CHILD & PARENT

RESOURCE INSTITUTE CPRI MINISTRY OF CHILDREN

AND YOUTH SERVICES

Understanding “Leaky Brakes”: Navigating Neurological Storms Becky Richards, Community Behaviour Consultant (CPRI)

Jenna Koning, Community Behaviour Consultant (CPRI) 1

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RESOURCE INSTITUTE CPRI Who are we? Services

We provide highly specialized,

trauma-informed mental health

and developmental services:

Assessment

Consultation

Treatment

Research

Education

Our services are:

Accessible

Inclusive

Culturally-sensitive

Individualized

Evidence-informed

Our mission is to support

children and youth with complex

mental health or developmental

challenges in reaching their full

potential and enhancing their

quality of life.

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A Multidiscipline Team including;

Becky

Richards Community Behaviour

Consultant

Jenna Koning Community

Behaviour

Consultant

Road Trip!!

Road Trip!!

Road Trip!!

Road Trip!!

UH –OH!!!!

You’re careless

You should have stopped

You don’t care about anyone but yourself

You’re a reckless driver.

You don’t abide by the rules of the road.

I’m a good person

I tried really hard to stop

My brakes didn’t work

I’m not reckless

I’m a good driver.

I’m smart, I know the rules .

I S

AY

, BU

T …

.. TH

EY S

AY

……

Now imagine you had to drive around in a car that had leaky brakes ALL

the time.

Wouldn’t YOU be frustrated?

CHILD & PARENT

RESOURCE INSTITUTE CPRI ‘Leaky Brakes’

Leaky Brake over attention +/or impulsivity (ADHD)

Leaky Brakes over thoughts (OCD)

Leaky Brakes over movements & sounds (TICS)

Leaky Brakes over behaviour (ODD, CD, Rage)

Leaky Brakes over senses (Sensory Integration Disorder)

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11

Notes on Tics & Other Leaky Brakes

Tics

•relatively common

•tend to be at their worst between ages 10-12

•It’s hard (if not impossible) to “hold in” tics

What is sometimes more disruptive

•ADHD – 50%,

•OCD – 30 to 40%

•Sensory Difficulties, Disruptive Behaviours, Rage, Learning Disabilities, Mood, Anxiety

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• Cries

• Swears

• Throws Things

• Out of Control

• Bad Kid

• Unmotivated

• Not Liked

• A huge PAIN!

Meet Johnny *

*fictional representation for illustrative purposes

Why would a

child do poorly

if they had the

skills to do

well?

Lazy Child

Poor

Parenting

“If he just tried harder, things would get better…

He could do well if he wanted to”

Conventional View

Could there be another explanation?

Is it because of poor parenting, lazy child behaviour

or

Could there be another explanation? Kids do well if they can

(NOT if they want to!)

Your explanation

of the behaviour

guides your

intervention

A Different View

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RESOURCE INSTITUTE CPRI Be A Detective : Figure out why your child is not

doing well…

WHY WOULD A KID HANDLE A SITUATION POORLY IF

THEY HAD THE SKILLS TO HANDLE IT WELL?

Understand and Learn about your child’s:

‘Leaky Brakes’ - described by Dr. B. Duncan McKinlay

‘Pathways & Triggers’ - described by Dr. Ross Greene

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Skill Deficit Model - Dr. Ross Greene, PhD.

Another explanation?

Flexibility/Adaptability

Change in routine

Difficulty shifting

Meeting new people

Trying new food

Frustration Tolerance

Accepting change

Having to wait

Sharing

Surprises

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RESOURCE INSTITUTE CPRI Lagging Skills

Solve the equation:

2cos2(x + π/6) – 3 sin (π /3- x) + 1 = 0

I’ll give you $100.00

I’ll take away your car

CHILD & PARENT

RESOURCE INSTITUTE CPRI ‘Leaky Brakes’

Leaky Brake over attention +/or impulsivity (ADHD)

Leaky Brakes over thoughts (OCD)

Leaky Brakes over movements & sounds (TICS)

Leaky Brakes over behaviour (ODD, CD, Rage)

Leaky Brakes over senses (Sensory Integration Disorder)

CHILD & PARENT

RESOURCE INSTITUTE CPRI ‘Pathways’

Executive Functioning Skills

Cognitive Functioning Skills

Language Processing Skills

Emotion Regulation Skills

Social Skills

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RESOURCE INSTITUTE CPRI Why focus on Leaky Brakes and Pathways?

Skill deficits drive explosive

behaviours

Accommodation and training

required

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Meet Your

Frustration Beaker

• Everyone has one

• They are all the same size

• Everyone reacts poorly when it is full

© B. Duncan McKinlay, 1998-2001

+ blame and

shame + more stress

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Beaker Check-In

• Show how full your

beaker is

• How are you doing right

now?

