Supporting social-emotional skills in neurodivergent children with Dr. Julie Scorah

Dr Julie Scora is a neuropsychologist specializing in neurodevelopmental conditions from McGill University here in Montreal , and the last time we spoke about some of the barriers that exist in our system when it comes to having a child diagnosed or trying to get some therapy for them or some assistance .

But today we're following up that conversation to focus more on the social , emotional skills and behavioral issues that we might have as a parent with a neurodivergent child . Before I begin , I'd like to thank the Tannenbaum Open Science Institute for supporting the curious neuron podcast . I'd also like to thank BetterHelp and PocPoc .

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They feel like they don't have a lot of resources , so they were hoping for us to have this follow up conversation so that they understand their child a little bit more . So can we maybe begin around that in terms of , you know , when we talk about tantrums a lot , but then is this what we're looking for ? Is this similar in a neurodivergent child ?

Or I hear a lot of parents talk about meltdowns and saying that they're much longer and it's very difficult to help the child regulate . So what are we looking at in terms of the differences ?

So I try to be inclusive and kind of switch it up . But there's people who talk about there are sort of the very autistic people that I've spoken with , and autistic self advocates have described the experience of a meltdown and even sometimes what they call an autistic meltdown . That can be different than a tantrum and it's because it's for different reasons .

So I think the impetus behind an autistic meltdown is more that the person feels overwhelmed , overloaded and unable to cope in that moment and they need time to regulate again . And that's why sometimes these meltdowns can be quite long . They can last a long time .

There can be a lot of big emotions that are happening and that kind of meltdown is different from what we consider a tantrum in most cases , because it's not being done to get something that they want necessarily or to protest against something that they don't want .

It can just be because that person is just completely overloaded and unable to cope , and so it's important to kind of distinguish between really what's causing that particular behavior so that you know what to do about it .

the parent who's having this child just have this meltdown and not be able to regulate them , how can a parent , if they point out that certain period of the day but they can't change the fact that they're in school , what can they do to support their child ?

So the proactive strategies are things that you do before the behavior occurs to try to prevent it from happening , and then sometimes maybe you're not doing those things effectively or at all , and then the behavior occurs and then there's strategies that you might use to react to that once the behavior does occur .

So it's always best to try to implement proactive strategies to stop that from happening in the first place , and really one of the best things to do in that case is to build functional skills to try to make sure that the child is able to communicate their needs and wants early enough that they don't reach that state .

So a lot of children maybe , especially our neurodivergent children maybe they can't always communicate very effectively what they're feeling , and so sometimes they can get a little bit too far into their emotions before somebody catches on that they're not doing okay . So teaching them means of communicating that earlier is actually one of the best strategies .

Obviously , that's not something you can do in the moment when the behavior has occurred . But it's really important to try to identify what is causing this behavior and then put in those proactive strategies that can help maybe derail a meltdown that might happen . But there's lots of other proactive strategies too that we can also discuss if you want to talk about .

What's happening , let's say , in the car , maybe coming back from school , rather than blasting music to kind of lower it , or the opposite , depending on what the needs of that child are .

What we do as psychologists is to do that very systematically , and what we do is we take a behavior that we are finding challenging , that we want to try to maybe modify , and we track that behavior over a period of time .

That helps us determine what is causing that behavior , what are the things or the antecedents that are happening right before the behavior occurs , that lead to that behavior happening , and then also what happens right after that behavior .

Are there things that other people are doing , we're doing or the child is doing , that actually reinforces that behavior or sustains that behavior ? So those are important things to look at too what happens before , what happens after , the antecedents and the consequences .

And then that allows us to figure out over a period of time , when you've tracked it , what it is that's triggering that behavior and maybe what's sustaining it . Once you do that , once you've played that detective role , then you can determine what strategies might be useful to help modify that behavior . But if you don't figure that out first , you're flying blind .

You could try lots of different strategies that won't work because you're not actually hitting the nail on the head as to what's causing that behavior . So it's really important to try to determine that first . Take the time to figure it out , see what might be causing that or triggering that , and then you can start making those changes .

Are we seeing , is this just as important with a neurodivergent child ? And how might that look differently if you're a parent of a neurodivergent child in terms of like that co-regulation piece ?

So it is important to be really in tune , as much as you can be , with your child's cues . We talk about in behavior modification the fact that every behavior is communication . So your child is always trying to communicate with you with these behaviors , and so it's important to try to listen to that and figure out .

