Transcript: Children’s Behavior Problems: Let’s Think Outside the Box

When it comes to the topic of children’s development and behavior, there’s lots of labels and we all have our own ideas of what’s normal, don’t we!

During my career as a childcare educator, I often found myself looking after children that were labeled with conditions such as ADHD and I’ve often found it tough knowing how best to support them.

I was thrilled this week to speak with Dr Nerissa Bauer, a behavioral pediatrician and the owner and blogger of Let’s Talk Kids Health. This platform is dedicated to bringing awareness, education and positive experiences around pediatric behavioral health, family wellness and parenting topics.

Nerissa had some great insights and shared some fascinating experiences from her own parenting journey and I thoroughly enjoyed talking with her. I really like how she thinks outside of the box and encourages parents to be creative and meet their children where they are.

Helen Thompson: Hi Nerissa, it’s great to have you on First Time Mum’s Chat, I’ve been really excited about having a chat to you because I know you are a behavior pediatrician and a lot of my first time moms always sort of asking me about how they can cope with behavior. So I’m very excited to have you here.

Nerissa Bauer: Thank you so much. I have been looking forward to joining you on the podcast. Thanks for the opportunity.

Helen Thompson: So first of all, tell me about your experience as a behavioral pediatrician and how you got started and what you’re passionate about.

Nerissa Bauer: Absolutely, that’s a great question, I get that all the time. What is a behavioral pediatrician? And what that means is I’m a pediatrician by training, but then afterwards I just decided that I wanted to specialize and focus much more on understanding and helping support parents when it comes to, children’s development and behavior and understanding what’s normal, what’s not normal and everything that goes along with that.

So I currently have a private practice two days a week in Indianapolis, Indiana. So quite far from where you are Helen. But I treat patients and see families and help them if their child has attention deficit, hyperactivity, disorder, anxiety, depression, if there are any parenting concerns or school concerns and how they learn.

I love what I do and through when I see families and I hear their stories, I often times think, how can I help support them, because raising a child is one of the most rewarding things ever, but it’s also not very easy at times, you know, there’s not a one size fits all approach to parenting. And there’s so many books out there. I have read many of them and I’ve been trained in a lot of different approaches, but, you know, I think the, the art of what I do and why I find it so rewarding is just that I get to know very quickly, what concerns a parent has. I hear everything , their hopes and dreams and their fears and their worries, the family history. So I’m privy to that and I do see that as an honor and a privilege, but I’m also so happy to be able to just sit with that first time mom or that family, and try to understand as much as possible their experience of what’s happening and then be able to help them guide them through that journey. And whether that is, do we need to do more medical workup and decide, is there something else going on and it’s not just, you know, behavior.

You know, pure behaviors, there’s something underlying that or is there some education that needs to happen? And you know, like I said, kids do not come with instruction manuals and trying to understand how a parent and a child interact because a child’s temperament can greatly influence how they are.

And what I mean by temperament is if you put them in a situation, how does a child respond? The how of behavior, right. And a parent, might be very easy, going very flexible and have a very spirited child and when you put those two together, it can be really hard because it doesn’t match what parents feel like they respond. Their reactivity level and it can be very stressful. So part of my job is, is making sure there’s nothing else going on medically, trying to understand the family history, trying to understand sort of what the parents, each bring to the table, you know, because we all are influenced by our own childhood experiences too and then putting that all together.

Helen Thompson: There seems to also be a big stigma about ADHD and every child is sort of labeled as something, whether it’s ADHD or ADD or dyslexia and I think having somebody like you, who’s got a passion to be able to help it’s great.

On your website, you have a wonderful way of dealing with it through art. There was a blog post, “Learning to Roll With It By Thinking Outside the Box”. When I read it, I thought that is amazing because that’s using their expression. It’s bringing the child into it. So can you give a bit about how that all came about?

Nerissa Bauer: Of course I’m happy to, so, let me first get back to your point about, you know, sometimes kids are labeled and I do want to say, when I meet with a family, I try to understand the families and the context, and really get to know them.