Key chain

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What fills your Beaker?

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Early Warning Signs

Eyebrows pull together Face turns red

Feel tense Start sweating

Talk fast Cry

Funny feeling in stomach Raise voice

Break things

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What empties your beaker?

Plus Many More Examples

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What happens if my beaker looks like this?

Detour Pass

• Learning a new skill

• NOT a consequence

• Create a detour room/space

What empties your beaker?

Detours

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CPRI Brake Shop

SENSORY ITEMS

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Relaxation Strategies

Some New Things about an Old Approach

• Why is this strategy useful for youth with TS? (Tics, OCD,

Rage)

• Why is this strategy useful for cheerleaders? (Lower your

beaker, decrease your stress, modelling)

• How would I use this strategy? (Scripts, CD’s, breathing

triangle, creating the right environment)

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Beaker check-ins, beaker key chains

Sensory Items

Detours

Relaxation Strategies

Individualized Education Plan

But WAIT…….

Teacher Concerns:

•We don’t have unlimited resources

• It’s Not fair to others

• They’ll rely too heavily on these resources

• Reward non-compliance?

This SOUNDS RIDCULOUS!!!!”

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RESOURCE INSTITUTE CPRI Learning Disability (Skill Deficit) Philosophy?

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Frustration Beaker Related Resources

• http://www.leakybrakes.ca

• Leaky Brake Tool Box

• Membership Cards

• Relaxation

• ‘Give Em a Brake Cards’

• Stickers

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CHILD & PARENT

RESOURCE INSTITUTE CPRI Collaborative & Proactive Solutions (CPS)

An approach to helping children/youth with behavioural

challenges developed by Dr. Ross Greene, Psychologist.

Our work in Brake Shop has been influenced by the CPS

model and the following information should be considered

an overview. To gain understanding, support, proficiency

in using this model, please refer to the resources

attached to this document for further information.

CHILD & PARENT

RESOURCE INSTITUTE CPRI Does CPS actually work?

Outcomes

Reduction

• Teacher Stress

• Discipline referrals

• Restraints, suspensions

• ADHD and ODD symptoms (6-10 weeks, outpatient family therapy, Sweden ,Ollendick, 2011)

Increased

•Perception of Control

•Management of Behaviour

• Improvement for CPS vs. Parent Management (Greene et al., 2004)

•Teacher confidence

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PROBLEM SOLVING -

There have always been ways of approaching a problem or an

unmet expectation…

1. Solving the problem, “MY WAY”

2. Working it out WITH the other person

3. DROPPING IT for now

CHILD & PARENT

RESOURCE INSTITUTE CPRI Problem Solving Style A = ADULT

A =ADULT WAY Approach

• Authoritarianism: Adult imposes will

• Can sound like “No”, “Because I said so”….

• Use for extreme safety concerns

Whose beaker does this approach fill?

Does this approach teach children the skills they are

having difficulty with (e.g., frustration tolerance)?

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RESOURCE INSTITUTE CPRI Problem Solving Style C = CHILD

C = The Drop it Approach • Permissiveness: • Adult removes/reduces expectations (even temporarily)

• Adult giving in to try and prevent a rage

Whose beaker does this approach fill?

Does this approach teach children the skills they are

having difficulty with (e.g., frustration tolerance)?

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The Flip Flopper

Back and forth between A and C approaches Inconsistent Not predictable to TS+ children/youth

BUT …

Our Kids STRIVE on Predictability & Structure

• Helps make transitions easier • Puts fewer demands on working memory • They don’t HAVE to remember anymore –

the consequences become automatic

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Basket A & C

in Action

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RESOURCE INSTITUTE CPRI Problem Solving Style B = BOTH

B = Solve Together Approach • Adult & Child problem solve together

• Adult & Child concerns are discussed

• Solution meets both needs

Whose beaker does this approach fill?

Does this approach teach children the skills they are

having difficulty with (e.g., frustration tolerance)?

Collaborative & Proactive Solutions – CPS

A (ADULT)

Make child do it (“because I said so”)

Doesn’t teach thinking skills

Fills Child’s Beaker

B (BOTH)

Solve the problem together

Helps teach thinking skills

Decreases Beaker Levels for Everyone

C (CHILD)

Make parent do it (“I don’t want to”)

Doesn’t build thinking skills

Fills Adult’s Beaker

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The Basket B Steps (EPI)

Empathy • I’ve noticed that…. • “What’s up?” – Get Child’s concern on table • Reflective listening… “I hear that …” • IMPORTANT: Solution Free Zone!

Problem Definition • Adult’s Concern: “The thing is….” • IMPORTANT: Solution Free Zone!

