Expert in neurodiversity on emotional regulation
“It’s really important that we only try specific calming strategies one at a time, and give them time to work. Just because they don’t completely settle the child immediately doesn’t mean that they’re not helping them.”
Dr. Billy Garvey @drbillygarey
We welcome Dr. Billy Garvey to this episode of My New Life. He runs a clinic in Melbourne, Australia, that helps parents focus on their children’s strengths, and move through some of their challenges.
The clinic has a 3-year waitlist and after listening to this episode, you’ll understand why: Dr. Billy is really good at helping caregivers and children connect in those moments when stronger limits are needed. He works with a lot of neurodiverse children, and brings that adaptive lens to our conversation. Dr. Billy is @drbillygarvey and has his own podcast, Pop Culture Parenting.
Transcript:
Jessica: Can you give me some of the scenarios of the parents that you’ve worked with? What are their life situations? How are they recognizing that they need help that they could use your support in a different approach?
Billy: Yeah, I think some of the biggest things they come with are just how stressed they are. So we know that a very high percentage across communities all around the world are experiencing daily stress in their parenting, finding that there’s challenging behaviors, they feel lost in how to guide kids around their emotions. We see a lot of children who are really struggling so much that they’re unable to attend daycare or childcare and early education environments because of the emotional difficulties they’re having and the conflict that they experience in their social relationships. So lots of kind of really stressed parents that are worried. And while sometimes they will be coming asking is this autism or do they have ADHD? What they really want is just to know how to help. And so, a lot of the work we do is really thinking about what are the skills that we can focus on for that child and that parent, because there’s always a partnership.
Themes in the parent-child relationship
Jessica: And let’s say it’s about the parent-child relationship and that dynamic, what are the key themes that come up in your work?
Billy: Yeah, that’s… I spend a lot of my time in that space because I think a lot of parent-child relationships can become quite comfortable when they’re not working. And I often challenge parents that kind of think this is just how it is or parenting’s meant to be hard. And what we know is really important in emotional regulation and co-regulation is that it’s really important that we connect with our kids before we try and correct their behaviors. And a lot of families will be very kind of well intended in trying to correct behaviors or problem solve, but really connecting with our kids and building that relationship from very early on. Jess, you’d know this well around attachment theory is just such an integral part of how well our relationship for the rest of our lives will be with them, but also in how much we can support them when they might be struggling.
How to set boundaries
Jessica: One of the things that I’ve struggled with as a parent is the attachment theory and being empathetic and attached to my child and then having an experience where I recognize that my child is hitting or doing something that is just inappropriate and I instinctively want to set the limit.
But then when I do, instead of complying, my child gets even more defiant and the situation can get just really out of control very fast. So how can I set limits when a child responds that way?
Billy: Yeah, it’s tough. And especially in preschool aged children or kids under five, what we know is that externalizing behavior can be really difficult. It can be hard for them in those environments where they’re around other kids. And it also, there’s a real sense of a parent feeling like they’re failing when their child is kind of lashing out, especially hitting other kids and it’s impacting how much they can be around other children. I like to think about when the child is completely dysregulated and really upset, and not all children who are hitting or lashing out will be like this, but our role is really just to show them that they’re safe. It’s not an opportunity really for skill development, and I do that for a couple of reasons. It doesn’t… There’s not many of us as adults actually, but there’s not many children who are really red hot emotionally and really distressed that can then hear what someone’s saying and be guided to different behaviors.
And I think if we think about ourselves when we’re like that, we also aren’t very receptive to someone coming in and saying, “Hey, just settle down” or whatever it is. So what we try and do is think about those experiences and reflect on what was going on, what was the trigger, what was the kind of early signs that that child was about to go down a dysfunctional path and start hitting another kid or start lashing out at me, and what could I do in the next time in the future to kind of go in and support them and guide them to a better behavior? I never liked the idea of trying to get kids to stop doing something.
