Producer: Welcome back to Full PreFrontal, where we are exposing the mysteries of executive function. Once again, I am here with our host, Sucheta Kamath. Good morning, Sucheta. Very much looking forward to today’s conversation. All right. So leading us off, coming of age, falling in love, falling in love in a great Oscar-nominated film called ‘Call Me By My Name.’ Tell us more.
Sucheta: Yes. And maybe we can add psychiatry and psychiatric problems and emotions. Thank you, Todd. I’m so happy to be with you. We have a podcast where we talk about executive function, and no conversation can really be complete without talking about emotions. And so emotions, what are they good for? In fact, they come in a way, they disrupt life, they create barriers, so to speak, and this was evident in one of the movies recently, as you mentioned, I saw. It’s a great movie. Todd, you haven’t seen it yet, right, Call Me By My Name?
Producer: I have not seen but because of this, I’ve added it to my list. I’m looking forward to it.
Sucheta: It’s a great movie. So I’m going to talk about two quick scenes in this movie and I’m going to show you how that relates to what we are about to talk about. So this is a movie about a17-year old teenager living with his parents in Italy. The father is a professor. It’s summertime. It’s a beautiful, beautiful scenery and the surroundings. They have a little house. The parents are about to entertain a couple for lunch and the father tells that son to go put away a shirt. It’s a gay couple that’s coming for lunch. The dialog between the son and father goes something like this. The son says, “I can’t put it on now. They have already met me.” So what happens is they meet downstairs and then he runs upstairs and the father tells him to change the shirt, and put on a shirt that the couple had given him as a gift, which is like a big Hawaiian shirt which is a little bit loose and big on him. So you can see why the kid is a little bit reluctant. So the son says, “I can’t put it on. It looks like a put up job. I just don’t want to do it.” And so the dad says, “No misbehaving tonight and no laughing. When I tell you to play, you play. You are to accept people as they are. What’s wrong with them? You can’t ask those kind of questions. You call them Sonny and Cher behind their back. Only person all this reflects badly is on you.” And so the dad takes that quick moment to tell the son a little bit about not to be so immature and also not to be so judgmental. You can see, tiny, tiny glimpse of this incidents. There’s an interaction between the son and the father where the tension is because of the son just being difficult and resistant and unyieldy, l nothing more. Nothing special. But the movie unfolds and I won’t give you all the details but it’s a beautiful love story. Eventually, the boy in the movie falls in love with the older man. So the boy is 17, the older man is 25 who is a research assistant who comes during the summer to do some work with his father and they fall in love. It’s the story about how they relate to each other. In fact, when the internship is over, the TA returns back to America and this is the ending scene, which is why I’m relating to our conversation is that the son sees him off and comes home, his face swollen. You can tell he’s really, really sad that his friend has left him. And the father doesn’t show that he knows about their interest in each other and the son is not sure if the father knows. So the son walks into the house and the father is reading. He puts away his book. He asked the son to come closer and then the son lays down on the sofa next to his dad. The dad throws away whatever he’s working on and takes his son’s head on his lap and puts his fingers through his hair and there’s a gentle moment in the conversation. The dad says, “Welcome home. You two had a very nice friendship. You’re too smart to know how rare and how special what you had was.” The son pauses and says, “No, no, no. He was far better than I was or I am.” And the dad just reminds him that I think he’ll say the same thing. The last sentence the dad says, “That when you least expect it, nature has cunning ways to find out our weakest parts. Just remember, I’m here.” What I loved about this scene is these emotional ups and downs that this young 17-year old is going on, the father has such enormous interest in it and attunement with it. He was right there to give advice. He was right there to support this young man. None of these were psychiatric behaviors or none of these was like depression or deep anxiety. It was just the angst that the child goes through.