What are they trying to tell you , and it can be difficult to do , but trying to be in tune with oh , this thing seems to work , you know , or they seem to need this kind of environment , let's say , to help them calm down . The things that they may need might require you to adapt your environment a little bit .

So we do talk about things like having a quiet corner set up , sometimes a little tent indoors , filled with blankets and cushions and other things that the child might find soothing , and so sometimes it's as simple as just directing them to that space and the parent maybe doesn't need to do a lot more beyond that , but certainly often neurodivergent children do need

a little bit more help because they don't always have the tools that come as naturally to them to help them cope as other children start to learn over time , and so sometimes they need to be taught that a little bit more systematically than a neurotypical child .

That might not be our best moments and then it's hard for us to kind of stay cool , Like a lot of parents here , like be calm when your parent and when your child has lots of emotions , but it's so hard in that moment and I know that parents kind of have the guilt around that you said something about . Like you know , sometimes we're not really .

We're kind of not making it worse but we're adding to it . What are some things that parents can keep in mind , you know , in terms of like try to avoid doing this or saying this in those moments , especially when you're struggling with regulating yourself .

So , you know , I often tell parents make sure you have plenty of time right , as much as you can , to get ready in the morning or pick your child up from school or go and get groceries , trying to plan ahead those things so that you don't end up in a situation where you're rushed and having to deal with the behavior you know in a stressful moment is right .

But of course it's easy to say that and very difficult to do in real life . Sometimes there is a way to kind of plan your day around .

Okay , this might trigger my child and therefore you know I need to be mindful that this might not be the right time to go to , you know , get groceries or something like that , to avoid times when they might be hungry or tired . Obviously , if you can't do that , there are things that you can do to try to remind yourself to step back .

Sometimes I tell parents because sometimes parents think I don't know what to do . You know and they grasp to try to find a solution and find something that they can do to react in the moment . And sometimes I tell parents you know what .

It's actually okay to just take a moment and breathe a few times and really try to think about what your reaction should be before you react . It's not always necessary to jump in right away . Sometimes it's okay to let your child maybe have a little bit of that meltdown for a little bit as you think about what might be the best response .

And it's very hard for parents because we want to get in , we want to fix it , we want to respond . But sometimes taking that minute to just reflect on what should I be doing here can be very helpful and take those deep breaths and try to figure out what strategy might work best in that moment and definitely having a plan in advance .

That's why I talked about these proactive and reactive strategies , kind of figuring out what it is that might drive that behavior . And sometimes you're going to do all the proactive things you can and the behavior is still going to happen . But it's important to try to plan in advance what is my response going to be if it does happen ?

Sometimes , if you're feeling really upset , think I'm going to pretend this is somebody else's child . What would I do ? Respond to them , because often we are more patient . I'm talking with other people's children , so sometimes that is a little trick that works .

I know that I think what would I do with my patients that I treat in this moment instead of my own child , and that actually makes me respond better to it .

We repeat ourselves and this is any parent we react to their behavior or to their big emotions , but when we actually take that time to respond , there's a very big difference . There's a pause . There's maybe we need to be our friend as well too right in our minds . It could be a little kinder to ourselves sometimes or just remind ourselves that we're tired .

With the today's we had the hour change right and yesterday and today's been quite a difficult day in my house and it's like we have to just be aware that behavior will be a little bit different this week in our home and I'm trying to be mindful of that . But that pause is just .

It could be a split second , but in our mind it's enough for us to kind of reconnect with ourselves and then connect with our child . It makes such a huge difference . I love that you've used those two words .

But there are times when the child is not safe , and that does happen too with our neurodivergent kids . Sometimes they are engaging in self-injurious behavior , they're thinking their heads on things . So first and foremost thing is make sure they're safe . Once you've established their safety , then you can take a minute to think about what you need to do next .

First I just wanna ask one little question , because I've seen this very often , or heard this , where parents say I heard this advice online and I applied it while my child was screaming . I told them take a deep breath , remember your meditation or whatever it was .

But I see that as like the right tool , but at the wrong time , because at that moment when your child is , I picture a mountain for kids , but just they're at the top of that mountain and there's just no way that we can get to them . Is this even ? Is this more like , I guess , amplified ? Or is it similar in ND kids ?

So if a child is unable to communicate their needs and wants , then the best thing to do is to teach them a means of communication , and it can be something as simple as a hand gesture or a picture that they hold up .

It doesn't have to be talking or words , it needs to be something that they can do , and once they have more skills in their toolbox , then often those behaviors will diminish on their own .

And some of the skills that we need to teach are things like how to relax , how to calm yourself , how to cope in those moments when you're feeling stressed out , and so often .