A lot of families will find that when the child is hitting is when they go in and try and do that redirection, but we’ve kind of missed it then. So what we want to do is go in earlier, even when they’re succeeding at it, and give kind of really focused, specific praise that says, “I’m so happy with how well you are guiding your younger brother in this game. I really like how you are giving your sister a turn”. What that does is it builds their narrative around, I’m good at this, but the specific praise reinforces that pathway in their brain that says, this is how I interact with other kids. It’s much harder to reinforce the wanted behavior or desired behavior if we’re just telling them, no, stop doing that. It doesn’t really guide them.
Jessica: Yeah, that’s such good advice. And I think that it is so easy to overlook the positive, we do that, our brain sometimes do that. As adults, we don’t praise ourselves enough, and so giving that to our children early, proactively sounds really valuable. When it gets to a point where you haven’t had the time or you haven’t been able to interact or know that something is brewing for your child, who may be neuro-diverse, how do you keep that neuro-diverse child safe in their anger or their big emotions? So sometimes I find that one of my children I needed to kinda hold them tight and then found that that wasn’t helpful, but I was really worried about letting go. What was going to happen if I let go? Was there going to be a big explosion of an attack to the other child, was there going to be destruction of the environment? Something I just didn’t feel safe, but I also didn’t love holding them so close, so do you have any tips for those circumstances?
Billy: Yeah, it’s a great point. I’m sure, Jess what you’re very good at and nightly doing is trying to be guided by your child in the behaviors that they’re showing you and what they’re expressing. And young kids are not very good at verbalizing their feelings and saying, this is what my needs are. They just become elevated. So what we want to try and do is say, what works? I’m going to try different things, we know it’s really important that we only try specific calming, soothing strategies one at a time and give them time to work. Just because they don’t completely settle the child immediately doesn’t mean that they’re not helping them.
So those kind of soothing, if it’s even just touch and calming and patting a child, if that’s… We’re learning over time what works for our kids. My daughter is nearly two, and most of the time that’s not what she wants, she just wants space, and when she’s stressed and she kind of lashes out and throws herself around, I’m still there with her though. It’s really important that you get a sense that I’m still with her. And what I’m trying to do in my mind just to validate the experience that she’s having, not try and get her to stop and say this isn’t okay. I’m trying to keep her safe, but I’m trying as much as possible to remain calm myself and watch her. Now I’ve learned over time that she’s not someone who wants to be held and hugged because of that, but that was my innate instinct was to go in and do that. I had a beautiful moment with her last night where she was struggling a bit and she actually just came in and hugged me and it was really nice. So, I kind of just soaked it up and I was sitting there going, this is a best moment in my week, because it’s tough to get hugs out of her. But it’s really important that we don’t try and just shut down their emotions, we show them that they’re valid and they’re important and including the negative ones, and try and give them healthier behaviors than lashing out in terms of expressing them and dealing with them.
Setting limits on getting physical
Jessica: So let’s say the scenario is my child has hit another child, a sibling or another child. They have a big, huge wave of emotion. I’ve been there with them, I’ve tried to, frankly I feel a little bit like I’m walking on eggshells, trying to navigate the whole situation as a parent. But, we’ve gotten through the big feelings, but there’s never been a “lesson” on let’s not hit. How do you set limits around physical… I don’t want to call it violence, but it is, hitting another child or these instances that feel really inappropriate, like you got to set a limit there. How do we do that as parents?
Billy: Yeah. I think coming down firmly and saying that is not something that we can accept and the language we use, it should be, “That behavior is not acceptable.” Not that kind of, “I’m frustrated with you,” or you’re not, you got to make sure we’re not showing kids that they can’t get angry, because we don’t want them to be suppressing those feelings either. So I think what’s important is that we go in and say, this interaction with another child is not working and they’re not succeeding at it. I need to bring them out and I leave with them and they come out of that environment. The temptation is to sit there with the two kids in between them and try and redirect them to sharing or more appropriate behavior in the moment. That’s very tough for any of us to do, is to be like, “I’m still in this environment.