So the reason I thought this is such an important and relevant story to what we are going to talk about is my guest today. My guest is Dr. Nancy Rappaport. She is the associate professor of psychiatry at Harvard Medical School. In 2012, she received the American Academy of Child and Adolescence Psychiatrist Sidney Berman Award for the school-based study and treatment of learning disorders and mental illness. She has received Cambridge Health Alliances Art of Healing Award in 2013, and award given to one who transcends boundaries, joyfully embraces humanity, and profoundly inspires the healing body and the spirit. Nancy has done many important written works that she has produces but one such book that I recommend that she has co-authored with Jessica [inaudible 00:06:43], it’s called ‘The Behavior Code: A Practical Guide to Understand and Teaching the Most Challenging Students,’ I think, is a brilliant read for everybody who’s interested in dealing with children and their emotions while educating or parenting them. And last but not the least, Her Memoir in Her Wake: Child Psychiatrist Explores the Mystery of Her Mother’s Suicide, was the winner of the Boston Author’s Club in 2010. They’re a [inaudible 00:07:10] Prize. In a starred review, Publishers Weekly called the book, “fearless, a stunning narrative of perspective, profound sadness, and unrelenting hope.” I am a big fan of Nancy. I have heard her many times and it’s such a privilege and delight to have her. She’s going to talk about children, their emotional life and the lens of psychiatric disorders and how to handle difficult children in the classrooms. So I can’t wait for us to discuss this, Todd.
Producer: Well, I’m looking forward to the conversation too, Sucheta, promises to be. And I can’t wait to dive into that film you were referencing. It sounds like a lovely, lovely piece, looking forward to seeing that too. All right. Well, let’s get to it. Here is Sucheta’s conversation with Dr. Nancy Rappaport.
Sucheta: Welcome to the podcast, Nancy. I’m so delighted to have you. Let me start with these questions: as a child and adolescent psychiatrist, how would you describe the link between brain development and behavioral manifestations of those things that a brain is responsible for? How is behavior a form of communication? And I’m sorry, I’m going to add one more question which is, what purpose do certain behaviors serve and the way people interact with it or react to it, they get reinforced? Can you tie all these things together for us?
Dr. Rappaport: So first of all, pleasure to be here and let’s think about this together because these are some complex and broad questions. The first thing I would say is I would add in that we want to think about brain development behavioral manifestations and relationships; because the foundation of managing behavior is having a strong relationship, whether it’s with your student or with your child. Sometimes, the manifestations that kids can have when they have brain challenges; so if they either have trauma or attention deficit disorder, is they can do behavior that can be incredibly difficult for caretakers. So it’s really helpful to think of many of the challenging behaviors. It’s an invisible disability.
So if you had a child walk into your classroom and they were using a wheelchair, you would make modifications because you would know they can’t go up the stairs to get to the gym. But in a classroom setting when a child misbehaves, sometimes, it can be seen as manipulative. It’s the aspect of the invisibleness of it because we don’t see when the brain is struggling in the same way as we do when a child has poor vision and needs glasses. So that ability to become curious when you see behavior is really a way to check yourself. Because when a child is presenting you with persistent behavior that’s quite frankly really annoying sometimes, it’s easy to get irritable or short and we’re all inhuman imperfect beings, including myself. And what this question of what is the child trying to communicate does is it makes us pause. It’s in the pausing that we can de-escalate a situation and give a child the benefit of the doubt. For example, if you have a child who was eating in the cafeteria and throws peanuts at the allergy peanut table, and people could think, she a burgeoning sociopath. I mean, why would you do that? And then you find out that actually, this is a child who has a parent at home that’s mentally ill and she’s trying to communicate her level of distress in a child form. They might think that nuts and being mentally ill unfortunately are comparable, then you have a little bit different response than thinking she’s trying to hurt the kids in the cafeteria. Or if you have a child that’s impulsive and has a reading disorder and bolts out of the classroom every time you start a reading assignment. If you haven’t done what’s called looking at the antecedents, behaviors and consequences; if you haven’t really looked at what’s the antecedent to this child bolting, you might just think it’s an oppositional kid without actually addressing the underlying problem.
So the last question was, you asked what purpose do certain behaviors serve and how do they get reinforced? A classic one in a school setting is that a child is being difficult in the classroom because maybe they don’t have the math skills they need to do the math homework or they have some apprehension with taking on the writing skill. Rather than really figuring out how can we help support this child in the task that we’re asking them to do, say, they need to have a first sentence prompt or they might need a photograph to help them with the English essay that you’re asking. What they do is they start to act up and do annoying stuff, poke another kid. Then what happens in exasperation, totally understandable, is the educator says, “Go to the principal’s office.” To me, that reinforces the behavior because if we think that there are functions of behavior and one of them is to escape a task, if you learn if I act up, I’m sent out of the classroom, that inadvertently reinforcing I need to keep acting up. Or sometimes what can happen both with parents and teachers is kids act up and then they get huge amount of negative attention where they get talked to and sometimes kids will then learn, well, if want to get attention, all I need to do is do something really disruptive. They’re not thinking this consciously but it’s something that is being reinforced.
