Play PodcastPlay Download PodcastDownload

Transcription:

Melanie Cole (Host): This is Long Live Childhood, a Pediatric Health and Wellness Podcast presented by Children's Health of Orange County. Together, we can keep kids happy and healthy. I'm Melanie Cole. And today I invite you to join us as we discuss impulsive behavior in kids. Joining me is Scott Ryan. He's a Licensed Marriage and Family Therapist with Children's Health of Orange County. Scott, it's a pleasure to have you join us today. As we get into this topic, which I'm looking forward to, can you tell us first a little bit about yourself and your expertise on this subject?

Scott Ryan, LMFT (Guest): Certainly. Yeah, I would love to Melanie. Thank you. I've been practicing with children in the form of a Licensed Marriage Family Therapist for a little over 15 years. And I myself have ADHD, so I very much have close to my heart, the idea of what impulsive behaviors look like, the impact it may have on a child or even adults.

And so for that reason, I really kind of studied and specialized in both the diagnosing of ADHD, as well as kind of the other factors. So, it's an area of interest for myself, within my professional purview, working with, at this point, high school, teenage children with suicidal thoughts and behaviors.

Host: Well, thank you for sharing that, Scott. So, tell us a little bit about the definition of impulsive behavior in kids. What does that look like?

Scott: Impulsive behaviors can look very differently across the spectrum and they may vary from very subtle, mild kind of things, very much like any of us might interrupt. Maybe we don't pause, or maybe we jump in front of others when it's not our turn. Those kinds of things may be very subtle and it can also go to much more impulsive and overt behaviors, such as grabbing things out of someone else's hands, yelling, being very emotionally dysregulated, having trouble waiting turn, or as adults it could be demonstrated by speeding, inappropriate lane changes or other high risk behaviors. And ideally we want to treat these things when children are younger, because then the outcome is so much better. And impulsivity can affect so many different domains across the spectrum, really may hurt children and their quality of life issues, their functioning in school, the quality of their relationships with their family and friends.

And then as they age or become adults, it can also impact their performance in the workplace, the chance they would have a divorce or use substances. So, these are all related to impulsivity. So, obviously it's important that we try to recognize it when children are younger.

Host: How does it differ? You mentioned a few examples, but how does it differ from tantrums in children? Is there a big difference with that?

Scott: In a sense that's maybe in a form of impulsivity, it doesn't exclusively relate to impulsivity and it can, for instance, many autistic children who are known for maybe tantruming or may tantrum even into their teenage years and it being kind of inappropriate for their age; about 50% of them also show ADHD like signs and symptoms.

And definitely in the sense that emotional regulation is a form of control, it makes sense that people who are more impulsive maybe are more dysregulated, that they're more likely to have a tantrum, to act inappropriately, or have a strong emotional response when limits are placed. So, tantrums are definitely related to impulsivity.

Host: Can you point to any of the causes of this type of behavior, if it's ADHD or something else or something on the spectrum in another way? Can you tell us a little bit about what we know about it?

Scott: Definitely Melanie. What we do know is in most terms, it's a deficit in executive functioning. This is, kind of the front part of the brain that acts like an executive, almost like an air traffic controller, trying to balance many different airplanes that are coming in for a landing and having to prioritize and delegate responsibilities.

And that part of the brain that we call executive functioning, kind of does the same thing. And it may be balancing the sensory input, like an ADHD child who is very inattentive may be easily distracted or the hyperactive boy or girl that decides, hey, I want to get out of my chair right now, even though the teacher said, no. That also is related to that executive functioning deficits.

It's a challenge. It's definitely one of the primary things that people do notice about children with ADHD or perhaps with autism. And conversely, executive functioning also impacts the degree to which a child can learn from their consequences. So, it also has this impact that they're less able incidental learners, meaning like if I did something and the teacher or a parent tells me no, I learn from that incident, but maybe not as fully as a neuro-typical child, meaning that I'm a slower learner learning these social skills and social rules. So, unfortunately that may mean I have to experience the consequence repeatedly before I figured out, oh, if I do this, I get in trouble. Or if I do this, I get rewarded. So, it takes a little bit longer. And because of these deficits, sometimes children with ADHD are considered hard to parent kids.

And that is due to the fact that they're not as responsive to rewards and punishments. And they are responsive, which just means we have bigger rewards or perhaps bigger consequences to really support their understanding of these kinds of social rules.

Host: So interesting what you just said and what we're discussing today. So, as this type of behavior progresses, or if it's happening in the moment, what do you tell parents? We're going to get into how to help the child manage their emotions overall and how to support our child, but what about in the moment of that impulsive behavior? Whether it's, as you said, taking something away or interrupting or whatever it is. What do we do right then?

Scott: I'm going to deflect for just a second, just to kind of put out the message there, that, children with impulsivity problems are often considered as being very defiant or uncaring or perhaps just having poor self-discipline and that's a common myth and that's not actually the case. So, the idea of attributing, like some kind of blame to the kid, if they cared, for instance, they wouldn't do these things. They could stop doing what they're doing, if they really tried harder. There is truth in that. And unfortunately though, a lot of times parents get kind of stuck on this idea that the kid's being very willful and forgetting the idea that, hey, this is a genetic disorder that makes my child more hyperactive or impulsive. So, they're already operating at a deficit. And the reason I wanted to kind of highlight that is this idea of validation, recognizing if our child does have impulsivity problems, they very well may be doing the best that they can in the moment.