The labels that sometimes comes out of that. I try very hard when I talk with families about what I’m concerned about. Sometimes, you know, I do always clarify my thinking and we do have to as physicians, use a quote label. So that way, when I refer a child to early intervention for instance, that therapist or that provider also understands kind of what that means, but I’m always very careful when I’m talking to families about like, gosh, you know, I’m concerned that your child has ADHD.

What does that mean? And I explain to them, and I always treat that child with dignity and they are a child first. Right? So there is a lot of stigma around mental health and awareness, but that’s part of what I love to do is just help us talk about these things so that it’s more normal and it’s just part of mental wellness.

We need to understand when things are different and unique and celebrate those differences and look at how to help every family get to where they need to be. So the learning to roll with it, story that that’s kind of funny because it’s a personal story. We know that kids especially toddlers, preschoolers, they may have periods of time where they don’t really have the words yet to explain their big feelings and emotions, right and you know, as it’s not easy being a toddler or a preschooler, you know, when you can jump and hop and skip, but then you can’t really tie a shoe yet, or you can’t really do a zipper and it’s very frustrating, but kids yet at that age, don’t have the words of what they’re feeling. This story is about my daughter, who is a very spirited child. And she gave me permission to share this story. But you know, it was one of those days I was coming home from work and within two minutes she was in full out tantrum mode and I was like, oh my gosh, what’s happening.

I’m not quite sure what happened. I just got home. You know, I had thought about very quickly in my head. Okay. I don’t want to just quickly respond or yell. You know, that’s not the right thing, even though I was super tired and you know, I just got home, I’m hungry. But then I said, oh gosh, how am I going to help her understand, like, help me understand what she needs.

And my daughter is an artist. She always had creative tendencies and I happen to always carry a pad of paper and some pens and pencils in my purse. So I just grabbed that out of my bag and I was like, okay, I’m going to see if I can coach her through this. And I said, drop me what it looks like, what you’re feeling right now.

And she looked at me kind of startled, cause I’d never asked her that before. And you know, here she was crying and, you know, starting to sweat because she was like really feeling these emotions. And when I said that to her, she was like, huh. And then she grabbed it and then she started scribbling. And the thing is, is that when she started doing that, that motion, I didn’t just stop there.

I actually was like, oh my gosh, you are drawing big circles. The lines are so heavy. You must be really upset right now. You’re feeling really upset, you know? Like as loud as she was, to kind of keep like so that she could hear me through her screaming. And she was kind of like riveted. She was like, oh my gosh, what’s happening, mom’s like, right. And then she ran out of space on that piece of paper and then she ripped it off and she looked at me again and then she starts like scribbling again. I was like, oh my gosh, you’re still so angry. Look at those circles. 1, 2, 3, 4, 5, you know, I was just like narrating what I was seeing and, you know, she was like still crying. And then she’d rip up that paper and then she looked at me again, then she was starting to like, slow down. She wasn’t like screaming as much, but I was like, gosh, you’re still so angry, look at, you’ve still got circles on that page. And that whole time I was keeping my tone matching to her level, like her energy level. Like if she was really upset, it was louder. And then as she was starting to calm down, I sort of match her tone through how I was taught. Oh my gosh. Look at that, you’ve got 1, 2, 3, 4, you still have four circles on that page. You’re still so angry. And then by the third page of circles, she then starts drawing this stick figure.

And I’m like, what is that? And then, you know, she keeps adding detail. I was like, oh, That’s that’s you, Emma, is that you? And then she kind of pauses and then she draws another set of stick figures and it looks like someone on somebody’s lap. And I was like, oh, and I was like, wait a second, my son is on my lap right now.

And I said, are you sad and she was like, she just wrote sad. Cause she was almost in kindergarten and she was saying yes, like that was what I was trying to tell you. And you know, and then we sort of went through this. She, she wrote like mad at first and then sad. And then I realized quickly what was making her sad is that when I came home, my son rushed to my lap and he’s being the big brother, beat her to it.

That’s what caused her to get upset. And then when I finally put two and two together, and I said, you didn’t like that Jack was sitting on my lap first, you wanted to sit on my lap. She looked at me and then she drew another picture and it said love. And it had me and her on it. I mean, it was like, okay, Hey Jack, it’s now your sister’s turn. And then she joined me on my lap and we snuggled, I mean, that was what she needed that connection.

