going, “Okay. Well, you are having a meltdown. I don’t want to have a meltdown. So how are we going to get this sorted?” And I think just helping myself by telling myself, “Okay, prioritise what we’ve got to get done.” So if it’s get them headphones on or take them out of that situation and then I can deal with my own regulation later on. 

(13:12): 

So I think it’s important for practitioners to let parents know that these things are going to happen. And it could be a sensory overload that’s a trigger for them, so taking your child into a shopping centre where there’s loud music, there’s crowds, there’s bright lights, there’s all these things could be a trigger, but it’s nothing to be embarrassed about and it’s nothing to feel ashamed about. It’s just important for parents to understand that these are behaviours that are going to come with neurodiversity, and you’ll find ways around managing that. 

Jacquie Lee (13:44): 

As Jason mentioned, co-regulation is an important and effective tool in supporting children of all ages to regulate their emotions. But building the child’s own regulation skills is essential for their long-term well-being. Esther explained how strengthening children’s interception, their ability to identify their body’s signals is a key part of this work. 

Esther Fidock (14:04): 

A really huge component of neurodiversity affirming practise is supporting autistic children to understand what uncomfortable feelings and sensations are like for them, and that they should honour and listen to those uncomfortable feelings. Because I think historically what has happened due to ableism is that autistic children have been forced to push aside or deny or ignore those uncomfortable feelings in order to perform in neurotypical ways. So what I think neuroaffirming practise has done is said, “If you are uncomfortable, that’s telling you something. And it’s not that you need to mask.” So I think that is super helpful in allowing a child to then develop an understanding of adults that they feel safe with versus adults that they don’t feel safe with. Because they haven’t got that internalised feeling of, “I must do what adults tell me. I must behave in ways that look appropriate.” They actually can truly sit with and understand, have that interoceptive ability to think what feels comfortable versus what feels uncomfortable. 

Jacquie Lee (15:06): 

I asked Jason, Jasmine, and Kate how they work with children to strengthen their interoception and build self-regulation skills. 

Jason Tran (15:13): 

So I think by understanding the young person as a whole, it can better inform us ways on how to help them self-regulate. I personally find it very effective to use sensory self-soothing strategies. That’s really informed by DBT, Dialectical Behaviour Therapy, where we use our senses as a way of soothing ourselves as well. For some children or young adolescents, it could be, let’s say, using our sense. If you find the scent of a lovely candle really soothing, using that as a way to help regulate. I call it a sensory self-soothing box, where you put together some things that you find really comforting and relaxing and using that as a way to regulate as well. 

Jasmine Deakin (15:54): 

Sometimes it can be helpful to incorporate sensory activities into play and even into everyday life. It doesn’t have to be a mundane therapy approach sort of style, for example, like repetitive physio exercises. Whilst I see the value in that, when we look at things like stimming, it’s very different. So an example could be that if someone wants to hop to the bathroom or roll to the bathroom, if they’re getting there and they’re doing what they need to do, is it really that bad? That it could make that experience more fun too. 

Kate Mulheron (16:35): 

What we can do is we can build the kids’ trust in themselves by showing them what they’re already doing to self-regulate a lot of the time, and that they don’t realise that that’s what they’re doing. So they’re already fidgeting, but they think they’re just fidgeting. And what we can tell them is, “Did you know that fidgeting is self-regulation?” And once they have that idea of like, “Oh, I already know what’s going on in my body a little bit, which I didn’t realise I did. And I’m already taking action,” now we can get more specific about the actions that we might be able to take. 

Jacquie Lee (17:09): 

Kate went on to explain why self-advocacy skills are important for self-regulation. 

Kate Mulheron (17:14): 

It’s really important that while you’re teaching them the skills to change the way their body is and you’re teaching them to trust themselves that they know their bodies, being able to also teach them the self-advocacy skills to be able to do that without feeling socially uncomfortable. Because if they know what to do, they might choose not to do it because it makes them feel weird. But if they can frame whatever they’re doing as a positive, like, “Hey, isn’t it cool that I can just do this and I can just change the way my body feels? So I’m just going to do it now.” People are going to accept it more than if it is framed as something that you have to do, otherwise you’re going to disrupt. Or if it’s framed as something that you have to do because your hearing is so different, then you have to use noise cancelers and stuff. People are going to feel more confident to use the strategies. 

Jacquie Lee (18:11): 

While self-advocacy skills support positive mental health throughout our lives, children also need the adults around them to advocate on their behalf. I asked Esther to elaborate. 

Esther Fidock (18:21): 

I think having a teacher who understands neurodiversity-informed practise is really helpful, because advocating is way easier if you’ve got a teacher who just honours and listens to children’s experiences. So I think again, going back to what is it that this child needs and how can we support them to have those needs met? 