Sucheta: I love this idea that you’re talking about, of intentionality. Behaviors, an assumption by an observer is that behavior is what the child intended or the teenager intended. And when you have the brain-behavior disconnect, I feel that they are children with these difficulties such as ADHD that they are really not intending to hurt anybody or intending to be annoying, intending to be causing conflict or distress but they just are impulsive or they haven’t thought through anything. They haven’t really paid attention to the impact it has on the others and that’s where I think what you are saying that people may be reactionary to a behavior and if they pause to think about what’s the link to the brain, they can bring in a different perspective. That really makes sense to me.
Dr. Rappaport: It builds on the idea of [inaudible 00:14:32] and explosive child talks about kids do well if they can. All of us want to be successful in what we do. So if we think that it’s intent and we get focused on their intending to disrupt the class, it makes it more murky and it can have the potential to make us more reactive. What we really want to help students do is to become reflective. So another common thing that people say is not to come at a child and say, “Why did you do this?” Because like you said, if it’s impulsive, they weren’t really thinking it through and why they don’t really have access to. But if you ask them what’s going on, you’re probably going to get a lot more clues.
So they may say, “Well, Little Johnny cut in front of me, that’s why I pushed him.” That was an impulsive decision and they were maybe a lot of other ways that they could have managed that. Or maybe they have poor social skills so they didn’t really take the time to read the room when they walked into the classroom or walked into family dinner. And so when you’re asking what’s going on, maybe you’ll get a chance to hear what they saw that then moved them into a reactive stance and began to sort of be a partner. What you want to do is be partners with them and try to keep finding language, still knowing, of course, that we are on some level if you’re talking about kindergarten through 8, that we want to be collaboratish at the same time as take a role where there are some things that aren’t acceptable and some things that are acceptable.
I always say with safety that I don’t really care what was going on with the child. I want them to be safe and I’m going to be fairly firm about that and not be as exploratory. But in other situations, I think it’s important.
Sucheta: It’s interesting. I’ll share a story with you along the lines that you just mentioned when parents did not use the method that you’re recommending. A family came to me and the child was having absolute no regulation on his own behavior, temper, his frustrations. Once he went downstairs to the basement and punched a hole in the wall and eventually would tell him, “Go punch the wall.” Instead of managing why are you wanting to punch the wall or what is going on with you that makes you so frustrated, by the time they came to me, the kid had 8 holes in the wall and they had lost track of what’s acceptable and “normal” or what needs a different way of handling it. This brings me to this question --
Dr. Rappaport: I’m sorry, just want to comment on that incredible story because it’s such a good story because what it also talks about is often when as parents or teachers, when we have really challenging behavior, sometimes what we do is we change our expectation and we lower our expectations. Not just out of desperation but think of what a message that child is getting if he’s being told the only thing we have in terms of managing your anger is to tell you to go punch a hole in the wall. The damage, I would think of not only the basement where the holes are happening but his hand. I’m so glad they had a chance to work with you so that they could learn both replacement skills and how to help him tolerate frustration in a way that was safe for him.
Sucheta: Exactly. Well, this brings me to the very question that drives this podcast which is executive function. And from your perspective as a child-adolescent psychiatrist, how do you frame executive function as it relates to the developing brain’s capacity to self-regulate? But most importantly, eventually its capacity to redirect ones own behaviors because that’s ultimately the mastery when we are operating in society, right? How do you see that?
Dr. Rappaport: To me, what executive functioning, and I’m sure you’ve talked about this before, is the ability to make good choices and the ability to be self-directed and to prioritize how you’re going to approach things. Embedded in that is also an ability to have, sort of, future glasses and see where you need to be. I think when kids have trouble with executive functioning, what they need is strategies with how to impose some order that can be incredibly creative but also scattered. If you just have straightforward executive functioning and you haven’t gotten into too much trouble, chances are you’re probably going to be able to accept help. But if you’ve had negative feedback either with parents or with teachers, one of the challenges is how do you look to adults to help you co-regulate?
So there’s a lot of emphasis on – so many times people will say, well, with executive functioning, you have low frustration tolerance. And so what you need to do is to learn what’s called self-regulation. I would say before you can learn self-regulation, you need to learn co-regulation. So that’s what happens when we are securely attached to our partners if we’re married or we have a partner. And it’s what happens from the beginning with a child and their caretaker is that the parent is helping the child to co-regulate.
