Full PreFrontal

Ep. 112: Sharon Saline – Counterbalancing Patterns of Failure

May 28, 2020 Sucheta Kamath Season 1 Episode 112
Full PreFrontal
Ep. 112: Sharon Saline – Counterbalancing Patterns of Failure
Chapters
Full PreFrontal
Ep. 112: Sharon Saline – Counterbalancing Patterns of Failure
May 28, 2020 Season 1 Episode 112
Sucheta Kamath

Having difficulties can be discouraging and counterproductive. Children with ADHD experience far more defeats and discouragements compared to their counterparts. It’s no surprise that promote thriving in struggling learners depends on the right support, the right tools, but above all, the right environment that conveys a message of acceptance and hope.

On this episode, our guest, Sharon Saline, Psy.D., an author and a clinical psychologist, discusses the unique needs created by the dopamine deficient ADHD brain and how best to coach, train, and support these brains to summon extra dopamine for something they don’t love or care.

About Sharon Saline, Psy.D.
Sharon Saline, Psy.D., clinical psychologist and author of the award-winning book, What Your ADHD Child Wishes You Knew: Working Together to Empower Kids for Success in School and Life  and The ADHD Solution Card Deck specializes in how ADHD, learning disabilities and mental health issues affect children, teens, young adults and families. She helps families navigate the confusing maze of information, emotions, stress and conflict related to ADHD, appreciate the positive aspects of living with ADHD and create successful dialogues, interventions and connections.

Dr. Saline has also worked extensively with schools and educators on understanding and assessing mental health issues in the classroom. An internationally sought-after lecturer and workshop facilitator known for combining her expertise in psychology with a background in theater, she addresses topics such as understanding ADHD and executive functioning, discovering new tools for managing anxiety, making sense of the teen brain and working with different kinds of learners. Dr. Saline is a regular columnist for ADDitudemag.com and Psychologytoday.com and is a part-time lecturer in the Continuing Education Program at the Smith School for Social Work. She appears monthly on WWLP’s Mass Appeal show as their resident child and family psychologist. A magna cum laude graduate of Brown University, she received her master’s degree in psychology from New College of California and her doctorate in psychology from the California School of Professional Psychology at Alliant University.

Website:

Books:

Show Notes Transcript

Having difficulties can be discouraging and counterproductive. Children with ADHD experience far more defeats and discouragements compared to their counterparts. It’s no surprise that promote thriving in struggling learners depends on the right support, the right tools, but above all, the right environment that conveys a message of acceptance and hope.

On this episode, our guest, Sharon Saline, Psy.D., an author and a clinical psychologist, discusses the unique needs created by the dopamine deficient ADHD brain and how best to coach, train, and support these brains to summon extra dopamine for something they don’t love or care.

About Sharon Saline, Psy.D.
Sharon Saline, Psy.D., clinical psychologist and author of the award-winning book, What Your ADHD Child Wishes You Knew: Working Together to Empower Kids for Success in School and Life  and The ADHD Solution Card Deck specializes in how ADHD, learning disabilities and mental health issues affect children, teens, young adults and families. She helps families navigate the confusing maze of information, emotions, stress and conflict related to ADHD, appreciate the positive aspects of living with ADHD and create successful dialogues, interventions and connections.

Dr. Saline has also worked extensively with schools and educators on understanding and assessing mental health issues in the classroom. An internationally sought-after lecturer and workshop facilitator known for combining her expertise in psychology with a background in theater, she addresses topics such as understanding ADHD and executive functioning, discovering new tools for managing anxiety, making sense of the teen brain and working with different kinds of learners. Dr. Saline is a regular columnist for ADDitudemag.com and Psychologytoday.com and is a part-time lecturer in the Continuing Education Program at the Smith School for Social Work. She appears monthly on WWLP’s Mass Appeal show as their resident child and family psychologist. A magna cum laude graduate of Brown University, she received her master’s degree in psychology from New College of California and her doctorate in psychology from the California School of Professional Psychology at Alliant University.

Website:

Books:

Support the show (https://mailchi.mp/7c848462e96f/full-prefrontal-sign-up)

Sucheta Kamath: Welcome to the podcast, Todd. How are you?

Producer: I’m doing great. It’s been a few weeks since we’ve been in studio to record. Looking forward to getting back on the saddle. Boy, what an important conversation today, ADHD. I’m blessed that I don’t suffer from that but I think this will be a critically important conversation.