What I recommend is sometimes there are sensory strategies that parents can do , and so they can institute little sensory breaks where they help their child perform different sensory activities on a regular basis throughout the day or throughout certain activities that might be stressful for them .

So those are things that you can incorporate ahead of time so that the child learns how to do those things . But also I often give parents little relaxation books or social stories that teach a child how to do those relaxation strategies like taking deep breaths and counting to 10 and squeezing a stress ball or whatever it might be that they find soothing .

The time to do that is to read those books with your child and practice those strategies in times when they're calm already .

So you incorporate those things at times when they are calm and they're available to learn , because nobody is available to learn anything when they're feeling stressed out and emotional and upset Right , myself included . So that's not the time to try to teach anything .

So if you catch them when they're calm and you can teach them those strategies , then once you start to see the behavior start to build and a mildew start to happen , then you can then sometimes prompt them to use those strategies and you have a lot more chance of being successful if you do that when they're already pre-prepared and they've pre-learned how to do

those things and you can kind of say oh , remember , let's practice the deep breaths and let's go to the quiet corner and let's put on our soothing music or whatever it might be . So definitely , definitely . You're absolutely right that the right tools need to be implemented at the right time in order for them to be useful .

I guess if I picture that mountain right Like they're ascending and you notice that they're starting to show these visible signs of being dysregulated or something is happening with their emotions , that's a good time to kind of say like , remember those tools that we've been practicing right , not when they're in those moments where you just can't connect with them , and

it happens to all kids too .

But that's where trying to take notice of those times when those things are likely to happen and then building in those calming strategies or those sensory strategies into that task or situation before the behavior happens is important , right To just kind of try to set them up for success from the beginning yeah , and what happens in the situation where you just

explained , when sometimes they might be trying to harm themselves or harm somebody around them ?

What does the consequence or what does discipline look like for that child in particular ?

Sometimes it can be as simple as just putting a mattress or a cushion or something between their head and the floor and that's all you can do in that moment .

Because if they are having such a big meltdown and I have seen this where it is dangerous for people around them and there's really nothing else to be done other than just trying to make sure that there is cushioning there so that they don't hurt themselves .

So sometimes it's really about just doing those quick things to make sure that they're safe and then kind of waiting it out , because sometimes if you try to get in their space and you try to physically restrain them , that can make it worse , right .

So , and sometimes not , I mean it's tricky because some kids respond well to what we call deep pressure , right .

So if you kind of give them a bare hug and you put your arms around them , and sometimes that kind of pressure can calm them down , that's where , again , you need to really pay attention to your child , to kind of know what they're gonna respond to and what's gonna make it worse .

So sometimes there's nothing to be done other than to just try to do something to make sure that they're safe .

And then , if they're banging their head on the floor but you've gotten a pillow or a cushion underneath them and they're not hurting themselves , sometimes you just kind of wait until they're done before you can kind of move on and try to do anything about it .

And it's unfortunate it's so hard to watch , but sometimes that can be the best thing to do , because our efforts at those moments can actually sometimes exacerbate the behavior or make it prolonged beyond what they would do if you just sort of took a step back . So it's really about just trying to find those things that can keep them safe in that moment .

And certainly , like I said , the main thing is , I think trying to explain to them probably isn't gonna be the most helpful strategy , because in that moment that explanation is gonna fly out of their head right .

So that's where focusing on building skills is really the thing to do , because often these meltdowns happen because a child is not able to communicate what they're needing or they are getting overwhelmed by certain stimuli .

And so that's where those proactive strategies are so important , because the more you build in skills to help them learn how to communicate better or at all what they need , or you build in that stress release as the situation is unfolding , the less and less these things will happen .

So really I always try to focus on okay , sometimes these meltdowns will happen and sometimes they will engage in these behaviors , but the goal is to try to teach them enough skills so that over time they just diminish and you can prevent them from happening at all , so that you don't have to worry about how to react to them , and often that does work .

It's not that it might disappear , from what I'm understanding , but it will get better with time .

And so trying to teach them means to communicate can be really tricky , and unfortunately here in our context not many children are offered the opportunity to learn alternative means of communication .

There are things like what we call AAC augmentative and alternative communication devices and that's really just not offered very often in our programs here for kids on the spectrum . We don't have enough of that , there are not enough experts in that and it's just not being done systematically enough unfortunately .

And so I have seen many kids who end up as teenagers and they still don't have a means to communicate and nobody's ever taught them a way to communicate their needs and their wants and their issues , and so those behaviors often will continue .

