Peter would not get out of the car. It was a hot summer day, I was standing outside the car with door open, and my skin was starting to prickle in the hot sun.
Mom: “But Peter, you love gymnastics! You seemed so eager to go.”
Peter: no reply, no movement
Mom: “Are you having trouble getting your body to move? How about doing it together step by step. Remember? First you unbuckle your safety belt.”
Peter: no reply, no movement
Mom: Maybe that isn’t it. How about we just get into the nice air-conditioned gym. We can sit at the tables and just talk about this. Don’t worry, I won’t try to make you start exercising. We might as well sit in a nice, cool room than sit here in the hot sun.”
To my relief, Peter got out of the car slowly but determinedly, and we made it to the table and chairs in the cool lobby.
I set up Peter’s iPad and keyboard, and asked, “So what’s going on, Pete?”
Peter: “on, a scale of 0 to 5 i’m at a 5. overstressed.”
Mom: “How come?”
Peter: “i have hot gas in my xesophagus.”
Mom: “Oh my gosh! You have reflux again. Want a TUMS?” I fished one out of my purse, and Peter took it eagerly.
A few minutes later, we continued our discussion.
Peter: “i ythi nk it’as gettinfg better.”
Mom: “Now we know another item that causes reflux in you. Remember how you had a bit of reflux after lunch, but felt better after the Pepcid? But then you grabbed something to eat on the way out that made you worse.”
Peter: “Doritos chili ppowder”
Mom: “You got it! And I’m so proud of you that you used your emotional state of regulation scale to communicate with me.
Because you identified your level of dysregulation, what happened?”
Peter: “i was able to get medicine and rrest. i get to get information on the chili powder.”
Mom “help for now and in the
Mom: “So what do you think of using an emotional thermometer?”
Peter: “it’s good”
Mom: “I am so proud of you because although you didn’t like the idea of the emotional thermometer at first, you still tried, and got pretty fluent at it fast- only 2 days of practice! Helps to be smart!”
This was a milestone for us. It’s the first time Peter has identified and communicated his state of emotional regulation to avert a meltdown. In the past, we caretakers were always the ones to notice the body language that clued us into how he was feeling, and we were always the ones to initiate the steps to help him calm down.
I’m telling you this story for two reasons
One is to share a practical tool. How many of us experience our kids going from zero to 60 miles a hour in a moment, in terms of emotional dysregulation? That was Peter. He would be trying to hold it together so hard until the moment he would explode. We tried to introduce the emotional thermometer years ago, but he told us it wasn’t useful because he had no warning. He was either at a 0 (no stress) or 5 (meltdown), and was not aware of the levels in between.
So I realized that Peter’s problem was not so much in communicating his emotions, but in becoming aware of them. A key piece in emotional regulation is to monitor one’s emotions. So for example, a person with reasonably developed emotional regulation might feel her blood start to boil during a confrontation with a colleague. She automatically senses she’s getting upset, and takes measures to regulate herself, like asking herself, “This isn’t like me. Why am I getting so upset?” She finds a way to end the conversation like saying, “I need a moment to think about this some more. Can we get back to this later?” She might leave to take some deep breaths, take a walk, talk herself down, vent with a friend, or otherwise regulate herself before thinking through the situation and coming up with the best way to deal with it.
But our kids don’t even realize how upset they are getting until they act out. So we talked to Peter about creating a way to practice this first step in emotional regulation, which is emotional self-awareness. We re-created the emotional thermometer, but anchored the stress levels to specific experiences he could relate to (idea from Dr. Gwen Palafox, meaningfulgrowth.com). So instead of 0 being no stress and 5 meltdown, we let Peter make the definitions based upon his own memories.
Peter made carrides and plane rides a 0 because they were not just no stress, but positively fun.
1 became no stress, like talking to his teacher at school, whom he likes very much.
2 became mild stress, like walking into his doctor’s newly remodeled office- it was different, he preferred the old one, but could handle it fine.
3 was stress, the kind, as Peter put it, “you could handle for now, but not forever.” He matched that to when his little brother Luke was fussing during a long car trip.
4 was very stressed, like when he went to Mass in a different city and the priest tried to give him Communion on the tongue instead of in the hand; it was “when you could hold it together barely, and needed help right away.”
5 was overstressed, as Peter put it, “out of control,” like when the car battery died right when he wanted to get a well-earned car ride. He felt so frustrated that he banged his head.
Then we spent an hour a day setting a timer and having Peter practice identifying his emotional state using the levels he defined on his stress thermometer every 10 minutes. And after just a couple of sessions, he was able to use the thermometer in a real life situation, and got to experience the benefits of emotional self-awareness, identification, and communication.
Now that’s a milestone, a success worth celebrating!
So that’s the first reason I’m telling you this story. To share a new way to use an old practical tool, to fill in the missing piece that made the emotional thermometer useful for Peter.
But there’s another level to this story. I have a dear friend who has almost exclusively used behavioral methods with her child who has moderately severe autism and big behavioral challenges. She asked me the other day what else was there out there to help her son.
The answer is there’s a whole world of intervention out there besides behavioral, and it’s big and deep. That whole world is the inner world of the child, his thoughts, feelings, desires, dreams, his personhood. His right to make his own decisions, and express his personality, to be loved and appreciated and listened to.
Your goal from the beginning has got to be to discover that inner person, develop it, and give it a means of expression.
Don’t get me wrong, I use and depend upon behavioral methods every day. I even teach Peter to use them on himself. This morning when he wanted an extra piece of toast, I told him, “Peter, I’d be happy to give you that toast. But my question is when do you want me to give it to you. I could give it to you right now, which is fine with me, because it will satisfy your appetite. But you could kill two birds with one stone. You look like you’re having trouble moving your body this morning, and I bet it’s hard for you to get up out of that chair and make it to the car. Do you want me to give you the toast in the car?”
Peter replied, “Use the toast to help me get in the car.”
So I made the toast, and held it in my hand. We walked to the car slowly, and Peter happily received his toast.
How different would this picture have looked if I had replied thusly to his request, “You can have that piece of toast if you get in the car.”
That’s the difference between a behavioral contract, and a floortime, person-oriented approach. Both can use behavioral methods, but in one case the emphasis is on what I want and the other on what you want. Internal vs external control, self-determination vs a degree of perceived intrusiveness.
So I’m so grateful for my floortime training as well as all the great tools I’ve learned from behaviorists. Because I could have used a straight behavioral formula at that moment when Peter would not come out of the car. “I’m boiling hot standing out here waiting for you. You were the one who kept asking for gymnastics today. Either come out now, or we’re quitting gymnastics.” “I see it’s taking extra effort to move your body today. If you make the extra effort to come out now, you earn an extra token for TV time later.” Positive or negative reinforcement would have been of no avail. “You’re not coming out, but that’s your choice. I’m going to sit in the shade and wait for you.” Natural or logical consequences (getting overheated in the car) would have been of no avail. Any of these courses of action would have resulted in a meltdown, as the reflux,heat, and frustration would have exacted their toll.
But thank heaven there is another way. The way we all need to be treated as human persons with a soul and will and dignity. To be understood, to be given reasonable options and accommodations. To be given a chance to communicate.
Because that’s where you’ll get your real answers and solutions. From the person himself. The only one who can give you the answers you need to help him.