Sucheta: Certainly, and I too am grateful for not having ADHD but I will tell you, being in practice for the last 20 years, one of my favorite group of children and adults to work with our children and adults with ADHD. They are very colorful, they are very exciting, engaging, a little bonkers but that’s what makes life very interesting, and what is so special today is we have a wonderful, wonderful expert and a good friend, Dr. Sharon Saline. She’s a clinical psychologist and an author of an award-winning book What You’re ADHD Child That Wishes You Knew: Working Together to Empower Kids for Success in School and Life, and she also has a very interesting ADHD solution card deck which is a very cool thing to use and have as a desk reference, so to speak. She specializes in ADHD, learning disabilities, mental health issues that affect children, teens, and young adults, and as well as families. One of the wonderful things she’s offering to the world is this incredibly thought out and well-organized way of thinking about ADHD at a global level. She is a regular columnist for ADDtudeMagazine.com and PsychologyToday.com. I have been a reader of her contributions. She was so generous to send me a copy of her books, so I have my personal copies directly from the author which I always revere, and finally, one thing that today she’s going to help us understand and you will see as she speaks, she has incredible love for this particular group who experiences a lot of stress, anxiety, and isolation because of ADHD. She believes that it is a confusing maze to deal with ADHD, and she helps families navigate with information, direct guidance, positive messaging, and a very carefully thought out strategy. So, it is my greatest pleasure to invite Sharon to the podcast.

Welcome!

Dr. Sharon Saline: Thank you for that beautiful introduction, and I am thrilled, thrilled to be here. I loved meeting you briefly at CHAD. We started chatting right away, we just are too excited, smart women and we love talking about things related to executive functioning and helping people, so I’m just thrilled to be here and honored, of course.

Sucheta: Thank you, Sharon, so I’ve been asking this question of all my guests, particularly, I looked at executive function as seven blind men with blindfolds looking at an elephant, and so each field of expertise taps into executive function a little bit differently, and my own experience comes from envisioning that time the fan that groups of the blindfolds and looks at the big picture of executive function, and you as a psychologist, particularly a clinical psychologist have much, much deeper understanding, and one special thing you bring to the table is intervention. But before we dive into the topic, tell us a little bit about your own executive function and how were you as a student and a learner, what did your self-regulation look like?

Sharon: Well, that’s a great question. I have some questions about the blindfolds and the elephants, but will have to come back to that. I was a pretty motivated and driven student. I was well-organized. It didn’t help that I had to be interested in subjects. I mean, I still – I’ll never forget this – I took AP Calculus as a senior and the first semester, I got an 89, and I got accepted to college and it dropped to a 79 at the end of the semester because I was just like, I don’t care, I really don’t like this. It’s not how my brain works! I remember the teacher, Mr. Drews said to me, “Sharon, you were doing so well. What happened to you?” I looked at him right in the eye and I said, “Mr. Drews, I was accepted to college and there are no requirements, and I’m never taking calculus again.”

Sucheta: Oh, my God, I love that story, so you pretty much had been on and off switch to your executive function with self-regulation there.

Sharon: It just sort of slowly went off in that area. I would say in terms of my executive functioning, the way I look at it now is that pretty strong in most areas, sometimes, I have trouble with shift flexibility but I can’t tell if that’s because I’ve been a mom who has run a family and try to manage so many things that when things don’t work out or they are more complicated, that’s a little challenging. I sometimes have difficulties with my time management. I think I can accomplish more than is humanly possible in a given amount of time, so I overestimate my capacity and I underestimate how long the tasks will take, but none of those are her significantly problematic. The challenge for me is around emotional control and I think that’s because I run on the anxious side and I come from a long line of neurotic Jewish women with big feelings. I’m one of those people, I wear my heart on my sleeve, so I’m particularly at my station in life which is the same as your stage, our bodies change and so it can make managing those emotions little bit more challenging. In fact, I went to a training a long time ago with a Russell Barkley and he said women going through menopause are like women who have ADD.

Sucheta: Yes!

Sharon: Struggling that way, and I thought, oh, and I got there, Yup, that’s true! But I grew up in a family with a brother who had undiagnosed untreated ADHD and I think one of my parents has it, and so I have wondered a lot about what it’s like to grow up with parents have executive functioning challenges that you learn those challenges, like my mother is terrible with time management and you always needs to be doing something and she’s not particularly flexible if things don’t go the way she wants them to. Is that something that I inherently have or is that something I learned? I think I learned a lot of that. I have spent a lot of time in my adult life and with the patience of my loving husband, unlearning some of those things.

Sucheta: Well, thank you for being so candid. I think spoken like a true psychologist – has greater awareness of self, much more [inaudible], so accepting of shortcomings, and that probably is like one of the starting points, I think those to have that mental state do so much better in our experience, isn’t it? Let’s dive into the issue of ADHD. The struggle of students and families with ADHD is real, and often, these struggles seep into the classrooms and home lives into their personal sense of self, as well as interpersonal relationships, so help us understand the plight of a person with ADHD.