I’m one foot from this child, I’m really frustrated. Mom’s just come in and now she’s just, because she’s saying share or stop hitting…” it’s too much to ask for a child not to do that. So what we do is we come out, bring them out even out of the different room, but we go with them and we stay with them. We help them calm back down and then we guide them back in with a narrative that’s really instructional. “We’re going to go back over and we’re going to sit down with Sally and we’re going to sit and play the game with Sally and we’re going to take turns and it’s going to be really good because I’m going to be there with you and we’re going to have fun and enjoy this experience”. Now if you go back in and you notice they’re getting elevated again, then once again the ask is too much, so we need to come back down.
What we want to think about is what’s a lower expectation of success that we can do? So it’s not that they’ll never get there, it’s just that we need to give them smaller steps.
Building emotional regulation skills
Jessica: So how can we help our children build these skills outside of those heated moments? Can you give some specifics? Like starting with toddlers?
Billy: Yeah, definitely. So the toddlers a good example is to have a very structured task that you’re doing. And so, the toddlers and as you know, like a lot of it is kind of just parallel play as opposed to really genuine back and forward exchange in the first few years of life. So what you want to do is just set up a specific task and ideally only at first have as another child there. And so they’re kind of learning how to gauge off the other child. You’ll see they’ll do a lot of mirroring, all of those things. But you want to just have short periods of time. If you kind of give them an hour to just sit there and you are nowhere near them, it is likely to result in conflict. And so, what I think is important is that we kind of go, “I’m going to be there.
It’s going to be short, it’s going to have a task to it such as playing with Play-Doh or in Sandpit, I’m going to be right there. I’m going to give them an opportunity and after 10 minutes we’re going to stop that and just talk about how great it was”. And the specific praise stuff, “I really liked how you both played with the equipment, you took it in turns, whatever it is”. And then we can increase the duration of it, we can reduce the intensity of support we’re giving. We can kind of even give them space and say, I’m going to stand further back now and watch. But whenever they struggle that’s just a signal that we need to come in more. We need to come physically closer to them, but we need to sit with them and guide them more and give them better kind of instruction and support.
It’s a really important part of it that we need to kind of move away from, I come in and tell them off and hopefully that negative experience will stop them doing this to, I just, my guidance is a little bit off and I just need to think about how I can guide them a bit better.
And that’s the beautiful thing about clinic, is I get to journey with these families and see that kind of success really come into that child’s narrative. And these kids are, it’s just beautiful because they really shift and a lot of the children we see in clinic have really sensitive temperaments. That can be hard when you’re a parent because they kind of have this lower threshold of emotional dysregulation and conflict and you just think, “God, I can’t believe that set them off”. But the beautiful thing is those kids are really sensitive to positive environments as well and they really thrive once you learn how to read them and kind of pick up their cues and see what their strengths are and really harness them.
Jessica: Yeah, that’s so interesting, you brought me right back to the dinner table last night when my… When one of my children left the table in a huff, and I was like, “Oh no, family dinner is ruined again by something that was a trigger that I just didn’t…” How can they be so sensitive, but they are… They can be very sensitive.
Billy: Yeah, meal times are really interesting, meal time, sleep, and toileting for kids in one to five years of age, are really… They are one of the first times that kids start to learn autonomy, that I have a say over what happens in this environment, and meal times can be like that. Meals are big sensory experience. We kind of forget about that because we’ve been doing them for so long, but the smells and taste and touch, and they also are learning what they like and what they don’t like. And I think a beautiful, we did this on the podcast, just an episode on fussy eating, and it’s really important as much as possible that we think about what we can control at meal times, so we can control what food is in front of them, but also the environment. We can’t control how much they eat, what their preferences are, whether they like that food or not. And it’s really hard, there’s so many things, and I do this too, but the classic of like, If you eat your broccoli, you’ll get some ice cream. You’re almost reinforcing broccoli sucks, [chuckle] this is how much I want you to eat broccoli.
That ice cream is the reward. And you’re unintentionally kind of setting a kid up to go, “Ah, broccoli must be really crummy, if the only way that it gets pitched to me is if I eat it, I’ll get an ice cream after it”. So yeah, meal times can be really challenging and they’re often when we are really stressed, parents have put so much effort into making these meals, and then the child just looks at it and goes, “No”. And you just… You became emotional and dysregulated, because you go, “Are you kidding me? I’ve worked all day, I’ve made this for you. I thought you liked this, and now you won’t even try it”.