But I have also seen the flip side , where I have seen kids who were taught those communication strategies and they were able to communicate better and those behaviors did decrease over time .

And so I really do think that that is the most important thing , but unfortunately it's often just not being offered to families here I find in our programs as much as it should .

Everybody sort of gets put on the same list for the same services and we don't have a lot of variety that's tailored to the child . Unfortunately , if you go privately and certainly in the US , where there are different providers and people's insurance might be for different types of things there are often more options .

And even in other parts of Canada there are some provinces that do allow parents to go out and sort of purchase the services for their child . They're kind of given the government kind of gives them control over the funding and then they go and they choose the services that make sense for their child , usually hopefully based on recommendations by professionals .

But and I have seen those kinds of systems work extremely well for kids . But here we are very much in a situation where there's sort of a one size fits all approach , unfortunately , yeah , it's unfortunate .

So I do want to address that before we move on to like the last sort of question that deals around social skills with kids . But I do want to .

Maybe we can talk about some signs that a parent should be , you know , aware of , because I know some parents sometimes ask of what is the difference between a they'll use the term normal , right , what's normal when it comes to tantrums ?

But what I like to say is like , what should you be looking out for in terms of signs that you could perhaps talk to your doctor about it , because the tantrum , or big emotion , is more than what it should be developmentally at that age . So what should parents be looking out for ?

I would say the main red flags around those kinds of behaviors would be , first of all , I think anytime a child is engaging in self-injury , that's an important thing to pay attention to and to talk to your doctor about .

And neurotypical kids will engage in self-injury sometimes , too Often , they will do it in a way where they kind of experiment with it a little bit . They might bang their head on something and then look to see what their parents' reaction is .

Yes , and they will often sort of figure out pretty quickly that that doesn't feel very good for them and they sometimes won't continue to do it . Sometimes they will a little bit if they see a good reaction and they get a A .

But quite often if we have kids who are engaging in self-injury and they're not necessarily checking in with the parent to kind of look at that parent's reaction and they are just sort of doing it in a way that seems like they may not have a lot of control over their behavior .

That , to me , is something that I would be concerned about and would talk to the doctor about , because most children aren't going to purposely harm themselves or they're not going to often do it for long if they are typically developing and they are looking for a reaction or getting the consequence that they like . So that's a flag for me .

I also feel like just the length of time . So a lot of kids will wear themselves out after 20 minutes , half an hour maybe , but we hear about some parents who talk about their children having it meltdown . That can last 45 minutes , an hour , over an hour Once it gets to be quite long like that .

That is something that I would also want to bring up to my doctors . That's really about sort of how long is it going on for how much do they seem like they're really able to control themselves ? When you do get involved and you try to help them calm themselves and regulate again , how long does that take ? How do they respond to that ?

Those are the things I would watch for , but certainly those are usually not things that are happening alone . So quite often there are other signs that we need to be mindful of as well .

So if a child is having other developmental delays and they are not keeping up with their peers in terms of their language development or their motor development or their social development , other things like that , then that would definitely prompt me to be even more concerned .

If I see that there are those kinds of challenging behaviors , or we sometimes call them behaviors that challenge , and as well there are other developmental delays , I would then be sure to talk to my pediatrician about that .

We've you've mentioned now a few times in terms of the communication and the social skills . I'd love , I'd love , to end our conversation with this , because I find that as a society and as parents , we often put a lot of pressure on our kids to be social and to develop these skills . I hear parents saying you know , when they're 12 month old starts daycare .

You know , I want them to learn to be social right now , and there's a lot that goes around that there's a huge importance on that . But then we know that in our divergent children or kids on the spectrum , that it's not the path or this . You know , the what we expected to be is not going to look the same .

How do we support our child who is on the spectrum or neurodivergent , who might be struggling with the social aspect that we expect them to be developing ? You know , we we from a very good place obviously want them to have friends and , to you know , support that part of their development . How can we do that as parents ?

So they might put them into soccer and want them to play in a soccer team because they think , okay , they're going to be there amongst a group of kids and they're going to , you know , have to interact .

That might be a level of demand that is just too high , and so I often tell parents maybe try a different activity that doesn't have that level of demand regarding cooperation with a group of kids .

You know , group play and that interactive play in a group can be very , very tricky when you're also , at the same time , trying to actually learn how to motorically play a sport . There's a lot of things going on and there are a lot of neurodivergent kids who also struggle with motor skills and coordination , and so that can be even more challenging .

So I often would recommend things like maybe think about a sport that doesn't have the same demand for interactive play .