Sharon: Well, let’s start by defining ADHD according to the world of Sharon Saline. ADHD is a chronic condition marked by persistent inattention, hyperactivity and sometimes, impulsivity. And that is more frequent and severe than we would typically observe in children, teens, or adults of the same age. It’s a biologically-based disorder related to the neurotransmitters dopamine and norepinephrine. It’s not about laziness or purposeful destructiveness. It’s a performance-based condition. You can’t access what you know and apply it in the way that you want to or should any particular moment or in a given situation, and people who live with ADHD have often severe executive functioning skills challenges and deficits, so we all have executive functioning skills, as you know, Sucheta, and we all have strengths and challenges, but for me, I’m your typical. I have one or two areas that I really need to kind of work on the rest of my executive functioning is pretty well intact. For people with ADHD, it’s the reverse. They have one or two areas that are pretty well intact, and the rest of the nine executive functioning skills, so there are 11 in total are really a, they struggle with or they need to shore up, and as they mature over time and become adults, they learned how to manage those challenges, and some of those challenges may improve or get better as the frontal lobes fully develop, and the frontal lobes connect with the rest of the brain around age 25 in neurotypical brains and there is about a three-year delay in people living with ADHD, and so in order to be diagnosed with ADHD, if you’re under the age of 17, you have to have five out of nine symptoms in two areas of functioning after ruling out medical or other mental health or environmental issues that there is clear evidence that the symptoms interfere with or reduce the quality of social academic or what we call occupational functioning. For people who are 17 and older, it’s usually five symptoms. One of the challenges of diagnosing adult ADHD is that the sort of standard for diagnosing the requirements, they are not as stringent as they are for children, and that makes it a little harder for us to get the numbers right in terms of how many adults do we really see in this country with ADHD? Because the diagnosis is about 10%, 10.9% for school-aged children, and then it dropped to 4.5% for adults. It’s not because all of those kids magically wake up one morning and they are ADHD is gone. In reality, there is a maximum of it maybe a third of kids who outgrow ADHD, but I had this conversation with Dr. Ari Tuckman and he said – we talked, I said, I’m not sure that they outgrow it but they actually adapt to it, and he said, “That’s right, because we don’t have stringent measures for measuring adult ADHD.” So, if you’re adult and you are doing okay in your work and in your personal life, you’re not going to necessarily take yourself to the doctor to get a diagnosis, and even if you’re struggling, you may not take yourself to get a diagnosis, but if you’re a kid and you are not doing well in school or there are a lot of problems at home, your parents will take you to get an assessment or to try to figure out what’s going on, so that’s part of why there is such a gap.

Sucheta: Thank you, Sharon, for going into the depth of it because it is disconcerting to me we are in 2020 and yet I cannot tell you the number of parents telling me that they have known that their child has ADHD since age 2 but it wasn’t until they show up in somebody’s office like mine that they hear the term executive function or dysfunction for the first time, so there is certainly a gap in delivering this information about ADHD equals executive dysfunction and to look for signs of mismanagement, but I’m seeing that they wait for her mismanagement to reach a boiling point, and only then that they are either looking for explanation, or for parents and teachers, all these are some particle speech loading in the universe, they have not put them together to formulate this idea of what this cohesive thing means.

I have a question about what you just said about this help. People understand that meeting the criteria issue with diagnosing ADHD, we do not diagnose ADHD by drawing blood but we look for these five out of nine in two areas of functioning. Tell us what happens in four out of nine areas in two areas of functioning is a problem. Those kids don’t necessarily receive the diagnosis, right?

Sharon: Well, it’s six out of 9 for kids under the age of 17 and five out of nine over the age of 17. When you get to four out of nine and you are a child, what that is telling us is that you have executive functioning challenges, they are not severe enough to receive an ADHD diagnosis, but you are struggling and it’s worth noting that kids who have learning disabilities often have executive functioning challenges and the kids who have high-functioning autism spectrum disorders have executive functioning challenges as well, and so there is a wide range one of the challenges is a you may have some struggles in some areas but you may not meet the criteria for an ADHD diagnosis yet or perhaps ever, but that doesn’t mean that you shouldn’t get remediation in the areas where you are struggling, so essentially, if you have some executive functioning skills deficits but you don’t meet the diagnosis for an ADHD, you still should get help in the skill areas that are weaker for you.

Sucheta: So, you wrote this beautiful book, What Your ADHD Child Wishes to You Knew, and in the title itself, you phrased it that what your ADHD Child wishes to you knew, so tell us about that perspective, why did you come up with this title and what is it that you want, what do you think our kids want that parents don’t know where adults in their lives do not know?