Sucheta: When you talk about co-regulation, it’s my hand on my husbands need that taps gently when he starts talking too much?
Dr. Rappaport: Yes. And hopefully, he doesn’t interpret that as your hitting him but you’re actually giving him --
Sucheta: Of course.
Dr. Rappaport: No, no. I’m saying because sometimes with the kid that’s escalated, they’ll take that co-regulation that you’re trying to do and they may ramp it up. If you say you have three children and you have two that don’t have executive functioning difficulty and don’t have a low frustration tolerance, they may interpret the hand on the shoulder as mom’s trying to tell me slow down. But somebody who’s disregulated may take offense to that and part of our challenge and that’s why I was saying it’s not just about the brain and the behavior manifestations, it’s around the relationship because it’s a challenge to us as adults that care deeply about out students and our own children to figure out how do we co-regulate. Because if you think you’re trying to help a kid slow down and they’re still escalating, you want to be stepping back and thinking about what are some of the ways that I can slow this down and help my son or my daughter or my student tolerate distress? That’s a huge piece.
Sucheta: Yeah. And I think my experience as parents who get difficult children, they can’t necessarily pinpoint where all this began. These children show some signs of disregulation early on but it’s the reaction that they have gotten from the environment that escalates it to becoming a problem. It’s not managed well. And I also find that that there’s such a control that comes into play rather than compassionate supportive, like a redirection. People somehow find that as a weakness, to really say, “I’m so sorry that you are having a hard time. Is there anything I can do to help you?” or “Is there anything you can do to help yourself?” Instead, “Stop it now. Stop it. I said stop it.”
Dr. Rappaport: Yes. So I want to build on that though because I want to be sympathetic to our families because if you’re from the field of psychiatry/psychology counseling, it seems intuitively obvious that what you want to do is be empathetic first and try to understand what your child is feeling. It’s counterintuitive as a parent. If your kid is doing something really stupid and irritating, you just want them to stop it. So to me, it’s really more about a learning curve for parents than that they didn’t – I guess I’m building on it and trying to soften it in a way that it’s not – if you are from a background where you just tell people what to do, you’re a CEO in an office. And maybe you’re lucky enough that you actually have ADD but you have a secretary or somebody that supports you and you come home and your child is doing something incredibly irritating, you may think, well, what I just need to do is tell him what to do and he’s going to do it. What I love what you’re saying is unfortunately, I think, what we end up getting to in as parents and educators is we keep doing the same thing and it doesn’t work. So my question would be why do that?
There’s a study by Mark Adkins around hostile impulse of kids which is sometimes what happens if impulsivity isn’t channeled right then you start tog et hostility. It showed with suspensions that, all right, if you have just a kid that’s a little bit impulsive and you suspend them, they will never get suspended again. If you have kids that are hostile and impulsive and you suspend them, you start out in the fall and you just keep suspending them more and more and their behavior is staying stable. So that’s where I would encourage parents to be reflective about is our strategy working? Because saying “stop it” to kids, a lot of times that’s a good healthy message to give to kids. Unfortunately, when you’re stuck with repetitive behavior and you’re still using the same thing, that’s when you want to step back and say, “All right. What do I need to understand?”
There is a psychologist, Dan Hughes, and he has model called PACE. He wrote a book Settling to Learn. He talks about pausing, playfulness, acceptance, curiosity, and empathy. Where parents struggle with this model, I think the pause is pretty straightforward. You pause to get you bearings. You can’t control the wind but you can control your sail. So you just get yourself grounded, however you do it; take a walk around the block, five sit-ups, breathe, whatever it needs to get you, go into the bathroom, make funny faces at yourself. The playfulness is a little bit tricky. When you have a kid that’s escalating and you don’t want to shame them but you want to in some ways say, “Are we really going in this direction over a cookie, really?” Why not go in this direction around a wedding cake or something? You want to loosen up the intensity of it. But the acceptance is the place where the parents can get stuck on. Because what you’re accepting is the feeling but not the behavior. So with your --
Sucheta: Say something more about that. That’s so powerful. You hit on something that I don’t think parents distinguish between the two.