Invitation • Summarize concerns • Brainstorm solutions (encourage youth ideas) • Choose a solution that is WIN/WIN: doable, realistic,

mutually satisfying

Step 1: Empathy

IMPORTANT: Solution Free Zone!

Purpose: Gather info. about youth concern & perspective

How to begin: “I’ve noticed that”.. , Or “It look’s like..” , “what sucks about..” (Focus: problem to be solved!!!)

“What’s up?” – Get Child’s concern on table

Are these good examples of ways to begin CPS? A. I’ve noticed you swear to staff and are disrespectful. B. I’ve noticed you want food lots when it is not mealtime. C. I’ve noticed you don’t want to take your medications lately.

BUT….

Step 1 : Empathy (Continued)

…What happens if you get stuck

(“I dunno”, “Nothing”, or the dreaded silence, etc.)

How to continue (detective work for getting unstuck):

Fishing Strategies – attempts for further details/explanation

Clarifying Questions (e.g., Why? I don’t understand)

Educated Guessing (e.g., Mind if I take a guess)

Reflective Listening (e.g., I hear you saying…)

Reassurance (e.g., You are not in trouble)

IMPORTANT: Solution Free Zone!

Empathy: Fishing Strategies CLARIFYING QUESTIONS EDUCATED GUESSING

REFLECTIVE LISTENING REASSURANCE

Why ? Play 20

?’s

Can you

tell me

more

about this?

Mind if I

take a

guess?

Let me

know if I’m

getting

warm Am I right

that….?

You are not

in trouble

I’m not

saying you

can’t.

Your idea

is

important.

Mmm, that

sounds

frustrating

Sounds

like you

are saying

Let’s see if

I have this

straight…

52

Step 2: Problem Definition

Purpose: Clarify Cheerleader concern or perspective

How to begin: • “The thing is” or “My concern is”

• “What’s important to me is”

IMPORTANT: Solution Free Zone!

Move on when you have both (yours & youth) CONCERNS on the table

Step 3: Invitation

Purpose: Brainstorm solutions together

How to begin: • Recap concerns

• “I wonder if there is a way….”

How to continue: • Give youth first chance to generate solutions (“Any ideas”)

• Encourage creativity, Don’t judge, if no ideas – try to work together

• Once potential list, review to find 1 solution that is a WIN-WIN, Realistic, and Do-able Solution for both parties

End Product Goal: Mutually Satisfactory Solution

WHAT “B” YOUR CONCERN

*

Activity

Purpose: Recognize that the same situation can elicit

very different solutions. This is why it is so important to

spend time on the empathy step fishing for the concern.

What “B” Your Concern ?

Situation: On the way to SMG last week you said, “I want pizza”.

Parent Invitation: Discussing it later, your cheerleader says, “What’s Up?”

Child Concern: You tell your Cheerleader, _________________________________

A B C

“We don’t have time, we’re

going to SMG”.

Cheerleader drives to Pizza,

Pizza and buys a pizza right

away.

Cheerleader ignores

comment.

Cheerleader sure, whatever

you want, honey!

Cheerleader says No. Your wish is my command,

whatever you want my little

angel.

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A Few More Important Points …

Proactive vs. Emergency Plan B

• This can be tough! • Don’t have to do all 3 steps in 1 session

• Breaks can help

• Worksheet can help

• Use other strategies to problem solve (e.g. hot/cold for concern)

• Skills Training (Individualized Education Plan) • Expressing concerns

• Taking other people’s perspectives

• Generating Ideas, Problem Solving

• Flexible Thinking

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59

What is a detour pass and how do you use it?

What does EPI stand for?

What does basket A stand for? Whose beaker fills?

Which basket teaches skills?

What 3 things are we learning about our beaker?

What does basket C stand for? Whose beaker fills?

1

2

3

5

6

4

Empty My Beaker Game

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RESOURCE INSTITUTE CPRI

Collaborative & Proactive Solutions (CPS)

Resources http://www.leakybrakes.ca – Go to Self Management Group Page http://www.livesinthebalance.org http://www.thinkkids.org The Explosive Child, Understanding and Helping Easily Frustrated, “Chronically Inflexible" Children, author Ross W. Greene, PhD., 2005 Treating Explosive Kids, authors Ross W. Greene, PhD., Stuart Ablon, PhD., 2006 Lost At School, author Ross W. Greene, PhD., 2008

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Your New Toolbox of Resources

• Beaker Check-ins (How full is it?)

• Noticing when your beaker is filling

• Ways to empty your beaker

(Detours, Relaxation)

• Different problem solving approach

(Basket B Approach)

* All material in this presentation is used in accordance with Fair Dealing for educational purposes. All copyrighted material is property of the copyright holder