Sharon: I decided to write this book because what I was seeing in my office and when I went to give workshops was that parents were telling me one thing about what it was like to live with their kids and kids were telling me something else about what it was like to live with ADHD and to live with their parents or their teachers, and I felt that people were not listening actually enough to kids and what they are saying, and so I wanted to open up the dialogue, and what I learned where there were five themes of what kids were telling me. One, it’s very disconcerting for them when parents lose it because they are struggling, the kids, to manage themselves and when parents lose it, they can’t hold it together. Two, they want to be accepted for who they are, not who you think they should be because it takes a lot of work for them to get through every day, and they feel like that isn’t enough of the equation. They want to be included in programs for plans that have to do with them and are supposed to help them because they not sure that what you think might help them is actually how their brain works, and they need incentives to motivate them, so the incentives can’t be you think is important for them but something that you talk about with them and decide together because punishments don’t work for kids with ADHD. In fact, punishments don’t work in general because they don’t teach skills, they just tell you what not to do.

Sucheta: I love that. If I may just bask in the glory of that, punishments don’t motivate kids. It’s really because I think it’s also a reflection of incredible inpatients on the person who’s trying to deal with somebody else’s dysfunction, right?

Sharon: Correct, right, and for kids with ADHD, here’s the thing: I mentioned the dopamine and norepinephrine. Dopamine is a neurotransmitter that has to do with interest, pleasure, and reward. ADHD brains naturally do not have enough dopamine, and so if they don’t have a problem doing something that already interests them, that’s fine, that’s not where the challenge is. The challenge is when they have to do something that is a hard. It’s not interesting, and applied themselves because in those instances, we all have to summon out extra dopamine to apply ourselves and get it done, so with these kids, they don’t have that extra dopamine, so they can’t. It’s a now or not now brain. If now seems miserable, who appears about with the consequences later? That’s something that we have to keep in mind that. The other two things they told me where it’s very hard for them when adults say they are going to do one thing and do something else and they need more encouragement. Kids with ADHD feel like they are trying to do the right thing and unless they get it right, nobody notices, and sometimes, when they do get it right, nobody notices because it is expected of them, and so I call this efforting – they want to be seen in their attempt to make this effort. The last one is positivity. Most kids with ADHD feel like they receive a lot more negative comments than positive ones, and so this is not motivating for that. It actually discourages them because they get into this feedback loop of why bother even trying? I’m just going to fail anyway, or no one is going to notice the hard work that I’m doing. These were the themes that they talk to me about.

Sucheta: I love that and I think that the marriage to your work is that the hands-on experience, and I love the way you also have written, you have this vignette that you weave into telling a story as well as telling the message behind that story because I think well-meeting people are looking at resources as educate me, inform me, and then I will filter that into my personal lens of what is doable for me and what’s not doable for me, so they are so focused on who they are and not what the need is, and that’s what I really like this idea that you were talking about. For example, I’ll give you your “. You said that when kids meet defeat, it’s because they don’t see other choices for themselves in that moment. This perspective can be hard for our adult minds to grasp. Please tell us a little bit how you go about inviting parents were adult in the child’s life to shift their own perspective while dealing with children’s failures.

Sharon: The themes that I recounted earlier, I transformed these into what I call the five Cs of ADHD parenting: self-control, compassion, collaboration, consistency, and celebration, and so if we want to transform defeat  into something more positive, more productive, then we need to rely on these five Cs. We need to manage ourselves first, we need to manage ourselves first, we need to manage our frustration and disappointment, and not lose our temper with our kids. It’s like putting the oxygen mask on yourself first on an airplane, and then on your child. You center yourself, and then you can help your child. Compassion, we have to meet our kids where they are and offer them understanding and empathy. Often, the things that are hard for them or that they can’t do or they forget, it’s not because they wake up in the morning and think, all, my goodness, how am I going to mess up mom’s day by forgetting my lunchbox? They don’t do that, right? They just forget the lunchbox, and so sometimes, it’s hard as a parent. You are so angry, again, that this happened. We forget that and we compare our kids, like if you have a kid who’s more typical and a kid with ADHD, the kid with ADHD will be just sort of either verbal or nonverbal messaging about why they are not like the other child, and that’s really hard for kids, and this idea of efforting, so then we have collaboration, you are going to work together for solutions to problems you both identify and use incentives that matter to kids, and consistency. What consistency is, is that you’re going to do the best you can given the resources you have just like your kids are doing the best they can and try to do what you say you’re going to do, not all the time – there’s exceptions, but more times than not, and you are going to notice when kids are actually trying to do something that’s hard for them. They may not finish their homework but they sit down and they give it a good 20 minutes. That’s progress.