Dr. Rappaport: So if we’re talking about the boy that you were talking about that was punching holes in the wall, the family sees him start to escalate and they say to themselves, “Okay. Go punch the wall because you’re so angry.” So what I would rather them say to the child is to accept the emotion first. So they’re connecting with the – you are so mad and you want to match the affect, meaning you want to match the emotion. You want to let them know that if behavior is communication, you have gotten how pissed off they are. And then, it’s around, “So what’s going on that’s gotten you so mad?” “You won’t let me watch TV for 29 hours a day.” “That’s got to be frustrating because you love that TV and I’m sorry that it’s so hard for you,” and then you set the limit.
Because I think sometimes parents feel like, if I accept the emotion of how mad they are, then somehow that means I have to renegotiate the limit and I am all for limits. I think we have too many kids with the executive functioning who wear parents down and parents ending up capitulating and saying, “Okay. Honey, it is too hard for me to tell you not to do XYZ because you badger me.” There’s a guy names Patterson who talks about that. That’s a coercive pattern of aggression and it’s something we typically see with kids. Think about any of you all listening about being in a supermarket with a toddler and the toddler wants the pop tarts. They want not just one pop tart, they want 10 pop tarts. They start to escalate and first of all, parents are using way too many words. I’m watching them on the supermarket and they’re like, “No, no, you can’t have that pop tart because you know pop tarts aren’t good for you.” That’s when I think actually “no, you can’t have them” would be better. And then the little girl starts escalating so much, creaming at the top of their lungs and finally in desperation, a parent just gives the kid the pop tart because they just want to get out of the supermarket alive. That’s a coercive pattern of aggression because what the child is taking away from that is, if I up the ante high enough, I’m going to get what I want. And as a parent or as an educator, you’re now screwed. I would much rather think about this whole idea of antecedents behavior and consequences like, okay. Actually, let’s think about what was going on before we walked into the supermarket. Well, I picked up the kid at daycare and I didn’t have a chance to feed them so when they’re walking into the supermarket, they are already hungry and they’re going to go for the most enticing thing. So what I need to do is actually feed them before I go into the supermarket or tell them if I am going to give them the pop tart, if you can keep your act together as I go to the supermarket, I’ll give you a pop tart in the car. You see the difference?
Sucheta: Absolutely. I think you’re encouraging parents to employ their own executive function to plan ahead, wear those future forwards glasses and anticipate these things.
Dr. Rappaport: Yes. That’s great, yes, which is hard because a lot of time if you don’t have – it takes one to know. Definitely, executive functioning is a challenge for me. Those of us who have executive functioning difficulties probably are going to end up having some kids, our own kids may have executive functioning, so it’s a challenging match to figure out how you frontload. And many times, if people are listening to this, they are ahead of the game because they recognize they have executive functioning. But a lot of times I’ve seen in my experience working in public schools, sometimes you’re identifying children who have executive functioning and then adults realize, oh, I’ve been struggling with this all my life. I just didn’t recognize this. And they can learn – for me, reading the room I still have trouble with that. It wasn’t until I started teaching about executive function that I realized, oh, so that’s what happens to me when I walk into the party and I knock over the wine glass as the host is making the toast. I just didn’t do such a great job reading the room.
I have learned things like self-narrating, the idea that with executive functioning, you don’t have great working memory. So by the time I go from the first floor to the third floor to pick up something, I’ve forgotten what it was that I was supposed to go pick up. So I’ve taught myself, okay, say out loud to yourself what you’re going to pick. So [inaudible 00:31:25] third floor and you did something completely different, you get down to the first floor that you may have a chance of getting it. I have a lot of sympathy for the challenges of executive functioning.
Sucheta: This brings me to our last question. I think I love the way you have described these strategies and particularly these developing households and nurturing tools that parents can carry with them and rethink their approach but pause and look at the big picture of managing not just the child’s behavior but the child’s trajectory of developing these skills and abilities over time. Can I ask you a personal question in that context? You have a personal story that is incredibly moving and compelling and as I have read about it, I’ve been very touched. I see you being such a compassionate and true champion for children and I personally see that there is a connection between your story and where you are in helping children. Would you mind taking a minute to share that with our listeners?
Dr. Rappaport: Thank you, Sucheta. It’s such a gentle way of asking me that question. So anybody who knows me would say when I come in to a situation where a child is stuck, that I’m a little bit like an energy bunny. Not to be derogatory to myself but this fierce belief that we can do better for our kids and a recognition of how important it is for us to help children build their best self.