Strategies for emotional regulation
Jessica: Yes, totally. [chuckle] It’s such a challenge. I would love to go over some specific needs that you see in your clinic and share strategies that work well.
Billy: Working memory is a really good one to use as an example, because a lot of families will give instructions to kids that are multi-step, so they’ll go, “Can you get your stuff and get in the car”. Now, that’s like 20 steps that I’ve got to put my shoes on, I’ve got to go get my bag, I’ve got to go, get my hat and I’ll go get my water bottle. And so, what happens is that a parent, then five minutes later goes, “Why are you now sitting in front of the TV with none of those things done?” And it’s because it was beyond their capacity to remember those four things to go and step through them and do them. It doesn’t mean it’s always going to be beyond their capacity, but what we need to understand is that we go, “Cool, I’m going to actually step it out for them.” I’m not going to say, ‘get your stuff and get to the car’, I’m going to go, ‘Let’s go and do this’, and I’ll do it one at a time at first. And then when they’re nailing this, “I go, Cool, I’m going to do two things at a time now and see how they go with that”. They nail it. It get to three things and you go, they get the water bottle but they are in front of the TV again, you just go, cool, they are not at three yet, we just need to keep reinforcing two.
Every child with ADHD is different, but we know that those are the most frequent challenges they have around mental flexibility, working memory and impulse control.
Tips for sensory overload
Jessica: What about kids who experience sensory overwhelm, what kind of needs or strategies do you have that work well?
Billy: It’s very easy to kinda go, “I can’t believe that you just got upset about that”, or “This shopping center is not that noisy”. But what we need to think about is, “I think they really struggle with how noisy this environment is”, or “I think they really struggle with…
When there’s lights that are flashing and there’s kind of a lot happening”. So the noise is kind of the easiest one to explain in terms of if we’re kind of taking them into environments and noticing that when they’re really noisy, they get really distressed, they’re not able to focus and they find it too challenging, then we need to go, “Cool. The shopping center is the last place that they’re going to be able to succeed in kind of following instructions and being able to remain calm. So how can I start at lower level environments?” But also in moments when they have the energy, I’ve noticed they’ve slept well. I’ve got good capacity, so I’m not stressed and I’m not dragging them into the shopping center going, “I’m really stressed. I need to kind of get everything for the house for tonight for dinner and I’ve done a full day of work and I didn’t sleep last night”.
It’s not that we don’t take them into the shopping center in those environments, but we give everyone in the family a break to say, “This is probably going to be a bit tough. I’m going to be here to support them. But my expectation is not that they won’t struggle emotionally”. When we do want to build that skill, we have to have capacity ourselves, but give them the opportunity to succeed at it by saying, “It’s not going to be the shopping center, it’s going to be kind of a noisy environment such as a friend’s house where you feel more comfortable. It’s not as stimulating and it’s not as foreign an environment when you’ve got some ability and you’ve slept well and you’re in, seem like you’re in a good mood and there’s other positive elements of the environment such as your mates are here”.
Jessica: Yeah. And what about kids who may tap and flap their hands if they’re overstimulated? Do you need to set limits there and how do we support them?
Billy: Yeah, it’s a great opportunity for co-regulation.
What we want to do is kind of really go in and soothe them and then what we do is we guide them towards behaviors that are more soothing. We used to think about kids with autism and say, “Why are they hand flapping, and we need to stop them hand flapping”, for example. What we realize though now thanks to the advocacy within the autism community, is actually those are quite functional, self soothing methods that they will use. And if we are saying stop doing that and not giving them an alternative pathway that can just actually elevate their distress. So sometimes whatever that child is doing, we’ve got to be careful that we’re giving them more support than we were prior. And also guiding them to another strategy, not just saying, “Stop hand flapping or stop hitting your head”. It’s just, you are kind of taking away that opportunity for them to use their body in a way that will help calm them down.