So it can be something like a martial arts class where you know you're in a group of kids but you are kind of paying attention to your instructor and practicing , doing some of the movements you know on your own but then paired up , maybe one-on-one right , or a swimming class where again you're paying attention to the instructor and you're doing things alone or

with the instructor and not necessarily in some kind of you know , interactive joint play . So it's about trying to just adjust those expectations a little bit . And we do also know that for kids on the spectrum often just having one close friend , you know , can be enough . That can be protective , that can make a big difference .

We don't need to have a giant group of friends , but one good friend is great , you know . That can be a very protective thing . And so Definitely it's about trying to support them socially , but not push so hard that it becomes really stressful , and pay attention to what it is that they want .

Some kids on the spectrum are actually quite motivated to want to socialize and they definitely want to have friends and they want to play with other kids . Some children on the spectrum have less of a motivation towards that .

So it's really about figuring out where your child is at and then figuring out what might be the right level of socialization for them and , of course , if they really are wanting to go and make friends , teaching them those strategies , building those skills right . This is how we have a conversation . This is how we approach somebody and ask them to play .

This is how we might say hello to someone and give them a compliment . There's a lot of these kinds of skills that we can teach that are not necessarily coming so naturally , and all we need to do is to make it very explicit .

These are the essentials to having a conversation and this is what you need to know , and those can be taught to kids , often using social stories , but definitely that's what I would suggest is try to just adjust your expectations to your child and where they're at regarding their socialization , and then teach those skills that they are maybe missing .

So I guess breaking it down for them into the baby steps right , so that they know exactly what's step one or two and how to go about it .

So going to the park , for example , sometimes that can be overwhelming because there are a lot of kids , there is a lot of activity and there's a lot of noise , and so sometimes that's not the ideal scenario for them to be able to go and try to practice those social skills and try to make a friend or play with another child .

Sometimes it can be better if you arrange a play date and you have one child over to your own home where your child is comfortable and they have their things around them , and you keep it very short and you plan an activity so that we know exactly what we're going to be doing . We're going to be doing these particular steps .

It's not sort of vague in terms of what they're expected to do . We plan an activity , we do the steps .

We might have a visual schedule showing us first we're going to do this , then this , then this , and when the activity is over the friend goes , you know , and so it's a nice little packaged time for them where they really know what to expect for them to be able to practice those skills that can make it easier .

Sometimes having unstructured play is just really , really challenging . But if you can structure it for them and say , okay , we're going to do this little activity , that can really help , because then they kind of know this is what I got to do .

You know people emailing me from different countries as well that just don't even have their child hasn't even seen a doctor . They see the signs and symptoms , but there's no diagnosis . So I think it's important for them to hear all this to be able to support their child in a way that helps them with their development too .

And so I'm trying to kind of give some general ideas , but at the same time , it is so important for people to talk to a professional clinician , a teacher , somebody who can offer strategies tailored to that particular child , because every child is so different and their needs are so different , and it's really about meeting them where they're at and trying to build

on the skills that they have and that's not the same for everybody . And so , you know , I do want to just sort of , you know , give that little caveat that some of the things that I said today you know parents might go and try and that might not be the right thing for their child , right ?

So it's important that they really do try to , as much as possible , seek out someone that can give them those very individualized strategies .

If not , it's okay , we can add it to the show notes if you can't remember of any , but something that can help a parent , you know , get started with the first steps and how to support their child .

So programs like the Hannon program , more Than Words , those kinds of books and More Than Words also has , I think you know , a video that parents can watch things like that can be really useful to help parents learn how to intervene with their kids .

So in my lab we have a research study that is running an intervention trial using the caregiver skills training , which is a parent mediated intervention that was developed by the WHO and that particular program was designed to be able to be adapted to many different countries and contexts and it's available in lots of places and in lots of languages .

And the whole goal of that program is exactly that to kind of teach parents how to work with their kids through play and through home routines that they're already doing , to just try to stimulate their communication skills , stimulate their play skills , stimulate their social skills .

So that kind of program I think is super interesting for parents to look up as well . And the good thing about this CST , what we call the caregiver skills training program , is that there is now an electronic module for it .

So even though it is something that has started to be offered more and more by interventionists in different places , there is this electronic version that parents can sort of self guide themselves through so that they can do the program and learn some of these skills on their own online to be able to know kind of how to just how to reach their kids and the

things that they're already doing at home in a way that stimulates that development . And really , like I said , those are the main things is building those skills and trying to get in there and the functional skills to help prevent those behaviors that can be challenging .