It’s a little bit of front ramp. When I was 4 years old, my mother dies by suicide and I was the youngest of 6 children back a long time ago. I’m 58 now and so had 50 years to think about it. In my 40s, I wrote a memoirs called Inner Wake: A Child Psychiatrist Explores the Mystery of Her Mother’s Suicide. I wanted to understand that experience as both a mother, a daughter, and a child psychiatrist. There are certain aspects of this that might be useful to your listeners. One is the concept of ghosts in the nursery so that when you have your own children, you bring in your own stories of abandonment, loss, your experience with nurturing and I felt like it was incredibly important to be reflective of that so I could be as available and the best mother that I could be. And the other piece I would say is I almost didn’t go into child psychiatry because I felt like when people heard that piece of information about me or when people would talk with patients, they would say, well, X happened to them when they were 7. So now, we understand why they’re not functioning. I fiercely believe that we can have all sorts of challenges. We can have losing a parent, we can have executive functioning difficulties, and it’s an explanation not an excuse and that nothing that happens in our life means that it’s a fixed outcome. So that’s what I bring in to working with children, both an understanding of what their challenges are. I don’t typically talk about that with my patients unless I think they’re going to go on my website and see the book and they’re old enough to do that. But I have seen over the years that teenagers in particular know without me saying anything, know that I have some depth to me and that I’ve had probably my own challenge. So that’s what I’d say.
Sucheta: Thank you, Nancy. I think your vulnerability and your honesty is so infectious and it is inviting people to lower their guard because I don’t know a single person who is not going through a challenge and if they are denying it, there is something wrong with them. So I think finding that in a resiliency and shaping that by taking great care of yourself allows you to affect the world in so many ways and you are exceptional example of that and a true inspiration. So thank you for joining us on this podcast and sharing your wisdom with us today.
Dr. Rappaport: I’ve loved the opportunity. Thank you.
Producer: All right. Wow. What a great conversation with Dr. Nancy Rappaport, Sucheta. Goodness gracious. I don’t know where to start. So why don’t you lead us off by sharing some of the overarching ideas that you want people to take away from that conversation.
Sucheta: Thank you, Todd. Yes, I really enjoyed my conversation and once again, I am so moved by this way of thinking about diving deep into children and their needs and the wisdom Nancy brings to this conversation is really something worth thinking about.
So here are my overarching thoughts. 21st Century has seen the rise in technological advancements and all that has brought hyperconnectivity along with social isolation. In addition, our awareness of childhood vulnerabilities, meaningful ways of distinguishing developmental challenges from a problematic and non-problematic behaviors and a precarious rise in school violence has made it essential that parents and educators discover ways to cope with and respond to behavioral struggles of children and adolescent in a timely and appropriate manner before they escalate into unmanageable disaster.
That’s why having experts like Nancy on my podcast who delve at the intersection of psychiatry and education and provide a very appropriate and timely attention because she brings knowledgeable insights about behavioral issues in children and adolescent. As you heard Nancy talk about this but her perspective comes not just from a practicing psychiatrist but her fieldwork where she has trained parents and teachers to help them actually implement practical solutions can really be of enormous value to everybody who is listening.
For starters, what I like since our podcast is about executive function is how she defines executive function which is simply put, she says executive function is your ability to make good choices and take good decisions. The biggest barrier to taking good decisions and making good choices is of course your emotional state. Most of us are unaware of the ways our emotions affect our thinking but it’s more so in case of children who are yet to develop that maturity and self-reflection capacity.
In terms of talking about choices, what are we talking about? Choices about what you do, what you choose to out off later, for later, choices in friends, choices in terms of who you listen to for advice, choices about solutions for everyday problems. All these choices collectively are referred to as executive function. The important message is to investigate what affects the child’s capacity to take good decisions and what does the child present with instead of taking good decisions.
Producer: Well, one of the things the two of you talked about were problematic behaviors. I want to understand that better. Can you shed some additional light on that, please.