Sucheta: It’s a really beautiful point. Two things that strike me about this consistency, so there’s an apple and there’s a tree, so we know the genetic element of ADHD, and so the parents may or may not have managed their own ADHD or have not received a diagnosis, or I see often, particularly if a highly organized, well put together, type A parent is married to an ADHD flower child parent, and then they produced this beautiful child who does not have these organizational traits or these impeccable executive function traits, then that parent is really hard on that child, then the flip side of that, a parent who themselves may have these challenges do not do a good job with follow-through and that creates incredible sense of just dicing is in the whole home environment and there is no sense of stability or anchoring. The last thing you said about not noticing, that takes me back to this idea of ADHD and attention. I read this somewhere recently that the best gift that you can give somebody is attention, and imagine how little gifts we are giving each other, let alone ADHD having more difficulty. Tell us a little about this consistency issue because I tell parents about consistency and they are such good listeners and they deeply want to be consistent, but they just can’t help it. They just don’t have all the internal models to stay consistent and they forget their own punishment rules, their rules of praise, they forget how to be nice to their kids, particularly when the challenge has escalated. What do you suggest we do that?

Sharon: Well, that’s a very good question. I think that one thing we have to remember is that 57% of adults with ADHD have a child with ADHD, and if you have a child with ADHD, there is a 33% chance you can have a second child with ADHD.

Sucheta: Wow, that’s a very big number there.

Sharon: Let’s just stick with that. Yes, those are big numbers, so what we want to think about is consistency in that you don’t say you are going to do something you can’t actually remember or follow through on. What’s the point of that? In that way, if you’re setting up seven plans for seven different problems, that’s six plans to many. Start with one thing at a time. Most people can only change one thing at a time, and so particularly for kids with ADHD, they often feel like they are supposed to be changing seven things at one time and they really can barely do one, and so it’s a lot to keep track of, and so I think parents are asking themselves too much, so what we want to do instead is set a goal and set a program or a plan that you can remember and follow through on that actually matters to you but also matters to your kid, and so what that means is that let’s say that mornings are not going well and there is yelling and screaming, and everybody is unhappy. Well, there’s also evenings aren’t going well, after school isn’t going well. I would sit down to your child and say, “Which is the worst time of the day for you?” Your child may say after school, and even though that isn’t the worst time of the day for you parents, they have identified something that matters to the, and it also matters to you, so I would start with what they want, and if you feel that you have two, I would do one thing for the afternoon, and then maybe add one thing from the morning, and that’s it. You work on those until those can be somewhat different, then you can move on. Write things down, get a whiteboard, have a list for reminders after school, morning, to do. Instead of you being the reminder, he returned them to the list and if kids can’t, we use pictures. That way, what they are learning our executive function skills. They are learning organization, they are learning sequencing, they are working on their working memory, they are learning some time management, you refer them to the list rather than a human being the holder of the reminders. No one wants to be a reminder machine. I had one mom who at the beginning of the school every year, she would tell her daughter to get ready for school with the backpack and the lunch and the sweater and she would take a picture and post it on the refrigerator, and in the morning, every morning, she would say, “Do you look like your picture?” The girl would go, “I’m ready,” and the mom would say, “Hmm… Do you look like your picture?” Because there was no lunchbox or no shoes, or no sweater, and so that way, the daughter had a chance to kind of assessing herself, and this child was eight.

Sucheta: Wow, yes. Another thing you just pointed out in the solution you provided here is, prioritize your mission as a family. Sometimes, I think once we recognize that the child has problems, they try to fix the child without really thinking about does us as a family function well? Because to me, fixing really comes from a very poorly framed the problem. That means somebody is in charge of somebody else and somebody is wrong or somebody is incomplete, but I like to tell parents that my morning me is a lot more competent than my evening meeting, so we have a natural course of ups and downs executive function proficiency that we need to be really listening to. So, I really like that, that you are empowering parents to think about their agency, and then kind of mirroring the child’s need to their desire to contribute to their success. That brings us to the last point you were bringing about celebration, so tell us about that approach.

Sharon: Celebration is critical that is critical because of what happens for the kids is that they have a negative conversation in their brain about themselves. It’s called negative self-talk, and what they’ve done is they have internalized the negative voices from caring adults in their lives: teachers, coaches, parents, grandparents, and those voices now have become their own voice. They fused into what they tell themselves. Dr. Barbara Fredrickson have done some research on the positivity ratio, and in her book Positivity, he says it should be 3 to 1. I have traveled all around the country and internationally, and I asked parents all the time, what do you think the ratio is of positive to negative statements that your child receives? Are everyone positive statement, how many negative statements in the course of the day today? And that would include redirecting, telling them to stop, and think about this, listeners, please right now, and then I will share with you that what I have heard parents say is that they believe their children receive anywhere from 10 to 30 or 40 messages per day.