Supporting caregivers
Jessica: Yeah, that’s so helpful to hear. And when our children are having a really hard time, it can also be just so upsetting for us for the caregivers and… What strategies can you suggest that we offer adults if they find themselves overwhelmed? I’ve been there. What ideas do you have for me?
Billy: Yeah, definitely. So the most important thing is give yourself a break. What we know about these strategies is it’s not, you actually don’t need to do them all the time. So you don’t need to be perfect with this. And some people would say, if 60% of the time you can try that kind of plan A, which is I’m trying to guide you to a more appropriate behavior, then that’s amazing and that gives you a pass on like 40% of the time to say, I’m just going to do whatever it takes. I’m going to give you the ice cream, I’m going to like… Whatever it is.
We think about emotions and how we support our kids in them in just in how we respond to them in a moment that they’re struggling and that is really important but there’s two other elements that are really important about it as well. One of them is how we talk about emotions when they’re not struggling. So kids are much more receptive to information and learning things when they’re not emotionally dysregulated. So it’s this really great opportunity to talk about how emotions are really important and it’s, I get angry sometimes, I get frustrated, I get sad, I get jealous and all those things. Because what you’re doing is you’re giving them good language around those experiences that they’re having.
And toddlers really need to learn that. The other bit is, and most important bit, is how we role model emotions is really important including when we lose control ourselves. So a lot of parents will come and see us in clinic and go, “Oh, so I got really frustrated and I yelled and I just can’t believe I did that”. And, I will say, “That’s actually really important because you are role modeling that we also are not perfect at this. And it gives you this amazing opportunity to role model the recovery”. So you go, “I got really distressed and I yelled and I’m really sorry I did that and what I did is I made sure that I went out for a run or I just left the room and came out of like the environment I was in that I was really struggling in because I was getting really annoyed in here everything that was happening and I left.
I took some deep breaths and I came back in and I thought about how can I help? And that’s how I was able to do it”. And then the kid is not going, “Oh, no one else has emotions, I’m different. I’m the only one that struggles with this”. That they see, we all do and everyone around me is trying to get better at it.
So interacting with them and the relationship trumps everything. It doesn’t matter how big a meltdown they’ve had, it doesn’t matter what’s going on. I’m here, I’m always going to be here.
It’s the best bit about it just because it builds and reinforces that attachment and engagement. And that’s the thing to prioritize. So if anyone’s listening and they’re like, “Oh, I’m not nailing stuff,” just nail that. Just interact with them as much as you can support them and guide them. And it’s messy but it’s really fun, and that’s what I try and do with my daughter as opposed to expect her to always be able to handle her own emotions or expect me to be able to, which is probably the more difficult bit.
Jessica: It’s 60%, not 70%. I always heard you had to be get it 70%. Right now I’m saying. Okay, good. It’s 60%.
Billy: Yeah, there is another 10%. [laughter]
Jessica: Okay, good. Well thank you so much Dr. Billy, it’s been wonderful having you here.
Billy: Yeah, thanks Jess. It’s great to talk to you.
Jessica: Dr. Billy has his own podcast, Pop Culture Parenting. You can find him @drbillygarvey. Here are my takeaways:
- If your child is elevated — hitting or lashing out — it is not the time to build skills. Our role in that moment is to show them they are safe. Rather than instructing them to “settle down,” take that moment to be a calming presence for your child.
- You might be thinking: I can’t believe that set them off! But Dr. Billy reminds us that the same sensitivity that feeds the emotional dysregulation also makes them really receptive to positive feedback — so focus on their strengths and harnessing those. Be proactive with your praise: Look for opportunities to praise them when they are interacting positively with a sibling or doing what they’ve been asked.
- Struggling to get out the door in the morning? See if you can chunk the larger request into smaller ones. For example, start with a specific 2-step direction (put on your socks and shoes) and, once that is mastered, you can move onto more steps.
- If your child is repeating a behavior that you’d like to see less of, be sure to give them an alternative rather than simply asking them to stop. If the behavior involves another child, create some distance, whenever possible. They need time to cool off.
Learn more on our Lovevery blog.