Sucheta: Yeah. I use this example in my clinical practice. Let’s say if I’m trying to get out of a room and the door is locked and I try to press the door handle down and then push, it doesn’t work. Then I press the door handle up and push and it doesn’t work. Then I press the door handle down and then pull and then I press the door handle again and up and then pull. All those four attempts don’t work. And then finally I’m so frustrated that I kick the door. Now, what’s most visible to a person who is in the room, who has not been watching me is they hear loud thud of me kicking the door and they become aware of me losing it. So behaviors are like that. behaviors completely hide the logic behind that motivated that behavior. Nancy mentioned a researcher Dreikurs, who has done a lot of work, understanding the motivations of the children in his work and he titles that as Child’s Private Logic. He says that the children are pursuing goals using this private logic and your behaviors can be categorized based on those logical rationale behind each goal. The first one he describes that as attention-getting goal. The attention-getting behavior stem from the child’s desire to belong or to be recognized. And so said child may present himself need for a praise. He may demand praise, in fact. He even may engage in behaviors that ultimately demand some verbal attention which may be criticism.
So Dreikurs famously says children prefer being beaten to being ignored. So how does a teacher feel about this, that you might hear her say that I feel annoyed of being with this child. Her teacher’s way of managing a behavior of a child who is inviting criticism or constantly seeking praise may be to really putting him in place. So that’s what Nancy is talking about, that the behaviors need to be studied because they are speaking of underlying goals. The second goal Dreikurs talks about is power as a goal. A feeling of inferiority is the driver of the need for the pursuit of power and control and so a self-critical student is unable to measure up to the expectations he or she have of himself and that of others. Unfortunately, these lead to a lot of inappropriate behaviors such as compensating that sense of inferiority by choosing or imposing themselves on others or excessively bragging or even class clowning, so to speak.
So the key here is to establish that you are in charge. The teacher’s job is to establish that you are in charge of the student and recognize that need for power and control needs to be diminished by providing appropriate guidelines so the teacher in these circumstances may feel that I’m feeling beaten down or intimidated by this student and the student’s need to fee liked and useful can be very overpowering.
The third thing Dreikurs describes is revenge as a goal. In this scenario, the student feels powerless and unequipped to gain attention and equal stature in the social group. He may quietly loathe that inferior position and seek revenge instead. So this child is motivated by revenge and he harbors emotion or mindset that I’ll show you, just the way it hurts me, I will make sure you hurt too. So the teacher in this situation may feel that I feel wronged or hurt or attacked. This teacher, if she doesn’t understand this revenge as a goal that motivates bad behaviors, she may mistreat that child in a way that will not be a success for her.
And finally, the fourth goals is helplessness as a goal. So this is a child who has actually lost status in the membership as he belongs to the group or a larger group. He doesn’t even have a status, so to speak. So the child is more resigned and he hangs back and he continues to live in this space where he’s faceless and nameless entity of the group and is a simple nobody and is likely to not care what happens to him anymore. In this situation, a teacher may recognize these behaviors and may feel that, I feel incapable of reaching out to this child in any possible way. And her tendency may be to overly excessively indulge or ignore because he is not responding back.
This is an important kind of really analysis that I feel valuable for teachers to recognize, that a child’s behavior is symbolic of the unspoken motivations that may be governing those behaviors.
Producer: So Sucheta, how best to handle challenging behaviors? What do you do?
Sucheta: Such a good question. Nancy went through this so I’ll try to summarize my best understanding of this as well. But let’s make a list of daily setbacks and roadblocks, rejections and disappointments. So for a child, if we take a child’s perspective, what is a child facing? His toy breaks. The math problem was way too hard or his teacher wanted something different and so reprimanded the child. Or the child misplaced something special, a coin, for example, his father got from Italy. Or the child gets picked on for not being as competent or he’s the last one to be chosen for a team. Those are all kinds of setbacks that the child is experiencing. These experiences generate emotions and the child may overreact or underreact or may not be reacting that is visibly shown. And so an adult who is just a bystander and observing may be subjected to a child’s overreaction concerning behaviors that result from inability to process these demands or cope with challenges that is exactly what executive function allows you to do, which is become adaptive and handle setbacks graciously, so to speak, right?
So then what happens is the child is communicating those things through behaviors. So the child is showing what he’s feeling but he’s not telling how he’s feeling. So disregulated behaviors will not become well-regulated behaviors simply by child experiencing setbacks. Globally, what needs to happen is (1) adult in child’s life needs to become curious instead of curt. He needs to become patient instead of preachy. And he needs to become tempered instead of tyrannical. So those are the broad kind of ideas that I think really will help when handling child’s challenging behaviors. Then second thing is successful ways to manage behaviors is forging a partnership with the child. The child needs to be important part of this developing skill process, so to speak. The child can be easily redirected to self-reflect rather than the adult in the child’s life trying to control those behaviors. So let’s say the child is throwing a tantrum, the parent can really drag that child out of that scene and then reprimand or put him in a timeout. Without any self-reflection, none of those behaviors are really going to change. Some children are very quick to understand the reaction of the world to make the tweaks in their behaviors but some are not.