And for that reason, they need additional supports. So, they may need additional parenting structure, rewards, and punishment. So, to go back to your question, the most important thing would be to respond in the moment. So, the more immediately you do respond, the more quickly the child may learn the link between what I did and the consequence. Typically, we want the command or the instructions to be very brief, something like 10 words or less, not going into a long winded explanation. Do you know what you did was wrong? No, very short and simple kind of rules that they could remember. You did this, this is the consequence. Don't do that again, period. So, avoiding these longer conversations, but just being right to the point, that is very helpful for an ADHD or impulsive child.

Host: Wow, you are giving us direct, awesome advice right here for parents to really hear and be able to take and use right away. And now, as we look at the bigger picture, how can we help our child to manage their emotions and support our impulsive child? What kinds of alternative behaviors can we suggest? Tell us a little bit about what we can do.

Scott: I think in general terms, as parents or educators, we want to provide clear expectations. We want to be very consistent with providing praise and reinforcers when they do the things that we want. And then also kind of having predictable consequences, such as setting up maybe, some punishments in advance, so it's not a surprise if you did this, that this would happen. It's just kind of a logical outcome, so they can learn more quickly that this results in that. Now, obviously we have to be consistent as parents. So, when we set up these kinds of rules, we want to be as consistent as possible.

Otherwise, we're kind of teaching them well, sometimes the rules apply and other times they don't apply, which may mean I should kind of continue what I'm doing, because I prefer that rather than, oh, every time I do this, mom takes this away. So, I'm going to stop doing this. Right? The other part too, as parents, we often pay a lot of attention to the behaviors we don't want, and we may ignore the behaviors that we do want, cause we may take them for granted. Oh, they're playing nicely right now. Or they did what I wanted them to do, putting the backpack there, putting away their clothes. So, the other aspect might be to really increase the praise of those behaviors that we do want. In some terms of positive psychology, they state, that the best ratio for behavior change would be somewhere from three to one or five to one, which means every time my child does something that I like, I am providing clear and immediate praise, and we want that ratio to be at least three, but five may be better, of five pieces of praise that are accurate, authentic to every one change message. So, I like the way you did that. That was great. Thank you for doing that for me. Or putting away your clothes or doing your homework on time. And I want you to put your shoes by the door next time, not over there by the couch. So, that would be an example of three to one ratio and that makes it more likely the child's going to do what we want. So, that would be another way to kind of support the impulsive child.

I would also think we want to teach our children to pause before acting. That's not easy, especially for an impulsive child. And it is a skill that can be built upon. So, that may look like taking several deep breaths before you say the next thing or maybe let's do it together. I'm going to role model. Here's the idea. Let's take a few deep breaths. And now what do you think we could do? We're trying to engage that kind of logic or problem solving part of the brain. And depending on the age of the child, there's many different ways to kind of support that pause. It could be even as much as playing control building games with your child, such as Sorry, UNO, red light green light, Simon says. And then, perhaps, lastly, I would also recommend that you set reasonable expectations for your child in advance of the situation they're preparing for.

So, if we're going to the grocery store and normally they may like try to take items off. Mommy, why can't I have this, for instance, maybe in advance, what you're saying is here's what I expect you to do when you go to the grocery store. It would be okay for you to ask for one thing, perhaps, and I may or may not give it to you. And I expect you to hold onto the cart and not walk or run around. You need to stay next to me. And perhaps there's some kind of reinforcer, right? The reward will be, we're going to have your favorite food for dinner, but at this point, if you provide those expectations in advance, they're much more likely to know what you want from them.

Host: What great advice you're giving us here today, Scott. As we get ready to wrap up, I'd like you to tell parents where they can find additional support for their child. But I also want you to touch on the parents because if we have a child that has impulsive behaviors or a child with ADHD, managing our own emotions, and you mentioned role modeling even earlier, managing our own emotions at that time, can be really difficult and it can be hard for a parent to practice patience. So, can you kind of wrap this up with your best advice for those of us that have children in this situation to help us manage how we react to this?

Scott: I'm glad you asked that. It can be very difficult for parents, as I said before, they are typically hard to parent kids. And what I didn't say is genetically, we know, there's a fair chance that one of the two parents also has ADHD. So, they too may have their own issues with impulsivity or mood regulation, for instance.

So in a sense, I think we would want the parent to practice the same kinds of ideas where maybe they're pausing before they say the thing. Maybe they're taking a few deep breaths or they're scheduling breaks for themselves, before they issue consequences. Because obviously if we're very heated or emotional, we're much more likely to be punitive.

And it's hard in our busy, modern days to really respond to our child, but maybe they did something we had thought was behavior they had no longer done. It's not easy to be neutral in your response. So, I think it is important to kind of practice good self-soothe, have mini vacations and to remind yourself that just like your child, you are doing the best that you can.

This is what it looks like for you to be a parent of this impulsive child. And everyone's learning. It's an adventure. And this is a process, and over time, things keep getting better. So, to kind of find that silver lining in what you're doing and why you're doing it for your child as a parent.

Melanie Cole (Host): Wow. What an informative episode. This was Scott. Thank you so much for joining us and not only for sharing your story, but for your incredible expertise and great advice on this topic.

Thank you again for more mental health tips, please visit chalk.org/mental. Thanks so much for listening to long lived childhood, a pediatric health and wellness podcast presented by children's health of orange county. Together. We can keep kids happy and healthy. Please also remember to share on your social channels as we're all learning from the experts at CHOC together.

I'm Melanie Cole.