(18:43): 

Sometimes you have to come at it from a very clinical angle of, “Well,” for a teacher, “we know that you want this child to learn well in the classroom. We want this child to have a good experience of school. So therefore, this is what it needs to look like for them to learn in your classroom.” Really getting specific about what it is that they need to advocate. For example, if that’s wearing headphones in the classroom because it’s too loud, what that might mean in terms of when they’re wearing the headphones versus when they’re not wearing the headphones, if they need to sit in certain spots in the classroom. So I think being the adult advocate for younger children is really, really important because that child is then seeing you using your voice strongly to make sure that they feel comfortable and well in different spaces in their life, which then will allow them to do that themselves. 

Jacquie Lee (19:40): 

So how can practitioners support parents to strengthen their own advocacy skills? Jasmine, Tammie, and Jason shared their thoughts. 

Jasmine Deakin (19:49): 

I think a lot of it is centred around boundaries when it comes to self-advocacy, and really understanding the difference between setting a boundary and making a request. That a boundary exists to protect your own wellbeing, and if someone doesn’t protect that wellbeing, that comes with consequences rather than being a request that you’re at the mercy of whether they agree or not or whether they want to comply. And I think that someone needs to understand their rights and reasonable grounds to advocate for themselves as well. When people don’t understand their rights and that it is reasonable and validated that they can set a boundary or advocate for themselves, that’s probably when it can feel the most shaky to do it. 

Tammie Sinclair (20:44): 

Therapists could support parents to understand that it’s okay to be loud about what that child needs, so don’t worry about being the squeaky wheel. If you have to contact the school every week to let them know, “This is what my child needs. Why hasn’t it been put in place yet?” Do it. Sometimes you don’t get what you need unless you ask. And if you are the squeaky wheel, eventually they’ll listen, and then hopefully that will translate to all the other children in that environment who need a similar thing. The more we express what we need, the more they’ll listen. So the more parents advocating, the more they will listen. And the system will change, and how quickly it changes is determined by how many of us are advocating. 

Jasmine Deakin (21:30): 

And supporting families and young people to practise in a safe environment is really important as well. So whether that’s practising consent in your therapeutic environment, I often working with young people, particularly if they’re overly compliant, really encourage the no side of it, that you can say no. And often I say though, “I don’t mind if you can say yes or if it’s a maybe, but I’d really like you to be sure of your no’s.” And we start there. 

Jacquie Lee (22:08): 

As Jason and Bec highlighted, practitioners also have a key role to play in advocating for children’s needs. 

Jason Tran (22:14): 

From my experience, unfortunately, especially working with schools, they do put more emphasis on, of course, a lot of professionals over their own parents’ individual voices. And so, that’s quite disheartening because the parents do have a lot of understanding and knowledge about their own young person’s unique challenges as well. So usually when that happens, a clinician or being a psychologist, we help support the families together in collaborating with the schools and how we can better support the young person. We’re not going for the pointing fingers kind of thing. It’s all a collaborative approach. 

Bec (22:48): 

As well as doing the assessment, they helped us develop a bit of a plan for what accommodations might be needed at school, and they were really sort of specific things around having visual reminders. A big one was just not having homework because it just wasn’t achievable and wasn’t going to achieve anything for our child. The main thing was that they were getting so exhausted just by attending school for the whole day that there wasn’t any point in trying to bring work home that wasn’t finished, and that some of their schoolwork would need to be maybe miss some elements that other children had, things like that. 

(23:36): 

 So I’m sure there’s a name for it, but there was this sort of plan developed that we could put to the school, and we had backing of the psychologist that had helped us develop that as well as them offering to talk to the school alongside us. Because I think we’d been having a lot of conversations, but until that we had that, I guess, backing by a practitioner saying the same things that we were saying, it didn’t necessarily get implemented in a busy school with a lot of children. Sometimes you just need that backing from practitioners to make sure that your child’s getting the support that they need. Yeah. 

Jacquie Lee (24:21): 

For some families, a diagnosis of autism or ADHD can be difficult to accept. Esther, Jason, Jasmine, and Kate shared how they’ve navigated this in their work. 

Esther Fidock (24:32): 

Yeah, I think it’s really hard sometimes when we have people who maybe have a lot of stigma around how autism or ADHD present and maybe just don’t really quite understand what it looks like. So I tend to see a lot of families who they have this formal identification of autism or ADHD. They’ve seen a professional and that professional has said, “Okay, your child’s autistic.” But the family still doesn’t quite understand exactly what autism is or what that means. So I think what that leads to is people thinking that their children are being really naughty or really defiant or particularly obtuse for reasons unknown. 

(25:12): 

But I think what happens when you help everyone understand actually what is autism and what does it look like and how does it present, down to the nitty gritty of I’ll go through all of the criteria and say, “This is how this is probably showing up in this part of your life, and that’s because your child is autistic or your child has ADHD.” And if we can help to bring them along in that understanding, I think that goes a long way in then understanding the child’s perspective. 

Jason Tran (25:38): 

I work with a lot of clients from an Asian background as well, and sometimes I guess having a diagnosis of autism is almost considered a very taboo-like topic. It’s a very shameful thing in some certain cultures. It’s like losing face, we call it in Chinese culture. And that can make it really incredibly hard to accept a diagnosis or even to let people know about the diagnosis as well. So as this guest, as a practitioner, I think it’s very important to understand the cultural factors that might be involved in the person’s family or young person’s life, to better understand how to better work with the family. And going gently with the family, working with them rather than against them I think is very, very important. 