Sucheta: Wow.

Sharon: Kids themselves feel like it’s between 25 or 30 if not more. What do they need from you as a parent? A reminder that you love them and accept them, and you see their efforts, you see their accomplishments. You are noticing the ways in which they are changing, and so that means a high five widget where a way, well, we can’t high-five) coronavirus but an elbow bump for clearing the table, or your eyes, make eye contact, I thank you, playing music while you’re doing the dishes and having some fun, maybe sitting in the room while they are picking up their clothes and helping them – I’ll be the sock roller, you pick up all your socks. Instead of saying “Go clean your room,” because kids with ADHD can’t really do that until they are in their teens, and sometimes even then, so they made even need a parent there to help them role of the socks or fold the shirts, or kind of a move them along. We call that a body double, and when we catch them being good, okay, we let them know. You want to catch them being good.

Sucheta: I love that, yes. What I love about the way you are presenting this is you are saying you recognize these themes in what ways the kids are not getting recognized, not getting accepted, not getting the right help through the right lens, and then you propose to these wonderful five themes. Do you mind if we go into a little bit detail with a few of them? So, let’s talk a little bit about that self-control and how does that translate into strategies in every day? If you can give us some examples of a pushback that you may get from a child as you are trying to deploy strategies where you have to pivot and adjust your strategies, so could we do both on this?

Sharon: Of course. One of the major ways to deal with self-control is to notice when you are becoming dysregulated. What happens when you get dysregulated? Do you get a knot in your stomach? Does your energy sort of flow up into your head? Do you start to speak loudly? Does your heart rate increase? Are you sweating? What happens when you start to get activated? That is the signal for you as the adult that you need time apart, and what are you going to do during that time apart? You’re going to take some deep breaths, maybe stick your head outside or take your body outside to breathe a couple deep breath, go to the bathroom, wash your hands, look in the mirror and say, “You’ve got this.” Whatever it is that you need to do to bring yourself into a more settled and composition.

Sucheta: Now, you’re talking about parents, of course?

Sharon: Of course. Right. Then, you can help your children with their dysregulation, but if you are trying to control them while you are activated, I’m going to tell you, it’s like taking sticks and paper and throwing it on the budding fire that is your child, adding fuel to the fire.

Sucheta: Yes, I love that, yes.

Sharon: Right, so what we want to do is set up meltdowns for success in advance, so what are we going to do when there is a meltdown?

Sucheta: Quickly give me an example for our listeners, what would an adult meltdown look like so the parent can take a little inventory of self?

Sharon: Actually, I think I explained what an adult meltdown would look like, what the triggers are. I’m talking about when your child is being annoying, aggravating, aggressive, defiant, and things are escalating. You can tell because they escalate superfast in ADHD families. They go from 0 to 65 in about three seconds, so we are talking when you get to 2 ½ seconds to call it time apart, and that time apart has to be planned when people are not in the middle of an episode, and so what we do is it takes about 12 to 15 minutes for the amygdala, the fight or flight parts of the brain settled down after it’s activated that intensely, so what we want to do is have a time apart where we have a list of activities or things that people can do to help manage themselves, and so if you’re at home, it’s a little bit easier and that if you’re at the grocery store, but again, you need to have an agreement. At the grocery store, if you start to have a meltdown, we are leaving, like I’m not good by any groceries at all. For just going to walk out and go into the car, and you can scream the whole way, but I’m not going to do – I’m not going to stay in the grocery store. We are just going to leave. If we are home and things aren’t evolving into an interruption or building into eruption maybe is a better use of language, then we are going to call a time apart and you can use the things we bought at the dollars to work for your calm me down box. You can listen to music in your room. You can pet the dog. Well, we agreed that I could sit on the couch and read you some stories even though as a parent, the last thing I want to do is be near you. You have told me that helps you calm down, so you have things to rely on rather than pulling it out of some magic hat in the moment when you can’t think very clearly either because you are angry.

Sucheta: Yes.

Sharon: This is hard for me to do. This is hard for all of us to do. I moved my daughter out of her dorm yesterday because of this virus thing and she was not the most pleasant person, and I was so good because I said nothing to her about it. We drove all the way down and she was cranky, cranky, cranky, and we got to where she’s living and I went to the kitchen and I packed up all the groceries, and she went into a room, and when I had packed up all the things from the kitchen, I went to her room and said, “I packed everything up. What would you like me to do next?” She looked at me and she said, “Thank you so much. I’m sorry I was cranky in the car. Could you work on my books?” And I practically did my happy dance.

Sucheta: Yes, she knows how to do it.