Helen Thompson: That’s so beautiful. The way she described it like that. ,

Nerissa Bauer: I know and I wasn’t quite sure it was gonna work and I was like, oh my gosh, this was kind of amazing, but sometimes when you’re parenting a child, you’ve got to think outside the box and be a little bit creative and meet them where they are.

And for my daughter, she, she was experienced some strong emotions and she really needed me to understand that. And at the time she could only flail her arms scream, yell, cry, and get sweaty. She didn’t know how to communicate that to me, but through the medium of art and me keeping her there, not sending her away to her room, keeping her there and commenting as she was drawing, me putting words and describing what I thought she was in, interpreting that, it connected. We connected. It was so beautiful. So that story has stuck with me.

Helen Thompson: Yeah. I said, well, when I looked at it in a website, it was amazing and because I come from a childcare background, I looked at it and I thought, wow, that’s an amazing thing to do to support a child and to help them to overcome, getting their emotions out.

Nerissa Bauer: Yeah and you know, there’s lots of other ways to do it. I mean, you know, as a pediatrician, a behavioral pediatrician, when I talked with families about different emotions, one of the first skills I teach them is that we need to be able to be our child’s emotion coach. And what that means is first, we need to help them get the words.

So behind me here I have a little feelings chart and, having parents describe all emotions, not just the bad ones, but the positive ones too and not just happy, sad, mad, or scared. There’s so much more to our human experience and believe me, kids can say the word frustrated. They can say disappointed. They can say overwhelmed. They are sponges and they will repeat words that we use. So I tell parents all the time, use yourself as a model. You know, when you’re coming home, if you’re frustrated, gosh, I’m today. I was really frustrated, you know, and what I did was I took a deep breath and then, you know, I just felt a little bit better, you know, like just even saying it out loud so that kids can see that not only do I feel this way, but parents feel this way too. And it just helps kids understand that emotions, good or bad are all fine. We all have them.

Helen Thompson: Yeah, I think it’s good for parents to be able to be open about that because sometimes if a kid has got ADHD, a kid may not understand what’s going on for them and you, as a pediatrician can help the child to understand more about what’s going on for them. Is that accurate?

Nerissa Bauer: Yes. Yes. You are absolutely a hundred percent correct. I mean, that’s one of the things that I love to do. I not only see patients, but I develop courses. So I have right now a teach me ADHD course that is intended for kids and parents to take together. And it’s perfect for kids eight to 12, and really the idea behind it is that I want, first of all, kids to have that knowledge and information about ADHD, so they don’t have to be scared of it or, you know, worried about it.

I just want them to understand what’s happening. I want them to be an active participant whenever they see me or any doctor. To be able to just talk about it, because I believe that it’s not too early to teach kids to self-advocate for themselves, right? Cause if I’m going to ask them to organize a backpack or manage their emotions, or, maybe take a medicine, even though that’s not always first line, they need to understand why.

And with information comes knowledge and knowledge is power and I want kids to be an active part of any decision about their mental health, along with their parents.

Helen Thompson: Yeah, and I think play is very valuable too. I think being able to express themselves through play. People think that kids should be academic and always learning songs and things like that. But you learn so much through play and play is so valuable.

Nerissa Bauer: It really is and I’m so glad you brought that up because, you know, as a pediatrician, I’m a member of the American Academy of Pediatrics. It’s our professional organization that represents 67,000 pediatricians worldwide. One of the things that we do with the AAP is we have clinical practice guidelines and policy statements, and we have one on play specifically, because play is so fundamentally important to a child’s development, not just cognitively, but also physical development, social, emotional skills. That’s the space in which kids learn how to interact with others.

Right. Not just with parents playing with them, but with peers. And it gives them that space to work things out, to practice things and to use their imagination. So play is so important and I think sometimes, academics is important too, math and reading and all that, but, but I don’t want to minimize or lose how important play is fundamentally.

We’re all so busy, but I think I want to also give parents permission that it’s okay to play with your child and, you know, play can look differently as the child ages, but it just fundamentally means that connection, that connection to others.

Helen Thompson: You can actually teach children to play and learn mathematics and learn the concepts while they’re doing it. I read this book ages ago called “Play Is a Feeling” and that’s what really inspired me and when I speak to you as a behavioral therapist, it’s nice to be able to think that play is still so valuable.