So that’s why I love what Nancy said, if we lower the expectations based on child’s behavior that we observe which are not good behaviors, we are sending a terrible message to our children. So I hope that’s what comes through that globally, we need to really change our approach.
Producer: Well, what becomes important obviously is learning how to nurture children, right? So walk us through some of the tools that you could deploy to nurture children.
Sucheta: Yes. As I mentioned, once you have changed the framing of the question by not being curt or preachy or tyrannical, you begin to be curious about the behaviors, you will begin to show patience and you become more tempered, then you can deploy a lot of strategies. So whether the child has difficulty or disregulation or disorder, fundamental premise doesn’t change, that the child needs newer ways to adapt to emotional challenges within. These emotional challenges are not special. They could be special but they could be simple having to live life, so to speak.
So the nurturing tools parents and teachers can deploy as one is to probably pause. They need to be a shepherd of child’s inability to manage emotions. So they need to manage that by creating better planned, more anticipated way of living life, particularly parents. If they know their child lose it if they plan is not followed through, they begin to give heads up to the child. If the child tends to really, really get upset when he’s hungry or he gets upset when there’s lot of noise around or there are too many people talking, then they can disclose the news or unfavorable news in a more private space, when there’s quiet. The third thing is to maybe even give time to unwind so the child is given some time to have a reaction and not restrain that reaction by parents saying that now, you can’t or you shouldn’t, instead, just saying, “I understand this must really, really hurt” or “I can understand this must be so frustrating.”
So most important thing that Nancy talked about here that I think really, really, I 100% get behind is, the parents need to find acceptance at the heart of their interactions with their child. The caveat is to accept the feelings and not the behavior so you’re not promoting the behaviors but you recognize and accept that yes, my child is feeling hurt; yes, my child is feeling neglected; yes, my child is hungry, to be recognized as an equal. And the behaviors may be wrong or unacceptable but feelings are.
Producer: Lot to think about there. Thank you for sharing all that. So nearing the end here, Sucheta, any final thoughts you want to share?
Sucheta: Yeah. So if someone doesn’t know how to tie a shoelace or play piano, want to know it’s the skill that they don’t have. But if a child grabs a pencil because they don’t have one or shoves somebody because they want to be the first one on line or if they grab a turn from somebody because they are enthusiastic about sharing their story, we consider those as bad behaviors. We don’t see them as failure to demonstrate a skill.
So the first step to manage misbehavior, bad behavior, is to assess the skill deficit and teach those skills. A psych-wise approach, psychologically-wise approach here is to regulate ones own emotions first and then direct that energy to take care of the need of a child who is yet to master the emotional control. Life experiences expand the context, they open up the mind’s eye and dust off cobwebs of unidimensional perspective. The child who is kind of stuck, it is stuck because he doesn’t have a global perspective or wide perspective. At a brain level, the brain’s network begins to thrive on interconnectivity and that’s when the robust executive function come into play and collectively, they act as a filter. So part of ways the parents and teachers can promote emotional security and emotional expansion is to expose the child to variety of experiences that can provoke different emotional undertones. That’s why I love books, movies, those are the ones that can allow you to do time traveling and that allows you to get into the shoes of other people and understand what they might be going through and we get to vicariously experience emotions without having those experiences ourselves and feel safe.
So what I feel, finally, by employing concrete and yet effective strategies, parents and teachers can nurture the child with actions that speak louder than any promise they can make to the child in simple ways by saying to the child, “I respect you for who you are. I like to be with you and you are safe here.” You are really promoting the child’s sense of emotional security and they are going to be willing to self-reflect with your help.
Producer: Sucheta, wow. What an episode. Awful lot to think about and digest and comprehend. Great, great stuff and how lucky are we to have Nancy back next week; looking forward to that. So that’s it for today. On behalf of our host Sucheta Kamath and all of us at Cerebral Matters, thank you for tuning in and listening today. And as I said, we look forward to seeing you next week where we get to chat with Dr. Nancy Rappaport once again.