Sharon: I was so proud of myself because the me four or five years ago, I would’ve been like, “Why are you talking to me that way? It’s the rude! I’m coming down [inaudible] help you,” and I am learning. This is my growing curve.

Sucheta: I love this idea about, as you said, noticing when you get dysregulated. I find that many people are so not self-attuned that they need some outward symptoms of them having lost it to even begin to their self-reflection. By then, they raised their voice, they have yanked some major chain in their child’s emotional life for the themselves to have thrown a massive tantrum by yelling and schooling the child. Do you have any suggestions, how can people develop that internal radar that helps them become more attuned with the gradual shift which as you said, it could literally be happening in three seconds, so it’s gradual but it’s very fast? Is there any mechanism they can tap into to either slow that down kind of have the internal mechanics? Like you mentioned, the racing heart or sweating, or just the throbbing pain in your temple.

Sharon: If your neck hurts [inaudible].

Sucheta: [inaudible]

Sharon: I think the thing is to actually take some time, if you are listening to this podcast, make a note, like put on your posted and say, think about what happens when I’m starting to get angry. Make a post it, write that down, and then get a second posted and write down some of the things that you notice happen when you are starting to get angry, and put that up in your bathroom mirror or someplace where you can see it, and you can refer to it to remind yourself each day, these are the signs when I’m veering off. Because as an adult with our mature frontal lobe, we have a much better chance of managing ourselves than our nine-year-olds do. Forget it, they are being run by their emotional brain. We hopefully are being run by our thinking brain which is the prefrontal cortex. We have to really understand, it’s okay to be upset and it’s okay to say to your kids, I’m getting upset because I’m telling you that it’s time for you to put your magic cards down and put your shoes on and go to school, and we have talked about this and you are not doing it. This isn’t our agreement.

Sucheta: Got it, got it, that so helpful.

Sharon: at and then, you make that to something they want. We have agreed that if you cannot get off your magic cards when I ask you to in the morning with a warning that you are not going to get to play with them after school, so I’m going to count to three which is what we agreed on, and when the cards are down at three, you may have the privilege of playing with them in the afternoon, but if they are not, you are not going to get the cards later today. One, two, and three.

Sucheta: That’s great.

Sharon: So, I was counting for my kid for years. I love this Magic 1-2-3 book by Thomas Phelan, and if you don’t have it, I encourage you –

Sucheta: Yes, I love that!

Sharon: When my son was 13, we were at a family vacation in Florida and he was all that, he was 13, and he was really annoying his sister whose four years younger – she’s nine, and he kept [inaudible] her and it was her turn for the TV because he wanted to watch March madness at a certain time, so she’s watching her Ella Enchanted video or whatever, and he is annoying her, like, “When is this going to be over? Isn’t it my turn yet? Can I hold the zapper even though you are watching your movie?” And he just wouldn’t stop and I kept saying, “You need to stop, you need to stop,” and then I said, “I’m going to count to three and if you’re not in your room by three, you will not have earned March madness,” and he looked at me and he’s like, “I’m 13, from an eighth grade and you’re going to count for me?” I’m like, “I’m counting.”

Sucheta: Watch me.

Sharon: And I was [inaudible]. I said, “I’m counting. That’s one.” Oh, my God, he stood up and started walking through, “I can’t believe you’re counting.” I’m like, “That’s a 2,” and then he stepped over the edge into his bedroom and he basically said, “This stinks,” and I said, “Three, you are in your room.”

Sucheta: I think it’s adorable.

Sharon: But it’s hard as a parent, it’s hard because you just want to wring your neck sometimes and say, “Don’t talk to me that way. Who do you think you are?” and you just have to stick with what you know is going to help you stay centered is as soon as the veer off into yell-at-them mode and getting upset mode, they now have won; they have offloaded all of their upsets on to you, you are now carrying it around and exploding, and so the focus is now on you as the exploder, and sad to say, I did this way too many times which is part of why I’m trying to teach parents something different.

Sucheta: But it sounds like you have truly drawn a lot of insights that are going to help so many people, and you are being honest and you are showing your human side. It’s really hard to show up like that, and it can’t be perfect. Some situations just bring out the worst in you.

Sharon: Exactly, and I am absolutely in no way advocating perfection because that’s an unrealistic goal. I’m just advocating that people accept themselves, warts and all. We are all doing the best we can with whatever resources we have available at this given moment, including our children, and once we accept that, that helps us move to a better place. You may have a nephew who’s neurotypical who at age 9 can go upstairs when his parents say, “Time to go upstairs, brush your teeth, input your pajamas on,” and go upstairs, but the pajamas on, brush their teeth and get to bed, and your nine-year-old daughter may not be able to make it to the stairs because your nine year old daughter in executive functioning years in this way is actually six, and would you expect a six-year-old to go upstairs and put on their pajamas, brush their teeth, and get in bed alone? No, you would not.