Nerissa Bauer: Yeah, it really is. I mean, especially if a child is struggling in a certain academic area, it can be really hard to motivate them, to be thinking about things. And so getting back to thinking outside the box, I think therapists who work with children, they understand that, you know, you’ve got to reset it and maybe reframe it a little bit, so it can be engaging and fun and playful.

You know, that way we can retain it. We can associate it with happy emotions and retain that much better and willingly. Be more active participation, if it’s playful.

Helen Thompson: And we go back to the communication as well, because it helps the child to communicate and develop more.

Nerissa Bauer: Yes it really does. So play is absolute fun, but also a necessary part of childhood.

Helen Thompson: Yeah. So is there any other tips that you would like to pass on to a mum who has a child who has these issues, or the first time mom who’s coming home and realises suddenly that somebody’s told them that their child has ADHD have you got any sort of tips?

Nerissa Bauer: Yes, absolutely. I mean, first of all, I would really encourage all parents to think about their GPs or their pediatrician first. If you have any concern about how your child is learning or behaving , but trust your mommy radar, because you are the expert of your child. You spend the most time with your child. If there’s anything that you’re concerned about, no question and no concern is a stupid question, right? Always talk to your GP or your pediatrician about anything they, they want to support you.

Secondly, It’s going to be really important if your child does end up needing to have an evaluation for ADHD or what we call executive functioning deficits, because we know that ADHD is much more than just a behavior diagnosis. It’s actually a brain-based condition and we know that it affects the frontal lobe of the brain where the executive function skills are.

And executive function skills really are a set of thinking skills that help you navigate life, make decisions, you know, and complete projects and things like that and we know that kids with ADHD or individuals with ADHD often have some difficulties with that part of the brain, because they’re called lagging skills. It’s about two to three years behind in development, but they ultimately will catch up, but the thing is we need to be able to support them. So if you have concerns about your child with ADHD, I would, first of all, encourage you to talk to your doctor. Secondly, if your child does get a diagnosis of ADHD, just know that there are so many resources out there to support, not just your child, but you, in that ADHD is a very heritable disorder condition. It runs in families. So sometimes some parents after their child receives a diagnosis. They’re like, I actually am kind of like that, you know, and they realize, wow, I’ve been able to compensate, but I’m wondering if maybe I have it, or maybe my husband has it, you know, cause it’s very highly genetic and passes through families.

But you know what, just in my teach me ADHD class, I teach kids that ADHD is a superpower and that there are no reasons why they can’t still achieve their goals and dreams. There are many famous people with ADHD including astronauts and movie stars and Olympic swimmers. You know what I mean? So people don’t let ADHD get in their way.

And that’s, my mission is really to help de-stigmatize those kinds of conditions, because we do know they exist. But what I want to really impart is that there are people like me out there that want to support families. It can be really confusing, really scary when you’re first getting that diagnosis or that label.

But that doesn’t mean your child doesn’t have gifts and unique strengths and so our job really is to support everybody, not just the parents, but the child too, and be able to do what they need to do to really thrive.

Helen Thompson: ADHD kids, they’ve got a lot of intelligence. They’re probably more creative or they might be better at doing something else but people, they think, oh why are they being like that? If you engage them in what they’re good at and like doing, you can support them. Through my career, until recently I’ve always thought of it as the behavior issue. I’ve always thought they’re misbehaving, they’re not communicating with me, they’re being stubborn or they’re not listening to me.

Nerissa Bauer: Right. And, and, you know, Helen, I’m so glad you just said that out loud, because I think one of the biggest things that I want to impart to families is that whole concept that, you know, kids aren’t necessarily doing these things on purpose.

They’re not forgetting things at school. They’re not, you know, running around just because they can, I mean, there really is ADHD and associated mental health issues. They are. brain based conditions. There is a reason for those issues and symptoms and I think that’s beautiful and I think one of the things is really working with someone who can help reframe that, you know, when you’re tired and you’re, you know, you’re having to make dinner, but then your child is acting out. It’s not because they’re really trying to do that. They actually have a hard time regulating their emotions.