Jasmine Deakin (26:19): 

Particularly with strong beliefs. I think it’s important to value those and ensure that they have a place in conversations around neurodivergence, rather than looking at neurodivergence challenging those values and beliefs; that actually they can coexist together rather than it being, again, a competition or a choice in between. 

Kate Mulheron (26:47): 

Sometimes it takes a little bit more support to let go of some of those ideas that are keeping the parents safe psychologically. So they shouldn’t be expected to suddenly make themselves super vulnerable without support. I like to frame it as an exciting new thing that we can all learn about. So it’s a positive thing. All of this learning experience is freeing the parents from their worries about, “What are people going to think if my kid doesn’t say hi to them?” The parents get to be released from that worry. The kid gets to be released from their, “I have to say hi, even though I’m really uncomfortable.” I like to frame it as, “You didn’t use to have a choice and now you do. Isn’t that awesome?” 

(27:41): 

I try not to be too militant about it because it’s not compassionate to the parents. It’s like meeting everyone where they’re at; not just meeting the kids where they’re at, but where are the parents at as well. And then, it’s about the parents’ internalised worries. And in the case of neurodivergent parents, internalised ableism, like, “I have to say hi. Otherwise, I’m doing the wrong thing. That means my kid has to say hi. Otherwise, we are both doing the wrong thing.” And that feeling, it’s a freedom to get away from that for everybody. 

Esther Fidock (28:20): 

And I think a more overarching and not talked about thing is that this idea of ableism is so pervasive in our society, that the reason that it feels so bad is because neurotypical people are doing what you’re meant to do because of ableism, is that this is what’s expected of you. But just because that’s what’s expected and what we see most often, that doesn’t mean that it’s the best way to approach communicating with other people. So I think also there’s that real societal underpinning that I like to make clear is that, “You’re not doing this because there’s anything wrong with you or you’re lesser than or anything like that. This is just your neurotype. And actually, neurotypical people can learn to communicate in different ways too.” 

Jacquie Lee (29:02): 

Esther, Jasmine, and Kate discussed how they help families to shift their perspectives on neurodivergence. 

Esther Fidock (29:09): 

I think if we’re helping to take away the stigma from autism and ADHD, then a child’s going to become more confident, they’re going to become more comfortable in their environment. They’re less likely to experience things like anxiety and depression because they fully understand how they see the world, how they interact with the world, and that that’s totally normal for someone who is autistic or someone who has ADHD. 

(29:35): 

So for example, if they’re looking at their room and it’s a huge mess and they just don’t know where to start, instead of internalising that voice of, “I’m such an idiot. I never know what to do. I’m always so overwhelmed. I can’t cope.” All of those kind of horrible internal monologues, it becomes more like, “Well, of course I find this hard because I have ADHD. I find doing things step-by-step really hard, so therefore here’s what I can do. Here’s what’s going to help me. Here’s who will help me. Here’s how things become easier.” So it really just flips that, and it means that they can develop that real strength and understanding of themselves rather than beating themselves up about things that they find hard I think. 

Jasmine Deakin (30:18): 

Sometimes I find it helpful to flip the narrative a little bit as well and challenge people to look for the strength in a problem or a difficulty. And so, examples of that could be that someone might be highly fixated on a certain thing, but the strength might be that they have great attention to detail and they’re really invested in each detail, rather than it being that they overly fixate on things which might be seen as problematic. Other examples could be someone who might be seen as rigid. We could look at that as someone that works really well with structure. Someone who we might look at to be argumentative might have a really strong sense of justice. The same if someone might be seen as blunt, which might be seen as problematic. We could look at that as someone who’s quite honest and tells you exactly what they’re thinking and takes the fluff out of it. 

Kate Mulheron (31:17): 

I would say I really come back to this idea that being autistic isn’t good or bad. Being ADHD isn’t good or bad. Being neurotypical isn’t good or bad. But knowing what you are and working with yourself is good. Thinking you have one type of brain and actually having the other type of brain is bad, because you’re fighting with yourself and you’re not able to make yourself comfortable while also doing the public-facing things you want to be doing. Whereas if you know yourself, you can be empowered. So it’s always a good thing to learn you’re autistic. It’s not a good or bad thing to be autistic. 

Jacquie Lee (32:00): 

Thanks again to Jason Tran, Esther Fidock, Kate Mulheron, Jasmine Deaking, Tammie Sinclair, Bec, and Jaisen for sharing their time and wisdom with us. If you’d like to learn more about working with neurodivergent children, check out the links in our show notes and sign up for our newsletter to be the first to hear when our new online courses are released. In the meantime, thank you for listening and I hope you’ll join us again soon. 

Narrator (32:26): 

Visit our website at emergingminds.com.au to access a range of resources to assist your practise. Brought to you by the National Workforce Centre for Child Mental Health. Led by Emerging Minds, the Centre is funded by the Australian Government Department of Health and Aged Care under the National Support for Child and Youth Mental Health Program.