Sucheta: Exactly.

Sharon: So, that’s part of how we have to conceptualize things.

Sucheta: As we come to an and of our discussion – I can’t believe that time is just float. I can talk to you for hours, I hope you know that. I want to know, we addressed these emotions, what is the big picture that you want parents to know and remember as the kids are behind in their skills and as they themselves may be on their a game or sometimes totally off their rockers, what should be the family’s mission as they go through life by wanting to raise children and anchoring togetherness even through times of difficulty, whether you have neurotypical or neuro-atypical children, what is your big picture?

Sharon: This is a good question because this is related to the defeat question as well. What we want our kids to feel is connected to us, to have a positive connection to their parents, to see their parents as their allies in taking on and figuring out how to bushwhack your way through the forest while living with ADHD. That’s really what we are talking about because they can’t get there on their own, and so they will hit defeats, they will because we learned through our defeats, all right? We learned through our struggles. I was grocery shopping recently and I ran into this ninth-grade biology teacher at our local high school and we shared a student, and I said, “I think about you all the time because of the student we shared,” and he said, “I know exactly what you’re talking about.” This has been six years, seven years.

Sucheta: Oh, yes, wow.

Sharon: The reason he remembers is because of this student had failed bio the first year and had to repeat it and studied very hard for the first bio test of the year and felt, and came into my office and said, “I’m not even going to bother trying. What’s the point? I failed. Again, I’m just going to fail this year,” I said to her, “Holdup, something is different this fall than it was last year. What do you think that is?” and she said, “I don’t know,” and I said, “Well, you’re looking at her, right? You’re here with me. We are going to come up with a strategy, so I said, “I would like you to go back and meet with your teacher after school, and asked him what kind of studying would be more helpful than what you are doing. Show him what you did and what may be is missing,” and she said, “I’m not doing that.” I said, “Why?” and she said, “Because I don’t want to ask him.” I said, “Okay, I will email him with a warning that you are going to approach him to stay after school to get some help area at all you have to do is show up. You agree to that?” She said yes and she did because the incentive with was a cookie and a hot chocolate from the café near my office, and she came in the next week – I’m sort of joking but not totally – that wasn’t the only incentive, of course. She came in the next week and she said, “I went to see him,” and I said, “How was it?” He said, “Well, he showed me what I was missing and he told me, if I could get the things wrong in the test that I missed, I could get some credit,” and then they made an agreement that she would come once a week after school and he would assist her in what she was missing because this is a kid who’s diagnosed as a sophomore in high school with dyslexia and ADHD.

Sucheta: Oh, wow, yeah.

Sharon: That year, I’m just going to tell you because this is an amazing story – at the end of that year, she made second honor roll. She was the first person in her entire family to ever make the owner all.

Sucheta: Oh, my goodness. I’m getting goosebumps. Oh, wow.

Sharon: Right, so that’s why we have to be with our kids, and I brought her mom in and her dad, and I said, “This is what we are doing, this is our plan. This is the hallmark that we’ve set up, here’s the support that this girl would like from you,” and she was very specific about what she wanted and what she didn’t want, and everybody worked with that as well as some of my input and input from the teacher, and she passed nicely.

Sucheta: So wonderful. I always imagined the work we do as a Highway 1 in California: there is a big massive rock on one side and the guard rail – we have the guard rail, they are going to bump into the [inaudible] the road is very curvaceous, the rock is very solid, but thank God for the guard rail, and that’s the only thing we can offer and teaching them a little bit about maybe slowing down as they take an inventory of the road itself, but Sharon, this was so exciting, powerful, very optimistic, full of the message of hope and positivity, so I really appreciate you coming on today at sharing your wisdom, and it’s so fun, so fun to learn from you, so I can imagine all those kids who worked with you and the families are so lucky to have you. Thank you so much.

Sharon: Thank you so much, Sucheta. Of those are such lovely words, they go right to my heart, and I am so thrilled to be here to speak with you and I hope that I can come back and we can take on a few other topics.

Sucheta: I hope so, really.

Sharon: But it is lovely to be here and you asked the most thoughtful questions, it’s a pleasure to talk to you.

Producer: Well, I can speak for myself, I’m looking forward to those future conversations. Alright, that’s all the time we have for today. If you know of someone who might benefit from listening to this conversation, a teacher, perhaps, a principal, coach, parent, or student, we would be most grateful if you would kindly forward it to them. So, on behalf of your host Sucheta Kamath, today’s guest Dr. Sharon Saline, and all of us at EXQ, thanks for listening and we look forward to seeing you again right here next week on Full PreFrontal.