And if you can just remember and keep in mind, okay, this is not personal. He does have a problem with regulating his emotions. We talked about that. I learned about that. So I need to meet him where he is. Okay. And then, you know, that sort of helps because if you can regulate how you respond your reactivity to your child, it just goes so much better.

I think that’s my biggest takeaway, you know I have this pneumonic called best brain-based emotion, coaching supports and treatment plan when I talk with families, but I already gave you the emotion coach one and the second one is remembering that ADHD is a brain-based condition. And if you can just keep that in mind and become a coach to your child and recognize they are not doing this on purpose. They definitely have areas where they’re lagging. They have strengths as well. But when you find that a child is acting out, it’s probably not because they’re meaning to do it. It’s because either they don’t have the skills, they don’t know how to ask for help and your job is really to support them and figure out how to do that. And the best way is to take on that coach mindset, because if, if you remember when a child first learns to walk, like we never yell at them for falling down. Right? No, of course not. Right. Instead we say, look at you, you did it, oh my gosh. I wonder if you could do it again. So if you can kind of keep that mindset when you have your child, who’s acting out, not wanting to do homework or just, you know, screaming, crying, having a hard time. If you can just remember, my child is not doing this on purpose. I can’t take it personally.

This means that I need to help support them. They just don’t have the skills yet. Then take that active coach stance and say, Hey bud, I see that you’re feeling frustrated. Let’s figure this out together. It’s a much different approach than, you know, yelling, screaming, getting upset,

Helen Thompson: That just makes them worse. Yes, you’re doing that. It makes them more hyper and then it’s harder to reduce the meltdown. If they’re having this meltdown and you’re screaming and shouting at them, you’re just making the meltdown worse because they’re not understanding why you’re yelling at them because they don’t get it.

Nerissa Bauer: Right. Right. So, you know, I think again, part of the philosophy and the approach is really educating and onboarding both kids and parents when we get the diagnosis of ADHD too. So they learn, and it’s a fun, playful environment. The classes has a detective theme. They do family missions together, which are really.

Meant to promote positive parent child experiences. So we want to just remind parents that we’re all in this together and, you know, work together with people on your team, not just the doctor, but therapists, the teachers, the educators, whoever helps with your child. So that we’re all on the same page. My job and my goal is to help as many families feel, you know, even, even if they have a child or themselves has ADHD, I want them to know that they’re not alone and you know, they can talk with professionals who get them, who understand them and can really help guide them through this.

Helen Thompson: Thank you. I’m sure there’s lots of parents out there who think great, I’ve found somebody who I can really talk to if they, if they want to get in touch with you how do they go about doing that.

Nerissa Bauer: So I have a couple of different ways. So unfortunately I can only practice medicine in the state of Indiana at the private practice. However, I have lots of other ways for families to reach out to me, even if they’re in another country.

And so, they’re free. So I have a website called letstalkkidshealth.org all together and that’s a website where I have access to my course, Teach Me ADHD, which is currently enrolling now and I host a free parenting book club on my Facebook page, let’s talk kids health and every month or every other month we read different parenting books and I interview authors. I also bring in parenting experts to just chat with me, just like what we’re doing here and then we support each other in a community. And then I’m also on Instagram and I also do a Facebook live show every Thursday night at 7:30 PM Eastern time. So again, my job and my mission is to bring together people and topics so that we can all talk together about behavior, health, parenting, and family wellness.

So thank you again for the opportunity. Just talk with you because I think it’s so important and I think your approach and philosophy was very in alignment with mine. And I think that’s why I just was really drawn to being able to come on and really excited to come on this podcast. So thank you so much.

Helen Thompson: Thank you so much. I’ve also listened to some of your Facebook lives, so I’ll pass on to my audience, how wonderful they are.

Nerissa Bauer: Thank you.

I really enjoyed talking with Nerissa, who shared some great tips and I hope you’ve taken away some good learnings from this episode.

I know that from now, I will be doing my utmost when interacting with children to meet them where they are, instead of making assumptions about how they are likely to behave and react.

I’ve included links in the show notes to Nerissa’s blog/website as well her Facebook, Instagram and YouTube channel. I also highly recommend checking out her weekly Facebook live show as well as her free parenting book club.

These can be accessed at mybabymassage.net/podcast/033.